DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA.
Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA.
J Patient Rep Outcomes. 2023 Jul 13;7(1):67. doi: 10.1186/s41687-023-00600-z.
This study characterized depression trajectories during the COVID pandemic and investigated how appraisal and changes in appraisal over time related to these depression trajectories.
This longitudinal study of the psychosocial impact of the COVID-19 pandemic included 771 people with data at three timepoints over 15.5 months. The depression index was validated using item-response-theory methods and receiver-operating-characteristic curve analysis. The Quality of Life (QOL) Appraisal Profile Short-Form assessed cognitive-appraisal processes. Sequence analysis characterized depression-trajectory groups, and random effects models examined appraisal main effects, appraisal-by-group, and appraisal-by-group-by-time interactions.
Sequence analysis generated six trajectory groups: Stably Well (n = 241), Stably Depressed (n = 299), Worsening (n = 79), Improving (n = 83), Fluctuating Pattern 1 (No-Yes-No; n = 41), and Fluctuating Pattern 2 (Yes-No-Yes; n = 28). While all groups engaged in negative appraisal processes when they were depressed, the Stably Depressed group consistently focused on negative aspects of their life. Response-shift effects were revealed such that there were differences in the appraisal-depression relationship over time for standards of comparison and recent changes for the Stably Depressed, and in health goals for those Getting Better.
The present work is, to our knowledge, the first study of response-shift effects in depression. During these first 15.5 pandemic months, group differences highlighted the connection between negative appraisals and depression, and response-shift effects in these relationships over time. Egregious life circumstances may play a lesser role for the Stably Depressed but a greater role for people who have transient periods of depression as well as for those with improving trajectories (i.e., endogenous vs. reactive depression). How one thinks about QOL is intrinsically linked to mental health, with clear clinical implications.
本研究描述了 COVID 大流行期间的抑郁轨迹，并探讨了随着时间的推移，评估及其变化如何与这些抑郁轨迹相关。
本项关于 COVID-19 大流行心理社会影响的纵向研究纳入了 771 名参与者，在 15.5 个月内分 3 个时间点收集数据。采用项目反应理论方法和受试者工作特征曲线分析对抑郁指数进行验证。使用生活质量（QOL）评估概况短式量表评估认知评估过程。序列分析描述了抑郁轨迹组，随机效应模型检验了评估的主要效应、评估与组、评估与组与时间的交互作用。
序列分析生成了 6 个轨迹组：稳定良好（n = 241）、稳定抑郁（n = 299）、恶化（n = 79）、改善（n = 83）、波动模式 1（无-是-无；n = 41）和波动模式 2（是-否-是；n = 28）。虽然所有组在抑郁时都采用了消极评估过程，但稳定抑郁组始终关注生活的消极方面。反应转移效应被揭示，即随着时间的推移，稳定抑郁组的比较标准和近期变化在评估-抑郁关系中存在差异，在那些情况好转的人群中健康目标也存在差异。
据我们所知，本研究是首次研究抑郁中的反应转移效应。在这 15.5 个大流行月期间，群组差异突出了消极评估与抑郁之间的联系，以及随着时间的推移这些关系中反应转移效应的差异。对于稳定抑郁的人来说，恶劣的生活环境可能起到的作用较小，而对于那些有短暂抑郁期的人以及情况改善的人（即内源性抑郁与反应性抑郁）来说，作用更大。一个人对 QOL 的看法与心理健康密切相关，具有明确的临床意义。
