Utility of in-session assessments during cognitive behavioral therapy for depression after traumatic brain injury: Results from a randomized controlled trial.

BACKGROUND The development of depression after moderate to severe traumatic brain injury (TBI) is common. Cognitive-behavioral therapy (CBT) can be used to treat post-TBI depression, but the symptoms response is poorly described. OBJECTIVE This secondary analysis assessed: (1) the trajectory of depression symptoms up to 12 sessions of CBT, (2) which depressive symptom clusters were responsive to in-person and phone CBT, and (3) whether interim depression thresholds predict 16-week treatment response. METHOD This secondary analysis of the IRB-approved Life Improvement Following Traumatic Brain Injury trial included 100 adults with major depressive disorder (MDD) within ten years of moderate to severe traumatic brain injury from throughout the US. We used a combination of descriptive, graphical, and diagnostic accuracy methods. RESULTS Cardinal and cognitive-affective symptom clusters improved most from CBT over 16 weeks. At 8 and 16 weeks, the most responsive individual symptoms were anhedonia, depressed mood, and fatigue; the least responsive were sleep and appetite. PHQ-9 thresholds with a Negative Predictive Value greater than 0.7 for sessions 6, 7, and 8 were, respectively: >15, >10, and >9. CONCLUSION In-person and phone CBT led to similar symptom responses during treatment. Additionally, using PHQ-9 thresholds for predicting intervention response within eight sessions may help identify the need for treatment adjustments.

背景 中度至重度创伤性脑损伤（TBI）后发生抑郁是常见的。认知行为疗法（CBT）可用于治疗创伤性脑损伤后的抑郁，但对症状的反应描述欠佳。 目的 这项二次分析评估了：（1）进行多达12次认知行为疗法期间抑郁症状的发展轨迹；（2）哪些抑郁症状群对面对面和电话认知行为疗法有反应；（3）中期抑郁阈值是否能预测16周的治疗反应。 方法 这项对经伦理审查委员会批准的创伤性脑损伤后生活改善试验的二次分析纳入了来自美国各地的100名在中度至重度创伤性脑损伤后十年内患有重度抑郁症（MDD）的成年人。我们使用了描述性、图表和诊断准确性方法相结合的方式。 结果 在16周的时间里，主要症状和认知 - 情感症状群通过认知行为疗法改善最为明显。在第8周和第16周，反应最明显的个体症状是快感缺失、情绪低落和疲劳；反应最不明显的是睡眠和食欲。在第6、7和8次治疗时，PHQ - 9阈值的阴性预测值大于0.7，分别为：>15、>10和>9。 结论 面对面和电话认知行为疗法在治疗期间导致了相似的症状反应。此外，使用PHQ - 9阈值在8次治疗内预测干预反应可能有助于确定是否需要调整治疗。