<p>Patient-reported depression severity and cognitive symptoms as determinants of functioning in patients with major depressive disorder: a secondary analysis of the 2-year prospective PERFORM study</p>

Abstract

Purpose To investigate the temporal interrelationship between depression severity, cognitive symptoms, and functioning in patients with major depressive disorder (MDD) in the PERFORM study (NCT01427439). Patients and methods PERFORM was a 2-year, multicenter, prospective, noninterventional cohort study in outpatients with MDD who were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. Patients were enrolled by a general practitioner or psychiatrist. Structural equation model (SEM) analysis was used to explore temporal associations between patient-reported depression severity (9-item Patient Health Questionnaire score), cognitive symptoms (5-item Perceived Deficits Questionnaire score), and functional impairment (Sheehan Disability Scale total score). Standardized regression coefficients (SRCs) were used to evaluate the relationship between each outcome and scores from the most recent prior visit over the 2 years of follow-up. Results Between February 25, 2011, and February 19, 2015, 1,159 eligible patients with MDD completed the baseline and ≥1 follow-up visit at 194 sites in five European countries (France, Germany, Spain, Sweden, and the UK). Overall, 1,090 patients had assessments for ≥1 outcome measure at two consecutive visits. Severity of cognitive symptoms at baseline and Months 2 and 18 predicted functional impairment at Months 2, 6, and 24, respectively (SRC: 0.18, 0.15, and 0.22; P <0.001). Depression severity at Months 2, 6, and 12 predicted functional impairment at Months 6, 12, and 18, respectively (SRC: 0.17, 0.25, and 0.22; P <0.001). Severity of cognitive symptoms at baseline and Month 18 predicted depression severity at Months 2 and 24, respectively (SRC: 0.19 and 0.22; P <0.001). Functional impairment did not significantly predict the severity of depression or cognitive symptoms, and depression severity did not significantly predict the severity of cognitive symptoms at any time point. Conclusion Patient-reported severity of cognitive symptoms appears to be an independent and significant determinant of subsequent functional impairment and depression severity in patients with MDD.

The Relationship Between Cognitive Dysfunction Through THINC-Integrated Tool (THINC-it) and Psychosocial Function in Chinese Patients With Major Depressive Disorder

“…We observed a positive correlation between cognitive function and social function in our study, indicating that the impact of cognitive function on social function was an independent contributing factor (7). Herein, we found no correlation between the severity of depression and cognitive impairment.…”

“…According to a study assessing cognitive and social dysfunction in European and Asian populations, the severity of MDD was the main predictor of dysfunction, and impairment of subjective cognitive function was an independent and important predictor of dysfunction. Moreover, only the subjective five-item Perception Deficits Questionnaire (PDQ-5-D) was used to assess the cognitive dysfunction (7)(8)(9).…”

Inflammatory phenotype of depression symptom structure: A network perspective

“…Majd and colleagues (2020) highlight several measurement issues common in inflammatory studies of psychomotor problems, including that most measures do not distinguish between physical and cognitive slowing. It is possible that the elevated expected influence of both difficulty concentrating and psychomotor problems reflect shared variance reflective of cognitive slowing/impairment, a robust predictor of depression course and functional impairment (e.g., Haro et al, 2019). Considered in light of theory (Borsboom & Cramer, 2013) and recent empirical work (Elliott et al, 2020) suggesting that central symptoms might have prognostic utility, these symptoms might be particularly relevant for disease course/intervention planning in individuals with elevated CRP.…”

Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ?

“…The presence of cognitive symptoms affects patient functioning broadly, including difficulty in maintaining performance at work, experiencing household and financial strains, and difficulty in participating in social life (30)(31)(32). Improvements in these symptoms have been shown to precede improvements in functional outcome, even after adjustment for depressive symptom severity (33)(34)(35). Our findings may indicate that patients experience the functional consequences of cognitive symptoms in the short term to a much greater extent than realized or observed by HCPs and therefore report them as significant over and above depressive symptoms.…”