Article

Health related quality of life in recurrent depression: a comparison with a general population sample.

Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Journal of Affective Disorders (Impact Factor: 3.71). 06/2009; 120(1-3):126-32. DOI: 10.1016/j.jad.2009.04.026
Source: PubMed

ABSTRACT In the acute phase major depressive disorder (MDD) is a disabling disease. We compared HRQOL in patients with remitted MDD (rMDD) with a community sample and longitudinally assessed the relation between depressive symptoms and HRQOL in recurrently depressed patients.
We used 12-month data of patients from the Depression Evaluation Longitudinal Therapy Assessment (DELTA) study. HRQOL was assessed with the Medical Outcome Short Form (SF-36). Remission was determined with the Structured Clinical Interview for DSM-IV and depressive symptoms were assessed with the Beck Depression Inventory. Patients' mean SF-36 scores were compared with those of an age- and sex-matched Dutch reference population. The longitudinal relation between levels of SF-36 and levels of depressive symptomatology was assessed with a repeated measures linear regression analysis using the mixed models module.
In patients with rMDD in the remitted phase, especially in women, both physical and mental HRQOL was lower than in a Dutch population sample. An increase in the level of depressive symptoms corresponded to a decrease in all scales of the SF-36.
Also in remitted rMDD patients, especially in women, HRQOL is lower than in the general population which emphasizes that also in this phase of recurrent depression HRQOL deserves attention. Furthermore, in patients with rMDD a higher depressive symptom severity level is associated with a lower HRQOL. These findings imply that residual symptoms should be treated aggressively and HRQOL enhancement therapies should be developed.

