{"title":"童年遭受虐待对接受元认知疗法或行为激活疗法治疗的重度抑郁症患者的治疗效果具有预测和调节作用。","authors":"","doi":"10.1016/j.jad.2024.09.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Childhood maltreatment (CM) is a risk factor for developing and maintaining depression. It is unclear whether CM influences the effect of treatments for depression. This study examined CM's predictor and moderator effect in Behavioral Activation (BA) and Metacognitive Therapy (MCT).</p></div><div><h3>Method</h3><p>CM was analyzed in a trial comparing a six months treatment program of either BA or MCT for 122 outpatients with major depressive disorder (MDD). Depression was assessed by the Hamilton Rating Scale for Depression (HRSD-24). CM was assessed using the Childhood Trauma Questionnaire (CTQ).</p></div><div><h3>Results</h3><p>Linear mixed models showed no predictor or moderator effects for the CTQ total score (all <em>p</em> > .58) but revealed a moderator effect for ‘sexual abuse’ on the reduction of depressive symptoms (β = 10.98, SE = 4.48, <em>p</em> = .015) indicating that patients with experiences of childhood sexual abuse benefited more from BA. There also was a predictor effect for ‘physical neglect’ (β = −3.35, SE = 1.70, <em>p</em> = .049): patients without the experience of physical neglect benefited more from treatment regardless of condition. Exploratory analyses indicated no predictor or moderator effects for the onset or persistence of depression, comorbid anxiety disorders or Cluster-C PDs (all <em>p</em> > .28).</p></div><div><h3>Limitations</h3><p>Limitations include small sample sizes for some of the subsamples.</p></div><div><h3>Conclusion</h3><p>Childhood sexual abuse seems to moderate treatment effectiveness in a sample of severely affected outpatients with MDD treated with MCT or BA. If confirmed in further trials, a history of sexual abuse might guide the choice between MCT and BA.</p></div><div><h3>Trial registration</h3><p>German Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered on February 13, 2017, without changes to the study protocol).</p></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Childhood maltreatment as predictor and moderator for treatment outcome in patients with major depressive disorders treated with metacognitive therapy or behavioral activation\",\"authors\":\"\",\"doi\":\"10.1016/j.jad.2024.09.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Childhood maltreatment (CM) is a risk factor for developing and maintaining depression. It is unclear whether CM influences the effect of treatments for depression. This study examined CM's predictor and moderator effect in Behavioral Activation (BA) and Metacognitive Therapy (MCT).</p></div><div><h3>Method</h3><p>CM was analyzed in a trial comparing a six months treatment program of either BA or MCT for 122 outpatients with major depressive disorder (MDD). Depression was assessed by the Hamilton Rating Scale for Depression (HRSD-24). CM was assessed using the Childhood Trauma Questionnaire (CTQ).</p></div><div><h3>Results</h3><p>Linear mixed models showed no predictor or moderator effects for the CTQ total score (all <em>p</em> > .58) but revealed a moderator effect for ‘sexual abuse’ on the reduction of depressive symptoms (β = 10.98, SE = 4.48, <em>p</em> = .015) indicating that patients with experiences of childhood sexual abuse benefited more from BA. There also was a predictor effect for ‘physical neglect’ (β = −3.35, SE = 1.70, <em>p</em> = .049): patients without the experience of physical neglect benefited more from treatment regardless of condition. Exploratory analyses indicated no predictor or moderator effects for the onset or persistence of depression, comorbid anxiety disorders or Cluster-C PDs (all <em>p</em> > .28).</p></div><div><h3>Limitations</h3><p>Limitations include small sample sizes for some of the subsamples.</p></div><div><h3>Conclusion</h3><p>Childhood sexual abuse seems to moderate treatment effectiveness in a sample of severely affected outpatients with MDD treated with MCT or BA. If confirmed in further trials, a history of sexual abuse might guide the choice between MCT and BA.</p></div><div><h3>Trial registration</h3><p>German Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered on February 13, 2017, without changes to the study protocol).</p></div>\",\"PeriodicalId\":14963,\"journal\":{\"name\":\"Journal of affective disorders\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of affective disorders\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0165032724014745\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of affective disorders","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0165032724014745","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:童年虐待(CM)是抑郁症发病和持续存在的一个风险因素。目前尚不清楚儿童虐待是否会影响抑郁症的治疗效果。本研究探讨了儿童虐待对行为激活疗法(BA)和元认知疗法(MCT)的预测和调节作用:在一项针对 122 名重度抑郁障碍(MDD)门诊患者的为期 6 个月的 BA 或 MCT 治疗方案比较试验中,对 CM 进行了分析。抑郁通过汉密尔顿抑郁评定量表(HRSD-24)进行评估。CM通过童年创伤问卷(CTQ)进行评估:线性混合模型显示 CTQ 总分没有预测或调节效应(所有 p > .58),但显示 "性虐待 "对抑郁症状减轻有调节效应(β = 10.98,SE = 4.48,p = .015),表明有童年性虐待经历的患者从 BA 中获益更多。身体忽视 "也存在预测效应(β = -3.35,SE = 1.70,p = .049):没有身体忽视经历的患者无论病情如何,都能从治疗中获益更多。探索性分析表明,抑郁症、合并焦虑症或C群PD的发生或持续没有预测或调节作用(所有P > .28):局限性:某些子样本的样本量较小:在接受MCT或BA治疗的严重MDD门诊患者样本中,童年性虐待似乎会降低治疗效果。如果在进一步的试验中得到证实,性虐待史可能会指导MCT和BA的选择:德国临床试验注册DRKS-ID:DRKS00011536(2017年2月13日回顾性注册,研究方案未作变更)。
Childhood maltreatment as predictor and moderator for treatment outcome in patients with major depressive disorders treated with metacognitive therapy or behavioral activation
Background
Childhood maltreatment (CM) is a risk factor for developing and maintaining depression. It is unclear whether CM influences the effect of treatments for depression. This study examined CM's predictor and moderator effect in Behavioral Activation (BA) and Metacognitive Therapy (MCT).
Method
CM was analyzed in a trial comparing a six months treatment program of either BA or MCT for 122 outpatients with major depressive disorder (MDD). Depression was assessed by the Hamilton Rating Scale for Depression (HRSD-24). CM was assessed using the Childhood Trauma Questionnaire (CTQ).
Results
Linear mixed models showed no predictor or moderator effects for the CTQ total score (all p > .58) but revealed a moderator effect for ‘sexual abuse’ on the reduction of depressive symptoms (β = 10.98, SE = 4.48, p = .015) indicating that patients with experiences of childhood sexual abuse benefited more from BA. There also was a predictor effect for ‘physical neglect’ (β = −3.35, SE = 1.70, p = .049): patients without the experience of physical neglect benefited more from treatment regardless of condition. Exploratory analyses indicated no predictor or moderator effects for the onset or persistence of depression, comorbid anxiety disorders or Cluster-C PDs (all p > .28).
Limitations
Limitations include small sample sizes for some of the subsamples.
Conclusion
Childhood sexual abuse seems to moderate treatment effectiveness in a sample of severely affected outpatients with MDD treated with MCT or BA. If confirmed in further trials, a history of sexual abuse might guide the choice between MCT and BA.
Trial registration
German Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered on February 13, 2017, without changes to the study protocol).
期刊介绍:
The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.