Change in functioning outcomes as a predictor of the course of depression: a 12-month longitudinal study
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Functioning is a necessary diagnostic criterion for depression, and thus routinely assessed in depressive patients. While it is highly informative of disorder severity, its change has not been tested for prognostic purposes. Our study aimed to analyze to what extent early functioning changes predict depression in the mid-term.
Longitudinal study (four occasions: baseline, 1, 3, and 12 months) of 243 patients with depressive symptomatology at three different services (primary care, outpatients, and hospital). Functioning was assessed on the first three occasions using the Global Assessment of Functioning (GAF), the WHODAS-2.0, and a self-reported functioning (SRF) rating scale. Growth mixture modeling of initial assessments served to estimate individual person-change parameters of each outcome. Person-growth parameters were used as predictors of major depressive episode at 12 months in a logistic regression model, adjusted by sex, age, healthcare level, and depression clinical status at third month. Predictive accuracy of all measures was assessed with area under the receiver operating curve (AUC).
Of the 179 patients who completed all assessments, 58% had an active depression episode at baseline and 20% at 12 months (64% non-recoveries and 36% new onsets). Individual trends of change in functioning significantly predicted patient depression status a year later (AUCWHODAS = 0.76; AUCGAF = 0.92; AUCSRF = 0.93).
Longitudinal modeling of functioning was highly predictive of patients’ clinical status after 1 year. Although clinical and patient-reported assessment had high prognostic value, the use of very simple patient-reported outcome measures could improve case management outside specialized psychiatric services.
KeywordsAffective disorders Early intervention Questionnaire Functional disability WHODAS
This work was supported by grants from the Spanish Ministry of Health, Instituto de Salud Carlos III-FEDER (PI10/00530, PI13/00506 and PI16/00165); Contract of training in research, ISCIII-FIS Río Hortega (CM14/00125); and by DIUE (2017 SGR 452; 2014 SGR 748).
The list of authors in INSAyD Investigators were Jordi Alonso, Carlos G Forero, Gemma Vilagut, Pilar Álvarez, José-Ignacio Castro-Rodriguez, Luis Miguel Martín-López, Lina Abellanas, Carrie Garnier, Maria Rosa Mas, Elena Pérez-Gallo, Marta Reinoso, Gabriela Barbaglia, Miquel A. Fullana, Alberto Maydeu, and Anna Brown.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The protocol, information letters, questionnaires, and the informed consent forms of the study were approved by the Clinical Research Institutional Review Board (IRB) at Parc de Salut Mar, Barcelona in Spain. As a non-intervention, there was no expected adverse event or side effect for participants.
Informed consent was obtained from all individual participants included in the study.
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