Download full-text

Full-text

Available from: Claudi L H Bockting, Jul 06, 2015
1 Follower
 · 
234 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Evidence of cognitive dysfunction in depressive and anxiety disorders is growing. However, the neuropsychological profile of young adults has received only little systematic investigation, although depressive and anxiety disorders are major public health problems for this age group. Available studies have typically failed to account for psychiatric comorbidity, and samples derived from population-based settings have also seldom been investigated. Burnout-related cognitive functioning has previously been investigated in only few studies, again all using clinical samples and wide age groups. Aims. Based on the information gained by conducting a comprehensive review, studies on cognitive impairment in depressive and anxiety disorders among young adults are rare. The present study examined cognitive functioning in young adults with a history of unipolar depressive or anxiety disorders in comparison to healthy peers, and associations of current burnout symptoms with cognitive functioning, in a population-based setting. The aim was also to determine whether cognitive deficits vary as a function of different disorder characteristics, such as severity, psychiatric comorbidity, age at onset, or the treatments received. Methods. Verbal and visual short-term memory, verbal long-term memory and learning, attention, psychomotor processing speed, verbal intelligence, and executive functioning were measured in a population-based sample of 21-35 year olds. Performance was compared firstly between participants with pure non-psychotic depression (n=68) and healthy peers (n=70), secondly between pure (n=69) and comorbid depression (n=57), and thirdly between participants with anxiety disorders (n=76) and healthy peers (n=71). The diagnostic procedure was based on the SCID interview. Fourthly, the associations of current burnout symptoms, measured with the Maslach Burnout Inventory General Survey, and neuropsychological test performance were investigated among working young adults (n=225). Results. Young adults with depressive or anxiety disorders, with or without psychiatric comorbidity, were not found to have major cognitive impairments when compared to healthy peers. Only mildly compromised verbal learning was found among depressed participants. Pure and comorbid depression groups did not differ in cognitive functioning, either. Among depressed participants, those who had received treatment showed more impaired verbal memory and executive functioning, and earlier onset corresponded with more impaired executive functioning. In anxiety disorders, psychotropic medication and low psychosocial functioning were associated with deficits in executive functioning, psychomotor processing speed, and visual short-term memory. Current burnout symptoms were associated with better performance in verbal working memory and verbal intelligence. However, lower examiner-rated social and occupational functioning was associated with problems in verbal attention, memory, and learning. Conclusions. Depression, anxiety disorders, or burnout symptoms may not be associated with major cognitive deficits among young adults derived from the general population. Even psychiatric comorbidity may not aggravate cognitive functioning in depressive or anxiety disorders among these young adults. However, treatment-seeking in depression was found to be associated with cognitive deficits, suggesting that these deficits relate to increased distress. Additionally, early-onset depression, found to be associated with executive dysfunction, may represent a more severe form of the disorder. In anxiety disorders, those with low symptom-related psychosocial functioning may have cognitive impairment. An association with self-reported burnout symptoms and cognitive deficits was not detected, but individuals with low social and occupational functioning may have impaired cognition. Tutkimus masennus- ja ahdistuneisuushäiriöihin liittyvistä kognitiivisista eli tiedonkäsittelyyn liittyvistä vaikeuksista on lisääntynyt viime vuosina. Tutkimus ei kuitenkaan ole ulottunut koskemaan nuoria aikuisia, vaikka masennus- ja ahdistuneisuushäiriöt ovat yleisiä tässä ikäryhmässä. Lisäksi tutkimus ei juurikaan ole koskenut ei-kliinisiä otoksia, ja psykiatrisen komorbiditeetin eli monihäiriöisyyden huomioon otto on tutkimusasetelmissa ollut heikkoa. Työuupumukseen liittyvää kognitiivista toimintakykyä on tutkittu vain muutamissa tutkimuksissa, ja niissäkin on kaikissa käytetty kliinisiä otoksia ja laajoja ikäryhmiä. Väitöstutkimuksen aluksi tehdyn kattavan kirjallisuuskatsauksen perusteella nuorten aikuisten kognitiivisia vaikeuksia masennus- ja ahdistuneisuushäiriöissä on tutkittu hyvin vähän. Siksi tämän tutkimuksen muissa osatöissä kartoitettiin väestöpohjaisessa otoksessa kognitiivista toimintakykyä yksisuuntaista masennusta ja ahdistuneisuushäiriöitä sairastaneilla nuorilla aikuisilla terveisiin verrokkeihin nähden, sekä yhteyksiä ajankohtaisten työuupumuksen oireiden ja kognitiivisten toimintojen välillä. Tutkimuksen tarkoituksena oli lisäksi selvittää, vaihteleeko kognitiivisten vaikeuksien olemassaolo sairauden piirteiden mukaan, kuten sen vakavuudesta, psykiatrisesta komorbiditeetista, tai sairastumisiästä riippuen. Tutkimuksessa mitattiin kielellistä ja visuaalista lyhytkestoista muistia, kielellistä pitkäkestoista muistia ja oppimista, tarkkaavaisuutta, toiminnanohjausta, psykomotorista prosessointinopeutta ja verbaalista yleistä älykkyyttä 21-35-vuotiaiden nuorten aikuisten väestöpohjaisessa otoksessa. Suoriutumista neuropsykologisissa testeissä verrattiin ensin puhdasta ei-psykoottista masennusta sairastaneiden ja terveiden verrokkien välillä, toiseksi puhdasta ja komorbidia masennusta sairastaneiden välillä ja kolmanneksi ahdistuneisuushäiriöitä sairastaneiden ja terveiden verrokkien välillä. Neljänneksi, ajankohtaisten työuupumuksen oireiden ja neuropsykologisen testisuoriutumisen välistä yhteyttä tarkasteltiin työssäkäyvien nuorten aikuisten kesken. Tulokset osoittivat, että masennus, ahdistuneisuushäiriö tai työuupumuksen oireet eivät olleet yhteydessä merkittäviin kognitiivisiin vaikeuksiin nuorten aikuisten väestössä, eikä edes psykiatrinen komorbiditeetti näyttänyt vaikeuttavan kognitiivista toimintakykyä näillä nuorilla aikuisilla. Hoitoon hakeutuminen masennuksessa oli yhteydessä kognitiivisiin vaikeuksiin, osoittaen, että nämä vaikeudet saattavat liittyä lisääntyneeseen yleiseen psyykkiseen pahoinvointiin. Lisäksi varhaisempi masennuksen sairastumisikä oli yhteydessä toiminnanohjauksen vaikeuksiin, mikä voi merkitä vakavampaa sairauden muotoa. Ahdistuneisuushäiriöistä kärsineillä psykotrooppinen lääkitys ja matala psykososiaalinen toimintakyky oli yhteydessä kognitiivisiin vaikeuksiin, osoittaen, että kognitiiviset vaikeudet saattavat liittyä vakavampaan sairauden muotoon. Itse arvioidut työuupumuksen oireet eivät liittyneet kognitiivisiin ongelmiin, mutta niillä, joilla on matalampi sosiaalinen ja ammatillinen toimintakyky, saattaa olla myös heikompi kognitiivinen toimintakyky.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although the preceding chapters discuss much of the new knowledge of neurocircuitry of neuropsychiatric diseases, and an invasive approach to treatment, this chapter describes and reviews the noninvasive methods of testing circuit-based theories and treating neuropsychiatric diseases that do not involve implanting electrodes into the brain or on its surface. These techniques are transcranial magnetic stimulation, vagus nerve stimulation, and transcranial direct current stimulation. Two of these approaches have FDA approval as therapies.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 09/2009; 35(1):301-16. DOI:10.1038/npp.2009.87 · 7.83 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Quality of life (QOL) is greatly diminished in patients with major depressive disorder (MDD) before treatment. This deficit persists even when patients are in remission; thus, interventions are needed to improve QOL. This article reviews QOL impairment in MDD and the cost of impairment, then summarizes the empiric literature on the effects of dopaminergic agents on QOL in patients with MDD. Studies were identified through a MEDLINE search from the past 35 years (1974-2009) using key terms "quality of life," "major depression," and "major depressive disorder," and "dopaminergic," "bupropion," or "modafinil." A total of 47 studies were included in this review. A brief overview of the relationship between QOL and MDD is presented, followed by a review of dopaminergic agent chemistry, mechanism of action, use, and trials conducted to investigate agents' effects on QOL. Preliminary evidence suggests dopaminergic agents may have a positive effect on QOL for patients with MDD. Prospective, randomized, double-blind, placebo-controlled studies are needed to extend these findings.
    Current Psychiatry Reports 12/2009; 11(6):503-8. DOI:10.1007/s11920-009-0076-z · 3.05 Impact Factor