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.
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Impaired cognition is likely associated with difficulties in everyday tasks, contributing to psychosocial and functional impairments, reduced productivity, and disability in major depressive disorder.
“Impaired cognition is likely associated with difficulties in everyday tasks contributing to the high degree of psychosocial and functional impairments [6–8], reduced productivity [9], and disability associated with MDD [10, 11].”
Residual cognitive impairment may contribute to increased risk of relapse, impaired quality of life, and poorer overall prognosis.
“residual cognitive impairment may contribute to increased risk of relapse, impaired quality of life, and poorer overall prognosis [6, 25, 26].”
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- Authors
- Judd, L. L., Akiskal, H. S., Zeller, P. J., Paulus, M., Leon, A. C., Maser, J. D., Endicott, J., Coryell, W., Kunovac, J. L., Mueller, T. I., Rice, J. P., & Keller, M. B.
- Affiliations
- National Institute of Mental Health (US)
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2000-04-01
- Volume
- 57
- Issue
- 4
- Pages
- 375
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2170691050
- Cited by
- 593
- References
- 30
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 14 · 2023: 12 · 2022: 17 · 2021: 23 · 2020: 19 · 2019: 16 · 2018: 20 · 2017: 21 · 2016: 25 · 2015: 28 · 2014: 32 · 2013: 29 · 2012: 30
- FWCI
- 13.37
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention (PHSMH30914)
- National Institute of Mental Health (R01MH025478, P30MH049671, 5 P30 MH49671-06)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- psychosocial disability, unipolar major depression, depression severity, subthreshold depression, minor depression, dysthymia, social functioning
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Aged, Depressive Disorder, Disability Evaluation, Employment, Female, Follow-Up Studies, Humans, Interpersonal Relations, Longitudinal Studies, Male, Middle Aged, Psychiatric Status Rating Scales, Regression Analysis, Severity of Illness Index, Social Adjustment, Disease Progression, Dysthymic Disorder
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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