A Comparative Study Of Psychosocial Functions In Patients With Depression After Clinical Cure

Major Depressive Disorder (MDD) is a mental disorder with high incidence,high morbidity, high relapse rate, and the main goal of its acute phase treatment is remission. The operational definition of remission is HAMD-17<7, which means asymptomatic. A large number of studies have found that the recovery of psychosocial functioning also played an important role in remission,the patients’psychosocial functioning was still damaged when HAMD-17<7. However, most of the studies adopted horizontal comparative method only to compare the psychosocial functioning when patients just arrived remission, and very few studies adopted the longitudinal method to verify it.In this longitudinal follow-up study,167 patients who achieved the remission were grouped by the BDI (Beck Depression Inventory) score: low-score group(BDI≤4) and high-score group (BDI≥4), and then we conducted a one-year comparative study of the psychosocial functioning of the two groups with the Generic Quality of Life Inventory (GQOLI-74). The purpose of this study: ①to investigate the relapse of both groups after achieving remission within one year;② to understand the differences of psychosocial functioning recovery between the two groups after achieving remission; ③To probe the impact of social support, automatic thoughts on psychosocial functioning recovery during the follow-up study. We conducted descriptive analysis, survival analysis,t-test,repeated measures ANOVA,χ2 test, correlation analysis and multiple regression analysis with SPSS 19.0. The conclusions were as follows:(1) After achieving remission, the relapse rate (27.8%) of the high-score group patients was higher than that (22.2%) of the low-score group patients but the difference was not significant (χ2 = 0.62,p = 0.43> 0.05).(2) After achieving remission, there were differences in the psychosocial functioning recovery between the two groups: the psychosocial functioning level of the high-score group was higher than that of the low-score group at the baseline. Then the psychosocial functioning of the high-score group of patients improved significantly, and the differences between the two groups disappeared in the second month, but the overall level of the high-score group was still lower than that of the low-score group. On the whole, the psychosocial functioning of the low-score group was stable and showed an increasing overall trend. The psychosocial functioning of the high-score group changed dramatically,and showed a trend of "first rapid,then gradual", and body function and psychological function showed a decreasing trend in the ninth month. That is to say, the psychosocial functioning did not return to normal and the process of its recovery was not good enough, which means the validity and comprehensiveness of current remission criteria (HAMD-17 ≤ 7) is not enough.(3) Compared with HAMD-17, BDI can reflect the level of psychosocial functioning and its changes better, and the self-evaluation of depression degree from depressed patients is similar with the psychosocial functioning on the trend of variation. So in clinical practice we need more attention to the patients’ reported outcomes.(4) Within one year after remission, the severity of symptoms always had a significant negative predictive effect on the psychosocial functioning of depressed patients. The automatic thoughts had a significant negative predictive effect on the psychosocial functioning in the early stage after remission,so did objective support and subjective support. The utilization of support began to take effect in the second month after remission, moreover, its importance becomes more prominent over time.