DOI QR코드

DOI QR Code

Quality of Life and Characteristics of Depression with Subjective Cognitive Decline in Korean Adults : Data from the Seventh Korea National Health and Nutrition Examination Survey

한국 성인에서 주관적 인지저하를 동반한 우울증의 특성과 삶의 질 : 제 7기 국민건강영양조사를 중심으로

  • Jeong, Jae-Hoon (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Sung-Jin (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine) ;
  • Jung, Do-Un (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine) ;
  • Moon, Jung-Joon (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine) ;
  • Jeon, Dong-Wook (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine) ;
  • Kim, Yeon-Sue (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine) ;
  • Choi, Hyeon-Seok (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine) ;
  • Lee, Min-Joo (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine) ;
  • Jeon, Gyeong-Su (Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine)
  • 정재훈 (인제대학교 의과대학 부산백병원 정신건강의학교실) ;
  • 김성진 (인제대학교 의과대학 부산백병원 정신건강의학교실) ;
  • 정도운 (인제대학교 의과대학 부산백병원 정신건강의학교실) ;
  • 문정준 (인제대학교 의과대학 부산백병원 정신건강의학교실) ;
  • 전동욱 (인제대학교 의과대학 부산백병원 정신건강의학교실) ;
  • 김연수 (인제대학교 의과대학 부산백병원 정신건강의학교실) ;
  • 최현석 (인제대학교 의과대학 부산백병원 정신건강의학교실) ;
  • 이민주 (인제대학교 의과대학 부산백병원 정신건강의학교실) ;
  • 전경수 (인제대학교 의과대학 부산백병원 정신건강의학교실)
  • Received : 2021.03.24
  • Accepted : 2021.06.13
  • Published : 2021.06.30

Abstract

Objectives : This study aimed to investigate quality of life, severity of depression, suicidality, subjective health and subjective stress of depression with subjective cognitive decline in Korean adults. Methods : We used the 7th KNHANES data to enroll 415 participants with a score of 10 or higher on Patient Health Questionnaire-9 (PHQ-9), aged 20-64. Depression was divided into two groups based on the presence/absence of subjective cognitive decline. Demographic and psychological characteristics were compared between two groups. Correlation analysis of subjective cognitive decline, quality of life, depression, suicidal idea was carried out. To detect which variables influenced quality of life, a multiple regression analysis was carried out. Results : Among the 415 participants, 98 had depression with subjective cognitive decline. We identified significant differences in age, marital status, education, employment between the two groups. After adjusting for these variables, depression with subjective cognitive decline had lower EuroQol-5D index scores, more severe depressive symptoms without cognition and worse subjective health than depression without cognitive decline. There was a significant correlation between subjective cognitive decline and quality of life (r=-0.236, p<0.001), suicidal idea (r=0.182, p<0.001), depression score without cognition (r=0.108, p=0.028). Through multiple regression analysis, subjective cognitive decline was predictor of reduced quality of life (β=-0.178, p<0.001). Conclusions : Depression with subjective cognitive decline has poor quality of life and severe depression. Cognitive decline should be considered to improve treatment result in depression.

연구목적 국내의 성인을 대상으로 주관적 인지 저하를 동반한 우울증에서 삶의 질, 우울의 심각도, 자살 관련 특성, 주관적 건강 상태 및 스트레스 인지에 대해 조사하고자 하였다. 방 법 국민건강영양조사 제 7기 자료를 이용하여 Patient Health Questionnaire (PHQ-9)에서 10점 이상인 인구 415명을 대상으로 하였다. 주관적 인지 저하 유무에 따라 두 군의 특성 차이를 비교했다. 주관적 인지 저하와 삶의 질, 우울, 자살사고의 상관성을 보기 위해 상관분석 및 회귀 분석을 실시했다. 결 과 주관적 인지 저하를 동반한 우울증 집단이 삶의 질과 주관적 건강이 더 좋지 않았고 우울의 심각도가 심했다. 주관적 인지 저하와 삶의 질은 음의 상관관계, 자살사고와 우울은 양의 상관관계를 보였다. 회귀 분석을 통해 주관적 인지 저하가 삶의 질에 부정적 영향을 미치는 것을 확인했다. 결 론 주관적 인지 저하를 동반한 우울증은 삶의 질을 저해하고 우울의 심각도가 심하며 삶의 질, 자살사고 및 우울을 악화시키는 것으로 확인되었다.

