Background

Non-response to first-line treatment for major depressive disorder (MDD) is common; for such individuals, quality of life (QoL) impairments can be severe. Identifying predictors of QoL changes may support the management of cases with persistent depressive symptoms despite adequate initial pharmacological/psychological treatment.

Objective

The present study aimed to explore predictors of domain-specific QoL improvement following adjunctive aripiprazole treatment for inadequate response to initial antidepressant therapy.

Methods

We evaluated secondary QoL outcomes from a CAN-BIND (Canadian Biomarker Integration Network in Depression) study in patients with MDD who did not respond to an initial 8 weeks of escitalopram and received a further 8 weeks of adjunctive aripiprazole (n = 96). Physical, psychological, social, and environmental QoL domains were assessed using the World Health Organization QoL Scale Brief Version (WHOQOL-BREF). Clinician-rated depressive symptoms were assessed using the Montgomery–Åsberg Depression Rating Scale (MADRS). Functioning was measured with the Sheehan Disability Scale (SDS). Satisfaction with medication was assessed with a single item from the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Exploratory t-tests were used to describe domain score changes. A hierarchical linear regression was used to explore demographic, clinical, and treatment-related predictors of improvement.

Results

Across domains, QoL improved with adjunctive aripiprazole treatment. Satisfaction with medication and MADRS and SDS scores similarly improved. Symptom reduction was a predictor for positive change to physical and psychological QoL; functioning improvements were predictive of increases to all QoL domains. Satisfaction with medication predicted improvements to physical and psychological domains, whereas number of medication trials was a predictor of worsening QoL in the physical domain.

Conclusion

The final model explained the most variance in psychological (68%) and physical (67%) QoL. Less variance was explained for environmental (43%) and social QoL (33%), highlighting a need for further exploration of predictors in these domains. Strategies such as functional remediation may have potential to support QoL for individuals with persistent depressive symptoms.

Clinical Trials Registry

ClinicalTrials.gov identifier: NCT016557.

中文翻译：

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依他普仑和阿立哌唑辅助治疗重度抑郁症患者生活质量改善的预测因素：CAN-BIND 研究报告

背景

对重度抑郁症 (MDD) 的一线治疗无反应是常见的；对于这些人，生活质量 (QoL) 损害可能很严重。尽管有足够的初始药理学/心理治疗，但识别生活质量变化的预测因子可能支持对持续抑郁症状病例的管理。

客观的

本研究旨在探讨在阿立哌唑辅助治疗后对初始抗抑郁治疗反应不足的领域特异性生活质量改善的预测因素。

方法

我们评估了一项 CAN-BIND（加拿大抑郁症生物标志物整合网络）研究对最初 8 周依他普仑治疗无反应并接受额外 8 周阿立哌唑辅助治疗的 MDD 患者的次要生活质量结果（n= 96)。使用世界卫生组织 QoL 量表简版 (WHOQOL-BREF) 评估身体、心理、社会和环境 QoL 领域。使用蒙哥马利-埃斯伯格抑郁评定量表 (MADRS) 评估临床医生评定的抑郁症状。使用 Sheehan 残疾量表 (SDS) 测量功能。使用生活享受质量和满意度问卷简表 (Q-LES-Q-SF) 中的单个项目评估对药物的满意度。探索性 t 检验用于描述领域分数的变化。分层线性回归用于探索人口统计学、临床和治疗相关的改善预测因素。

结果

在各个领域，阿立哌唑辅助治疗改善了生活质量。对药物治疗的满意度以及 MADRS 和 SDS 评分同样有所提高。症状减轻是生理和心理 QoL 发生积极变化的预测因素；功能改善预示着所有 QoL 领域的增加。对药物的满意度预示着身体和心理领域的改善，而药物试验的数量是身体领域生活质量恶化的预测因素。

结论

最终模型解释了心理 (68%) 和身体 (67%) 生活质量的最大差异。环境 (43%) 和社会生活质量 (33%) 的差异较小，强调需要进一步探索这些领域的预测因子。功能性补救等策略可能有可能支持患有持续抑郁症状的个体的生活质量。

临床试验登记处

ClinicalTrials.gov 标识符：NCT016557。