title: Psychosocial disability during the long-term course of unipolar major depressive disorder.
abstract: 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.
authors.affiliation: National Institute of Mental Health Collaborative Program on the Psychobiology of Depression, Rockville, MD, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Judd
authors.forename: H S
authors.initials: HS
authors.lastname: Akiskal
authors.forename: P J
authors.initials: PJ
authors.lastname: Zeller
authors.forename: M
authors.initials: M
authors.lastname: Paulus
authors.forename: A C
authors.initials: AC
authors.lastname: Leon
authors.forename: J D
authors.initials: JD
authors.lastname: Maser
authors.forename: J
authors.initials: J
authors.lastname: Endicott
authors.forename: W
authors.initials: W
authors.lastname: Coryell
authors.forename: J L
authors.initials: JL
authors.lastname: Kunovac
authors.forename: T I
authors.initials: TI
authors.lastname: Mueller
authors.forename: J P
authors.initials: JP
authors.lastname: Rice
authors.forename: M B
authors.initials: MB
authors.lastname: Keller
mesh_terms: 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