Psychosocial disability during the long-term course of unipolar major depressive disorder.
BACKGROUND
The goal of this study was to investigate psychosocial disability in relation to depressive symptom severity during the long-term course of unipolar major depressive disorder (MDD).


METHODS
Monthly ratings of impairment in major life functions and social relationships were obtained during an average of 10 years' systematic follow-up of 371 patients with unipolar MDD in the National Institute of Mental Health Collaborative Depression Study. Random regression models were used to examine variations in psychosocial functioning associated with 3 levels of depressive symptom severity and the asymptomatic status.


RESULTS
A progressive gradient of psychosocial impairment was associated with a parallel gradient in the level of depressive symptom severity, which ranges from asymptomatic to subthreshold depressive symptoms to symptoms at the minor depression/dysthymia level to symptoms at the MDD level. Significant increases in disability occurred with each stepwise increment in depressive symptom severity.


CONCLUSIONS
During the long-term course, disability is pervasive and chronic but disappears when patients become asymptomatic. Depressive symptoms at levels of subthreshold depressive symptoms, minor depression/ dysthymia, and MDD represent a continuum of depressive symptom severity in unipolar MDD, each level of which is associated with a significant stepwise increment in psychosocial disability.
Judd
L L
LL
National Institute of Mental Health Collaborative Program on the Psychobiology of Depression, Rockville, MD, USA.
Akiskal
H S
HS
Zeller
P J
PJ
Paulus
M
M
Leon
A C
AC
Maser
J D
JD
Endicott
J
J
Coryell
W
W
Kunovac
J L
JL
Mueller
T I
TI
Rice
J P
JP
Keller
M B
MB
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D004185:Disability Evaluation; D018450:Disease Progression; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000523:psychology; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012044:Regression Analysis; D012720:Severity of Illness Index; D012917:Social Adjustment