Otis Nicholas P, Kline Alexander C, Glassman Lisa H, Michael Hunt W, Walter Kristen H
Psychological Health & Readiness, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA.
Psychological Health & Readiness, Naval Health Research Center, San Diego, CA, USA; Leidos, Inc., San Diego, CA, USA.
Behav Res Ther. 2025 Jul;190:104753. doi: 10.1016/j.brat.2025.104753. Epub 2025 Apr 22.
Sudden gains-large, rapid, and stable symptom reductions during treatment-are associated with better patient outcomes. Little is known about sudden gains among patients with co-occurring posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), yet better understanding of sudden gains in this population may improve treatment of this comorbidity. This study evaluated sudden gains in PTSD and depression symptoms and their association with treatment outcomes among active duty service members with comorbid PTSD and MDD (N = 94) who were randomized to behavioral activation-enhanced cognitive processing therapy (BA + CPT) or CPT alone. Outcomes were interviewer-rated PTSD and depression severity at posttreatment and 3-month follow-up. PTSD and depression sudden gains occurred in 19 % and 27 % of the sample, respectively. Multilevel modeling showed sudden gains in depression symptoms were associated with clinically and statistically significant improvements in PTSD (p < .001) and depression severity (p < .001) outcomes. PTSD sudden gains were not associated with PTSD (p = .137) or depression (p = .187) outcomes. Improvements in both PTSD and depression outcomes following sudden depression gains may highlight the importance of depression symptom change during treatment as a prognostic marker of outcomes in this comorbid population. CLINICALTRIALS GOV IDENTIFIER: NCT02874131.
突然改善——治疗期间症状大幅、快速且稳定地减轻——与更好的患者预后相关。对于同时患有创伤后应激障碍（PTSD）和重度抑郁症（MDD）的患者的突然改善情况，我们知之甚少，然而更好地了解这一人群的突然改善情况可能会改善对这种共病的治疗。本研究评估了患有PTSD和MDD共病的现役军人（N = 94）中PTSD和抑郁症状的突然改善情况及其与治疗结果的关联，这些军人被随机分配接受行为激活强化认知加工疗法（BA + CPT）或仅接受CPT。结果是治疗后及3个月随访时由访谈者评定的PTSD和抑郁严重程度。样本中分别有19%和27%出现了PTSD和抑郁的突然改善。多水平模型显示，抑郁症状的突然改善与PTSD（p <.001）和抑郁严重程度（p <.001）结果在临床和统计学上的显著改善相关。PTSD的突然改善与PTSD（p =.137）或抑郁（p =.187）结果无关。抑郁症状突然改善后PTSD和抑郁结果均有所改善，这可能突出了治疗期间抑郁症状变化作为这一共病群体预后指标的重要性。临床试验注册号：NCT02874131。
