A Follow-up Study On The Recovery Of Psychosocial Function Of Depression After "clinical Cure"

Major depressive disorder(MDD)is a chronic mental disease with high recurrent rate.With the development of antidepressants and psychotherapy,the treatment of MDD is becoming more and more standardization in the last 20 years,but the many longitude studies implied long effect of treatment was still not as good as we considered,the recurrent rate of MDD was as high as before.With the researches on depression prognosis go further and further,more and more researchers consider the damage of psychosocial functioning plays an important role of recurrence of MDD.While the damage of psychosocial functioning persists even after they achieve"remission"(HAMD-17≤7),which will induce further relapse/recurrence.We designed a prospective,longitudinal,observational study to evaluate psychosocial functioning of 167 remitted MDD patients with Generic Quality of Life Inventory(GQOLI)for 1 year.The study was proposed:1)to figure out the regular restoration pattern of psychosocial functioning after remission;2)to observe and study the result of recurrent in 1 year after remission;3)to confirm the predictive effect of psychosocial functioning damage;4)to detect the influencing factors of psychosocial functioning.We conducted descriptive statistic,survival analysis,t-test,repeated measures ANOVA,Logistics regression and multiple regression analysis with SPSS 19.0,path analysis with Amos21.0 and hierarchical linear modeling with HLM6.08.All the diagrams were drew with GraphPad Prism5.The results were listed below:(1)Both depressive symptom and psychosocial functioning improved after acute phase treatment.But 30.77%of those evaluated as remission by clinicians still report moderate or severe depressive symptom.Even though those with self-evaluated depressive symptom didn’t show more tendency to recurrence,their psychosocial functioning level was lower than those without self-evaluated depressive symptom.What’s more,those who recurred during maintenance treatment phase had poorer psychosocial functioning.(2)The risk of recurrence is high in 6th～10th month after remission.The recurrence rate during 6th～10th month in this study was 19.66%,accounting 71.88%of total recurrence rate.It is essential to follow the 6-12 month maintenance treatment advice after first episode proposed in Clinical guidelines-Psychiatry fascicle.(3)The level of psychosocial functioning when remitted from last episode didn’t reach the climax,while the restoration would continue during maintenance treatment.All the three dimensions of psychosocial functioning would increase significantly and reach into stable stage at the 2nd month after remission.The notability is the restoration of psychological functioning in relapse group is not significant.It is essential to pay attention to restoration of psychosocial functioning during maintenance treatment after elimination of core symptom.(4)Automatic thought,social support,coping style and emotional expression are all effective factor to some different extent to psychosocial functioning.Objective support influence psychosocial functioning via influencing subjective support,while subjective support influence psychosocial functioning both directly and via influencing the utilization of support.Emotional expression could buffer the effect of automatic thought on social functioning.The combination of positive coping and negative coping may promote the restoration of social functioning.