Patient-reported depression severity and cognitive symptoms as determinants of functioning in patients with major depressive disorder: a secondary analysis of the 2-year prospective PERFORM study
Received 26 February 2019
Accepted for publication 17 June 2019
Published 13 August 2019 Volume 2019:15 Pages 2313—2323
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Roger Pinder
Josep Maria Haro,1 Lene Hammer-Helmich,2 Delphine Saragoussi,3 Anders Ettrup,4 Klaus Groes Larsen5
1Research and Teaching Unit, Parc Sanitari Sant Joan De Deu, CIBERSAM, University of Barcelona, Sant Boi De Llobregat, Barcelona, Spain; 2Medical Affairs, Real World Evidence, H. Lundbeck A/S, Valby, Denmark; 3Real World Evidence and Epidemiology, Lundbeck SAS, Issy-les-Moulineaux, France; 4Medical Affairs, Vortioxetine, H. Lundbeck A/S, Valby, Denmark; 5Biometrics, H. Lundbeck A/S, Valby, Denmark
Purpose: To investigate the temporal interrelationship between depression severity, cognitive symptoms, and functioning in patients with major depressive disorder (MDD) in the PERFORM study (NCT01427439).
Patients and methods: PERFORM was a 2-year, multicenter, prospective, noninterventional cohort study in outpatients with MDD who were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. Patients were enrolled by a general practitioner or psychiatrist. Structural equation model (SEM) analysis was used to explore temporal associations between patient-reported depression severity (9-item Patient Health Questionnaire score), cognitive symptoms (5-item Perceived Deficits Questionnaire score), and functional impairment (Sheehan Disability Scale total score). Standardized regression coefficients (SRCs) were used to evaluate the relationship between each outcome and scores from the most recent prior visit over the 2 years of follow-up.
Results: Between February 25, 2011, and February 19, 2015, 1,159 eligible patients with MDD completed the baseline and ≥1 follow-up visit at 194 sites in five European countries (France, Germany, Spain, Sweden, and the UK). Overall, 1,090 patients had assessments for ≥1 outcome measure at two consecutive visits. Severity of cognitive symptoms at baseline and Months 2 and 18 predicted functional impairment at Months 2, 6, and 24, respectively (SRC: 0.18, 0.15, and 0.22; P<0.001). Depression severity at Months 2, 6, and 12 predicted functional impairment at Months 6, 12, and 18, respectively (SRC: 0.17, 0.25, and 0.22; P<0.001). Severity of cognitive symptoms at baseline and Month 18 predicted depression severity at Months 2 and 24, respectively (SRC: 0.19 and 0.22; P<0.001). Functional impairment did not significantly predict the severity of depression or cognitive symptoms, and depression severity did not significantly predict the severity of cognitive symptoms at any time point.
Conclusion: Patient-reported severity of cognitive symptoms appears to be an independent and significant determinant of subsequent functional impairment and depression severity in patients with MDD.
Keywords: major depressive disorder, cognitive symptoms, functional impairment, structural equation model
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