Abstract
Relationships among childhood maltreatment (CM), hypothalamic-pituitary-adrenal (HPA) axis disturbances, major depressive disorder (MDD), poor functionality, and lower quality of life (QoL) in adulthood have been described. We aimed to study the roles of the remission status of depression and HPA axis function in the relationships between CM and functionality and QoL. Ninety-seven patients with MDD and 97 healthy controls were included. The cortisol awakening response, cortisol suppression ratio in the dexamethasone suppression test, and diurnal cortisol slope were assessed. Participants completed measures of psychopathology, CM, functionality, and QoL. Multiple linear regression analyses were performed to study the relationships between CM and functionality and QoL. Only non-remitted MDD patients showed lower functionality and QoL than controls, indicating that depressive symptoms may partly predict functionality and QoL. Cortisol measures did not differ between remitted and non-remitted patients. Although neither HPA axis measures nor depression remission status were consistently associated with functionality or QoL, these factors moderated the effects of CM on functionality and QoL. In conclusion, subtle neurobiological dysfunctions in stress-related systems could help to explain diminished functionality and QoL in individuals with CM and MDD and contribute to the persistence of these impairments even after the remission of depressive symptoms.
Highlights
Major depressive disorder (MDD) is a recurrent psychiatric condition estimated to affect more than 320 million people worldwide and has been identified as the leading cause of disability [1]
healthy controls (HC) were significantly younger than patients with remitted major depressive disorder (MDD), and there were no differences in gender between groups
HPA axis measures did not differ between groups except for evening cortisol levels, which was higher in non-remitted MDD patients than in HCs
Summary
Major depressive disorder (MDD) is a recurrent psychiatric condition estimated to affect more than 320 million people worldwide and has been identified as the leading cause of disability [1]. As a chronic and recurrent illness, MDD is associated with reduced quality of life (QoL) [3,4]. The decrease in functionality and reduced QoL generally occur in parallel with the worsening of depressive symptoms [5,6]. Some authors have observed the persistence of substantial functional impairment and lower QoL in patients with subthreshold symptoms of depression or in remitted patients; functional impairment and poor. Impaired functioning and poor QoL may predict the relapse of depressive episodes [4,10,11,12,13]. The recovery of functionality and QoL is critical for depression patients to achieve and remain in remission, allowing them to return to productive and fulfilling daily lives [7,14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
