Zhou Jingjing, Xu Jinjie, Feng Zizhao, Liu Rui, Xiao Le, Li Ruinan, Li Xiaoya, Zhang Xueshan, Liu Jing, Feng Yuan, Zhou Jia, Wang Gang
The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
Psychol Med. 2025 May 2;55:e131. doi: 10.1017/S0033291725001011.
The relationship between emotional symptoms and cognitive impairments in major depressive disorder (MDD) is key to understanding cognitive dysfunction and optimizing recovery strategies. This study investigates the relationship between subjective and objective cognitive functions and emotional symptoms in MDD and evaluates their contributions to social functioning recovery.
The Prospective Cohort Study of Depression in China (PROUD) involved 1,376 MDD patients, who underwent 8 weeks of antidepressant monotherapy with assessments at baseline, week 8, and week 52. Measures included the Hamilton Depression Rating Scale (HAMD-17), Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR16), Chinese Brief Cognitive Test (C-BCT), Perceived Deficits Questionnaire for Depression-5 (PDQ-D5), and Sheehan Disability Scale (SDS). Cross-lagged panel modeling (CLPM) was used to analyze temporal relationships.
Depressive symptoms and cognitive measures demonstrated significant improvement over 8 weeks ( < 0.001). Baseline subjective cognitive dysfunction predicted depressive symptoms at week 8 (HAMD-17: β = 0.190, 95% CI: 0.108-0.271; QIDS-SR16: β = 0.217, 95% CI: 0.126-0.308). Meanwhile, baseline depressive symptoms (QIDS-SR16) also predicted subsequent subjective cognitive dysfunction (β = 0.090, 95% CI: 0.003-0.177). Recovery of social functioning was driven by improvements in depressive symptoms (β = 0.384, < 0.0001) and subjective cognition (β = 0.551, < 0.0001), with subjective cognition contributing more substantially (R = 0.196 vs. 0.075).
Subjective cognitive dysfunction is more strongly associated with depressive symptoms and plays a significant role in social functioning recovery, highlighting the need for targeted interventions addressing subjective cognitive deficits in MDD.
重度抑郁症（MDD）中情绪症状与认知障碍之间的关系是理解认知功能障碍和优化康复策略的关键。本研究调查了MDD患者主观和客观认知功能与情绪症状之间的关系，并评估它们对社会功能恢复的作用。
中国抑郁症前瞻性队列研究（PROUD）纳入了1376例MDD患者，他们接受了为期8周的抗抑郁单药治疗，并在基线、第8周和第52周进行评估。测量指标包括汉密尔顿抑郁量表（HAMD-17）、抑郁症状快速自评量表（QIDS-SR16）、中文版简易认知测试（C-BCT）、抑郁症感知缺陷问卷-5（PDQ-D5）和希恩残疾量表（SDS）。采用交叉滞后面板模型（CLPM）分析时间关系。
抑郁症状和认知指标在8周内有显著改善（<0.001）。基线主观认知功能障碍可预测第8周的抑郁症状（HAMD-17：β = 0.190，95%CI：0.108-0.271；QIDS-SR16：β = 0.217，95%CI：0.126-0.308）。同时，基线抑郁症状（QIDS-SR16）也可预测随后的主观认知功能障碍（β = 0.090，95%CI：0.003-0.177）。抑郁症状（β = 0.384，<0.0001）和主观认知（β = 0.551，<0.0001）的改善推动了社会功能的恢复，主观认知的作用更为显著（R = 0.196对0.075）。
主观认知功能障碍与抑郁症状的关联更强，且在社会功能恢复中起重要作用，这凸显了针对MDD患者主观认知缺陷进行针对性干预的必要性。
