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

Authors
  • Iancu, Sorana C1
  • Wong, Yak Mee2
  • Rhebergen, Didi1
  • van Balkom, Anton J L M1
  • Batelaan, Neeltje M1
  • 1 Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute and GGZ inGeest, Amsterdam, The Netherlands. , (Netherlands)
  • 2 Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. , (Netherlands)
Type
Published Article
Journal
Psychological Medicine
Publisher
Cambridge University Press
Publication Date
Jul 01, 2020
Volume
50
Issue
10
Pages
1644–1652
Identifiers
DOI: 10.1017/S0033291719001612
PMID: 31284881
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Major 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. We 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. At 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. Symptomatic 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.

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