A randomised controlled trial of cognitive behaviour therapy vs treatment as usual in the treatment of mild to moderate late life depression

OBJECTIVES: This study provides an empirical evaluation of Cognitive Behaviour Therapy (CBT) alone vs Treatment as usual (TAU) alone (generally pharmacotherapy) for late life depression in a UK primary care setting. METHOD: General Practitioners in Fife and Glasgow referred 114 Participants to the study with 44 meeting inclusion criteria and 40 participants providing data that permitted analysis. All participants had a diagnosis of mild to moderate Major Depressive Episode. Participants were randomly allocated to receive either TAU alone or CBT alone. RESULTS: Participants in both treatment conditions benefited from treatment with reduced scores on primary measures of mood at end of treatment and at 6 months follow-up from the end of treatment. When adjusting for differences in baseline scores, gender and living arrangements, CBT may be beneficial in levels of hopelessness at 6 months follow-up. When evaluating outcome in terms of numbers of participants meeting Research Diagnostic Criteria for depression, there were significant differences favouring the CBT condition at the end of treatment and at 3 months follow-up after treatment. CONCLUSIONS: CBT alone and TAU alone produced significant reductions in depressive symptoms at the end of treatment and at 6 months follow-up. CBT on its own is shown to be an effective treatment procedure for mild to moderate late life depression and has utility as a treatment alternative for older people who cannot or will not tolerate physical treatment approaches for depression.     

Effectiveness of cognitive behaviour therapy for treatment-resistant depression with psychiatric comorbidity: comparison of individual versus group CBT in an interdisciplinary rehabilitation setting

Background: Cognitive behaviour therapy (CBT) has been shown to be effective, yet there is a paucity of research on the differential effectiveness of individual and group CBT for adults with treatment-resistant depression with psychiatric comorbidity.

Aims: To investigate the effectiveness of individual and group CBT for inpatients, in an interdisciplinary rehabilitation setting; the extent of psychiatric comorbidity; and who benefits the most from group CBT.

Methods: All patients (n?=?181) received 6 weeks of rehabilitation (treatment as usual, TAU). In addition, they were randomly allocated to group CBT (n?=?86) or individual CBT (n?=?59) combined with TAU, or TAU only (n?=?36). All CBT therapists were part of an interdisciplinary team, had at least 1-year CBT training, and attended weekly supervision. The same CBT manual was used for individual and group therapy, providing 12 sessions, two per week. Groups had 12–15 participants and two therapists in each session.

Results: Individual CBT was superior in efficacy to group CBT and TAU, with a large within-subject effect size (ES?=?2.10). Group CBT was not superior to TAU. The benefits of treatment decreased over time, but remained large at 18-month follow-up for individual CBT (ES?=?1.02), and medium for group CBT (ES?=?0.46) and TAU (ES?=?0.60).

Conclusions: Individual CBT was an effective addition to TAU and showed significant improvements in symptom severity post-treatment and at 18-month follow-up. Disorder severity and comorbidity may have decreased effectiveness of group therapy primarily aimed at depression.     

Cost-effectiveness of cognitive-behavioral therapy versus treatment as usual for anxiety disorders in children with autism spectrum disorder

The study's aim was to evaluate the cost-effectiveness of CBT compared to treatment as usual (TAU). In total, 49 children aged 8–18 years with ASD and comorbid anxiety disorders, and their parents, participated; 24 were assigned to CBT and 25 were assigned to TAU. Outcome measures were the percentage of children free from their primary anxiety disorder and quality adjusted life years (QALYs). Costs were measured using a retrospective cost-questionnaire. Effects and costs were assessed at pre-, post-, and three months after treatment. Effects and costs were not statistically different between CBT and TAU, however the incremental cost-effectiveness ratio (ICER) demonstrated that CBT dominates TAU. Bootstrapped ICERs demonstrated that CBT has a high probability to be more effective than TAU, however, the probability that either CBT or TAU is more costly did not differ much. Secondary analyses demonstrated fairly robust results. CBT seems a cost-effective intervention compared to TAU, however, long-term follow-ups and comparisons between CBT and specific TAUs are necessary. Cost-effectiveness analyses may help inform policy makers to decide how to treat anxiety disorders in children with ASD.     

