Don’t sweat the small stuff? Daily hassles, uplifts relationship with depression treatment. Öffentlichkeit
Furman, Benjamin (Spring 2022)
Published
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
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