Breitzig Mason T, He Fan, Kong Lan, Liu Guodong, Waschbusch Daniel A, Yanosky Jeff D, Liao Duanping, Saunders Erika F H
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
J Clin Transl Sci. 2024 Sep 16;8(1):e123. doi: 10.1017/cts.2024.562. eCollection 2024.
Alleviation of symptom severity for major depressive disorder (MDD) is known to be associated with a lagged improvement of functioning. Pharmacotherapy guidelines support algorithms for MDD treatment. However, it is currently unclear whether concordance with guidelines influences functional recovery. A guideline concordance algorithm (GCA-8) was used to measure this pathway in a naturalistic clinical setting.
Data from 1403 adults (67% female, 84% non-Hispanic/Latino White, mean age of 43 years) with nonpsychotic MDD from the Penn State Psychiatry Clinical Assessment and Rating Evaluation System registry (visits from 02/01/2015 to 04/13/2021) were evaluated. Multivariable linear regression measured associations between GCA-8 and World Health Organization Disability Assessment Schedule 2.0 (WHODAS) scores. Mediation by MDD symptom severity using the Patient Health Questionnaire depression module (PHQ-9) was also evaluated.
This study found a statistically significant improvement in WHODAS scores (functioning) between baseline and final measures (-2 points, < .001) within one year. A one standard deviation increase in the GCA-8 score was associated with a 0.48-point reduction in mean disability score (total effect; = .02) with significant mediation by the change in MDD symptom severity (coefficient = -0.51, < .001) and a nonsignificant natural direct effect of the GCA-8 independent of PHQ-9 change (coefficient = -0.02, = .92).
Higher pharmacotherapy guideline concordance is associated with better functioning for MDD patients; this association likely occurs through improvement in MDD symptom severity rather than directly.
已知缓解重度抑郁症（MDD）的症状严重程度与功能改善的延迟相关。药物治疗指南支持MDD治疗的算法。然而，目前尚不清楚遵循指南是否会影响功能恢复。在自然临床环境中，使用指南一致性算法（GCA - 8）来衡量这一途径。
对来自宾夕法尼亚州立大学精神病学临床评估与评级评估系统登记处（2015年2月1日至2021年4月13日的就诊记录）的1403名患有非精神病性MDD的成年人（67%为女性，84%为非西班牙裔/拉丁裔白人，平均年龄43岁）的数据进行评估。多变量线性回归测量GCA - 8与世界卫生组织残疾评估量表2.0（WHODAS）评分之间的关联。还评估了使用患者健康问卷抑郁模块（PHQ - 9）对MDD症状严重程度的中介作用。
本研究发现，在一年内，基线和最终测量之间WHODAS评分（功能）有统计学显著改善（降低2分，P <.001）。GCA - 8评分每增加一个标准差，平均残疾评分降低0.48分（总效应；P =.02），MDD症状严重程度的变化起到显著中介作用（系数 = -0.51，P <.001），GCA - 8独立于PHQ - 9变化的自然直接效应不显著（系数 = -0.02，P =.92）。
更高的药物治疗指南依从性与MDD患者更好的功能相关；这种关联可能是通过改善MDD症状严重程度而非直接发生。