早期干预治疗对脑卒中后抑郁患者生活质量的影响

目的 探讨早期干预治疗对脑卒巾后抑郁患者生活质量的影响.方法 选用抑郁自评量表(SDS)筛选评定出脑卒中后抑郁患者246例.分为2组,其中治疗组154例.口服抗抑郁药物治疗;对照组92例,未进行抗抑郁治疗.采用汉密顿抑郁量表(HAMD)、修订的Banhel指数(MBI)、生活质量指数(QLI)量表对两组患者在治疗前和治疗后1个月、3个月和6个月进行评分,对所得结果进行统计学分析.结果 治疗组与对照组相比.治疗后1个月、3个月、6个月HAMD量表评分明显减低,差异有统计学意义(P(0.05);MBI量表评分和QH量表评分明显提高,差异均有统计学意义(P(0.05).结论 早期干支治疗脑卒中后抑郁不仅可以改善患者抑郁状态,而且还可以促进患者躯体功能恢复,改善患者主观生活满意度.提高患者生活质量.     

Attribution,cognition and psychopathology in persistent insomnia disorder: outcome and mediation analysis from a randomized placebo-controlled trial of online cognitive behavioural therapy

ObjectivesInsomnia patients complain that mental events keep them awake. This study investigates how cognitive behavioural therapy (CBT) affects such events and considers how attributional, cognitive and psychopathological symptoms may mediate sleep improvement.MethodA pragmatic, parallel-group randomized controlled trial of 164 adults (120 F: (mean 49 years (18–78 years)) meeting Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for insomnia disorder, assigned to CBT (n = 55; 40 F), imagery relief therapy (IRT placebo; n = 55; 42 F), or treatment as usual (TAU; n = 54; 38 F), was conducted. CBT/IRT comprised six online sessions delivered by an animated therapist, with automated web/e-mail support. CBT users had access to a moderated community. TAU comprised ‘usual care’. Participants completed the Sleep Disturbance Questionnaire (SDQ), Glasgow Content of Thoughts Inventory (GCTI), Depression Anxiety and Stress Scales (DASS) and Sleep Condition Indicator (SCI) at baseline, post treatment and 8-week follow-up.ResultsThe sample was characterised by mental arousal, notably ‘trying too hard’ to sleep (SDQ), and by ‘sleep and sleeplessness’ and ‘rehearsal and planning’ thoughts (GCTI). Treatment effects were observed for all SDQ domains (e.g., CBT vs. IRT: d = 0.76 for ‘trying too hard’). CBT was also superior to IRT on the GCTI (e.g., ‘rehearsal and planning’, d = 0.62; ‘sleep and sleeplessness’, d = 0.74). CBT vs. TAU comparisons yielded larger effects, whereas placebo effects (IRT vs. TAU) were small to moderate. Hierarchical regression demonstrated partial mediation of SCI improvement by attributional and cognitive factors (R² = 21–27%) following CBT. Improvement in sleep efficiency appears to be independent of such factors.ConclusionOnline CBT modifies sleep-related attributions, night-time thought content and psychopathology. This process partly mediates improvement in DSM-5-defined insomnia.     

Cognitive Behavioral Therapy for Subjects at Ultrahigh Risk for Developing Psychosis: A Randomized Controlled Clinical Trial

Background

: Evidence for the effectiveness of treatments for subjects at ultrahigh risk (UHR) for developing psychosis remains inconclusive. Objective : A new cognitive behavioral intervention specifically targeted at cognitive biases (ie, Cognitive Behavioral Therapy [CBT] for UHR patients plus treatment as usual [TAU] called CBTuhr) is compared with TAU in a group of young help-seeking UHR subjects. Methods : A total of 201 patients were recruited at 4 sites and randomized. In most cases, CBTuhr was an add-on therapy because most people were seeking help for a comorbid disorder. The CBT was provided for 6 months, and the follow-up period was 18 months. Results : In the CBTuhr condition, 10 patients transitioned to psychosis compared with 22 in the TAU condition (χ ² (1) = 5.575, P = .03). The number needed to treat (NNT) was 9 (95% confidence interval [CI]: 4.7–89.9). At 18-month follow-up the CBTuhr group was significantly more often remitted from an at-risk mental state, with a NNT of 7 (95% CI: 3.7–71.2). Intention-to-treat analysis, including 5 violations against exclusion criteria, showed a statistical tendency (χ ² (1) = 3.338, P = .06). Conclusions : Compared with TAU, this new CBT (focusing on normalization and awareness of cognitive biases) showed a favorable effect on the transition to psychosis and reduction of subclinical psychotic symptoms in subjects at UHR to develop psychosis. Key words: cognitive behavioral therapy, ultrahigh risk, cognitive biases, prevention, psychosis, schizophrenia     

