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首页> 外文OA文献 >Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial.
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Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial.

机译：青少年单相严重抑郁症（IMPACT）的认知行为治疗和短期心理分析心理治疗与短暂心理社会干预的比较：一项多中心，实用，观察者盲目的随机对照试验。

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Although there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years. To determine whether or not either of two specialist psychological treatments, cognitive-behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment. Observer-blind, parallel-group, pragmatic superiority randomised controlled trial. A total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London. Adolescents aged 11-17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses. In total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up. Mean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation. There were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = -0.578, 95% confidence interval (CI) -2.948 to 4.104; p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = -1.898, 95% CI -4.922 to 1.126; p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49-52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome. The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings. Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data. Current Controlled Trials ISRCTN83033550. This project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit to The Lancet.
机译：尽管有针对青少年单极性重度抑郁症的有效心理治疗方法，但尚不知道一种或多种可用的治疗方法在治疗结束后1年是否能保持减轻的抑郁症状。这是一个重要的问题，因为将抑郁症状的降低保持在临床阈值水平以下可降低诊断性复发至成年的风险。为了确定两种专业心理疗法（认知行为疗法（CBT）或短期心理分析心理疗法（STPP））在维持一年中抑郁症症状减轻方面是否比参考简要心理社会干预（BPI）更有效。治疗后。观察者盲，平行组，务实优势随机对照试验。英国在东安格利亚，英格兰西北部和北伦敦共有15家门诊NHS诊所。年龄在11-17岁之间的青少年，《精神疾病诊断和统计手册》第四版，重度抑郁症，包括自杀，抑郁症，精神病和品行障碍者。患者采用随机最小化方法随机分组，控制年龄，性别和自我报告的抑郁总和得分； 470例患者被随机分组​​，其中465例纳入分析。总共154名青少年接受了CBT，156名青少年接受了STPP，155名接受了BPI。该试验历时86周，在前36周进行了研究治疗，并进行了52周的随访。在最终研究评估时（标称86周，治疗结束后至少52周）自我报告的抑郁症状（主要结局）的平均总得分。次要指标是自我报告的焦虑症状的平均总和得分的变化，以及研究人员对儿童和青少年的心理健康状况进行的国家健康等级评定。进行基线评估后，在随机分组后的6、12、52和86周的名义时间点进行了另外5次计划的随访评估。与STPP相比，CBT有非劣效性[通过最终随访的治疗效果= -0.578，95％置信区间（CI）-2.948至4.104； p = 0.748]。与BPI相比，两种专科治疗（CBT + STPP）没有优越性（最终随访的治疗效果treatment = -1.898，95％CI -4.922至1.126； p = 0.219）。最终评估时，治疗组之间的平均抑郁症状评分无显着差异。到研究结束时，抑郁症状平均减少了49-52％。各治疗组之间的总费用或生活质量评分无差异，并且在治疗期间或随访期间开具选择性5-羟色胺再摄取抑制剂（SSRI）的处方在各治疗组之间没有差异，因此也没有介导结果。这三种心理治疗在理论和临床方法上均存在显着差异，并与相似程度的临床改善，成本效益以及随后的抑郁症状减轻保持相关。 STPP和BPI与CBT一起，为参加专科儿童和青少年心理健康服务的抑郁青少年提供了额外的患者治疗选择。进一步的研究应集中在与治疗反应，维持阳性反应，无反应的决定因素以及在初级保健和社区环境中是否使用简短的心理治疗有关的心理机制。在整个研究过程中，均未控制使用SSRI开处方或监测药物依从性的原因，并且由于缺少数据而限制了经济结果。电流对照试验ISRCTN83033550。该项目由美国国立卫生研究院健康技术评估计划资助，将在《健康技术评估》中全文发表；卷21，第12号。有关更多项目信息，请参阅美国国家卫生研究院期刊图书馆网站。卫生署也提供了资金。资助者在研究设计，患者招募，数据收集，研究分析或撰写，与研究有关的任何方面或提交《柳叶刀》的决定中均不起作用。

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