Impact of PTSD comorbidity on one-year outcomes in a depression trial.
Low-income African American, Latino, and White women were screened and recruited for a depression treatment trial in social service and family planning settings. Those meeting full criteria for major depression (MDD; N = 267) were randomized to cognitive-behavior therapy (CBT), antidepressant medication, or community mental health referral. All randomly assigned participants were evaluated by baseline telephone and clinical interview, and followed by telephone for one year. Posttraumatic stress disorder (PTSD) comorbidity was assessed at baseline and one-year follow-up in a clinical interview. At baseline, 33% of the depressed women had current comorbid PTSD. These participants had more exposure to assaultive violence, had higher levels of depression and anxiety, and were more functionally impaired than women with depression alone. Depression in both groups improved over the course of one year, but the PTSD subgroup remained more impaired throughout the one-year follow-up period. Thus, evidence-based treatments (antidepressant medication or structured psychotherapy) decrease depression regardless of PTSD comorbidity, but women with PTSD were more distressed and impaired throughout. Including direct treatment of PTSD associated with interpersonal violence may be more effective in alleviating depression in those with both diagnoses.
Green
Bonnie L
BL
Georgetown Center for Trauma and the Community, Georgetown University Medical Center, Washington, DC 20007, USA. bgreen01@georgetown.edu
Krupnick
Janice L
JL
Chung
Joyce
J
Siddique
Juned
J
Krause
Elizabeth D
ED
Revicki
Dennis
D
Frank
Lori
L
Miranda
Jeanne
J
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D016896:Treatment Outcome
D000928:Antidepressive Agents