The Study Of The Risk Factors Of Treatment-resistant Depression

Objective:To explore the risk factors of treatment-resistant depression.Methods:355first-episode major depressive disorder patients were surveyed with the situation of demography, past history, family history and personal history, while they were also elevated by Life Events Scale (LES), Automatic Thoughts Questionnaire (ATQ), Minnesota multiphase personality inventory (MMPI), Hamiltion Depression Scale (HAMD,17items), Hamiltion Anxiety Scale (HAMA), The Brief Psychiatric Rating Scale (BPRS), Wisconsin card sorting test (WCST), Trail Marking Test (TMT), Verbal Fluency task (VF), Tower of Hanoi (TOH) and Wechsler adult intelligence scale revised in China (WAIS-RC). They were given SSRIs or SNRIs antidepressant drugs for six weeks. The patients were getting into the non-treatment-resistant depression group, according to the decreasing rate of score of HAMD≥50%. The patients whose the decreasing rate of score of HAMD <50%were given the other antidepressant which different from that used before. After6-week treatment, the patients were divided into the non-treatment-resistant depression group and treatment-resistant depression group, according to the decreasing rate of score of HAMD≥50%and<50%respectively. Sociodemographic, clinical factors and cognitive data were compared between the non-treatment-resistant depression group and treatment-resistant depression group. Bivariate Logistic regression models were used to assess association between independent variables and treatment-resistant depression.Results:(1) Significant differences were found in the constituent ratio of the family history of psychosis and the type of onset between the non-treatment-resistant depression group and treatment-resistant depression group (P<0.05). No significant differences were found in gender, age, marital status, educational level, past history, stress life events of earlier, parents marriage, interpersonal relationship, working ability before sick, stress life events of recently and the score of LES between the two groups (P>0.05).(2) The duration, the scores of ATQ, HAMD, retardation factor, psychic anxiety factor, BPRS, anxiety depression factor, Hs, D and Hy of MMPI in treatment-resistant depression group were significant higher than that in non-treatment-resistant depression group (P<0.05).(3) The average plan and execution time of TOH in treatment-resistant depression group were significant higher than that in non-treatment-resistant depression group (P<0.05). No significant differences were found in the score of WCST, TMT, VF, WAIS-RC and the total score of TOH between the two groups (P>0.05).(4) Logistic regression analysis showed that family history of psychosis, long durations, the score of ATQ, the score of retardation factor of HAMD, comorbid anxiety symptoms, the score of Hy of MMPI and the average plan time of TOH entered into the regression equation.(5) The correlation coefficient between the score of ATQ and the total score of HAMD, the four subfactors (anxiety/somatization, cognitive, retardation and dyssomnia) score of HAMD, the total score of HAMA, the score of psychic anxiety factor in treatment-resistant depression group (P<0.05).Conclusion:(1) Compared to non-treatment-resistant depression, treatment-resistant depression patients may have the family history of psychosis, the hysteria, hypochondria, depression personality traits, chronic onset, longer duration, higher lever of depression and anxiety, more retardation symptoms, more negative automatic thoughts and worse execution function.(2) The family history of psychosis, longer duration, higher negative automatic thoughts, the hysteria personality traits, more retardation symptoms and comorbid anxiety were the risk factors of treatment-resistant depression.