Psychosocial predictors of treatment outcome for trauma-affected refugees

The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. The total score of the CTP Predictor Index correlated significantly with outcomes on most of the rating scales, but correlations were modest in size, possibly due to the number of different factors influencing treatment outcome.

在针对受创伤难民的临床试验中，治疗效果不仅在不同研究间存在显著差异，在同一研究内的不同患者间亦相差悬殊。然而，目前学界对为何部分患者能从治疗中获益更多的认知仍较为匮乏——因鲜有研究分析过治疗结局的预测因子。本研究旨在探讨受创伤难民的治疗结局可能存在的社会心理预测因子。本研究的受试对象为195名成年创伤后应激障碍（Posttraumatic Stress Disorder, PTSD）难民，他们均在丹麦跨文化精神病学能力中心（Competence Centre for Transcultural Psychiatry, CTP）参与了为期6至7个月的治疗项目。本研究采用的CTP预测指数共涵盖15项潜在结局预测因子，涉及患者既往史、精神健康问题的慢性病程、疼痛状况、治疗动机、参与心理治疗的前置条件以及社会处境。主要结局指标为采用哈佛创伤问卷（Harvard Trauma Questionnaire, HTQ）评估的PTSD症状严重程度。其他结局指标包括霍普金斯症状清单-25（Hopkins Symptom Check List-25）、世界卫生组织-5幸福感指数（WHO-5 Well-being Index）、希恩残疾量表（Sheehan Disability Scale）、汉密尔顿抑郁与焦虑量表、症状清单-90（Symptoms Checklist-90）的躯体化分量表、整体功能评定量表，以及采用视觉模拟评分量表评估的疼痛程度。研究分析了治疗结局与CTP预测指数的总分及各子得分之间的相关性。整体而言，CTP预测指数的总分与上述多数评估指标的治疗前后得分变化呈显著相关。其中，就业状态是唯一与HTQ得分变化显著相关的单一预测因子；而CTP预测指数中的多个单项虽与抑郁、焦虑症状的变化呈显著相关，但相关系数的效应量较小。CTP预测指数的总分与多数评估量表的结局指标均呈显著相关，但相关程度普遍较弱，这可能与影响治疗结局的因素种类繁多有关。