Long-term disability in major depressive disorder: a 6-year follow-up study

Abstract

BackgroundMajor depressive disorder (MDD) represents a leading cause of disability. This study examines the course of disability in patients with chronic, recurrent and remitting MDD compared to healthy controls and identifies predictors of disability in remitting MDD.MethodsWe included 914 participants from the Netherlands Study of Depression and Anxiety (NESDA). DSM-IV MDD and WHO DAS II disability were assessed at baseline and at 2, 4 and 6 years. Six-year total and domain-specific disability were analysed and compared in participants with chronic (n = 57), recurrent (n = 120), remitting (n = 127) MDD and in healthy controls (n = 430). Predictors of residual disability were identified using linear regression analysis.ResultsAt baseline, most disability was found in chronic MDD, followed by recurrent MDD, remitting MDD and healthy controls. Across diagnostic groups, most disability was found in household activities, interpersonal functioning, participation in society and cognition. A chronic course was associated with chronic disability. Symptom remission was associated with a decrease in disability, but some disability remained. In remitting MDD, higher residual disability was predicted by older age, more severe avoidance symptoms, higher disability at baseline and late symptom remission. Severity of residual disability correlated with the severity of residual depressive symptoms.ConclusionsSymptomatic remission is a prerequisite for improvements in disability. However, disability persists despite symptom remission. Therefore, treatment of MDD should include an explicit focus on disability, especially on the more complex domains. To this end, treatments should promote behavioural activation and address subthreshold depressive symptoms in patients with remitted MDD.

5HTTLPR Genetic Variant and Major Depressive Disorder: A Review

“…The inclusion criteria were: (1) studies should relate in some way to a genetic variant of 5HTTLPR and MDD; (2) present the laboratory methods used; (3) be original articles.…”

“…Articles were excluded if they: (1) presented incomplete data, including statistical data; (2) was not focused just on MDD; (3) were systematic reviews or meta-analysis; (4) were duplicated.…”

“…Characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-esteem, altered sleep and appetite, tiredness or lack of concentration, depression is a common mental disorder and one of the foremost causes of disability worldwide [1][2][3][4]. It tends to affect more women than men and may lead to suicide [1].…”

First-Episode Patients Report Cognitive Difficulties in Executive Functioning 1 Year After Initial Episode of Major Depressive Disorder

“…Studies have shown that neurocognitive functioning might be a key determinant affecting this relationship (9-11) with authors stressing the importance of recognizing cognitive impairments in clinical practice to improve clinical interventions (12). Importantly, studies find that disability and poorer quality of life are found to persist for years despite symptom reduction and remission (13,14), and cognitive impairment has been found to be a significant illness characteristic mediating the association between MDD and disability in everyday life (15,16). One study found that cognitive impairment in first episode patients, especially Executive Functioning (EF) impairment, predicted symptom severity in follow-up, highlighting the importance of interventions and treatment of cognitive deficits at an early stage of illness (11).…”

Individual participant data (IPD) meta-analysis of psychological relapse prevention interventions versus control for patients in remission from depression: a protocol

“…Depression is a highly debilitating mental health problem, and one of the leading causes of disability worldwide 1. Depression or major depressive disorder (MDD) has a chronic course, and relapse rates are high 2 3. Approximately 40%–60% of patients who develop a major depressive episode relapse, and this risk increases up to 90% after three episodes 4–7…”