Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder

Yıl: 2020 Cilt: 21 Sayı: 1 Sayfa Aralığı: 45 - 52 Metin Dili: İngilizce DOI: 10.5455/apd.47873 İndeks Tarihi: 22-11-2019

Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder

Öz:
Objective: To determine associations between remission status, residual symptoms, quality of life (QoL) sub-domains and disability and to examine predictive role of specific residual symptoms on disability and QoL in elderlypatients (age≥60) with depression. Methods: One hundred and sixty patients who had initially been diagnosed withMDD, were randomized into two groups (partly remitted (PRD) vs remitted (RD). By using the 17-item HamiltonRating Scale for Depression (HAM-D), PRD was defined as a score between 8 and 18 and RD as a score of ≤7.Residual symptoms were assessed using the HAM-D. QoL and disability were measured using SF-36 andWHODAS 2.0, respectively. Results: Among the PRD, 94.2% of them were experiencing at least one residualsymptom (HAM-D symptom subscore≥1). Among the RD, 48.2% of them were experiencing at least one residualsymptom. Most of the SF-36 subscores were substantially higher in subjects with RD than in PRD subjects. Therewere significant correlations between QoL, disability and specific residual symptoms. In the Beta regressionanalyses, there were different and specific residual symptoms and clinical risk factors for each SF-36 domain.Conclusions: Residual symptoms are found common in both partial and full remitters in older patients with MDDand were significantly associated with disability and QoL in older depressive patients. Given the negative impact ofresidual symptoms and partial remission status on functionality and QoL, more attention needs to treat effectivelydepressive episodes. (Anatolian Journal of Psychiatry 2020; 21(1):45-52)
Anahtar Kelime:

Konular: Psikiyatri

Remisyondaki ve kısmi remisyondaki majör depresif bozukluk tanılı geriyatrik hastalarda kalıntı depresyon belirtileri, yaşam kalitesi ve yeti yitimi üzerine etkileri

Öz:
Amaç: Çalışmanın amacı depresif bozukluğu olan geriyatrik hasta popülasyonunda rezidüel (kalıntı) depresyon belirtilerini, bu belirtilerin hastaların işlevselliği ve yeti yitimi üzerine olan etkilerini ve özgül residüel belirtilerin yeti yitimi üzerindeki yordayıcı etkilerini araştırmaktır. Yöntem: Çalışmaya depresif bozukluk tanısı ile tedavi görmekte olan 160 hasta (≥60) ve 80 (≥60) sağlıklı gönüllü alındı. Hastalar ‘remisyonda depresyon’ ve ‘kısmi remisyonda depresyon’ grubu olarak ikiye ayrıldı. Hamilton Depresyon Derecelendirme Ölçeği (HAMD-17) puanı ≤7 olanlar remisyonda depresyon grubunu, HAMD-17 puanı 8-18 arasında olan ve majör depresyon tanısını karşılamayan hastalar ise ‘kısmi remisyonda depresyon’ gurubunu oluşturdu. Rezidüel belirtiler (HAMD-17) formu kullanılarak belirlendi. Katılımcıların yaşam kalitesi Kısa Form 36 Yaşam Kalitesi Ölçeği (SF-36), yeti yitimi Dünya Sağlık Örgütü Yeti Yitimi Değerlendirme Formu kullanılarak ölçüldü. Sonuçlar: ‘Kısmi remisyonda depresyon’ gurubunun %94.2’- sinde ve ‘remisyondaki depresyon’ grubunun ise %48.2’sinde en az bir kalıntı depresyon belirtisi (HAM-D belirti alt grup puanı ≥1) vardı. Remisyondaki depresyon grubunda SF-36 alt ölçeklerinin birçoğu ‘kısmı remisyonda grubun- dan belirgin derecede yüksek (daha iyi yaşam kalitesi) idi. Hastaların özgül kalıntı depresyon belirtileri ile yeti yitimi ve yaşam kalitesi değerlendirme sonuçları arasında anlamlı derecede ilişki vardı. Tartışma: Depresif bozukluk tanısı ile tedavi gören hem remisyondaki, hem de kısmı remisyondaki hastalarda sıklıkla çeşitli derecelerde kalıntı belirti olmaktadır. Kalıntı belirtilerin yaşam kalitesi ve yeti yitimi üzerine olumsuz etkileri vardır. Bu hasta grubunun kalıntı belirtilerin varlığı ve tedavisi açısından dikkatle izlenmesi daha iyi tedavi sonuçları alınması bakımından önem taşımaktadır. (Anadolu Psikiyatri Derg 2020; 21(1):45-52)
Anahtar Kelime:

