Psychosocial disability during the long-term course of unipolar major depressive disorder

Arch Gen Psychiatry. 2000 Apr;57(4):375-80. doi: 10.1001/archpsyc.57.4.375.


Background: The goal of this study was to investigate psychosocial disability in relation to depressive symptom severity during the long-term course of unipolar major depressive disorder (MDD).

Methods: Monthly ratings of impairment in major life functions and social relationships were obtained during an average of 10 years' systematic follow-up of 371 patients with unipolar MDD in the National Institute of Mental Health Collaborative Depression Study. Random regression models were used to examine variations in psychosocial functioning associated with 3 levels of depressive symptom severity and the asymptomatic status.

Results: A progressive gradient of psychosocial impairment was associated with a parallel gradient in the level of depressive symptom severity, which ranges from asymptomatic to subthreshold depressive symptoms to symptoms at the minor depression/dysthymia level to symptoms at the MDD level. Significant increases in disability occurred with each stepwise increment in depressive symptom severity.

Conclusions: During the long-term course, disability is pervasive and chronic but disappears when patients become asymptomatic. Depressive symptoms at levels of subthreshold depressive symptoms, minor depression/ dysthymia, and MDD represent a continuum of depressive symptom severity in unipolar MDD, each level of which is associated with a significant stepwise increment in psychosocial disability.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adaptation, Psychological*
  • Adolescent
  • Adult
  • Aged
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / psychology
  • Disability Evaluation
  • Disease Progression
  • Dysthymic Disorder / diagnosis
  • Dysthymic Disorder / psychology
  • Employment
  • Female
  • Follow-Up Studies
  • Humans
  • Interpersonal Relations
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Regression Analysis
  • Severity of Illness Index
  • Social Adjustment*