A Study Of Psychosocial Function And Brain Functional Connectivity In Depressive Patients With Clinical Remission

Objective: After treatment,there is still a high recurrence and suicide rate among remitted Major Depressive Disorder(r MDD)patients who were already achieved clinical remission,which seriously affected their health and quality of life of patients.This research explored the recovery characteristics and evaluation index of r MDD patients from two aspects of clinical psychology and brain imaging.This research explored the recovery characteristics of psychosocial function,salience network(SN),and central executive network(CEN)in r MDD patients.And the relationship between psychosocial function and functional connectivity(FC)of brain networks(SN and CED)was also explored.Furthermore,this paper also explored better evaluation indexes of psychosocial function and imaging indicators for r MDD.Methods: In this study,psychological assessment and resting-state functional magnetic resonance imaging(rs-f MRI)technology were used to conduct longitudinal clinical natural follow-up observation on r MDD patients.The subjects included three groups.The first group included 116 r MDD patients who were enrolled from the inpatient of Nanjing Brain Hospital,the second group included 132 patients in acute phase of MDD(a MDD),and 114 healthy controls(HCs)as the third group.The demographic characteristics of the a MDD and HCs matched those of the r MDD.All subjects aged 18-55 years.The r MDD patients were evaluated at baseline(T0),as well as the first(T1),second(T2),sixth(T3),nineth(T4)and 12 th months(T5)after remission,using Hamilton Depression Scale-17(HAMD-17),general quality of life inventory(GQOLI-74)and Beck Depression Scale(BDI-13).According to the convenient sampling principle,the r MDD patients were scanned by rs-f MRI at baseline and 6th months.The a MDD patients were evaluated at baseline using the same scales.The HCs were evaluated using the same scales and scanned using rs-f MRI at baseline.The rs-f MRI data were preprocessed by Matlab and SPM8.Independent component analysis(ICA)of preprocessed resting state data was analyzed by GIFT.Descriptive analysis,t test,χ2 test,repeated ANOVA and Pearson correlation analysis were calculated by SPSS21.0.A prediction model is established using Cox proportional risk regression model.Results:1.Psychosocial Functioning of r MDD patients1.1 r MDD,a MDD and HCs groups had significant difference in total score of psychosocial functioning,physical function dimension,psychological function dimension and social function dimension.Ex post-test showed that the scores of total score of psychosocial functioning,physical function,psychological function and social function in r MDD and HCs groups were higher than those in a MDD group.The r MDD group scored significantly lower than HCs group in total score of psychosocial function,physical function and psychological function dimension.1.2 The r MDD patients showed continuous improvement in psychosocial functioning after remission,especially significant in the first month,reaching their best level at the sixth to nineth months.1.3 Poor recovery of psychosocial function in the first month after clinical remission is a risk factor for recurrence of MDD.2.Brain functional connectivity of r MDD patients2.1 r MDD patients in baseline had higher functional connectivity than HCs included:dorsolateral prefrontal cortex(dl PFC)(SN),left inferior parietal lobe(IPL)and the right insula(CEN).r MDD patients had no significant difference in SN,and higher functional connectivity than HCs in right dl PFC and right IPL in CEN after 6 month.r MDD patients had higher functional connectivity included medial prefrontal cortex(m PFC)(SN),left IPL(CEN)and right dl PFC(CEN),as well as lower functional connectivity included dl PFC(SN),precuneus(SN)and left IPL(CEN)than baseline after 6 months.2.2 Multiple dimensions of psychosocial functioning of r MDD patients were significantly related with brain functional connection included: left dl PFC(SN),right insula(CEN),right dl PFC(CEN),and left IPL(CEN).Conclusion:The psychosocial function and brain functional connectivity of r MDD patients do not recovery back to a normal state.6-9 months after clinical remission may be the better time for more objective evaluation of MDD recovery.The recovery degree of the psychosocial function and FC of brain networks can be used to assist clinical evaluation of the recovery status of MDD,and the evaluation of psychosocial function is more simple and feasible.