Konular: Psikiyatri
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • World Health Organization: The Global Burden of Disease: 2004 Update. Geneva, World Health Organization, 2008.
  • Park JH, Lee JJ, Lee SB Huh Y, Choi EA, Youn JC et al. Prevalence of MDD and minor depres-sive disorder in an elderly Korean population: results from the Korean Longitudinal Study on Health and Aging (KLoSHA). J Affect Disord 2010; 125:234-240.
  • Kaya B. Yaşlılık ve depresyon-1. Tanı ve değer-lendirme. Geriatri 1999; 2:76-82.
  • Kavakcı Ö, Bilici M, Cam G, Ülgen M. Prevalence of depression and cognitive impairment in old age in Trabzon. Anadolu Psikiyatri Derg 2011; 12(4):258-265.
  • Maral I, Aslan S, İlhan MN, Yıldırım A, Candan-sayar S, Bumin A. Depresyon yaygınlığı ve risk etkenleri: Huzurevinde ve evde yaşayan yaşlılar-da karşılaştırmalı bir çalışma. Türk Psikiyatri Derg 2001; 12:251-259.
  • Demet MM, Taşkın O, Deniz F, Karaca N, İcelli İ. Manisa Huzurevlerinde kalan yaşlılarda depress-yon belirtilerinin yaygınlığı ve ilişlkili risk etkenleri. Turk Psikiyatri Derg 2002; 13(4):290-299.
  • Paykel ES, Ramana R, Cooper Z, Hayhurst H, Kerr J, Barocka A. Residual symptoms after parti-al remission: an important out-come in depres-sion. Psychol Med 1995; 25:1171-1180.
  • Mojtabai R. Residual symptoms and impairment in major depression in the community. Am J Psychi-atry 2001; 158:1645-1651. Gasto C, Nevarro V, Catalan R, Portella MJ, Marcos T. Residual symptoms in elderly major depression remitters. Acta Psychiatr Scand 2003; 108:15-19.
  • Carvalho AF, Berk M, Hyphantis TN, McIntyre RS. The integrative management of treatment-resis-tant depression: a comprehensive review and perspectives. Psychother Psychosom 2014; 83:70-88.
  • Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, et al. Evaluation of out-comes with citalopram for depression using mea-surement based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006; 163:28-40.
  • Nierenberg AA, Husain MM, Trivedi MH, Fava M, Warden D, Wisniewski SR, et al. Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: a STAR*D report and risk of relapse: a STAR*D report. Psychol Med 2010; 40:41-50.
  • Judd LL, Akiskal HS, Maser JD, Pamela JZ, Endi-cotta J, Correl W, et al. MDD: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord 1998; 50:97-108.
  • Yang H, Chuzi S, Sinicropi-Yao L, Johnson D, Chen Y, Alisabet C, et al. Type of residual symp-tom and risk of relapse during the continuation/ maintenance phase treatment of MDD with the selective serotonin reuptake inhibitor fluoxetine. Eur Arch Psychiatry Clin Neurosci 2010; 260:145-150.
  • Kennedy N, Paykel ES. Residual symptoms at remission from depression: impact on long-term outcome. J Affect Disord 2004; 80:135-144.
  • Romera I, Pérez V, Quail D, Berggren L, Lenox-Smith A, Gilaberte I. Individual residual symptoms and functional impairment in patients with depres-sion. Psych Res 2014; 220:258-262.
  • Xiao L, Feng L, Zhu X, Y Feng, W Wu, GS Ungvari et al. Comparison of residual depressive symp-toms and functional impairment between fully and partially remitted patients with MDD: a multicenter study. Psychiatr Res 2018; 261:547-553.
  • Woo JM, Joen HJ, Noh E Kim HJ, Lee SW, Lee KK, et al. Importance of remission and residual somatic symptoms in health-related quality of life among outpatients with major depressive disorder: a cross-sectional study. Health Qual Life Out-comes 2014; 12:188.
  • Hiranyatheb T, Nakawiro D, Wongpakaranet T, Wongpakaran N, Bookkamana P, Pinyopornpa-nish M, et al. The impact of residual symptoms on relapse and QoL among Thai depressive patients. Neuropsychiatr Dis Treat 2016; 12:3175-3181.
  • Akyol Y, Durmuş D, Doğan C, Bek Y, Cantürk F. Geriatrik populasyonda yaşam kalitesi ve depresif belirti düzeyi. Türk Romatoloji Derg 2010; 25:165-173.
  • NIH Consensus Development Panel on Depres-sion in Late Life. Diagnosis and treatment of de-pression in late life. JAMA 1992; 268:1018-1024.
  • Beekman AT, Penninx BW, Deeg DJ, De Beurs E, Geerling SW, Van Tilburg W. The impact of depression on the wellbeing disability and use of services in older adults: a longitudinal perspective. Acta Psychiatr Scand 2002; 105:20-27.
  • Dombrovski AY, Mulsant BH, Houck PR, Mazum-dar S, lenze EJ, Andesque C, et al. Residual symptoms and recurrence during maintenance treatment of late life depression. J Affect Disord 2007; 103:77-82.
  • Dombrovski AY, Cyranowski JM, Mulsant BH, Houck PR, Buysee DJ, Andrescue J, et al. Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy? Depress Anxiety 2008; 25(12):1060-1066.
  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. (4th ed). Text revision (DSM-IV-TR). Washington, DC: APA, 2000.
  • Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56-62.
  • Akdemir A, Turkcapar MH, Orsel SD, Demirergi N, Dag İ, Ozbay MH. Reliability and validity of the Turkish version of the Hamilton Depression Rating Scale. Compr Psychiatry 2001; 42:1615‐.
  • Ware JE, Sherbourne CD. A 36 item Short Form Health Survey (SF36): conceptual framework and item selection. Med Care 1992; 30:473-483.
  • Kocyigit H. Reliability and validity of the Turkish version of short form-36 (SF-36): a study in a group of patients will rheumatic diseases. Turk J Drugs Ther 1999; 12:102-106.
  • Ustün TB, Kostanjsek N, Chatterji S, Rehm J. Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0), World Health Organization, 2010.
  • Kunt Aslan D, Dereboy F. Dünya Sağlık Örgütü Yetiyitimi Değerlendirme Çizelgesinin (WHODAS 2.0) Türkçe çevirisinin geçerlik ve güvenirliğinin psikiyatri hastaları ve sağlıklı kontrollerde incelen-mesi. Türk Psikiyatri Derg 2018; 29(4):248-257.
  • Harada E, Satoi Y, Kikuchi T, Watanabe K, Alev L, Mimura M, et al. Residual symptoms in patients with partial versus complete remission of a major depressive disorder episode: patterns of painful physical symptoms in depression. Neuropsychiatr Dis Treat 2016; 12:1599-607.
  • Zimmerman M, Posternak MA, Chelminski I. Is the cutoff to define remission on the Hamilton Rating Scale for Depression too high? J Nerv Ment Dis 2005; 193:170-175.
  • Zimmerman M, Martinez J, Attiullah N, Friedman M, Toba C, Boerescu DA. How should residual symptoms be defined in depressed patients who have remitted? Compr Psychiatry 2013; 54:91-96.
  • Kennedy N, Foy K, Sherazi R, McDonough M, McKeon P. Long-term social functioning after de-pression treated by psychiatrists: a review. Bipolar Disord 2007; 9(1-2):25-37.
  • Nil R, Lütolf S, Seifritz E. Residual symptoms and functionality in depressed outpatients: a one-year observational study in Switzerland with escitalop-ram. J Affect Disord 2016; 197:245-250.
  • Liu YH, Chen L, Su YA Fang YR, Sirisurapanont M, Hong JP et al. Is early-onset in major depres-sion a predictor of specific clinical features with more impaired social function? Chin Med J 2015; 128:811-815.
  • Zisook S, Lesser I, Stewart JW, Wisneiefsvki SR, Balasubramani GK, Fava M, et al. Effect of age at onset on the course of major depressive disorder. Am J Psychiatry 2007; 164:1539-1546. Romera I, Pérez V, Ciudad A, Caballero L, Roca M, Polavieja P, et al. Residual symptoms and functioning in depression, does the type of residu-al symptom matter? A post-hoc analysis. BMC Psychiatry 2013; 13:51.
APA TULACI R, Ekinci O (2020). Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. , 45 - 52. 10.5455/apd.47873
Chicago TULACI RIza Gökçer,Ekinci Okan Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. (2020): 45 - 52. 10.5455/apd.47873
MLA TULACI RIza Gökçer,Ekinci Okan Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. , 2020, ss.45 - 52. 10.5455/apd.47873
AMA TULACI R,Ekinci O Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. . 2020; 45 - 52. 10.5455/apd.47873
Vancouver TULACI R,Ekinci O Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. . 2020; 45 - 52. 10.5455/apd.47873
IEEE TULACI R,Ekinci O "Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder." , ss.45 - 52, 2020. 10.5455/apd.47873
ISNAD TULACI, RIza Gökçer - Ekinci, Okan. "Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder". (2020), 45-52. https://doi.org/10.5455/apd.47873
APA TULACI R, Ekinci O (2020). Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. Anadolu Psikiyatri Dergisi, 21(1), 45 - 52. 10.5455/apd.47873
Chicago TULACI RIza Gökçer,Ekinci Okan Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. Anadolu Psikiyatri Dergisi 21, no.1 (2020): 45 - 52. 10.5455/apd.47873
MLA TULACI RIza Gökçer,Ekinci Okan Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. Anadolu Psikiyatri Dergisi, vol.21, no.1, 2020, ss.45 - 52. 10.5455/apd.47873
AMA TULACI R,Ekinci O Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. Anadolu Psikiyatri Dergisi. 2020; 21(1): 45 - 52. 10.5455/apd.47873
Vancouver TULACI R,Ekinci O Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder. Anadolu Psikiyatri Dergisi. 2020; 21(1): 45 - 52. 10.5455/apd.47873
IEEE TULACI R,Ekinci O "Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder." Anadolu Psikiyatri Dergisi, 21, ss.45 - 52, 2020. 10.5455/apd.47873
ISNAD TULACI, RIza Gökçer - Ekinci, Okan. "Quality of life, disability, and residual depressive symptoms in older remitted and partly remitted patients with major depressive disorder". Anadolu Psikiyatri Dergisi 21/1 (2020), 45-52. https://doi.org/10.5455/apd.47873