Verboom CE, Ormel J, Nolen WA, Penninx BWJH, Sijtsema JJ. Moderators of the synchrony of change between decreasing depression severity and disability. Objective: To identify moderators of... Show moreVerboom CE, Ormel J, Nolen WA, Penninx BWJH, Sijtsema JJ. Moderators of the synchrony of change between decreasing depression severity and disability. Objective: To identify moderators of synchrony of change between depression severity and disability. Method: From a large cohort study with 2 years of follow-up, patients with major depressive disorder at baseline who decreased at least 25% in depression severity after 2 years (n = 245) were selected. We measured overall and domain-specific disability at baseline, and at 1- and 2-year follow-up. Possible moderators, among which several demographic, clinical, personality, and contextual factors, were measured at baseline. We used linear mixed models to analyze the data. Results: Decrease in depression severity correlated strongly with reductions of overall disability (r = 0.54). Synchrony of change for the disability domains ranged from 0.13 for self-care to 0.47 for participation. From the possible moderators, only age and work stress moderated the association between change in depression severity and disability, with stronger synchrony of change among younger patients and patients who experienced moderate work stress. Conclusion: Strong synchrony of change exists between depression severity and disability. Perhaps, because of the strength of this synchrony, few contextual characteristics moderated the association. Clinicians should be aware of the risk of slower or incomplete functional recovery in older people and those without a job or those experiencing low work stress. Show less
Background: Although major depressive disorder (MDD) is associated with disability, some persons do function well despite their illness. Aim of the present study was to examine the effect of... Show moreBackground: Although major depressive disorder (MDD) is associated with disability, some persons do function well despite their illness. Aim of the present study was to examine the effect of illness characteristics and comorbid mental disorders on various aspects of disability among persons with a current MDD episode. Methods: Data were derived from 607 participants with a current MDD based on the Composite International Diagnostic Interview (CIDI). Severity was assessed via the Inventory of Depressive Symptoms self-report (IDS-SR). For disability three outcome measures were used: World Health Organization Disability Assessment Schedule II (WHODAS) disability and its 7 dimensions, days out of role, and work absence. Using multiple regression analysis the effects of MDD characteristics and comorbid mental disorders were estimated. Results: The IDS-SR score was the best predictor of all disability outcomes. Of the comorbid mental disorders, agoraphobia was significantly associated with overall disability. Collectively, all illness characteristics accounted for 43% of variance in WHODAS disability, 13% in days out of role and 10% in work absence, suggesting substantial unexplained variance. Limitations: Only self-report measures of disability were used. There were no assessments of other diagnoses than depressive, anxiety and alcohol use disorders. Conclusions: Although heterogeneity in disability of persons with current MDD is partially explained by illness characteristics of MDD (especially symptom severity) and comorbid mental disorders, most of the variance is not accounted for. (C) 2010 Elsevier By. All rights reserved. Show less
