Department of Psychiatry and EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands.
J Affect Disord. 2010 Jul;124(1-2):148-56. doi: 10.1016/j.jad.2009.10.029. Epub 2009 Nov 28.
Depressive disorders have a large impact on psychosocial functioning. Since lower functioning predicts recurrence of a depressive episode, insight into the post-morbid course of psychosocial functioning of persons with different depressive disorders may facilitate recurrence prevention.
Data were derived from NEMESIS, an epidemiologic survey in the adult population in the Netherlands. Respondents, who met the CIDI criteria of major depression (MDD; n=102), dysthymic disorder (Dysth; n=66) or double depression (DD; n=73) at baseline, and recovered during three year follow-up, were included; as was a control group without any diagnosis (NoDiag, n=4140). Functioning was assessed using the Groningen Social Disability Schedule (GSDS) and the SF-36 physical health summary-scale. Linear Mixed Models were conducted to compare 3-year trajectories of functioning across depressive groups and with NoDiag group.
Compared to NoDiag, all depressed groups were significantly impaired on social and physical functioning. Dysth and DD had a lower level of post-morbid physical functioning compared to MDD (after 1 and 3 years respectively: Dysth: B=-13.8, p=.002 and B=-8.11, p=.09; DD: B=-8.9, p=.03 and B=-9.1, p=.05). Determinants for impaired social functioning (neuroticism) and for impaired physical functioning (age, comorbid somatic disorders and neuroticism) were identified.
Attrition was higher among persons with a depression. Inclusion of the drop-outs would most likely have resulted in stronger associations, since we expect lower functioning among the drop-outs.
This study indicates the long-term debilitating effects of psychopathology, even after recovery of depressive disorders. Duration of the index symptoms appears to be associated with impaired functioning, since especially those with Dysthymia (either with or without a MDD) showed slower and less recovery of functioning.
抑郁障碍对心理社会功能有很大影响。由于功能较低预示着抑郁发作的复发，因此了解不同抑郁障碍患者发病后的心理社会功能病程可能有助于预防复发。
数据来自 NEMESIS，这是荷兰成年人的一项流行病学调查。符合主要抑郁障碍（MDD；n=102）、心境恶劣障碍（Dysth；n=66）或双重抑郁障碍（DD；n=73）诊断标准的基线患者在 3 年随访期间康复，包括在该研究中；此外还包括一个无任何诊断的对照组（NoDiag，n=4140）。使用 Groningen 社会残疾量表（GSDS）和 SF-36 健康状况简表评估功能。使用线性混合模型比较抑郁组和 NoDiag 组在 3 年内的功能轨迹。
与 NoDiag 相比，所有抑郁组在社会和身体功能方面均明显受损。与 MDD 相比，Dysth 和 DD 发病后的身体功能水平较低（分别在 1 年和 3 年时：Dysth：B=-13.8，p=.002 和 B=-8.11，p=.09；DD：B=-8.9，p=.03 和 B=-9.1，p=.05）。确定了导致社会功能受损（神经质）和身体功能受损（年龄、共病躯体疾病和神经质）的决定因素。
患有抑郁症的患者的脱落率更高。纳入这些脱落者很可能会产生更强的关联，因为我们预计这些脱落者的功能水平会更低。
这项研究表明，即使在抑郁障碍康复后，精神病理学也会长期造成身体虚弱。症状持续时间似乎与功能受损有关，因为尤其是心境恶劣障碍（无论是否伴有 MDD）患者的功能恢复速度较慢且恢复程度较低。
