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. 2023 Mar 24:58:101927.
doi: 10.1016/j.eclinm.2023.101927. eCollection 2023 Apr.

Association of neurocognitive function with psychiatric hospitalization and socio-demographic conditions in individuals with bipolar and major depressive disorders

Anjali Sankar  1   2 , Simon C Ziersen  1   3 , Brice Ozenne  1   3 , Emily E Beaman  1 , Vibeke H Dam  1 , Patrick M Fisher  1 , Gitte M Knudsen  1   4 , Lars V Kessing  4   5 , Vibe Frokjaer  1   4 , Kamilla W Miskowiak  5   2
Affiliations

Association of neurocognitive function with psychiatric hospitalization and socio-demographic conditions in individuals with bipolar and major depressive disorders

Anjali Sankar et al. EClinicalMedicine. .

Abstract

Background: Neurocognitive impairments are associated with poor clinical and employment outcomes in individuals with affective disorders. However, little is known about their associations with long-term clinical outcomes such as psychiatric hospitalizations, and with socio-demographic indicators other than employment. In the largest longitudinal study of neurocognition in affective disorders to date, we investigate the role of neurocognitive impairments on psychiatric hospitalizations and socio-demographic conditions.

Methods: The study included 518 individuals with bipolar or major depressive disorder. Neurocognitive assessments covered executive function and verbal memory domains. Longitudinal data on psychiatric hospitalization and socio-demographic conditions (employment, cohabitation, and marital status) for up to 11 years were obtained using National population-based registers. The primary and secondary outcomes were psychiatric hospitalizations (n = 398) and worsening of socio-demographic conditions (n = 518), in the follow-up period since study inclusion, respectively. Cox regression models were used to examine the association of neurocognition with future psychiatric hospitalizations and the worsening of socio-demographic conditions.

Findings: Clinically significant impairment in verbal memory (z-score ≤ -1; defined by the ISBD Cognition Task Force), but not in executive function, was associated with a higher risk of future hospitalization, when adjusted for age, sex, hospitalization in the year preceding inclusion, depression severity, diagnosis, and type of clinical trial (HR = 1.84, 95% CI:1.05-3.25, p = 0.034; n = 398). The results remained significant even after accounting for illness duration. Neurocognitive impairments were not associated with the worsening of socio-demographic conditions (p ≥ 0.17; n = 518).

Interpretation: Promoting neurocognitive function, especially verbal memory, may mitigate the risk of future psychiatric hospitalization in individuals with affective disorders.

Funding: Lundbeckfonden (R279-2018-1145).

Keywords: Bipolar disorder; Cognition; Hospitalization; Major depressive disorder; Socio-demographic status; Survival analysis.

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Conflict of interest statement

Dr. Knudsen has received honoraria as expert advisor for Sage Therapeutics, and Sanos, and as expert supervisor for Onsero, and Gilgamesh. Dr. Frokjaer has served as consultant for SAGE therapeutics, H. Lundbeck and Janssen-Cilag. Dr. Miskowiak has received consultancy fees from Lundbeck, Janssen and Angelini Pharma in the past three years. All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Cumulative incidence plot illustrating the probability of getting hospitalized in individuals with bipolar disorder or major depressive disorder. The cumulative incidence plot illustrates the probability of getting hospitalized in individuals with bipolar disorder or major depressive disorder. The risk of hospitalization was estimated using Aalen-Johansen estimator. The y-axis represents the risk of hospitalization and the x-axis represents follow-up time in months. The cumulative incidence plot is estimated on a sample of 398 individuals with bipolar disorder or major depressive disorder. The 1-year, 5-year, and 9-year rates for the risk of hospitalizations were 11%, 25%, and 39% respectively. The number of individuals at risk at each time point is as follows: start of follow-up (n = 398), 19.8 months (n = 186), 38.5 months (n = 102), 83.2 months (n = 50), 112 months (n < 5).
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