Lyons Margaret, Delgadillo Jaime
Clinical and Applied Psychology Unit, School of Psychology, University of Sheffield, Sheffield, UK.
Br J Clin Psychol. 2025 Sep;64(3):623-656. doi: 10.1111/bjc.12513. Epub 2024 Dec 31.
BACKGROUND: Although psychological interventions can be effective for the treatment of major depressive disorder, some patients' symptoms persist or rapidly recur after therapy. This study aimed to synthesize research findings on predictors and moderators of treatment response for persisting forms of depression, such as chronic, recurrent, and treatment-resistant depression. METHODS: A systematic review of studies investigating predictors and moderators of response to outpatient psychological treatment for adults with persisting forms of depression was conducted by searching Web of Science, Scopus, and PsycInfo. A total of 23 eligible studies were included, assessed for risk of bias, and summarized using a narrative synthesis. RESULTS: Sixty-five predictor and moderator variables were examined across studies, categorized into sociodemographic, clinical, interpersonal/personality, psychological, and treatment variables. Most variables were only examined in single studies, which were rarely adequately powered for predictor and moderator analyses. Among variables studied more frequently (age, gender, baseline depression severity, childhood trauma), only baseline depression severity was found to be a replicated and consistent predictor of poorer treatment response. Risk of bias was low to medium for the majority of studies. LIMITATIONS: Meta-analysis could not be done due to methodological heterogeneity among studies. CONCLUSION: Our current understanding of significant predictors and moderators for persisting forms of depression is limited. A high level of baseline severity of depressive symptoms is so far the only variable consistently associated with poorer treatment response in this clinical population.
背景:尽管心理干预对治疗重度抑郁症可能有效,但一些患者的症状在治疗后仍持续存在或迅速复发。本研究旨在综合关于持续性抑郁症(如慢性、复发性和难治性抑郁症)治疗反应的预测因素和调节因素的研究结果。 方法:通过检索科学网、Scopus和PsycInfo,对调查持续性抑郁症成人门诊心理治疗反应的预测因素和调节因素的研究进行系统综述。共纳入23项符合条件的研究,评估偏倚风险,并采用叙述性综合进行总结。 结果:各研究共检查了65个预测因素和调节因素变量,分为社会人口学、临床、人际/人格、心理和治疗变量。大多数变量仅在单一研究中进行了检查,这些研究很少有足够的效力进行预测因素和调节因素分析。在研究较为频繁的变量(年龄、性别、基线抑郁严重程度、童年创伤)中,仅发现基线抑郁严重程度是治疗反应较差的一个重复且一致的预测因素。大多数研究的偏倚风险为低到中度。 局限性:由于研究间方法学的异质性,无法进行荟萃分析。 结论:我们目前对持续性抑郁症的重要预测因素和调节因素的理解有限。到目前为止,抑郁症状的高基线严重程度是该临床人群中唯一与较差治疗反应始终相关的变量。
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