Kim Kyoung Min, Lee Kyung Hwa, Kim Haebin, Kim Ok, Kim Jae-Won
Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea; Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea.
Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea.
J Psychiatr Res. 2024 Apr;172:59-65. doi: 10.1016/j.jpsychires.2024.02.001. Epub 2024 Feb 9.
Symptoms of depression in adolescents are widely variable, but they are often interactive and clustered. The analysis of interactions and clusters among individual symptoms may help predict treatment outcomes. We aimed to determine clusters of individual symptoms in adolescent depression and their changes in the response to pharmacological treatment.
A total of 95 adolescents, aged 12-17 years, with major depressive disorder were included. Participants were treated with escitalopram, and depressive symptoms were assessed at baseline (V1) and 1, 2, 4, 6, and 8 weeks (V6). The severity of depression was assessed using the Children's Depression Rating Scale-Revised. To construct network and clustering structures among symptoms, the Gaussian graphical model and Exploratory Graph Analysis with the tuning parameter to minimize the extended Bayesian information criterion were adopted.
Exploratory Graph Analysis revealed that symptoms of depression comprised four clusters: impaired activity, somatic concerns, subjective mood, and observed affect. The main effect of visit with decreased symptom severity was significant in all four clusters; however, the degree of symptom improvement differed among the four clusters. The effect size of score differences from V1 to V6 was the highest in the subjective mood (Cohen's d = 1.075), and lowest in impaired activity (d = 0.501) clusters.
The present study identified four symptom clusters associated with adolescent depression and their differential changes related to antidepressant treatment. This finding suggests that escitalopram was the most effective at improving subjective mood among different clusters. However, other therapeutic modalities may be needed to improve other clusters of symptoms, consequently leading to increased overall improvement of depression in adolescents.
青少年抑郁症的症状差异很大，但它们通常相互作用且聚集出现。分析个体症状之间的相互作用和聚类情况可能有助于预测治疗结果。我们旨在确定青少年抑郁症中个体症状的聚类情况及其在药物治疗反应中的变化。
共纳入95名年龄在12至17岁之间的重度抑郁症青少年。参与者接受艾司西酞普兰治疗，并在基线（V1）以及第1、2、4、6和8周（V6）评估抑郁症状。使用儿童抑郁评定量表修订版评估抑郁严重程度。为构建症状之间的网络和聚类结构，采用高斯图形模型和探索性图形分析，并通过调整参数以最小化扩展贝叶斯信息准则。
探索性图形分析显示，抑郁症状包括四个聚类：活动受损、躯体担忧、主观情绪和观察到的情感。在所有四个聚类中，就诊时症状严重程度降低的主要效应均显著；然而，四个聚类之间症状改善的程度有所不同。从V1到V6得分差异的效应大小在主观情绪聚类中最高（科恩d值 = 1.075），在活动受损聚类中最低（d值 = 0.501）。
本研究确定了与青少年抑郁症相关的四个症状聚类及其与抗抑郁治疗相关的差异变化。这一发现表明，艾司西酞普兰在改善不同聚类中的主观情绪方面最有效。然而，可能需要其他治疗方式来改善其他聚类的症状，从而提高青少年抑郁症的总体改善程度。
