基于正念的干预对年轻乳腺癌幸存者的中介作用：对抑郁症状的影响。

Mediators of a Mindfulness-Based Intervention for Younger Breast Cancer Survivors: Effects on Depressive Symptoms.

机构信息

From the Department of Psychology (Korecki, Bower), UCLA, Los Angeles; UCLA Jonsson Comprehensive Cancer Center (Ganz, Petersen, Crespi, Bower); Department of Health Policy and Management (Ganz), UCLA Fielding School of Public Health; Department of Medicine, Division of Hematology-Oncology (Ganz), David Geffen School of Medicine at UCLA, Los Angeles, California; Department of Medical Oncology (Partridge), Dana-Farber Cancer Institute; Department of Medicine (Partridge), Brigham and Women's Hospital; Harvard Medical School (Partridge), Boston, Massachusetts; The Johns Hopkins University School of Medicine and Sidney Kimmel Comprehensive Cancer Center (Wolff), Baltimore, Maryland; Department of Biostatistics (Crespi), UCLA Fielding School of Public Health; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Bower), UCLA, Los Angeles; and Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior (Bower), Los Angeles, California.

出版信息

Psychosom Med. 2024 Oct 1;86(8):700-709. doi: 10.1097/PSY.0000000000001340. Epub 2024 Aug 10.

DOI:10.1097/PSY.0000000000001340

PMID:39132946

Abstract

OBJECTIVE

Depression is associated with poor outcomes in breast cancer patients, with higher prevalence among younger women. Although mindfulness-based interventions (MBIs) have demonstrated therapeutic effects, the mechanisms of intervention effects are poorly understood. We investigated whether rumination, self-kindness, intrusive thoughts about cancer, cancer-related worry, or a sense of meaning and peace mediated the intervention effects of an MBI, Mindful Awareness Practices (MAPs), on depressive symptoms. Additionally, we explored the same variables as mediators of a psychoeducation program, Survivorship Education (SE).

METHODS

Women diagnosed with stage 0-III breast cancer at age <50 years were randomized to 6 weeks of MAPs ( n = 85), SE ( n = 81), or wait-list control (WLC; n = 81). During preintervention, postintervention, and 6-month follow-up (FU), we assessed depressive symptoms, rumination, self-kindness, intrusive thoughts, worry, and meaning and peace.

RESULTS

MAPs and SE significantly reduced depressive symptoms at postintervention, and reductions remained through 6-month FU for MAPs. Models revealed that reductions in rumination ( β = -0.68, 95% confidence interval [CI] = -1.64 to -0.07) and intrusive thoughts ( β = 1.17, 95% CI = -2.17 to -0.37) and improvements in self-kindness ( β = -1.09, 95% CI = -2.37 to -0.28) and meaning and peace ( β = -1.09, 95% CI = -3.16 to -0.56) mediated MAPs' effects at all time points. Reductions in worry ( β = -1.34, 95% CI = -2.47 to -0.45]) mediated effects at postintervention only. Worry and intrusive thoughts mediated SE effects at postintervention and 6-month FU, respectively.

CONCLUSIONS

Findings identified depression-relevant mediators of MAPs' effects, expanding the understanding of MBI mechanisms. Results highlight pathways that could be leveraged to optimize intervention outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03025139 .

摘要

目的

抑郁症与乳腺癌患者预后不良有关，且在年轻女性中更为普遍。虽然基于正念的干预（MBI）已显示出治疗效果，但干预效果的机制仍不清楚。我们研究了反刍思维、自我友善、对癌症的侵入性思维、与癌症相关的担忧或意义和宁静感是否可以调节 MBI（正念意识实践（MAPs））对抑郁症状的干预效果。此外，我们还探讨了相同的变量作为心理教育计划（SE）的中介。

方法

年龄<50 岁被诊断为 0-III 期乳腺癌的女性被随机分为 6 周的 MAPs（n=85）、SE（n=81）或等待名单对照（WLC；n=81）。在干预前、干预后和 6 个月随访（FU）期间，我们评估了抑郁症状、反刍思维、自我友善、侵入性思维、担忧和意义与宁静感。

结果

MAPs 和 SE 在干预后显著降低了抑郁症状，MAPs 的降低效果持续到 6 个月 FU。模型显示，反刍思维（β=-0.68，95%置信区间[CI]=-1.64 至-0.07）和侵入性思维（β=1.17，95%CI=-2.17 至-0.37）的减少以及自我友善（β=-1.09，95%CI=-2.37 至-0.28）和意义与宁静感（β=-1.09，95%CI=-3.16 至-0.56）的改善在所有时间点均介导了 MAPs 的作用。仅在干预后，担忧的减少（β=-1.34，95%CI=-2.47 至-0.45）介导了 SE 的作用。仅在干预后和 6 个月 FU，担忧和侵入性思维分别介导了 SE 的作用。