Long-Term Psychosocial Disability in Major Depression
Abstract & Commentary
Source: Judd LL, et al. Psychosocial disability during the long-term course of unipolar major depressive disorder. Arch Gen Psychiatry 2000;57:375-380.
Judd and colleagues have published the results of a unique and well-designed study examining psychosocial disability during the waxing and waning long-term course of unipolar major depression. Their findings revealed that patients with symptomatic major depression have global difficulties functioning in their day-to-day lives, in proportion to the severity of the depressive symptoms. When recovered, these patients return to normal functioning.
These results may not seem surprising, but in some psychiatric disorders, such as bipolar disorder, functional recovery often lags far behind symptomatic or syndromic recovery. As Judd et al point out, unipolar major depression is prevalent, with 20% of the world’s population at risk for one or more episodes of major depression during their lifetime. Because of its high prevalence and severity, the World Health Organization lists major depression as one of the leading causes of disability and premature death across the world.
For many patients, major depression is a lifelong problem, with episodes of depression recurring throughout their life. Characterizing the features and epidemiological correlates of the psychosocial disability associated with major depression is the first step toward addressing this global problem. Understanding the time course of psychosocial disability in major depression can also help clinicians advise depressed patients about how to manage their lives around the periodic reappearance of depressive episodes.
The study used data from "Collaborative Depression Study," a large multicenter study funded by the National Institute of Mental Health. Ratings of psychosocial functioning were performed by trained professionals every six months for approximately 10 years in 371 subjects (233 women and 138 men) enrolled between 1978-1981. At the time of study enrollment, the mean age of the subjects was almost 40 years (range, 17-79), with more than half of the subjects being married and college graduates. The age of onset of major depression was about 30 years (range, 5-72), and 75% of the subjects were enrolled during a psychiatric hospitalization. All the subjects were white and English-speaking.
The data used for the present study included measures of depressive symptom severity and psychosocial impairment, using previously validated rating instruments in a structured interview format. The psychosocial ratings covered nine functional "domains," including work and intimate relationships, as well as a global score.
The results showed a close correlation in severity and time course between depressive symptoms and psychosocial disability. Even mild depressive symptoms resulted in some degree of psychosocial impairment. Each incremental level of severity of depressive symptoms was associated with an incremental worsening of psychosocial functioning. The absence of depressive symptoms was associated with good psychosocial functioning. However, even when patients were asymptomatic they exhibited more psychosocial dysfunction than a group of matched normal controls.
Comment by Andrew L. Stoll, MD
This well-designed and fairly definitive naturalistic study observed a tight correlation between depressive symptoms and psychosocial disability. It is encouraging that depressed patients can functionally recover between episodes. However, the prevalence, severity, and high recurrence of major depression suggest that much more work needs to be done to reduce the effect of major depression on our patients and society as a whole.
The degree of disability in major depression is tightly correlated with symptom severity.
a. True
b. False
According to the World Health Organization, major depression is one of the leading causes of disability and premature death.
a. True
b. False
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