Don’t sweat the small stuff? Daily hassles, uplifts relationship with depression treatment. Open Access

Abstract

Background: Major Depressive Disorder (MDD) is one of the most prevalent and debilitating diseases worldwide. While the primary first-line treatment options for MDD, evidence-based psychotherapy and pharmacotherapy, are equally effective for a population, for a given patient one treatment might provide significantly better results. Moreover, there have been few clinical or biological factors identified that predict differential response to these treatments and can thus guide optimal treatment selection

Objective: The Predictors of Remission in Depression to Individual and Combined Treatments (PReDICT) study aimed to identify both clinical and biological factors that are predictive of treatment outcomes in MDD in treatment-naïve adults. This study evaluated whether scores on the Daily Hassles and Uplifts Scale (HUPS) can serve as either general predictors of treatment outcome or moderators of the relationship between treatment type and treatment outcome.

Method: Treatment-naïve adults between the ages of 18 and 65 with MDD were randomly assigned with equal likelihood to 12 weeks of acute treatment in one of three treatment groups: escitalopram (selective serotonin reuptake inhibitor), duloxetine (serotonin norepinephrine reuptake inhibitor), or Cognitive Behavioral Therapy (CBT). Remitting patients entered a 21-month follow-up phase. Non-remitting patients were eligible to enter a 12-week combination treatment phase. Patients who remitted from combination treatment entered an 18-month follow-up phase. Prior to treatment and every 12 weeks following, participants responded to the HUPS. The primary outcome measure was change in the 17-item Hamilton Depression Rating Scale.

Results: In patients treated with antidepressant medication, hassle scores generally significantly decreased and uplift scores generally increased following the conclusion of acute treatment regardless of treatment outcome. In patients treated with CBT, hassle scores generally decreased and uplift scores generally increased in patients that remitted but did not in patients that did not remit. HUPS scores did not predict remission or recurrence in the whole sample, sample treated with antidepressant medications, or sample treated with CBT. HUPS score did not moderate the relationship between initial treatment type and remission or recurrence.

Conclusion: Scores on the HUPS do not predict remission or recurrence and do not moderate the differential remission or recurrence rates. Reduction of negative affective biases are characteristic of treatment with antidepressant medications but not treatment with CBT.

 

Table of Contents

Chapter I: Introduction And Statement Of The Problem And Purpose                                 1

Chapter II: Review Of The Literature                                                                                        3

Chapter III: Methods                                                                                                                  13

Study Overview                                                                                                                        13

Patient Population                                                                                                                  14

Randomization                                                                                                                          15

Study Visits And Treatments                                                                                                16

Concomitant Medications                                                                                                     17

Assessments                                                                                                                                17

Depression Outcome Definitions                                                                                          22

Statistical Analysis                                                                                                                22

Chapter IV: Results                                                                                                                     27

Demographic And Clinical Characteristics                                                                    28

Baseline Hups Scores As Predictors Of Remission                                                          28

Baseline Hups Scores As Moderators Of The Relationship Between Treatment Type And Remission    30

HUPS Scores As Predictors Of Recurrence                                                                                     31

Association Between Baseline Hups Scores And Dst Response                                    31

Association Between Baseline Hups Scores And Patient Preference For Treatment         32

Exploratory Analysis Of The HUPS                                                                                     32

Chapter V: Discussion                                                                                                                 40

Tables And Figures:                                                                                                                    48

Table 1: Baseline Hups Scores For Patients Receiving The Correct Hups Form Compared To Patients Receiving The Incorrect HUPS Form.                                                                                                             48

Table 2: Baseline HUPS Scores Across Escitalopram And Duloxetine Treatment Groups 49

Table 3: Spearman’s Rho Correlations Between Baseline HUPS Scores And Other Clinical Measures At Baseline  50

Table 4: Clinical Characteristics Of The Sample At Baseline                                  51

Table 5: Demographic Characteristics Of The Sample At Baseline                          52

Table 6: Baseline Hassle Frequency Scores Across Demographic Groups              53

Table 7: Baseline Mean Hassle Intensity Scores Across Demographic Groups     54

Table 8: Baseline Uplift Frequency Scores Across Demographic Groups               55

Table 9: Mean Uplift Intensity Scores Across Demographic Groups                        56

Table 10: Hassle Frequency To Uplift Frequency Scores Across Demographic Groups     57

Table 11: Mean Hassle Intensity To Mean Uplift Intensity Scores Across Demographic Groups 58

Table 12: Remission And Recurrence Rates By Treatment Group                              59

Table 13: Change In Ham-D Over The Twelve Week Acute Treatment Phase For The Whole Sample And By Treatment Group                                                                                                                                                       60

Table 14: One-Way ANCOVA Assessing Difference In Week-12 Ham-D Scores Across Treatment Groups Controlling For Baseline Ham-D                                                                                                                         61

