关键词: 首发抑郁障碍, 随访研究, 整体功能结局, 影响因素

Abstract: 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 with 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. Demographic data, disease characteristics, treatment status were collected through natural observation and follow-up. At the end of the 7-year follow-up, treatment emergent symptom scale (TESS), medication adherence rating scale (MARS), and global assessment function (GAF) were used to evaluate adverse reactions, compliance to medication, and patient's overall functional level. Patients who were in remission at follow-up after 7 year were grouped according to total GAF scores. GAF>70 was divided into the good overall function group, GAF total score≤70 was divided into the poor overall function group. 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 (farmer 50.6% vs. 52.2%, worker/service staff 16.0% vs. 15.2%, professional/administrative 1.2% vs. 13.0%, self-employed/temporary worker 27.2% vs. 6.5%, student/military personnel 3.7% vs. 10.9%, unemployed 1.2% vs. 2.2%) and educational level (illiterate 4.9% vs. 0.0%, primary school 17.3% vs. 15.2%, junior high school 50.6% vs. 34.8%, college and above 1.2% vs. 15.2%), with P < 0.05. The total number of episodes during the 7-year period (3.67±1.38 vs.2.74±1.48) in the group with overall poor function, the proportion of episodes with psychotic symptoms 0[0, 0.5] vs. 0[0, 0.38], and the TESS total score of 12[1.5, 16] vs. 0[0, 13] at follow-up after 7 years were higher than those in the group with good function. All are P<0.05. The results of multivariate binary logistic regression showed that the total number of episodes in 7 years (OR=1.504，95%CI:1.079~2.097 ) and the total score of TESS after 7 years (OR=1.068，95%CI:1.003~1.137 ) were independent risk factors for the overall functional outcome of patients after 7 years. The level of education at the time of first onset (OR=0.417，95%CI:0.247~0.704) was an independent protective factor (P < 0.05 ). Conclusion The number of relapses and side effects of drugs increased the risk of overall dysfunctional outcomes in patients with first-episode depressive disorder after 7 years.Besides,patients with high education level at the time of initial onset had relatively good functional outcomes after 7 years.

Key words: First-episode depression, Follow-up study, Overall functional outcome, Influencing factors