Dataset Information

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients.

ABSTRACT: The goal of this study was to evaluate the relationship between early change in psychosocial function independent of depression severity and longer-term symptomatic remission. Participants of Combining Medications to Enhance Depression Outcomes trial were randomly selected for model selection (n = 334) and validation (n = 331). Changes in psychosocial function (Work and Social Adjustment Scale, WSAS) from baseline to week 6 were assessed and two data-driven sub-groups of WSAS change were identified in the randomly selected model selection half. Results of analyses to predict symptomatic remission at 3 and 7 months were validated for these sub-groups in the second half (validation sample). From baseline to week 6, psychosocial function improved significantly even after adjusting for depression severity at each visit and select baseline variables (age, gender, race, ethnicity, education, income, employment, depression onset before age 18, anxious features, and suicidal ideation), treatment-arm, and WSAS score. The WSAS change patterns identified two (early improvement and gradual change) subgroups. After adjusting for baseline variables and remission status at week 6, participants with early improvement in the second half (validation sample) had greater remission rates than those with gradual change at both 3 (3.3 times) and 7 months (2.3 times) following acute treatment initiation. In conclusion, early improvement in psychosocial function provides a clinically meaningful prediction of longer-term symptomatic remission, independent of depression symptom severity.

SUBMITTER: Jha MK

PROVIDER: S-EPMC5193346 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

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Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients.

Jha Manish K MK Minhajuddin Abu A Greer Tracy L TL Carmody Thomas T Rush Augustus John AJ Trivedi Madhukar H MH

PloS one 20161228 12

The goal of this study was to evaluate the relationship between early change in psychosocial function independent of depression severity and longer-term symptomatic remission. Participants of Combining Medications to Enhance Depression Outcomes trial were randomly selected for model selection (n = 334) and validation (n = 331). Changes in psychosocial function (Work and Social Adjustment Scale, WSAS) from baseline to week 6 were assessed and two data-driven sub-groups of WSAS change were identif ...[more]

PMID: 28030546

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Project description:OBJECTIVE:To evaluate the relationship between symptom and functional improvement and remission in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) enrolled in an 11-week open-label dose-optimization phase of an methylphenidate extended release (MPH-MLR) pivotal study. METHODS:Assessments included the Weiss Functional Impairment Rating Scale-Parent (WFIRS-P) and ADHD Rating Scale, Fourth Edition (ADHD-RS-IV). Definitions included the following: symptom improvement (?30% decrease in ADHD-RS-IV total score); symptom remission (ADHD-RS-IV total score ?18); functional improvement (decrease in WFIRS-P total score ?0.25 [minimally important difference]); and functional remission (WFIRS-P total score ?0.65). RESULTS:Two hundred children completed the open-label phase. At initial assessment, functional impairment was evident across all WFIRS-P domains and similar between children and adolescents. Those who were treatment naive had more functional impairment (WFIRS-P total: 0.82 vs. 0.70, p?=?0.02). Significant improvements in all WFIRS-P domains were noted at open-label end (p?<?0.001), with the largest improvement in Learning. At open-label end, 94% of children and adolescents demonstrated symptom improvement, of which 57% also showed functional improvement, and 75% of children and adolescents showed symptom remission, of which 81% also showed functional remission. CONCLUSIONS:Children and adolescents treated with MPH-MLR showed moderate-to-large improvement in functioning during 3 months of treatment, both overall and in specific domains. However, a significant number of those who would be considered symptomatic responders failed to show improvement in functioning or continue to have significant functional impairment. Treatment with MPH-MLR showed that both symptomatic and functional remission are achievable goals. Identification of children and adolescents who have been successfully treated for their symptoms, but continue to suffer functional impairment, will allow us to offer additional targeted treatment interventions over and above medication to address residual difficulties.

Dataset Information

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients.

Publications

Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients.

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