Long-Term Effects of Cognitive-Behavioral Therapy and Yoga for Worried Older Adults

ObjectivesCognitive-behavioral therapy (CBT) and yoga decrease worry and anxiety. There are no long-term data comparing CBT and yoga for worry, anxiety, and sleep in older adults. The impact of preference and selection on these outcomes is unknown. In this secondary data analysis, we compared long-term effects of CBT by telephone and yoga on worry, anxiety, sleep, depressive symptoms, fatigue, physical function, social participation, and pain; and examined preference and selection effects.DesignIn this randomized preference trial, participants (N = 500) were randomized to a: 1) randomized controlled trial (RCT) of CBT or yoga (n = 250); or 2) preference trial (selected CBT or yoga; n = 250). Outcomes were measured at baseline and Week 37.SettingCommunity.ParticipantsCommunity-dwelling older adults (age 60+ years).InterventionsCBT (by telephone) and yoga (in-person group classes).MeasurementsPenn State Worry Questionnaire - Abbreviated (worry);^1,2 Insomnia Severity Index (sleep);³ PROMIS Anxiety Short Form v1.0 (anxiety);^4,5 Generalized Anxiety Disorder Screener (generalized anxiety);^6,7 and PROMIS-29 (depression, fatigue, physical function, social participation, pain).^8,9ResultsSix months after intervention completion, CBT and yoga RCT participants reported sustained improvements from baseline in worry, anxiety, sleep, depressive symptoms, fatigue, and social participation (no significant between-group differences). Using data combined from the randomized and preference trials, there were no significant preference or selection effects. Long-term intervention effects were observed at clinically meaningful levels for most of the study outcomes.ConclusionsCBT and yoga both demonstrated maintained improvements from baseline on multiple outcomes six months after intervention completion in a large sample of older adults.Trial Registrationwww.clinicaltrials.gov Identifier NCT 02968238.     

A one-year comparison of vagus nerve stimulation with treatment as usual for treatment-resistant depression.

BACKGROUND: Previous reports have described the effects of vagus nerve stimulation plus treatment as usual (VNS+TAU) during open trials of patients with treatment-resistant depression (TRD). To better understand these effects on long-term outcome, we compared 12-month VNS+TAU outcomes with those of a comparable TRD group. METHODS: Admission criteria were similar for those receiving VNS+TAU (n = 205) or only TAU (n = 124). In the primary analysis, repeated-measures linear regression was used to compare the VNS+TAU group (monthly data) with the TAU group (quarterly data) according to scores of the 30-item Inventory of Depressive Symptomatology-Self-Report (IDS-SR(30)). RESULTS: The two groups had similar baseline demographic data, psychiatric and treatment histories, and degrees of treatment resistance, except that more TAU participants had at least 10 prior major depressive episodes, and the VNS+TAU group had more electroconvulsive therapy before study entry. Vagus nerve stimulation plus treatment as usual was associated with greater improvement per month in IDS-SR(30) than TAU across 12 months (p < .001). Response rates according to the 24-item Hamilton Rating Scale for Depression (last observation carried forward) at 12 months were 27% for VNS+TAU and 13% for TAU (p < .011). Both groups received similar TAU (drugs and electroconvulsive therapy) during follow-up. CONCLUSIONS: This comparison of two similar but nonrandomized TRD groups showed that VNS+TAU was associated with a greater antidepressant benefit over 12 months.     

