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首页> 外文期刊>The journal of clinical psychiatry >Extreme attributions predict the course of bipolar depression: Results from the STEP-BD randomized controlled trial of psychosocial treatment
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Extreme attributions predict the course of bipolar depression: Results from the STEP-BD randomized controlled trial of psychosocial treatment

机译：极端归因预测双相抑郁的病程：STEP-BD心理社会治疗随机对照试验的结果

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Objective: Little is known about predictors of recovery from bipolar depression or moderators of treatment response. In the present study, we investigated attributional style (a cognitive pattern of explaining the causes of life events) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychotherapy for bipolar depression. Method: 106 depressed outpatients with DSM-IV bipolar I or II disorder who were enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder were randomly assigned to intensive psychotherapy for depression (n = 62) or to collaborative care (n = 44), a minimal psychoeducational intervention. The primary outcome was recovery status at each study visit as measured by the Clinical Monitoring Form. Attributional style was measured at baseline using the Attributional Style Questionnaire. Data were collected between 1998 and 2005. Results: All analyses were by intention to treat. Extreme attributions predicted a lower likelihood of recovery (P < .01; OR = 0.93; 95% CI, 0.88-0.98) and longer time until recovery (P < .01; OR = 0.96; 95% CI, 0.93-0.99), independent of the effects of initial depression severity. Among individuals with more pessimistic attributional styles, higher initial depression severity predicted a lower likelihood of recovery (P = .01; OR = 0.64; 95% CI, 0.45-0.91) and longer time until recovery (P < .001; OR = 0.76; 95% CI, 0.66-0.88). There was no difference in recovery rates between intensive psychotherapy and collaborative care (OR = 0.90; 95% CI, 0.40-2.01) in the full sample. Conclusions: These results suggest that extreme, rigid attributions may be associated with a more severe course of depression and that evaluating attributional style may help clinicians to identify patients who are at risk for experiencing a more severe course of depression.
机译：目的：关于双相抑郁症恢复的预测因子或治疗反应的调节剂知之甚少。在本研究中，我们调查了归因风格（一种解释生活事件原因的认知模式），作为双相抑郁症发作后的恢复指标和对双相抑郁症心理治疗反应的调节剂。方法：将106名参加双相情感障碍系统治疗增强计划的DSM-IV双相I型或II型双相情感障碍抑郁症患者随机分配至抑郁症强化心理治疗（n = 62）或合作治疗（n = 44），最少的心理教育干预。主要结果是每次随访时的恢复状态，如临床监测表所述。使用归因风格问卷在基线处测量归因风格。在1998年至2005年之间收集了数据。结果：所有分析均按治疗意图进行。极端归因预测恢复的可能性较低（P <.01; OR = 0.93; 95％CI，0.88-0.98）和更长的恢复时间（P <.01; OR = 0.96; 95％CI，0.93-0.99），不受最初抑郁症严重程度的影响。在具有较悲观归因风格的个体中，较高的初始抑郁症严重程度预示了康复的可能性较低（P = .01; OR = 0.64; 95％CI，0.45-0.91）;恢复之前的时间更长（P <.001; OR = 0.76 ; 95％CI，0.66-0.88）。在整个样本中，强化心理治疗和协作治疗之间的恢复率没有差异（OR = 0.90; 95％CI，0.40-2.01）。结论：这些结果表明，极端，僵化的归因可能与更严重的抑郁症病程有关，评估归因方式可能有助于临床医生识别处于更严重的抑郁症病程中的患者。

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