Abstract
Major Depressive Disorder is a costly and recurrent illness
affecting about 17% of adults in the United States throughout their
lifetimes. In order to achieve the ambition of treatment tailored
to an individual's needs, a better characterization of the process
of symptom change is needed. Extant studies treat changes to a
multi-dimensional construct in a unidimensional manner. The present
study, therefore, uses two-level exploratory factor analysis to
characterize four symptom change factors (SCF) in 338 treatment
naïve patients with Major Depressive Disorder randomized to 12
weeks of treatment with either cognitive behavior therapy (CBT) or
an antidepressant medication, escitalopram and duloxetine. A
primary SCF capturing change in emotional and cognitive depressive
symptoms and a secondary SCF capturing change in insomnia symptoms
were differentially predictive of end-of-treatment outcomes at
different times. In both the CBT and escitalopram groups, early
improvements in insomnia symptoms predicted better end-of-treatment
outcomes, however early improvements in insomnia were not a
predictor of outcomes in the duloxetine group. In the CBT group,
the predictive relationship was fully mediated by middle
improvements in emotional and cognitive depressive symptoms.
Specific early patterns of symptom change are differentially
predictive of outcomes during treatment with CBT, escitalopram, and
duloxetine. Further examinations of the temporal dynamics and
structure of symptom change during the treatment of MDD are
warranted.
Table of Contents
Introduction 1
Method 8
Study Overview 8
Participants 8
Randomization and Treatments 11
Symptom Measures 13
Outcome Measures 14
Data Analysis Overview 15
STEP 1: Modeling Structure of Symptom Change 15
STEP 2: Treatment Outcome Prediction 19
Results 20
Two-Level Exploratory Analysis 20
Treatment Outcome Prediction 23
Discussion 26
References 35
Appendix A 59
About this Dissertation
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