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.

Method: 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.

Conflict of interest statement

Declaration of Interest:

During the past two years Dr. Thase has consulted with, served on advisory boards for, or received honoraria for talks from: AstraZeneca, Bristol-Myers Squibb Company, Eli Lilly and Company, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, Lundbeck, MedAvante, Inc., Neuronetics, Inc., Novartis, Otsuka, Pamlab, Pfizer Pharmaceuticals, Schering-Plough, Shionogi, Shire US Inc., Supernus Pharmaceuticals, Takeda, Transcept Pharmaceuticals, and Wyeth Pharmaceuticals and he has received grant support from Eli Lilly and Company, Forest Laboratories, GlaxoSmithKline, Otsuka, and Sepracor, Inc., in addition to funding from the NIMH. He has equity holdings for MedAvante, Inc. and has received royalties from American Psychiatric Publishing, Inc. (APPI), Guilford Publications, Herald House, and W.W. Norton & Company, Inc. Two books currently promoted by the APPI specifically pertain to cognitive therapy. Dr. Thase also discloses that his spouse is an employee of Embryon, Inc. (formerly Cardinal Health and Advogent), which does business with several pharmaceutical companies that market medications used to treat depression.

Dr. Jarrett’s medical center receives the fees from the cognitive therapy she provides to patients. Dr. Jarrett is a paid consultant to the NIMH.

Thomas Carmody has been a consultant for Cyberonics, Inc.

Figures

Figure 1. Structural Equation Model Showing Potential Mediating Relationships between Psychosocial Functioning and Depressive Symptoms

Note. Rectangles represent the indices of psychosocial functioning and depressive symptom severity. Circles with an uppercase D are called disturbances, which represent the effect of unexplained variation on the indices. One-sided arrows signify direct effects, and double-sided arrows represent covariances, which control for covariation between variables.

Figure 2. Standardized Depressive Symptom and Psychosocial Functioning Scores across Acute-Phase Cognitive Therapy for Depression (CT)

Note. Depressive symptoms are a composite of the Hamilton Rating Scale for Depression, Beck Depression Inventory, and the Inventory of Depressive Symptomatology-Self-Report. Psychosocial functioning is a composite of the Social Adjustment Scale—Self-Report and the Range of Impaired Functioning Tool.

Figure 3. Correlations (95% Confidence Intervals) among Depressive Symptoms and Psychosocial Functioning during Acute Phase Cognitive Therapy (CT) for Depression

Note. Depressive symptoms are a composite of the Hamilton Rating Scale for Depression, Beck Depression Inventory, and the Inventory of Depressive Symptomatology-Self-Report. Psychosocial functioning is a composite of the Social Adjustment Scale—Self-Report and the Range of Impaired Functioning Tool. * p < .05