Abstract
Objective: Major Depressive Disorder (MDD) is associated with cognitive impairment in general, and Executive Functioning (EF) in particular, even in remitted phase of the disorder, suggesting residual cognitive symptoms. The aim of the present study was to investigate self-reported EF 1 year after the first episode of MDD and to explore this in relation to depressive mood symptoms, remission and relapse.Method: The study included data from 24 patients and 23 healthy control subjects 1 year after the patients' initial first episode of MDD. All participants completed the Behavior Rating Inventory of Executive Functioning-Adult version (BRIEF-A), a standardized self-report measure of perceived EF in everyday life, measuring nine different EF. Total index scores for metacognitive functions, behavior/emotional regulation functions and a global EF score is also calculated.Results: The patient group in total, independent of symptom status, reported significantly lower EF in all indexes compared to the healthy controls 1 year after the initial episode. However, higher depressive mood symptom load correlated with self-reported difficulties in metacognitive functions and poor global EF scores. Regulatory control of behavior and emotional responses did not show such strong association with mood symptoms, but low self-report scores on this measure was associated with relapse during the first year after the initial episode.Conclusion: First-episode patients report significant lower executive functioning in everyday life compared to individually matched healthy controls, 1 year after onset, independent of symptom load. Residual cognitive symptoms seem to be evident and associated with risk of relapse and should be targeted in treatment and prevention of recurrence in MDD.
Highlights
Major depressive disorder (MDD) is the most prevalent mental disorder [1], and is characterized by significant disability, including reduced social and work ability, and poor quality of life [2]
When dividing the groups by depression severity according to MADRS, 13 patients had a score ≤ 9 and were in remission, the Remitted Group (RG), and 11 patients had a score > 9 indicating the presence residual mood symptoms or mild to moderate depression, the Depressed Symptom Group (DSG)
The results showed that 1 year after their initial episode, first episode MDD patients reported significantly poorer Executive Functioning (EF) in everyday life compared to the healthy control group
Summary
Major depressive disorder (MDD) is the most prevalent mental disorder [1], and is characterized by significant disability, including reduced social and work ability, and poor quality of life [2]. Residual depressive mood symptomatology is recognized to be a significant factor contributing to general disability, relapse and recurrence in MDD [7], longitudinal studies of MDD patients clearly show that mood symptoms alone are unlikely to present a sufficient target for interventions [8]. Studies have shown that neurocognitive functioning might be a key determinant affecting this relationship [9,10,11] with authors stressing the importance of recognizing cognitive impairments in clinical practice to improve clinical interventions [12]. Studies find that disability and poorer quality of life are found to persist for years despite symptom reduction and remission [13, 14], and cognitive impairment has been found to be a significant illness characteristic mediating the association between MDD and disability in everyday life [15, 16]. Neurocognitive impairment in first episode patients has been associated with risk of relapse [5]
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