Cognitive Behavioral Therapy for Depressed Adults With Mild Intellectual Disability: A Pilot Study

There is a paucity of research on psychosocial treatments for depression in adults with intellectual disability (ID). In this pilot study, we explored the efficacy of a group CBT treatment that involved a caregiver component in adults with mild ID with a depressive disorder. Sixteen adults with mild ID and a depressive disorder participated in a 10-week group CBT treatment and eight adults with mild ID with a depressive disorder served as a treatment as usual (TAU) control group. Adults with mild ID and caregivers completed measures of depressive symptoms, behavior problems, and social skills at pretreatment, posttreatment, and a 3-month follow-up. Adults with mild ID also completed a series of tasks to measure their understanding of the principles of cognitive therapy pre- and posttreatment. The CBT group demonstrated significant decreases in depressive symptoms and behavior problems from pretreatment to posttreatment and these effects were maintained at a 3-month follow-up. The CBT group demonstrated significant improvements in their ability to infer emotions and thoughts based on various situation-thought-emotion pairings from pretreatment to posttreatment. Findings indicate that adults with mild ID with a depressive disorder benefitted from a group CBT treatment with a caregiver component. Moreover, adults with mild ID appeared to benefit, at least in part, from the cognitive therapy components of the treatment, in addition to the behavior therapy components.     

A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication

OBJECTIVE: To test a collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in HMO pediatric primary care. METHOD: A randomized effectiveness trial comparing a treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the experimental protocol (n = 75) versus TAU SSRI plus brief CBT (n = 77). Participants were identified by a recent dispense of SSRI medication followed by telephone screening. Adolescents with a diagnosis of major depressive disorder (n = 152) were enrolled. The CBT program employed cognitive restructuring and/or behavioral activation training. Therapists consulted with prescribing pediatricians to improve medication adherence. RESULTS: Through 1-year follow-up, the authors found CBT advantages on the Short Form-12 Mental Component Scale (p = .04), reductions in TAU outpatient visits (p = .02), and days' supply of all medications (p = .01). No effects were detected for major depressive disorder episodes; a nonsignificant trend favoring CBT was detected on the Center for Epidemiology Depression Scale (p = .07). CONCLUSIONS: The authors detected a weak CBT effect, possibly rendered less significant by the small sample and likely attenuated by the unexpected reduction in SSRI pharmacotherapy in the CBT condition. Small, incremental improvements over monotherapy, such as observed in this study, most likely represent the new norm in adolescent depression treatment research.     

规范化认知行为治疗对社区残留型精神分裂症患者生活质量和社会功能的影响

目的 探讨规范化的认知行为治疗（CBT）对社区慢性残留型精神分裂症患者的生活质量及其社会功能的改善作用.方法 于2011年6月～2012年1月将北京市原崇文区的社区慢性残留型精神分裂症患者32例按随机数字表分为CBT组和对照组,CBT组给予常规治疗联合规范化的认知行为治疗,对照组仅给予常规治疗,均干预3个月,比较两组患者的生活质量和社会功能变化.结果 12周时CBT组的心理因子、社会功能评分显著高于对照组（t分别为2.229,3.024; P＜0.05）;38周时CBT组的生活质量总分、心理因子和社会功能评分显著高于对照组（t分别为2.072,2.706,2.818;P＜0.05）;64周时CBT组的生活质量总分、生理因子、心理因子及社会功能评分均显著高于对照组（t分别为2.208,2.055,2.647,4.109; P＜0.05）.结论 规范化的认知行为治疗可能显著改善社区慢性残留型精神分裂症患者的生活质量和社会功能,但由于样本量小等因素尚需在社区中进一步研究与推广应用.     

米氮平联合乌灵胶囊治疗老年卒中后抑郁对照研究

目的 观察米氮平联合乌灵胶囊治疗老年卒中后抑郁患者的疗效.方法 将150例老年脑卒中后抑郁患者随机分为米氮平联合乌灵胶囊组52例,米氮平组48例,对照组50例,疗程3个月.治疗前后分别应用汉密尔顿抑郁量表（Hamilton rating scale for depression,HAMD）评估抑郁症状改善情况,应用匹兹堡睡眠质量指数（Pittsburgh sleep quality index,PSQI）评估睡眠改善情况,应用TESS副反应量表（treatment emergent symptom scale,TESS）评估药物不良反应.结果 米氮平联合乌灵胶囊组、米氮平组汉密尔顿抑郁量表评分较对照组明显降低,差异有统计学意义（P〈0.05）;米氮平联合乌灵胶囊组匹兹堡睡眠质量指数评分均较其余2组明显降低,差异有统计学意义（P〈0.05）;TESS副反应量表评分3组组间比较差异无统计学意义（P〉0.05）.结论 米氮平联合乌灵胶囊治疗老年卒中后抑郁有效,不良反应少,值得推广.     

