Danielle S Cha1, Nicole E Carmona1, Mehala Subramaniapillai1, Rodrigo B Mansur1, Yena Lee2, Jae Hon Lee3, JungGoo Lee4, Joshua D Rosenblat2, Margarita Shekotikhina1, Caroline Park1, Carola Rong5, Tracy L Greer6, Raymond Lam7, Bernhard T Baune8, John Harrison9, Roger S McIntyre10. 1. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada. 2. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada. 3. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, Samsung Seoul Hospital, Sungkyunkwan University, School of medicine, Seoul, Republic of Korea. 4. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea. 5. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; American University of Integrative Sciences, School of Medicine, Sint Maarten. 6. Associate Professor, Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA. 7. Associate Head for Research, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Director, Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada; Executive Chair, Canadian Network for Mood and Anxiety Treatments (CANMAT), Vancouver, BC, Canada. 8. Professor and Chair, Head of Discipline of Psychiatry, University of Adelaide, Adelaide, Australia. 9. Associate Professor, Alzheimer Center, VU Medical Center, Amsterdam, The Netherlands; Principal Consultant, Metis Cognition Ltd., Warminster, UK. 10. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Professor, Department of Pharmacology, University of Toronto, Toronto, ON, Canada. Electronic address: Roger.McIntyre@uhn.ca.
Abstract
BACKGROUND: Psychosocial impairment represents an important treatment target in major depressive disorder (MDD). The majority of patients with MDD do not regain premorbid levels of psychosocial functioning despite the resolution of core depressive symptoms. This study aimed to investigate the respective effects of cognitive function and depression severity on impaired psychosocial function in MDD. METHODS: Adults aged 18-65 with moderate-to-severe MDD (n = 100) and age-, sex-, and education-matched healthy controls participated in a cross-sectional study validating the THINC-integrated tool (THINC-it), a cognitive screening tool comprised of objective and subjective measures of cognitive function. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale and psychosocial function was assessed using the Sheehan Disability Scale (SDS). RESULTS: Subjects with MDD reported greater impairment in psychosocial function than healthy controls, with significant differences in SDS total and domain scores (ps < .01) after controlling for age, sex, and education. Generalized linear models indicated that subjective cognitive function was most strongly associated with SDS total score (RR = .14, p = .01) and SDS domains of work/school (RR = .15, p = .03), family and home responsibilities (RR = .15, p = .02), and economic days lost (RR = .18, p =.03). Depression severity was most strongly associated with SDS social life (RR = .08, p < .01) and economic days underproductive (RR = .07, p < .01). Objective cognitive function was not significantly associated with any SDS outcomes. LIMITATIONS: The cross-sectional, observational study design limits temporal inferences. The self-report nature of measures included may have influenced associations observed. Potential medication effects are not noted. CONCLUSIONS: Cognitive deficits, as measured by the THINC-it, are associated with significant psychosocial impairment in MDD. These results provide empirical support for the assessment of both subjective and objective measures of cognition, as they are not associated with each other and have differential effects on functional trajectory.
BACKGROUND:Psychosocial impairment represents an important treatment target in major depressive disorder (MDD). The majority of patients with MDD do not regain premorbid levels of psychosocial functioning despite the resolution of core depressive symptoms. This study aimed to investigate the respective effects of cognitive function and depression severity on impaired psychosocial function in MDD. METHODS: Adults aged 18-65 with moderate-to-severe MDD (n = 100) and age-, sex-, and education-matched healthy controls participated in a cross-sectional study validating the THINC-integrated tool (THINC-it), a cognitive screening tool comprised of objective and subjective measures of cognitive function. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale and psychosocial function was assessed using the Sheehan Disability Scale (SDS). RESULTS: Subjects with MDD reported greater impairment in psychosocial function than healthy controls, with significant differences in SDS total and domain scores (ps < .01) after controlling for age, sex, and education. Generalized linear models indicated that subjective cognitive function was most strongly associated with SDS total score (RR = .14, p = .01) and SDS domains of work/school (RR = .15, p = .03), family and home responsibilities (RR = .15, p = .02), and economic days lost (RR = .18, p =.03). Depression severity was most strongly associated with SDS social life (RR = .08, p < .01) and economic days underproductive (RR = .07, p < .01). Objective cognitive function was not significantly associated with any SDS outcomes. LIMITATIONS: The cross-sectional, observational study design limits temporal inferences. The self-report nature of measures included may have influenced associations observed. Potential medication effects are not noted. CONCLUSIONS:Cognitive deficits, as measured by the THINC-it, are associated with significant psychosocial impairment in MDD. These results provide empirical support for the assessment of both subjective and objective measures of cognition, as they are not associated with each other and have differential effects on functional trajectory.
Authors: Tamsyn E Van Rheenen; Kathryn E Lewandowski; Jessica M Lipschitz; Katherine E Burdick Journal: CNS Spectr Date: 2018-09-24 Impact factor: 3.790
Authors: Andrea Fiorillo; Bernardo Carpiniello; Serafino De Giorgi; Silvestro La Pia; Giuseppe Maina; Gaia Sampogna; Edoardo Spina; Alfonso Tortorella; Antonio Vita Journal: Front Psychiatry Date: 2018-10-11 Impact factor: 4.157