Abstract: 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.

Key words: Depressive disorder, First episode, Prospective study, Global functional outcome, Root cause analysis

摘要： 背景　抑郁症致残率高，预计 2030 年将成为全球首要致残疾病。抑郁症患者接受治疗后临床症状缓解，仍普遍存在功能恢复障碍，目前国内缺乏首发抑郁患者长期功能结局和影响因素研究。目的　了解首发抑郁障碍患者7年后的整体功能结局，探讨不良功能结局的影响因素。方法　纳入2013年5月—2016年5月河北省精神卫生中心的门诊和住院患者（n=346），均符合汉密尔顿抑郁量表17项（HAMD-17）得分≥ 18 分、年龄18~60岁、符合《精神障碍诊断与统计手册第四版》中重性抑郁障碍单次发作的诊断标准。通过自然观察随访，收集人口学信息、疾病特征、治疗情况等资料，7年末随访时采用药物副反应量表（TESS）、药物依从性评定量表（MARS）、整体功能评定量表（GAF）分别评估调查时患者存在的药物副反应、对药物治疗的依从情况、整体功能水平。将7年后随访时处于缓解期的患者根据GAF得分进行分组，GAF>70分为整体功能良好组、GAF得分≤70分为整体功能不良组。采用多因素Logistic回归分析患者不良功能结局的影响因素。结果　完成7年随访的患者共138例，处于缓解期者127例。其中，整体功能良好组46例（36.2%），整体功能不良组81例（63.8%）。首发时整体功能不良组与功能良好组职业类型、受教育水平比较，差异有统计学意义（P<0.05）；7年间整体功能不良组总发作次数、伴精神病性症状发作占比、7年末随访时TESS得分高于功能良好组（P<0.05）。多因素Logistic回归分析结果显示：7年间总发作次数多（OR=1.509，95%CI=1.083~2.102）、7年后TESS得分高（OR=1.067，95%CI=1.002~1.136）为患者7年后整体功能不良结局的危险因素（P<0.05），首发时受教育水平高（OR=0.486，95%CI=0.268~0.878）为保护因素（P<0.05）。结论　首发抑郁障碍患者 7 年后整体功能不良者占63.8%，复发次数、药物副反应会增加不良结局的发生风险，受教育水平高的患者7年后功能结局相对良好。

关键词: 抑郁障碍, 首次发作, 前瞻性研究, 整体功能结局, 影响因素分析