Jha Manish K, Teer Raymond B, Minhajuddin Abu, Greer Tracy L, Rush A John, Trivedi Madhukar H
Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center, Dallas.
University of Texas, Austin.
Neuropsychiatr Dis Treat. 2017 Mar 15;13:803-813. doi: 10.2147/NDT.S128407. eCollection 2017.
Major depressive disorder (MDD) significantly impacts performance of both work- and nonwork-related routine daily activities. We have shown that work productivity is significantly impaired in employed MDD patients, but the extent of impairments in nonwork-related routine activities and its association with antidepressant treatment outcomes has not been established.
Activity impairment was measured using the sixth item of Work Productivity and Activity Impairment Scale in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial (n=665). Published norms were used to define activity impairment levels. The relationship between activity impairment and baseline sociodemographic and clinical characteristics was evaluated along with changes in activity impairment and its relationship with other clinical outcomes such as symptom severity, function, and side effect burden. Remission status at 3 and 7 months was predicted based on week 6 activity impairment level.
Higher psychosocial and cognitive impairments and greater number of comorbid medical conditions were associated with greater activity impairment at baseline. Proportion of participants with severe activity impairment declined from 47.6% at baseline to 18.7% at 3 months, while mean activity impairment decreased from 57.1 at baseline to 32.8 at 3 months. During course of treatment, levels of activity impairment correlated most strongly with psychosocial function among measures of symptom severity, function, quality of life, and side effect burden. No or minimal activity impairment at week 6 was associated with two to three times higher rates of remission at 3 and 7 months as compared to moderate or severe activity impairment levels even after controlling for remission status at week 6 and select baseline variables.
Depressed patients have high levels of nonwork-related activity impairment at baseline that improves significantly with treatment and independently predicts long-term clinical outcomes. Brief systematic assessment of activity impairment during the course of antidepressant treatment can help inform clinical decision-making.
重度抑郁症（MDD）对工作及与工作无关的日常常规活动的表现均有显著影响。我们已经表明，受雇的MDD患者的工作效率会显著受损，但与工作无关的常规活动的受损程度及其与抗抑郁治疗结果的关联尚未明确。
在“联合用药改善抑郁结局”（CO-MED）试验（n = 665）中，使用工作效率和活动受损量表的第六项来测量活动受损情况。采用已发表的常模来定义活动受损水平。评估活动受损与基线社会人口统计学和临床特征之间的关系，以及活动受损的变化及其与其他临床结局（如症状严重程度、功能和副作用负担）的关系。根据第6周的活动受损水平预测3个月和7个月时的缓解状态。
在基线时，较高的心理社会和认知障碍以及更多的共病内科疾病与更大的活动受损相关。有严重活动受损的参与者比例从基线时的47.6%降至3个月时的18.7%，而平均活动受损从基线时的57.1降至3个月时的32.8。在治疗过程中，在症状严重程度、功能、生活质量和副作用负担的测量指标中，活动受损水平与心理社会功能的相关性最强。即使在控制了第6周的缓解状态和选定的基线变量后，第6周无或轻度活动受损与3个月和7个月时缓解率高出两到三倍相关，而中度或重度活动受损水平则不然。
抑郁症患者在基线时与工作无关的活动受损水平较高，治疗后有显著改善，且能独立预测长期临床结局。在抗抑郁治疗过程中对活动受损进行简短的系统评估有助于指导临床决策。
