Mediators of the association between depression and role functioning.
OBJECTIVE
While the adverse effect of Major Depressive Episode on role functioning is well established, the exact pathways remain unclear.


METHODS
Data from The European Study of the Epidemiology of Mental Disorders, a cross-sectional survey including 21 425 adults from six European countries, were used to assess 12-month depression (Composite International Diagnostic Interview), activity limitations and role functioning in the past 30 days (Disability Assessment Schedule). An a priori model based on the World Health Organization's International Classification of Functioning, Disability and Health was designed and a structural equation model for categorical and ordinal data was used (MPlus) to estimate the extent to which six limitations mediated the association between depression and role functioning.


RESULTS
The unadjusted association between depression and role functioning was strong (0.43; SE = 0.04). In the best-fitting model, only concentration and attention problems and embarrassment mediated a significant amount of association (direct effect dropped to 0.17; SE = 0.10, which was no longer significant).


CONCLUSIONS
Targeting cognition and embarrassment in treatment could help reduce depression-associated role disfunctioning.
University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
M A
MA
Buist-Bouwman
J
J
Ormel
R
R
de Graaf
P
P
de Jonge
E
E
van Sonderen
J
J
Alonso
R
R
Bruffaerts
W A M
WA
Vollebergh
D000203:Activities of Daily Living / Q000145:classification*; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004185:Disability Evaluation; D004526:Efficiency; D005060:Europe; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D010552:Personality Assessment; D012380:Role; D012752:Shame; D012931:Social Environment; D055815:Young Adult