Trajectories of recovery of social and physical functioning in major depression, dysthymic disorder and double depression: a 3-year follow-up.
BACKGROUND
Depressive disorders have a large impact on psychosocial functioning. Since lower functioning predicts recurrence of a depressive episode, insight into the post-morbid course of psychosocial functioning of persons with different depressive disorders may facilitate recurrence prevention.


METHODS
Data were derived from NEMESIS, an epidemiologic survey in the adult population in the Netherlands. Respondents, who met the CIDI criteria of major depression (MDD; n=102), dysthymic disorder (Dysth; n=66) or double depression (DD; n=73) at baseline, and recovered during three year follow-up, were included; as was a control group without any diagnosis (NoDiag, n=4140). Functioning was assessed using the Groningen Social Disability Schedule (GSDS) and the SF-36 physical health summary-scale. Linear Mixed Models were conducted to compare 3-year trajectories of functioning across depressive groups and with NoDiag group.


RESULTS
Compared to NoDiag, all depressed groups were significantly impaired on social and physical functioning. Dysth and DD had a lower level of post-morbid physical functioning compared to MDD (after 1 and 3 years respectively: Dysth: B=-13.8, p=.002 and B=-8.11, p=.09; DD: B=-8.9, p=.03 and B=-9.1, p=.05). Determinants for impaired social functioning (neuroticism) and for impaired physical functioning (age, comorbid somatic disorders and neuroticism) were identified.


CONCLUSIONS
Attrition was higher among persons with a depression. Inclusion of the drop-outs would most likely have resulted in stronger associations, since we expect lower functioning among the drop-outs.


CONCLUSIONS
This study indicates the long-term debilitating effects of psychopathology, even after recovery of depressive disorders. Duration of the index symptoms appears to be associated with impaired functioning, since especially those with Dysthymia (either with or without a MDD) showed slower and less recovery of functioning.
Rhebergen
Didi
D
Department of Psychiatry and EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands. d.rhebergen@ggzingeest.nl
Beekman
Aartjan T F
AT
de Graaf
Ron
R
Nolen
Willem A
WA
Spijker
Jan
J
Hoogendijk
Witte J
WJ
Penninx
Brenda W J H
BW
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004185:Disability Evaluation; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012307:Risk Factors; D012917:Social Adjustment; D055815:Young Adult