Abstract
Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Little is understood about subjective cognition and the longitudinal relationship with depression and anxiety symptoms in young people. To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth. This was a cohort study of 656 youth aged 12-25 years attending Australian headspace primary mental health services. Subjective changes in cognitive functioning (rated as better, same, worse) reported after 3 months of treatment was assessed using the Neuropsychological Symptom Self-Report. Multivariate multinomial logistic regression analysis was conducted to evaluate the impact of baseline levels of and changes in depression (nine-item Patient Health Questionnaire; PHQ9) and anxiety symptoms (seven-item Generalised Anxiety Disorder scale; GAD7) on changes in subjective cognitive function at follow-up while controlling for covariates. With a one-point reduction in PHQ9 at follow-up, there was an estimated 11-18% increase in ratings of better subjective cognitive functioning at follow-up, relative to stable cognitive functioning. A one-point increase in PHQ9 from baseline to follow-up was associated with 7-14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning. A similar attenuated pattern of findings was observed for the GAD7. A clear association exists between subjective cognitive functioning outcomes and changes in self-reported severity of affective symptoms in young people over the first 3 months of treatment. Understanding the timing and mechanisms of these associations is needed to tailor treatment.
Highlights
Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning
To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth
A one-point increase in PHQ9 from baseline to follow-up was associated with 7–14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning
Summary
Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Affective symptoms are common to all mental health conditions and little is known about the temporal relationship between subjective cognitive functioning and affective symptoms cross-diagnostically. It is important to understand how subjective cognitive symptoms relate to affective symptoms early in the course of mental illness and over time, given they are shown to be more strongly associated with self-efficacy and functioning than objective cognitive difficulties.[22] Ongoing subjective cognitive complaints may increase one’s risk for maintenance of affective symptoms, relapse or poor functional outcomes.[20,23,24] improvements in subjective cognitive functioning may signal clinical and functional improvement. Subjective cognitive functioning can be assessed within clinical settings and research understanding its course and clinical significance remains an important endeavour
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