Tầm quan trọng của việc đánh giá triệu chứng ở mức độ chuyển giao chẩn đoán trong việc hiểu rõ dự đoán cho người trưởng thành bị trầm cảm: phân tích dữ liệu từ sáu thử nghiệm kiểm soát ngẫu nhiên

BMC Medicine - 2021
Ciarán O’Driscoll1, Joshua E J Buckman1, Eiko I. Fried2, Rob Saunders1, Zachary D. Cohen3, Gareth Ambler4, Robert J. DeRubeis5, Simon Gilbody6, Steven D. Hollon7, Tony Kendrick8, David Keßler9, Glyn Lewis10, Edward Watkins11, Nicola Wiles12, Stephen Pilling13
1Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical Educational & Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
2Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
3Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
4Statistical Science, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
5School of Arts and Sciences, Department of Psychology, 425 S. University Avenue, Philadelphia, PA, 19104-60185, USA
6Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK
7Department of Psychology, Vanderbilt University, Nashville, TN, USA
8Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, UK
9Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
10Division of Psychiatry, University College London, Maple House, London, W1T 7NF, UK
11Department of Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter, EX4 4QG, UK
12Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Bristol, UK
13Camden & Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK

Tóm tắt

Tóm tắt Giới thiệu Trầm cảm thường được coi là một bệnh lý đơn lẻ với nhiều lựa chọn điều trị tiềm năng. Tuy nhiên, bệnh nhân mắc trầm cảm nặng khác nhau một cách rõ rệt về biểu hiện triệu chứng và các bệnh đồng mắc, ví dụ như với rối loạn lo âu. Ngoài ra, có những biến động lớn trong kết quả điều trị và sự liên quan của một số bệnh đồng mắc lo âu với tiên lượng xấu hơn, nhưng hiểu biết hạn chế về lý do, và ít thông tin để hướng dẫn quản lý lâm sàng đối với trầm cảm. Cần phải cải thiện sự hiểu biết của chúng ta về trầm cảm, bao gồm cả bệnh đồng mắc lo âu, và xem xét mối liên hệ của một loạt triệu chứng với kết quả điều trị. Phương pháp Dữ liệu cá nhân của bệnh nhân từ sáu thử nghiệm kiểm soát ngẫu nhiên (RCTs) trên bệnh nhân trầm cảm (tổng số n = 2858) được sử dụng để ước lượng tác động khác nhau của các triệu chứng đến kết quả ở ba thời điểm sau can thiệp bằng cách sử dụng các mục riêng lẻ và điểm tổng. Mạng lưới triệu chứng (mô hình Gaussian đồ họa) được ước lượng để khám phá các mối quan hệ chức năng giữa các triệu chứng trầm cảm và lo âu và so sánh mạng lưới cho những người hồi phục điều trị và những người có triệu chứng kéo dài nhằm xác định các chỉ số tiên lượng tiềm năng. Kết quả Dự đoán ở cấp độ mục thực hiện tương tự như điểm tổng khi dự đoán kết quả ở 3 đến 4 tháng và 6 đến 8 tháng, nhưng vượt trội hơn điểm tổng cho 9 đến 12 tháng. Bi quan nổi lên như là triệu chứng dự đoán quan trọng nhất (so với tất cả các triệu chứng khác) dựa trên các thời điểm này. Trong cấu trúc mạng lưới tại thời điểm nhập học, các triệu chứng tập hợp thành triệu chứng thể chất, triệu chứng nhận thức và triệu chứng lo âu. Nỗi buồn, bi quan và sự do dự đóng vai trò như những cầu nối giữa các cộng đồng, trong đó nỗi buồn và thất bại/không có giá trị là những triệu chứng trung tâm nhất (tức là liên kết với nhau nhiều nhất). Khả năng kết nối của các mạng lưới tại thời điểm nhập học không khác biệt giữa những người hồi phục trong tương lai so với những người có triệu chứng kéo dài. Kết luận Tầm quan trọng tương đối của các triệu chứng cụ thể trong mối liên quan với kết quả và các tương tác trong mạng lưới nhấn mạnh giá trị của việc đánh giá và xây dựng triệu chứng chuyển giao chẩn đoán trong cả điều trị và tiên lượng. Chúng tôi thảo luận về tiềm năng của các phương pháp thống kê bổ sung nhằm cải thiện sự hiểu biết của chúng ta về tâm bệnh học.

Từ khóa


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