Discrepancy between objective and subjective cognition and its association with the trajectory of symptoms and functioning in depressive patients

社会心理的 认知 生活质量(医疗保健) 心理学 联想(心理学) 临床心理学 抑郁症状 认知缺陷 精神科 认知障碍 心理治疗师
作者
Xuequan Zhu,Ruoxi Ding,Xu Chen,Xiaoyi Wang,Ping He,Gang Wang
出处
期刊:Psychological Medicine [Cambridge University Press]
卷期号:54 (4): 808-822
标识
DOI:10.1017/s0033291723002556
摘要

Abstract Background Discrepancy between objective and subjective cognitive deficit is common among patients with major depressive disorders (MDDs) and may play a key role in the mechanism linking cognition with recovery of symptom and psychosocial function. This study, therefore, explores the cognitive discrepancy, and its association with the trajectory of symptoms and functioning over a 6-month period. Methods We used data from the Prospective Research Observation to Assess Cognition in Treated patients with MDD (PROACT) study, from which 598 patients were included. Cognitive discrepancy scores were computed using a novel methodology, with positive values indicating more subjective than objective deficit (i.e. ‘underestimation’) and negative values indicating more objective than subjective difficulties (i.e. ‘overestimation’). Linear growth curve models were employed to examine the association of the cognitive discrepancy with the trajectory of depressive symptoms, psychosocial function, and quality of life. Results About 68% of patients displayed disproportionately more objective than subjective cognitive deficit at baseline, and the mean cognitive discrepancy score was −1.4 (2.7). Overestimation was associated with a faster decrease of HDRS-17 ( β = −0.46, p = 0.002) and a faster decrease of psychosocial function in social life ( β = −0.13, p = 0.013) and family life ( β = −0.12, p = 0.026), and a greater improvement of EQ-5D utility score ( β = 0.01, p < 0.001). Conclusion We found a lower sensitivity of cognitive deficit at baseline and its decrease was associated with better health outcomes. Our findings have clinical implications of the necessity to assess both subjective and objective cognition for identification and categorization and to incorporate cognitive and psychological therapies for optimized treatment outcomes.
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