重度抑郁症的每日治疗步骤:为期6个月的青少年基于互联网的正念认知行为治疗试验的症状改善和行为改变的预测因素和调节因素:二次分析(预印本)

IF 1.9 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Interactive Journal of Medical Research Pub Date : 2023-12-08 DOI:10.2196/46419
Kevin Dang, Paul Ritvo, Joel Katz, David Gratzer, Yuliya Knyahnytska, Abigail Ortiz, Clarice Walters, Mohamed Attia, Christina Gonzalez-Torres, Andrew Lustig, Zafiris Daskalakis
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引用次数: 0

摘要

背景:目前的证据支持将体育锻炼(PA)作为重度抑郁障碍(MDD)的辅助治疗手段。然而,很少有研究使用前瞻性数据对客观测量的 PA 与 MDD 治疗结果之间的关系进行研究:本研究是对一项为期 24 周的基于互联网、正念认知行为疗法的 MDD 项目数据进行的二次分析。这项分析有两个目的:(1)研究平均每日步数与 MDD 症状改善的关系,以及疼痛是否会调节这种关系;(2)研究治疗期间步数活动的变化(即步数轨迹)是否与基线症状和症状改善有关:来自成瘾与心理健康中心的患者参与了一项随机对照试验,该试验评估了基于互联网的正念认知行为疗法对患有 MDD 的年轻成人(18-30 岁)的治疗效果。研究人员对完成干预的 20 名参与者的数据进行了分析。使用 Fitbit-HR Charge 2(Fitbit 公司)以客观测量步数的形式测量 PA,并使用贝克抑郁量表-II(BDI-II)测量自我报告的抑郁严重程度。线性回归分析用于检验 PA 与抑郁改善的关系,以及疼痛严重程度和疼痛干扰的调节作用。采用增长曲线和多变量回归模型检验纵向关联:参与者平均每天步行 8269 步,在控制焦虑、疼痛干扰和坚持 Fitbit 监测的情况下,参与者之间每增加 +1000 步的差异与 BDI-II 改善(降低)2.66 分显著相关(P=.02)。疼痛严重程度似乎缓和(降低)了日均步数对 BDI-II 改善的积极影响(P=.03)。较高的基线抑郁和焦虑症状预示着整个治疗过程中较少的积极步数轨迹(Ps≤.001),而试验早期较多的积极步数轨迹预示着试验结束时更大的 MDD 改善(Ps结论:本研究通过客观测量证明,在认知行为治疗的背景下,PA 与抑郁症改善之间存在正相关。疼痛似乎缓和了这种关系,焦虑和抑郁的基线症状预测了 PA 的轨迹。研究结果为今后对重度抑郁症的干预提供了参考。未来对更大样本的研究应考虑与PA相关的治疗成功的其他调节因素,以及在多模式干预中结果与PA变化的相关程度:临床试验.gov NCT03406052;https://www.clinicaltrials.gov/ct2/show/NCT03406052.International 注册报告标识符(irrid):RR2-10.2196/11591。
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The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth.

Background: Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data.

Objective: This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement.

Methods: Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA's relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations.

Results: Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40).

Conclusions: This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions.

Trial registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052.

International registered report identifier (irrid): RR2-10.2196/11591.

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来源期刊
Interactive Journal of Medical Research
Interactive Journal of Medical Research MEDICINE, RESEARCH & EXPERIMENTAL-
自引率
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发文量
45
审稿时长
12 weeks
期刊最新文献
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