Personalised management of recurrent depression, considering individual patient characteristics, is crucial.

This study evaluates the potentially different mediating role of mindfulness skills in managing recurrent depression using mindfulness-based cognitive therapy (MBCT) among people with varying depression severity.

Data from the Prevention of Depressive Relapse or Recurrence (PREVENT) trial, comparing MBCT (with antidepressant medication (ADM) tapering support, MBCT-tapering support) versus maintenance-ADM, were used. The study included pre, post, 9-, 12-, 18- and 24-month follow-ups. Adults with ≥3 previous major depressive episodes, in full/partial remission (below threshold for a current episode), on ADM, were assessed for eligibility in primary care practices in the UK. People were randomised (1:1) to MBCT-tapering support or maintenance-ADM. We used the Beck Depression Inventory-II to evaluate depressive symptom changes over the six time points. Pre-post treatment, we employed the Five Facets of Mindfulness Questionnaire to gauge mindfulness skills. Baseline symptom and history variables were used to identify individuals with varying severity profiles. We conducted Latent Profile Moderated-Mediation Growth Mixture Models.

A total of 424 people (mean (s.d.) age = 49.44 (12.31) years; with 325 (76.7%) self-identified as female) were included. A mediating effect of mindfulness skills, between trial arm allocation and the linear rate of depressive symptoms change over 24 months, moderated by depression severity, was observed (moderated-mediation index = −0.27, 95% CI = −0.66, −0.03). Conditional indirect effects were −0.42 (95% CI = −0.78, −0.18) for higher severity (expected mean BDI-II reduction = 10 points), and −0.15 (95% CI = −0.35, −0.02) for lower severity (expected mean BDI-II reduction = 3.5 points).

Mindfulness skills constitute a unique mechanism driving change in MBCT (versus maintenance-ADM). Individuals with higher depression severity may benefit most from MBCT-tapering support for residual symptoms. It is unclear if these effects apply to those with a current depressive episode. Future research should investigate individuals who are not on medication. This study provides preliminary evidence for personalised management of recurrent depression.

ISRCTN26666654.

考虑到患者的个体特征，对复发性抑郁进行个体化管理至关重要。

本研究评估了正念技能在不同抑郁严重程度的人中使用基于正念的认知疗法 （MBCT） 管理复发性抑郁症中的潜在不同中介作用。

使用来自预防抑郁复发或复发 （PREVENT） 试验的数据，比较了 MBCT（抗抑郁药物 （ADM） 逐渐减量支持、MBCT 逐渐减量支持）与维持 ADM。该研究包括前、后、9 个月、12 个月、18 个月和 24 个月的随访。在英国，对既往 ≥3 次重性抑郁发作、完全/部分缓解（低于当前发作的阈值）的成人进行初级保健实践的资格评估。受试者被随机分配 （1：1） 接受 MBCT 逐渐减量支持或维持 ADM。我们使用 Beck Depression Inventory-II 来评估 6 个时间点的抑郁症状变化。治疗前后，我们采用了正念的五个方面问卷来衡量正念技能。基线症状和病史变量用于识别具有不同严重程度特征的个体。我们进行了 Latent Profile Moderated-Mediation Growth Mixture 模型。

共纳入 424 人 （平均 （s.d.） 年龄 = 49.44 （12.31） 岁;其中 325 人 （76.7%） 自我认同为女性）。观察到正念技能在试验组分配和 24 个月内抑郁症状线性变化率之间的中介作用，受抑郁严重程度的调节 （中度中介指数 = -0.27,95% CI = -0.66，-0.03）。条件间接效应为-0.42（95%CI = -0.78，-0.18），对于较高的严重程度（预期平均BDI-II降低=10分），和-0.15（95%CI = -0.35，-0.02），对于较低的严重程度（预期平均BDI-II降低=3.5分）。

正念技能构成了推动 MBCT 变化的独特机制（相对于维持性 ADM）。抑郁严重程度较高的个体可能从对残留症状的 MBCT 逐渐减量支持中受益最大。目前尚不清楚这些影响是否适用于当前抑郁发作的患者。未来的研究应该调查未服药的个体。本研究为复发性抑郁症的个体化管理提供了初步证据。

 ISRCTN26666654。