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

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 elderly patients (age≥60) with depression. Methods: One hundred and sixty patients who had initially been diagnosed with MDD, were randomized into two groups (partly remitted (PRD) vs remitted (RD). By using the 17-item Hamilton Rating 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 and WHODAS 2.0, respectively. Results: Among the PRD, 94.2% of them were experiencing at least one residual symptom (HAM-D symptom subscore≥1). Among the RD, 48.2% of them were experiencing at least one residual symptom. Most of the SF-36 subscores were substantially higher in subjects with RD than in PRD subjects. There were significant correlations between QoL, disability and specific residual symptoms. In the Beta regression analyses, 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 MDD and were significantly associated with disability and QoL in older depressive patients. Given the negative impact of residual symptoms and partial remission status on functionality and QoL, more attention needs to treat effectively depressive episodes. (Anatolian Journal of Psychiatry 2020; 21(1):45-52)

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

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)

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