Daily life stressors in the course of Major Depressive Disorder: Changes with treatment and potential predictor and moderator of treatment response 公开
Furman, Benjamin (Spring 2020)
Abstract
Background: Major Depressive Disorder (MDD) is one of the most prevalent and debilitating diseases worldwide. While the primary 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 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). Prior to treatment and following the end of acute treatment, participants responded to the HUPS. The primary outcome measure was change in the 17-item Hamilton Depression Rating Scale.
Results: Hassle scores generally significantly decreased and uplift scores generally increased following the conclusion of acute treatment. For the entire sample, the ratio of mean hassle intensity to mean uplift intensity scores (MHI:MUI) was a statistically significant predictor of treatment response and remission, and uplift frequency (UF) and the ratio of hassle frequency to uplift frequency (HF:UF) were significant, but weaker, predictors of remission. For patients in the CBT treatment arm, MHI:MUI was also a statistically significant predictor of response and remission while mean hassle intensity predicted response and UF and HF:UF predicted remission. However, HUPS scores did not predict response and remission for patients treated with medication. HUPS scores did not moderate the relationship between treatment method and treatment outcome.
Conclusion: Scores on the HUPS can predict treatment response and remission to CBT but not medication, yet they do not moderate differential remission rates.
Table of Contents
Introduction 1
Methods 7
Study Overview 7
Patients 7
Randomization 8
Study Visits and Treatments 9
Concomitant Medications 10
Assessments 10
Statistical Analysis 14
Results 18
Baseline Demographics and Clinical Variables 18
Baseline Correlates of HUPS Scale Scores 18
Changes in HUPS Scores over the 12 Week Acute Treatment Phase 19
Changes in HUPS Scores over 12 Week Acute Treatment Phase by Treatment Group 20
Baseline HUPS Scores as Predictors of Treatment Response 21
Baseline HUPS Scores as Moderators of Outcome by Treatment Group 22
Discussion 24
Tables and Figures 32
Table 1: Raw HUPS scores versus Imputed HUPS Scores at Baseline and Week 12 32
Table 2: Clinical Characteristics at Baseline 33
Table 3: Demographic Characteristics at Baseline 34
Table 4: Pearson’s r Correlations between HUPS Scores at Baseline 35
Table 5: Pearson’s r Correlations between HUPS Scores at Week 12 36
Table 6: Pearson’s r Correlations between Baseline HUPS Scores and Other 37
Clinical Measures at Baseline
Table 7: Pearson’s r Correlations between Baseline HUPS Scores and Other 38
Clinical Measures at Week 12
Table 8: Baseline Hassle Frequency Scores by Demographic Group 39
Table 9: Baseline Mean Hassle Intensity Scores by Demographic Group 40
Table 10: Baseline Uplift Frequency Scores by Demographic Group 41
Table 11: Baseline Mean Uplift Intensity Scores by Demographic Group 42
Table 12: Baseline Hassle Frequency to Uplift Frequency Ratios by 43
Demographic Groups
Table 13: Baseline Mean Hassle Intensity to Mean Uplift Intensity Ratios by 44
Demographic Groups
Figure 1: Change in HUPS Scores from Baseline to Week 12 45
Figure 2: Change in HUPS Scores from Baseline to Week 12 by 47
Treatment Group
Table 14: Effect of Treatment Group on Change in HUPS Scores 51
from Baseline to Week 12 for the Whole Sample
Table 15: Effect of Treatment Group on Change in HUPS Scores 52
from Baseline to Week 12 for Non-Responding Patients
Table 16: Effect of Treatment Group on Change in HUPS Scores 53
from Baseline to Week 12 for Responding Patients
Table 17: Response and Remission Rates by Treatment Group 54
Figure 3: HAM-D Scores from Baseline to Week 12 by Treatment Group 55
Table 18: Simple Logistic Regressions Predicting Likelihood 56
of Treatment Response for the Whole Sample
Table 19: Simple Logistic Regressions Predicting Likelihood 57
of Remission for the Whole Sample
Table 20: Simple Logistic Regressions Predicting Likelihood 58
of Treatment Response within the CBT Group
Table 21: Simple Logistic Regressions Predicting Likelihood 59
of Remission within the CBT Group
Table 22: Simple Logistic Regressions Predicting Likelihood 60
of Treatment Response within the Medication Group
Table 23: Simple Logistic Regressions Predicting Likelihood 61
of Remission within the Medication Group
Table 24: Means, Adjusted Means, Standard Deviations and Standard 62
Errors for Week 12 HAM-D Scores for the Treatment Groups
References 64
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