Mediators of the association between depression and role functioning
Open accessAbstract
Objective: While the adverse effect of Major Depressive Episode on role functioning is well established, the exact pathways remain unclear. Method: 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.
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In patients with major depressive disorder, cognitive complaint is correlated more closely with depressive symptoms and psychosocial functioning than is objective cognitive impairment.
“CC in MDD patients is correlated more closely with not only depressive symptoms, but also psychosocial functioning compared to objective cognitive impairment [19-23].”
From Acute Efficacy and Safety of Escitalopram Versus Desvenlafaxine and Vortioxetine in the Treatment of Depression With Cognitive Complaint: A Rater-Blinded Randomized Comparative Study (2022) · cites this paper as [21]
The Methods (page unavailable) measure reported cognitive difficulties, and the Results and Discussion (page unavailable) link those difficulties to major depressive episodes and role functioning. The paper does not compare cognitive complaints with objective cognitive impairment or show that complaints correlate more closely with depressive-symptom severity. Its sample is a population survey, not specifically patients with major depressive disorder. (LLM, conf=0.87)
Experimental — accuracy not yet measuredCognitive deficits may impede functional recovery, including workforce performance, in patients with major depressive disorder.
“Cognitive deficits may also impede functional recovery, including workforce performance, in patients with MDD.”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [15]
Several lines of evidence suggest that cognitive dysfunction is an important mediator of functioning, including workforce performance, in major depressive disorder.
“Several lines of evidence suggest that cognitive dysfunction is an important mediator of functioning, including workforce performance, in MDD [14–16].”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [15]
Cognitive deficits and embarrassment account for half of the association between a major depressive episode and work loss.
“Data from The European Study of the Epidemiology of Mental Disorders, a cross-sectional survey including 21,425 adults from six European countries, reported that cognitive deficits and embarrassment (i.e. stigma) account for half of the association between a MDE and work loss [15].”
From Cognitive remission: a novel objective for the treatment of major depression? (2016) · cites this paper as [15]
Cognitive symptoms have been associated with poor occupational functioning and unemployment, work-related disability, and adverse psychosocial outcomes.
“Cognitive symptoms have also been associated with poor occupational functioning [18] and unemployment [19], work-related disability, and adverse psychosocial outcomes [20-22].”
From Wearable technology for high-frequency cognitive and mood assessment in major depressive disorder: longitudinal observational study (2019) · cites this paper as [22]
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- Authors
- Buist‐Bouwman, M. A., Ormel, J., De Graaf, R., De Jonge, P., Van Sonderen, E., Alonso, J., Bruffaerts, R., Vollebergh, W. A. M., & the ESEMeD/MHEDEA 2000 investigators
- Affiliations
- University Medical Center Groningen (NL)
- Universitair Ziekenhuis Leuven (BE)
- Utrecht University (NL)
- Venue
- Acta Psychiatrica Scandinavica
- Publisher
- Wiley
- Published
- 2008-11-11
- Volume
- 118
- Issue
- 6
- Pages
- 451-458
- ISSN
- 0001-690X (ISSN-L)
- 1600-0447
- PMC
- PMC3659780
- OpenAlex
- W2170135777
- Cited by
- 127
- References
- 41
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 11 · 2022: 7 · 2021: 5 · 2020: 6 · 2019: 16 · 2018: 17 · 2017: 10 · 2016: 13 · 2015: 10 · 2014: 8 · 2013: 3 · 2012: 1
- FWCI
- 3.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Psychiatrica Scandinavica (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Funders
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- World Health Organization
- European Commission (1999-01042, QLG5–1999-01042, SANCO2004123, 2004123)
- Generalitat de Catalunya (01042)
- Regione Piemonte
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849)
- Pan American Health Organization
- Instituto de Salud Carlos III
- Departament de Salut, Generalitat de Catalunya
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, MH069864, MH066849, R01‐MH069864)
- National Institute on Drug Abuse (K05DA015799, R01DA016558)
- Fogarty International Center (FIRCA R01-TW006481, R01-TW006481, R03TW006481)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- depression, role functioning, mediation, activity limitation, embarrassment, disability, International Classification of Functioning, Disability and Health, major depressive episode, cognitive impairment
- MeSH terms
- Activities of Daily Living, Adaptation, Psychological, Adolescent, Adult, Aged, Cognition Disorders, Cross-Sectional Studies, Major Depressive Disorder, Disability Evaluation, Efficiency, Europe, Health Surveys, Humans, Middle Aged, Models, Psychological, Motivation, Personality Assessment, Role, Shame, Social Environment, Cost of Illness, Young Adult
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