title: Change in psychosocial functioning and depressive symptoms during acute-phase cognitive therapy for depression.
abstract: BACKGROUND
  Major depressive disorder (MDD) is highly prevalent, is recurrent, and impairs people's work, relationships and leisure. Acute-phase treatments improve psychosocial impairment associated with MDD, but how these improvements occur is unclear. In this study, we tested the hypotheses that reductions in depressive symptoms exceed, precede and predict improvements in psychosocial functioning.
  
  
  METHODS
  Patients with recurrent MDD (n=523; 68% women, 81% Caucasian, mean age 42 years) received acute-phase cognitive therapy (CT). We measured functioning and symptom severity with the Social Adjustment Scale - Self-Report (SAS-SR), Range of Impaired Functioning Tool (RIFT), Beck Depression Inventory (BDI), Hamilton Rating Scale for Depression (HAMD) and Inventory for Depressive Symptomatology - Self-Report (IDS-SR). We tested cross-lagged correlations between functioning and symptoms measured at baseline and the beginning, middle and end of acute-phase CT.
  
  
  RESULTS
  Pre- to post-treatment improvement in psychosocial functioning and depressive symptoms was large and intercorrelated. Depressive symptoms improved more and sooner than did psychosocial functioning. However, among four assessments across the course of treatment, improvements in functioning more strongly predicted later improvement in symptoms than vice versa.
  
  
  CONCLUSIONS
  Improvements in psychosocial functioning and depressive symptoms correlate substantially during acute-phase CT, and improvements in functioning may play a role in subsequent symptom reduction during acute-phase CT.
authors.affiliation: The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
authors.forename: T W
authors.initials: TW
authors.lastname: Dunn
authors.affiliation: Truman State University, Kirksville, MO, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Vittengl
authors.affiliation: University of Iowa, Iowa City, IA, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Clark
authors.affiliation: The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
authors.forename: T
authors.initials: T
authors.lastname: Carmody
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Thase
authors.affiliation: The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Jarrett
mesh_terms: D000208:Acute Disease; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012720:Severity of Illness Index; D012917:Social Adjustment; D016896:Treatment Outcome