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. 2018 Jan 9:14:239-249.
doi: 10.2147/NDT.S146098. eCollection 2018.

Functional impairment in patients with major depressive disorder: the 2-year PERFORM study

Lene Hammer-Helmich  1 , Josep Maria Haro  2 , Bengt Jönsson  3 , Audrey Tanguy Melac  4 , Sylvie Di Nicola  5 , Julien Chollet  6 , Dominique Milea  7 , Benoît Rive  8 , Delphine Saragoussi  4
Affiliations

Functional impairment in patients with major depressive disorder: the 2-year PERFORM study

Lene Hammer-Helmich et al. Neuropsychiatr Dis Treat. .

Abstract

Background: The Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder (PERFORM) study describes the course of depressive symptoms, perceived cognitive symptoms, and functional impairment over 2 years in outpatients with major depressive disorder (MDD) and investigates the patient-related factors associated with functional impairment.

Methods: This was a 2-year observational study in 1,159 outpatients with MDD aged 18-65 years who were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. Functional impairment was assessed by the Sheehan Disability Scale and the Work Productivity and Activity Impairment questionnaire. Patients assessed depression severity using the nine-item Patient Health Questionnaire and severity of perceived cognitive symptoms using the five-item Perceived Deficit Questionnaire. To investigate which patient-related factors were associated with functional impairment, univariate analyses of variance were performed to identify relevant factors that were then included in multivariate analyses of covariance at baseline, month 2, months 6 and 12 combined, and months 18 and 24 combined.

Results: The greatest improvement in depressive symptoms, perceived cognitive symptoms, and functional impairment was seen immediately (within 2 months) following initiation or switch of antidepressant therapy, followed by more gradual improvement and long-term stabilization. Improvement in perceived cognitive symptoms was less marked than improvement in depressive symptoms during the acute treatment phase. Functional impairment in patients with MDD was not only associated with severity of depressive symptoms but also independently associated with severity of perceived cognitive symptoms when adjusted for depression severity throughout the 2 years of follow-up.

Conclusion: These findings highlight the burden of functional impairment in MDD and the importance of recognizing and managing cognitive symptoms in daily practice.

Keywords: cognition; depression; functional impairment; functioning; major depressive disorder.

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Conflict of interest statement

Disclosure LHH is a full-time employee of Lundbeck A/S. JMH has received honoraria for being an advisor or providing educational talks for Lundbeck, Otsuka, Roche, and Eli Lilly and Company. BJ has received honoraria for being an advisor to Lundbeck. SDN is a shareholder of Inferential, Paris, France, a provider of biostatistical consulting services working with pharmaceutical companies including Lundbeck. ATM, JC, DM, BR, and DS were full-time employees of Lundbeck at the time this study was conducted. ATM has also been an employee of AbbVie Inc. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Changes from baseline to month 24 in: (A) SDS total score (range 0–30), (B) WPAI absenteeism and presenteeism scores (range 0–100), (C) PHQ-9 total score (range 0–27), and (D) PDQ-5 total score (range 0–20; analyzable population; N=1,159). Notes: Data are mean ± standard error; higher scores indicate worse outcomes. Abbreviations: PDQ-5, five-item Perceived Deficit Questionnaire; PHQ-9, nine-item Patient Health Questionnaire; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.
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