Cognitive-behavioral therapy for patients with somatoform disorders: A pilot preliminary randomized controlled trial.

Background and objective: Cognitive-behavioral therapy (CBT) for somatoform disorders (SFDs) is understudied in China. Western findings may not be applicable to Chinese culture. This preliminary study evaluated the efficacy of CBT for patients in China, relative to treatment-as-usual (TAU). Methods: Seventy patients with SFDs randomly received either combined CBT and TAU (CBT + TAU), or TAU alone between January 2018 to May 2019. The CBT + TAU group received 12 weekly individual 50-minute CBT sessions. Participants were blindly assessed at 4 timepoints (baseline, week 6, end of treatment: week 12; 12 weeks post-treatment: week 24) using the following outcome measures: SQSS (Self-screening Questionnaire for Somatic Symptoms); PHQ-15 (Patient-Health-Questionnaire-15) and the WI (Whiteley Index); GAD-7 (General Anxiety Disorder-7); HAMD-17 (Hamilton Depression Rating Scale-17); Family Burden Interview Schedule (FBIS); Sheehan Disability Scale (SDS); and the Short Form of Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). The primary endpoint was the difference between the SQSS total score at week 24 and the baseline. A mixed model for repeated measures was used to analyze inter- and intra-group changes from the baseline. Results: At week 24, The least-squares mean (LSM) change of the total score on the SQSS was -18.87 points and -9.69 points, respectively in the CBT + TAU group and in the TAU group (LSM difference, -9.18 points; 95% confidence interval, -15.72 to -2.64; P = 0.0068). At week 24, the LSM changes from baseline in the WI, HAMD, PHQ15, FBIS and SDS total scores were significantly different between the two groups, however, there was no significant difference in the Q-LES-Q-SF. The SQSS of group effect sizes were 0.63 at 24 weeks. The dropout rates of the CBT + TAU and TAU groups were comparable (22.9% and 19.3%). Conclusions: These preliminary findings suggest that CBT may be helpful for improving the symptoms of patients with SFDs in China.

Association between depressive symptoms and prediabetes: NHANES 2007-2016 findings.

INTRODUCTION: The association between diabetes and depressive symptoms is well recognized. However, the impact of depressive symptoms on prediabetes remains unclear. This study aims to explore the specific correlation between depressive symptoms and prediabetes. METHODS: A total of 7467 participants from the National Health and Nutrition Examination Survey (NHANES) were included in this study, spanning five rounds of surveys conducted between 2007 and 2016. Weighted logistic regression was utilized to assess the relationship between depressive symptoms and prediabetes. RESULTS: Compared with the normoglycemic population, individuals with prediabetes had a significantly higher probability of experiencing trouble sleeping (P = 0.020). After adjusting for non-glucose factors, there was no significant correlation between PHQ-9 and prediabetes; however, severe depressive symptoms were positively associated with abnormal fasting plasma glucose (FPG) levels (OR = 1.093 [95 % CI 1.002, 1.192]). There was a positive correlation between trouble concentrating and FPG abnormalities (OR = 1.065 [95 % CI 1.004, 1.129]). LIMITATIONS: The cross-sectional design limits causal inference. CONCLUSION: Individuals with depressive symptoms, especially severe cases, should be targeted for prediabetes prevention and management efforts. The diverse symptom presentations may have distinct impacts on glucose, necessitating personalized prevention and management strategies.

[Effect of community rehabilitation skill on patients with depression].

OBJECTIVE: To explore the effect of community depression rehabilitation skill on depressive symptoms and social function of patients with different diagnoses. METHODS: A total of 74 patients(20 males, 54 females)with depression in Beijing primary care center were divided into rehabilitation group(49 cases, average 51.80 years) and control group(25 cases, average 54.42 years) from August to November 2019.A total of 70 patients in two groups completed the final follow-up study. Patients in the rehabilitation group received depression community rehabilitation skill training for 8 weeks, while patients in the control group received daily community services. The two groups were assessed by the scale at baseline and 8 weeks later. The scales are as follow: basic information form and Hamilton depression scale(HAMD-17) and social disability screening schedule(SDSS), nurses global assessment of suicide risk(NGASR), morisky medication aderence scale(MMAS-8). For counting data χ~2inspection; The t-test for measurement data. RESULTS: Before the intervention, There was no significant difference in HAMD-17, NGASR, MMAS-8 and SDSS total score and each factor score of SDSS between the two groups(P>0.05). Paired t-test showed that after intervention, HAMD-17 total score, NGASR total score, and SDSS factors of social withdrawal, social activities outside the family, activities within the family, family functions, self-care of personal life, relationship and interest to the outside world, sense of responsibility and planning(P<0.05) in rehabilitation group were all significantly lower than before intervention. CONCLUSION: The rehabilitation skills of depression can improve the depressive symptoms and social function of different kinds of patients, and is suitable for promotion in the community.

