Saragoussi Delphine, Christensen Michael Cronquist, Hammer-Helmich Lene, Rive Benoît, Touya Maëlys, Haro Josep Maria
Real-World Evidence and Epidemiology, Lundbeck SAS, Issy-les-Moulineaux, France.
Medical Affairs Vortioxetine, H. Lundbeck A/S, Valby, Denmark.
Neuropsychiatr Dis Treat. 2018 May 22;14:1339-1350. doi: 10.2147/NDT.S159276. eCollection 2018.
Major depressive disorder (MDD) is associated with significant impairments in health-related quality of life (HRQoL) and everyday functioning. This cohort study investigated the long-term development of HRQoL in patients with MDD and its association with patient characteristics, including depressive symptom severity and cognitive symptoms.
The Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder (PERFORM) study was a longitudinal cohort study conducted in 1,159 outpatients aged 18-65 years with MDD in France, Germany, Spain, Sweden, and the UK. The patients were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. HRQoL was assessed using the Medical Outcomes Study Short-Form 12-item Health Survey (SF-12) up to month 12 and the EuroQol Five Dimensions questionnaire up to month 24 (UK only). Depressive symptom severity was assessed up to month 24 by the patient-reported Patient Health Questionnaire and cognitive symptoms by the Perceived Deficit Questionnaire. Multivariate analyses were performed to identify patient characteristics associated with HRQoL.
Mental HRQoL was severely impaired at baseline versus normative data (mean [SD] SF-12 mental component summary [MCS], 26.5 [9.2]); mean (SD) physical component summary (PCS) total score was 45.2 (12.1). SF-12 MCS improved over 12 months of follow-up (38.7 [11.6] at month 12), while SF-12 PCS remained stable (45.3 [11.1]). At each assessment time point, there was a clear pattern of lower SF-12 MCS and PCS total score in patients experiencing greater cognitive problems. The mean EuroQol Five Dimensions questionnaire utility index score generally decreased (i.e., worsened) with increasing severity of cognitive and depressive symptoms at all time points up to 24 months. Multivariate analyses identified both depression severity and cognitive symptoms as strongly and significantly associated with poor HRQoL.
These findings highlight the importance of recognizing and managing residual symptoms in patients with MDD, including the cognitive symptoms, to restore long-term psychosocial functioning.
重度抑郁症（MDD）与健康相关生活质量（HRQoL）及日常功能的显著损害相关。这项队列研究调查了MDD患者HRQoL的长期发展情况及其与患者特征（包括抑郁症状严重程度和认知症状）的关联。
重度抑郁症功能结局前瞻性流行病学研究（PERFORM）是一项纵向队列研究，在法国、德国、西班牙、瑞典和英国对1159名年龄在18 - 65岁的MDD门诊患者进行。这些患者要么开始接受抗抑郁单药治疗，要么首次更换抗抑郁药物。使用医学结局研究简明健康调查12项量表（SF - 12）评估至第12个月的HRQoL，在英国使用欧洲五维健康量表问卷评估至第24个月的HRQoL。通过患者报告的患者健康问卷评估至第24个月的抑郁症状严重程度，通过感知缺陷问卷评估认知症状。进行多变量分析以确定与HRQoL相关的患者特征。
与标准数据相比，基线时心理HRQoL严重受损（平均[标准差]SF - 12心理成分总结[MCS]，26.5[9.2]）；平均（标准差）身体成分总结（PCS）总分是45.2（12.1）。在12个月的随访中，SF - 12 MCS有所改善（第12个月时为38.7[11.6]），而SF - 12 PCS保持稳定（45.3[11.1]）。在每个评估时间点，认知问题较多的患者的SF - 12 MCS和PCS总分明显较低。在直至24个月的所有时间点，随着认知和抑郁症状严重程度的增加，欧洲五维健康量表问卷效用指数评分总体上下降（即恶化）。多变量分析确定抑郁严重程度和认知症状均与不良HRQoL密切且显著相关。
这些发现强调了识别和管理MDD患者残留症状（包括认知症状）以恢复长期心理社会功能的重要性。
