首发抑郁障碍患者7年后功能结局及影响因素研究OA

Background Depression has a high disability rate and is projected to become the leading cause of disability worldwide by 2030.Real-world evidence indicates that even after systematic treatment and clinical symptom remission,functional impairment often persists among depression patients.However,there is a lack of research on long-term functional outcomes and influencing factors in first-episode depression patients in China.Objective To investigate the overall functional outcome of patients with first-episode depressive disorder after 7 years and to analyse the influencing factors of adverse functional outcome.Methods A total of 346 patients were enrolled from outpatient and inpatient settings at the Hebei Mental Health Center between May 2013 and May 2016.Eligible participants met the following criteria:Hamilton Depression Scale-17(HAMD-17)score≥18,aged 18-60 years,who met the diagnostic criteria for single episode of major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ)were included.Through naturalistic observational follow-up,demographic characteristics,disease features,and treatment details were collected.At the 7-year follow-up,the Treatment Emergent Symptom Scale(TESS)was used to assess adverse drug reactions,the Medication Adherence Rating Scale(MARS)evaluated treatment adherence,and the Global Assessment of Functioning(GAF)measured overall functional level.Patients in remission at the 7-year follow-up were divided into two groups based on GAF scores:the good functional outcome group(GAF>70)and the poor functional outcome group(GAF≤70).Multivariate Logistic regression analysis was performed to identify factors associated with poor functional outcomes.Results A total of 138 cases were completed 7-year follow-up,including 127 cases in remission stage.The good overall function group was 46 cases(36.2%).The poor overall function group was 81 cases(63.8%).At the initial onset,there were significant differences between the overall poor-function group and the good-function group in terms of occupation and educational level(P<0.05).The total number of episodes during the 7-year period in the group with overall poor function,the proportion of episodes with psychotic symptoms,and the TESS total score at follow-up after 7 years were higher than those in the group with good function(P<0.05).The multivariate Logistic regression analysis results showed that a higher total number of episodes over 7 years(OR=1.509,95%CI=1.083-2.102)and a higher TESS total score at 7-year follow-up(OR=1.067,95%CI=1.002-1.136)were risk factors for poor global functional outcomes in patients after 7 years,while a higher education level at first onset(OR=0.486,95%CI=0.268-0.878)served as a protective factor(P<0.05).Conclusion Among patients with first-episode depressive disorder,63.8%had poor global functioning after 7 years.A higher number of relapses and more severe medication side effects increased the risk of adverse outcomes,while patients with higher education levels had relatively better functional outcomes at the 7-year follow-up.