Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland.
BMC Psychiatry. 2023 Nov 27;23(1):880. doi: 10.1186/s12888-023-05366-8.
Depression and alcohol use disorders frequently co-occur. However, research on psychosocial interventions for treating this dual pathology is limited. The Ostrobothnian Depression Study (ODS) aimed to increase the systematic use of evidence-based methods, particularly among patients with comorbid depression and substance use in a naturalistic setting. This is a secondary analysis of the ODS study. The aim of the present study was to explore the predictors of a response to treatment during the first six months of the ODS intervention with a specific focus on the role of comorbid heavy alcohol use.
The study sample (n = 242) comprised psychiatric specialist care patients with depression (Beck Depression Inventory score ≥ 17) at baseline. Patients with a baseline Alcohol Use Disorders Identification Test (AUDIT) score > 10 (n = 99) were assigned to the AUD (Alcohol Use Disorder) group in this study. The ODS intervention comprised behavioral activation (BA) for all and additional motivational interviewing (MI) for those in AUD group. The predictors of response to treatment (minimum of 50% reduction in depressive symptoms) during the first six months were analyzed with logistic regression models.
In the total sample at six months (n = 150), predictors of response to treatment were more severe depression (OR 1.10, CI 1.02-1.18), larger amounts of alcohol consumed (OR = 1.16, CI 1.03-1.31) and antipsychotic medication "not in use" (OR = 0.17, CI 0.07-0.44). In the non-AUD group (n = 100), more severe depression (OR 1.12, CI 1.01-1.25) and antipsychotics "not in use" (OR 0.20, CI 0.06-0.67) also predicted a positive response. Among AUD group patients (n = 50), larger amounts of alcohol consumed (OR 1.54, CI 1.04-2.27) and antipsychotic medication "not in use" (OR 0.12, CI 0.02-0.60) predicted a response to the treatment intervention.
The severity of symptoms and comorbid disorders were found to predict better treatment response, suggesting that the intervention was more effective in patients with severe symptoms. Patients with depression should be treated effectively regardless of having concomitant AUD. The results of this study suggest that BA combined with MI should be one of the treatment options for this dual pathology.
ClinicalTrials.gov Identifier NCT02520271 (11/08/2015).
抑郁症和酒精使用障碍经常同时发生。然而，针对治疗这种双重病症的心理社会干预的研究是有限的。奥斯特罗博尼亚抑郁研究（ODS）旨在增加循证方法的系统使用，特别是在自然环境中针对同时患有抑郁和物质使用的患者。这是 ODS 研究的二次分析。本研究的目的是探讨在 ODS 干预的前六个月内治疗反应的预测因素，特别关注共病重度酒精使用的作用。
研究样本（n=242）包括基线时抑郁（贝克抑郁量表评分≥17）的精神病专科护理患者。基线时酒精使用障碍识别测试（AUDIT）得分>10 的患者（n=99）在本研究中被分配到 AUD（酒精使用障碍）组。ODS 干预包括所有患者的行为激活（BA）和 AUD 组患者的额外动机访谈（MI）。使用逻辑回归模型分析前六个月治疗反应（抑郁症状至少减少 50%）的预测因素。
在六个月时的总样本（n=150）中，治疗反应的预测因素是更严重的抑郁（OR 1.10，CI 1.02-1.18）、更多的酒精摄入（OR=1.16，CI 1.03-1.31）和抗精神病药物“未使用”（OR=0.17，CI 0.07-0.44）。在非 AUD 组（n=100）中，更严重的抑郁（OR 1.12，CI 1.01-1.25）和抗精神病药物“未使用”（OR 0.20，CI 0.06-0.67）也预测了积极的反应。在 AUD 组患者（n=50）中，更多的酒精摄入（OR 1.54，CI 1.04-2.27）和抗精神病药物“未使用”（OR 0.12，CI 0.02-0.60）预测对治疗干预有反应。
症状严重程度和共病障碍被发现可预测更好的治疗反应，这表明该干预对症状严重的患者更有效。无论是否伴有共病 AUD，都应有效治疗患有抑郁症的患者。这项研究的结果表明，BA 结合 MI 应该是治疗这种双重病症的选择之一。
ClinicalTrials.gov 标识符 NCT02520271（2015 年 11 月 8 日）。