Comparison of Residual Depressive Symptoms, Functioning, and Quality of Life Between Patients with Recurrent Depression and First Episode Depression After Acute Treatment in China.

OBJECTIVE: This prospective study aimed to investigate the prognosis and rehabilitation of patients with recurrent depression and first episode depression after acute treatment in China. METHODS: A total of 434 patients with first-episode or recurrent depression who received acute treatment respectively from sixteen hospitals in thirteen cities in China were enrolled in this prospective study. All patients were followed up for 6 months after acute treatment. The following data were collected at baseline period and 1, 3, and 6 months after acute treatment: general information of patients, medication information and patient's condition changes, brief 16-item quick inventory of depressive symptomatology self-report (QIDS-SR16), patient health questionnaire-15 (PHQ-15), quality of life enjoyment and satisfaction questionnaire-short form (Q-LES-Q-SF), Sheehan disability scale (SDS) and digit symbol substitution test (DSST). RESULTS: During the baseline period, there was a significant difference in QIDS-SR16 between recurrent patients and first-episode patients (p < 0.05), and there was no significant difference in other indicators (p > 0.05). At one month after acute treatment, there were significant differences in the total QIDS-SR16 score, the total Q-LES-SF score, the social life score, and the family life/home responsibilities score of SDS in patients with recurrent depression and first-episode depression (p < 0.05). At three months after acute treatment, there were significant differences in the total Q-LES-SF score and social life score of SDS in patients with recurrent depression and first-episode depression (p < 0.05). At six months after acute treatment, there were significant differences in the total QIDS-SR16 score, the social life score, and the total Q-LES-SF score in patients with recurrent depression and first-episode depression (p < 0.05). Compared with that data during the baseline period, the QIDS-SR16 scores and the SDS scores of all patients decreased, and the Q-LES-SF scores of all patients gradually increased as time went on during the consolidation period. CONCLUSION: The recurrent patients have more severe social function impairment, depressive symptoms, and lower life quality than that of the first-episode depressed patients. Given the negative impact of depressed symptom on recurrent patient, more attention should be paid to the treatment of recurrent patient and recurrence prevention of first episode patient.

A comparison of cognitive-behavioral therapy, antidepressants, their combination and standard treatment for Chinese patients with moderate-severe major depressive disorders.

BACKGROUND: No study has examined the effect of cognitive-behavioral therapy (CBT) on moderate-severe major depressive disorders (MDD) in China. The objective of this study was to evaluate the effect of CBT, antidepressants alone (MED), combined CBT and antidepressants (COMB) and standard treatment (ST; i.e., receiving psycho-educational intervention and/or medication treatment determined by treating psychiatrists) on depressive symptoms and social functioning in Chinese patients with moderate-severe MDD. METHOD: A total of 180 patients diagnosed with MDD according to ICD-10 were randomly allocated to one of the four treatment regimens for a period of 6 months. Depressive symptoms were measured using the Hamilton Rating Scale for Depression (HAMD) and the Quick Inventory of Depressive Symptomatology-Self-Report (C-QIDS-SR). Remission threshold was defined as a C-QIDS-SR total score of <5. Social functioning was evaluated with the Work and Social Adjustment Scale (WSAS). All outcome measures were evaluated at entry, and at 3- and 6-months follow-up. RESULTS: At the 6-months assessment, the remission rates in the whole sample (n=96), the MED, the CBT, the COMB and the ST groups were 54.2%, 48%, 75%, 53.5% and 50%, respectively. Following the treatment periods, there was no significant difference in any of the study outcomes between the four groups. However, the CBT showed the greatest effect in the HAMD total score with the effect size=0.94, whereas the ST has only a moderate effect size in the WSAS total score (effect size=0.47). CONCLUSIONS: The findings support the feasibility and effectiveness of CBT as a psychosocial intervention for Chinese patients with moderate-severe MDD. We also found that single treatment using MED or CBT performed equally well as the combined CBT-antidepressant treatment in controlling the remission. The study provided important knowledge to inform the mental health care planning in China.

Associations of self-esteem, dysfunctional beliefs and coping style with depression in patients with schizophrenia: a preliminary survey.

Psychological models of depression in schizophrenia have proposed that cognitive structures (e.g., self-esteem, dysfunctional beliefs) may have a role in the development and maintenance of depression. However, it has not been clear what the characteristics of these cognitive structures were in people with schizophrenia and whether they have an independent association with depression, especially in those from a Chinese cultural background. The present investigation examined 133 people with schizophrenia and 50 healthy controls and indicated that compared to the controls people with schizophrenia showed lower self-esteem, higher levels of dysfunctional beliefs and negative coping styles. Multiple linear regression analysis revealed that only low frustration tolerance, problem solving and self-blame were found to be the independent correlates of depression in schizophrenia. Results are discussed with the view of clinical implications of cognitive formulation and therapy for schizophrenia in China.