Wang Gang, Tan Kristin Hui Xian, Ren Hongye, Hammer-Helmich Lene
Psychiatry Department, Beijing an Ding Hospital, Capital Medical University, China National Clinical Research Center for Mental Disorders, Beijing, People's Republic of China.
Health Economics & Epidemiology Statistics, Lundbeck Singapore Pte Ltd, Singapore.
Neuropsychiatr Dis Treat. 2020 Mar 13;16:749-759. doi: 10.2147/NDT.S230403. eCollection 2020.
This post hoc analysis was undertaken to further explore the association of cognitive symptoms with health-related quality of life (HRQoL) and work productivity at the time of treatment initiation in Chinese patients with major depressive disorder (MDD) in the Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study.
This was an epidemiological, non-interventional, prospective cohort study in adult outpatients with moderate-to-severe MDD initiating antidepressant monotherapy (first or second line). Crude and adjusted analyses of covariance were performed to assess the association of perceived cognitive symptoms (20-item Perceived Deficits Questionnaire-Depression [PDQ-D] total score) or observed cognitive performance (Digit Symbol Substitution Test [DSST] score) with HRQoL (EuroQoL 5-Dimensions Questionnaire index) and work productivity (Work Productivity and Activity Impairment [WPAI] or Sheehan Disability Scale [SDS] absenteeism and presenteeism scores). Adjusted analyses included depression severity, age, sex, residential area (urban/rural), and educational level.
Of 1008 patients enrolled in the PROACT study, 986 were included in this analysis. Severity of perceived cognitive symptoms (ie, higher PDQ-D total score) was significantly associated with worse HRQoL (<0.001) and higher levels of absenteeism (=0.020 for the WPAI and =0.002 for the SDS) and presenteeism (<0.001 for both scales). The association of perceived cognitive symptoms with HRQoL and presenteeism was independent of depression severity. The association between observed cognitive performance (DSST score) and HRQoL was less robust. No association was seen between observed cognitive performance and levels of absenteeism or presenteeism assessed by either scale.
Results of this real-world study illustrate the impact of cognitive symptoms on HRQoL and work productivity in Chinese patients with MDD, and highlight the importance of assessing and targeting cognitive symptoms in order to improve functional outcomes when treating patients with MDD.
在评估接受治疗的重度抑郁症（MDD）患者认知情况的前瞻性研究观察（PROACT）中，进行此项事后分析以进一步探究中国MDD患者在开始治疗时认知症状与健康相关生活质量（HRQoL）及工作效率之间的关联。
这是一项针对开始接受抗抑郁单药治疗（一线或二线）的中重度MDD成年门诊患者的流行病学、非干预性前瞻性队列研究。进行了粗协方差分析和校正协方差分析，以评估感知到的认知症状（20项感知缺陷问卷 - 抑郁[PDQ - D]总分）或观察到的认知表现（数字符号替换测验[DSST]得分）与HRQoL（欧洲五维健康量表指数）及工作效率（工作效率与活动障碍[WPAI]或希恩残疾量表[SDS]缺勤及出勤表现得分）之间的关联。校正分析纳入了抑郁严重程度、年龄、性别、居住地区（城市/农村）及教育水平。
在PROACT研究纳入的1008例患者中，986例纳入本分析。感知到的认知症状严重程度（即较高的PDQ - D总分）与较差的HRQoL（<0.001）、较高的缺勤水平（WPAI为 =0.020，SDS为 =0.002）及出勤表现（两个量表均<0.001）显著相关。感知到的认知症状与HRQoL及出勤表现之间的关联独立于抑郁严重程度。观察到的认知表现（DSST得分）与HRQoL之间的关联不太显著。未观察到观察到的认知表现与两种量表评估的缺勤或出勤表现水平之间存在关联。
这项真实世界研究的结果说明了认知症状对中国MDD患者HRQoL及工作效率的影响，并强调了在治疗MDD患者时评估及针对认知症状以改善功能结局的重要性。
