Andersen Lena S, Stanton Amelia M, Magidson Jessica F, Joska John A, O'Cleirigh Conall, Lee Jasper S, Kagee Ashraf, Witten Jade A, Safren Steven A
University of Copenhagen.
Massachusetts General Hospital and Harvard Medical School.
Behav Ther. 2023 Jan;54(1):91-100. doi: 10.1016/j.beth.2022.07.003. Epub 2022 Jul 16.
Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates. Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale-Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population. Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment. The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population.
抑郁症的认知行为疗法通常会针对行为（如激活）和认知（如沉思）两个组成部分，因此在资源丰富的环境中能够改善生活质量（QOL）和功能。然而，对于这些组成部分在南非以及其他艾滋病毒高流行率的资源有限的全球环境中对抑郁症症状严重程度、生活质量和功能损害的跨文化适用性和相对贡献，人们知之甚少。来自南非开普敦郊外一个城郊社区的274名艾滋病毒感染者接受了多项抑郁症测量（汉密尔顿抑郁量表、流行病学研究中心抑郁量表、南非抑郁量表）、与抑郁症相关的认知和行为组成部分（沉思反应量表、抑郁症行为激活量表）以及生活质量和功能测量（希恩残疾量表、生活质量享受与满意度量表简表）。采用多元线性回归模型来评估行为和认知组成部分对该人群抑郁症严重程度、生活质量和功能损害的相对贡献。纳入年龄和性别的模型显示，较低水平的行为激活（BA）与所有抑郁症测量指标以及生活质量和功能损害均显著相关（所有p值<0.01）。沉思与所有抑郁症测量指标相关（所有p值<0.01），但与生活质量或功能损害无关。BA与抑郁症、生活质量和功能损害之间持续且独特的关联支持了其作为该人群治疗靶点的重要性。