Table 15: Logistic Regressions Predicting Likelihood Of Depression Remission For The Whole Sample         62

Table 16: Logistic Regressions Predicting Likelihood Of Depression Remission For The Cbt Group     63

Table 17: Logistic Regressions Predicting Likelihood Of Depression Remission For The Medication Group  64

Table 18: Logistic Regressions Assessing HUPS Scores As Moderators Of The Relationship Between Treatment Type And Remission                                                                                                                                    65

Table 19: Baseline And Week 12 HUPS Scores Across Recurring And Non-Recurring Participants         66

Table 20: Spearman’s Rho Correlations Between Baseline HUPS Scores And Post-Dst Cortisol Levels In The Whole Sample And Per-Protocol Completers                                                                                            67

Table 21: Chi-Square Tests Of Independence For Patient Preference For Treatment By Median-Split HUPS Scores For The Whole Sample                                                                                                                           68

Table 22: Chi-Square Tests Of Independence For Patient Preference For Treatment By Median-Split HUPS Scores For Per-Protocol Completers                                                                                                             70

Table 23: Spearman’s Rho Correlations Between HUPS Scores At Baseline           72

Table 24: Spearman’s Rho Correlations Between HUPS Scores At Week 12            73

Table 25: Spearman’s Rho Correlations Between Baseline HUPS Scores And Their Respective Week 12 Score           74

Table 26: Spearman’s Rho Correlations Between Week 12 HUPS Scores And Other Clinical Measures At Week 12  76

Table 27: Paired T-Tests Assessing HUPS Score Changes Over Acute Treatment Phase For Whole Sample And Broken Down Across Treatment Group                                                                                                       77

Table 28: Paired T-Tests Assessing HUPS Score Changes Over Acute Treatment Phase For Non-Remitting Participants And Broken Down Across Treatment Group                                                                            79

Table 29: Paired T-Tests Assessing HUPS Score Changes Over Acute Treatment Phase For Remitting Participants And Broken Down Across Treatment Group                                                                            81

Table 30: Paired T-Tests Assessing HUPS Score Changes Over Acute Treatment Phase For Non-Recurring Participants And Broken Down Across Treatment Group                                                                            83

Table 31: Paired T-Tests Assessing HUPS Score Changes Over Acute Treatment Phase For Recurring Participants And Broken Down Across Treatment Group                                                                            85

Table 32: One-Way ANCOVA Assessing Difference In Week-12 HUPS Scores Across Treatment Groups Controlling For Baseline HUPS Scores In The Whole Sample87

Table 33: One-Way ANCOVA Assessing Difference In Week-12 HUPS Scores Across Treatment Groups Controlling For Baseline HUPS Scores In The Non-Remitting Sample                                                      88

Table 34: One-Way ANCOVA Assessing Difference In Week-12 HUPS Scores Across Treatment Groups Controlling For Baseline HUPS Scores In The Remitting Sample                                                               89

Table 35: One-Way ANCOVA Assessing Difference In Week-12 HUPS Scores Across Treatment Groups Controlling For Baseline HUPS Scores In The Non-Recurring Sample                                                      90

Table 36: One-Way ANCOVA Assessing Difference In Week-12 HUPS Scores Across Treatment Groups Controlling For Baseline HUPS Scores In The Recurring Sample                                                              91

Table 37: Differences In Change In HUPS Scores In The Three Months Prior To Recurrence Or End Of Treatment (For Non-Recurrers)                                                                                                                                 92

Table 38: Differences In Change In HUPS Ratios From Six To Three Months Prior To Recurrence Or End Of Treatment (For Non-Recurrers)                                                                                                                        94

Figure 1: Distributions Of Baseline And Week 12 HF, MHI, UF, And MUI Scores For The Whole Sample  95

Figure 2: Distributions Of Baseline And Week 12 HF:UF And MHI:MUI Scores For The Whole Sample    96

Figure 3: Distributions Of Baseline And Week 12 HF, MHI, UF, And MUI Scores For The Cbt Group          97

Figure 4: Distributions Of Baseline And Week 12 HF:UF And MHI:MUI Scores For The Cbt Group 98

Figure 5: Distributions Of Baseline And Week 12 HF, MHI, UF, And MUIi Scores For The Medication Group       99

Figure 6: Distributions Of Baseline And Week 12 HF:UF And MHI:MUI Scores For The Medication Group         100

References:                                                                                                                                 101

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Psychology, Clinical Psychology, Behavioral Sciences
Keyword	Chronic minor stress Depression Predictor Moderator
Committee Chair / Thesis Advisor	Benjamin Druss, MD, MPH, Emory University
Committee Members	Boadie Dunlop, MD, MS, Emory University

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