Montero-Marin Jesus, Hinze Verena, Maloney Shannon, van der Velden Anne Maj, Hayes Rachel, Watkins Edward R, Byford Sarah, Dalgleish Tim, Kuyken Willem
Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
Department of Psychiatry, Warneford Hospital, University of Oxford, UK.
Br J Psychiatry. 2025 Apr;226(4):213-221. doi: 10.1192/bjp.2024.178. Epub 2024 Nov 8.
Personalised management of recurrent depression, considering individual patient characteristics, is crucial.
This study evaluates the potentially different mediating role of mindfulness skills in managing recurrent depression using mindfulness-based cognitive therapy (MBCT) among people with varying depression severity.
Data from the Prevention of Depressive Relapse or Recurrence (PREVENT) trial, comparing MBCT (with antidepressant medication (ADM) tapering support, MBCT-tapering support) versus maintenance-ADM, were used. The study included pre, post, 9-, 12-, 18- and 24-month follow-ups. Adults with ≥3 previous major depressive episodes, in full/partial remission (below threshold for a current episode), on ADM, were assessed for eligibility in primary care practices in the UK. People were randomised (1:1) to MBCT-tapering support or maintenance-ADM. We used the Beck Depression Inventory-II to evaluate depressive symptom changes over the six time points. Pre-post treatment, we employed the Five Facets of Mindfulness Questionnaire to gauge mindfulness skills. Baseline symptom and history variables were used to identify individuals with varying severity profiles. We conducted Latent Profile Moderated-Mediation Growth Mixture Models.
A total of 424 people (mean (s.d.) age = 49.44 (12.31) years; with 325 (76.7%) self-identified as female) were included. A mediating effect of mindfulness skills, between trial arm allocation and the linear rate of depressive symptoms change over 24 months, moderated by depression severity, was observed (moderated-mediation index = -0.27, 95% CI = -0.66, -0.03). Conditional indirect effects were -0.42 (95% CI = -0.78, -0.18) for higher severity (expected mean BDI-II reduction = 10 points), and -0.15 (95% CI = -0.35, -0.02) for lower severity (expected mean BDI-II reduction = 3.5 points).
Mindfulness skills constitute a unique mechanism driving change in MBCT (versus maintenance-ADM). Individuals with higher depression severity may benefit most from MBCT-tapering support for residual symptoms. It is unclear if these effects apply to those with a current depressive episode. Future research should investigate individuals who are not on medication. This study provides preliminary evidence for personalised management of recurrent depression.
ISRCTN26666654.
考虑个体患者特征对复发性抑郁症进行个性化管理至关重要。
本研究评估了在不同抑郁严重程度的人群中，使用基于正念的认知疗法（MBCT）管理复发性抑郁症时，正念技能可能存在的不同中介作用。
使用了预防抑郁复发或再发（PREVENT）试验的数据，该试验比较了MBCT（联合抗抑郁药物（ADM）减药支持，即MBCT-减药支持）与维持性ADM。研究包括治疗前、治疗后、9个月、12个月、18个月和24个月的随访。在英国的初级保健机构中，对既往有≥3次重度抑郁发作、处于完全/部分缓解状态（低于当前发作阈值）且正在服用ADM的成年人进行资格评估。将患者随机（1:1）分配至MBCT-减药支持组或维持性ADM组。我们使用贝克抑郁量表-II评估六个时间点上的抑郁症状变化。在治疗前后，我们采用正念五因素问卷来衡量正念技能。利用基线症状和病史变量来确定具有不同严重程度特征的个体。我们进行了潜在剖面调节中介增长混合模型分析。
共纳入424人（平均（标准差）年龄 = 49.44（12.31）岁；其中325人（76.7%）自我认定为女性）。观察到正念技能在试验组分配与24个月内抑郁症状变化的线性速率之间存在中介作用，且该中介作用受抑郁严重程度的调节（调节中介指数 = -0.27，95%置信区间 = -0.66，-0.03）。对于较高严重程度（预期平均BDI-II降低 = 10分），条件间接效应为-0.42（95%置信区间 = -0.78，-0.18）；对于较低严重程度（预期平均BDI-II降低 = 3.5分），条件间接效应为-0.15（95%置信区间 = -0.35，-0.02）。
正念技能是MBCT（与维持性ADM相比）中推动改变的独特机制。抑郁严重程度较高的个体可能从针对残留症状的MBCT-减药支持中获益最大。目前尚不清楚这些效应是否适用于当前有抑郁发作的患者。未来的研究应调查未服用药物的个体。本研究为复发性抑郁症的个性化管理提供了初步证据。
ISRCTN26666654。