Cognitive--behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial

BACKGROUND: Family intervention reduces relapse rates in psychosis. Cognitive-behavioural therapy (CBT) improves positive symptoms but effects on relapse rates are not established. AIMS: To test the effectiveness of CBT and family intervention in reducing relapse, and in improving symptoms and functioning in patients who had recently relapsed with non-affective psychosis. METHOD: A multicentre randomised controlled trial (ISRCTN83557988) with two pathways: those without carers were allocated to treatment as usual or CBT plus treatment as usual, those with carers to treatment as usual, CBT plus treatment as usual or family intervention plus treatment as usual. The CBT and family intervention were focused on relapse prevention for 20 sessions over 9 months. RESULTS: A total of 301 patients and 83 carers participated. Primary outcome data were available on 96% of the total sample. The CBT and family intervention had no effects on rates of remission and relapse or on days in hospital at 12 or 24 months. For secondary outcomes, CBT showed a beneficial effect on depression at 24 months and there were no effects for family intervention. In people with carers, CBT significantly improved delusional distress and social functioning. Therapy did not change key psychological processes. CONCLUSIONS: Generic CBT for psychosis is not indicated for routine relapse prevention in people recovering from a recent relapse of psychosis and should currently be reserved for those with distressing medication-unresponsive positive symptoms. Any CBT targeted at this acute population requires development. The lack of effect of family intervention on relapse may be attributable to the low overall relapse rate in those with carers.     

Cognitive-behavioral therapy for depression in patients with temporal lobe epilepsy: a pilot study

Depression has a high prevalence among patients with temporal lobe epilepsy (TLE). A pilot study was carried out to evaluate group cognitive-behavioral therapy (CBT) as a treatment for depression in patients with TLE. Twenty-three outpatients with TLE and major depressive disorder, according to DSM-IV criteria, were enrolled and divided into two groups to receive 16 weekly sessions of CBT. The primary outcome measures were depression severity (assessed with the Beck Depression Inventory) and quality of life (measured with the Quality of Life in Epilepsy-31). Sixteen patients (70%) completed at least 80% of the sessions. From week 8, CBT had a significant positive effect on severity of depression that lasted until the end of treatment. A significant improvement in quality of life was also observed. CBT seems to be a useful intervention for treating depression and improving quality of life in patients with TLE.     

Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions

OBJECTIVE: This trial examined the effects of both acute and maintenance cognitive-behavioral therapy (CBT) for depressed adolescents. METHOD: Adolescents with major depression or dysthymia (N = 123) were randomly assigned to 1 of 3 eight-week acute conditions: adolescent group CBT (16 two-hour sessions); adolescent group CBT with a separate parent group; or waitlist control. Subsequently, participants completing the acute CBT groups were randomly reassigned to 1 of 3 conditions for the 24-month follow-up period: assessments every 4 months with booster sessions; assessments only every 4 months; or assessments only every 12 months. RESULTS: Acute CBT groups yielded higher depression recovery rates (66.7%) than the waitlist (48.1%), and greater reduction in self-reported depression. Outcomes for the adolescent-only and adolescent + parent conditions were not significantly different. Rates of recurrence during the 2-year follow-up were lower than found with treated adult depression. The booster sessions did not reduce the rate of recurrence in the follow-up period but appeared to accelerate recovery among participants who were still depressed at the end of the acute phase. CONCLUSIONS: The findings, which replicate and expand upon a previous study, support the growing evidence that CBT is an effective intervention for adolescent depression.     

Secondary outcomes from the pediatric obsessive compulsive disorder treatment study II

The Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II) investigated the benefit of serotonin reuptake inhibitor (SRI) augmentation with cognitive behavioral therapy (CBT). Primary outcomes focused on OCD symptom change and indicated benefit associated with a full course of CBT. Given that the majority of youth with OCD suffer from significant comorbid symptoms and impaired quality of life, the current study examined POTS II data for effects on secondary outcomes. Participants were 124 youth ages 7–17 years with a primary diagnosis of OCD who were partial responders to an adequate SRI trial. Participants were randomized to medication management, medication management plus instructions in cognitive behavioral therapy (CBT), or medication management plus full CBT. Acute effects on non-OCD anxiety, depression, inattention, hyperactivity, and quality of life were examined across treatment conditions. Improvement across treatment was observed for non-OCD anxiety, inattention, hyperactivity, and quality of life. Changes were generally significantly greater in the group receiving full CBT. Child-rated depression was not found to change. OCD-focused treatment lead to improvement in other areas of psychopathology and functioning. For youth who are partial responders to SRI monotherapy, augmentation with full CBT may yield the greatest benefit on these secondary outcomes.Clinical trials registrationTreatment of Pediatric OCD for SRI Partial Responders, Clinicaltrials.gov Identifier: NCT00074815, http://clinicaltrials.gov/show/NCT00074815.     

Clinical efficacy of psychotherapy targeted for insomnia in comorbid depression

Insomnia often persists despite adequate pharmacotherapy in depression and represents an obstacle to its full remission. It is unclear whether psychotherapy targeted for insomnia can improve clinical outcomes for patients with residual depression and treatment refractory insomnia. We aimed to evaluate the added value of brief Behavioral Therapy for insomnia (bBTi) over treatment as usual (TAU) for residual depression and refractory insomnia. Randomized controlled trial in 37 adults with residual depression and refractory insomnia was conducted. Twenty patients received TAU plus bBTi, consisting of 4 weekly 1-hour individual sessions, administered by psychiatrists or nurses. The rest received TAU alone. The Insomnia Severity Index (ISI) scores at 8 weeks were defined as the primary outcome. The Hamilton Rating Scale for Depression (HAMD) scores assessed by blind raters, and remission rates for both insomnia and depression were also evaluated. Analysis of covariance was used to test group effects while controlling for the baseline scores. The protocol was approved by the Ethics Committees of all the recruiting centers. Written informed consent was obtained from all participants. The bBTi plus TAU resulted in significantly lower ISI scores than TAU alone at 8 weeks (P < .0005). Significant differences were observed in favor of the combination group for both on the total HAMD scores (P = .013) and on the HAMD scores after removing the three sleep items (P = .008). The combination treatment produced higher rates of remission than TAU alone, both in terms of insomnia (50% [10/20] vs. 0% [0/17]) with a number-needed-to-treat (NNT) of 2 (95% confidence intervals, 1 to 4), and in terms of depression (50% [10/20] vs. 6% [1/17]) with an NNT of 2 (1 to 5). For the purpose of dissemination of bBTi, we are planning two additional trials taking account of the intensity of bBTi and of the effectiveness in a real-world situation.     

睡眠时长和睡眠质量与卒中后抑郁状态的关系研究

目的 探讨睡眠时长和睡眠质量与卒中后抑郁状态的关系。 方法 前瞻性连续纳入2017年7月-2019年5月在天津医科大学总医院神经内科住院的卒中患者为 研究对象，根据抑郁自评量表（sel f-rating depression scale，SDS）和17项汉密尔顿抑郁量表（Hamilton depression scale-17，HAMD-17）评分将患者分为抑郁状态组和非抑郁状态组。睡眠时长和睡眠质量采 用研究人员问询和受试者主观自评方式评估，按睡眠时长分为＜7 h、7～＜8 h、8～＜9 h、9～＜10 h 和≥10 h组，睡眠质量分为好、一般和差3个等级。采用自制问卷收集患者的人口学、生活方式[吸烟、 酗酒和国际体力活动问卷（international physical activity questionnaire，IPAQ）]、BMI、疾病史等信息。 结果 共入组836例卒中患者，抑郁状态组453例（54.2%），非抑郁状态组383例（45.8%）。抑郁状 态组的睡眠质量较非抑郁状态组差（P＜0.001），但两组的睡眠时长差异无统计学意义；抑郁状态组 的I PAQ评分更低（P＜0.001），女性比例更高（P =0.034），有疾病史者比例更高（P =0.006）。logistic回 归分析显示，与睡眠质量好相比，睡眠质量一般（OR 1.729，95%CI 1.232～2.428，P =0.002）和睡眠 质量差（OR 1.817，95%CI 1.250～2.640，P =0.002）均增加卒中后抑郁状态的风险；睡眠时长对卒中后 抑郁状态的影响不显著。 结论 卒中患者抑郁状态的发生率较高，睡眠质量是卒中后抑郁状态的独立预测因素。