Keywords

References

  1. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 2018;392:1789-1858. https://doi.org/10.1016/S0140-6736(18)32279-7
  2. World Health O. Depression and other common mental disorders: global health estimates;2017.
  3. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research 2012;21:169-184. https://doi.org/10.1002/mpr.1359
  4. Hong JP, Lee DW, Ham BJ, Lee SH, Sung SJ, Yoon T. The survey of mental disorders in Korea 2016. Seoul: Ministry of Health and Welfare;2017.
  5. Lonnqvist JK. Psychiatric aspects of suicidal behaviour: depression. International handbook of suicide and attempted suicide;2000.
  6. Oecd. Suicide rates;2018.
  7. Meltzer-Brody S, Davidson JRT. Completeness of response and quality of life in mood and anxiety disorders. Depression and Anxiety 2000;12:95-101. https://doi.org/10.1002/1520-6394(2000)12:1+<95::AID-DA14>3.0.CO;2-U
  8. Ormel J, Vonkorff M, Oldehinkel AJ, Simon G, Tiemens BG, ustun TB. Onset of disability in depressed and non-depressed primary care patients. Psychological Medicine 1999;29:847-853. https://doi.org/10.1017/S0033291799008600
  9. Broadhead WE, Blazer DG, George LK, Tse CK. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 1990;264:2524-2528. https://doi.org/10.1001/jama.1990.03450190056028
  10. Judd LL, Paulus MP, Wells KB, Rapaport MH. Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population;1996.
  11. Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA 1992;267:1478-1483. https://doi.org/10.1001/jama.1992.03480110054033
  12. Zajecka JM. Treating depression to remission. The Journal of Clinical Psychiatry 2003;64 Suppl 15:7-12. https://doi.org/10.4088/JCP.v64n1019b
  13. Simon GE, Revicki D, Heiligenstein J, Grothaus L, VonKorff M, Katon WJ, Hylan TR. Recovery from depression, work productivity, and health care costs among primary care patients. General Hospital Psychiatry 2000;22:153-162. https://doi.org/10.1016/S0163-8343(00)00072-4
  14. American Psychiatric A. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub;2013.
  15. Semkovska M, Quinlivan L, O'Grady T, Johnson R, Collins A, O'Connor J, Knittle H, Ahern E, Gload T. Cognitive function following a major depressive episode: a systematic review and meta-analysis. The Lancet Psychiatry 2019;6:851-861. https://doi.org/10.1016/S2215-0366(19)30291-3
  16. Stordal KI, Lundervold AJ, Egeland J, Mykletun A, Asbjornsen A, Landro NI, Roness A, Rund BR, Sundet K, Oedegaard KJ. Impairment across executive functions in recurrent major depression. Nordic Journal of Psychiatry 2004;58:41-47. https://doi.org/10.1080/08039480310000789
  17. Conradi H, Ormel J, De Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychological Medicine 2011;41:1165. https://doi.org/10.1017/S0033291710001911
  18. Woo YS, Rosenblat JD, Kakar R, Bahk WM, McIntyre RS. Cognitive deficits as a mediator of poor occupational function in remitted major depressive disorder patients. Clin Psychopharmacol Neurosci 2016;14:1-16. https://doi.org/10.9758/cpn.2016.14.1.1
  19. McIntyre RS, Cha DS, Soczynska JK, Woldeyohannes HO, Gallaugher LA, Kudlow P, Alsuwaidan M, Baskaran A. Cognitive deficits and functional outcomes in major depressive disorder: determinants, substrates, and treatment interventions. Depress Anxiety 2013;30:515-527. https://doi.org/10.1002/da.22063
  20. Jaeger J, Berns S, Uzelac S, Davis-Conway S. Neurocognitive deficits and disability in major depressive disorder. Psychiatry Research 2006;145:39-48. https://doi.org/10.1016/j.psychres.2005.11.011
  21. Evans VC, Chan SSL, Iverson GL, Bond DJ, Yatham LN, Lam RW. Systematic review of neurocognition and occupational functioning in major depressive disorder. Neuropsychiatry 2013;3:97. https://doi.org/10.2217/npy.13.3
  22. Park SJ, Jeon HJ, Kim JY, Kim S, Roh S. Sociodemographic factors associated with the use of mental health services in depressed adults: results from the Korea National Health and Nutrition Examination Survey (KNHANES). BMC Health Services Research 2014;14:645. https://doi.org/10.1186/s12913-014-0645-7
  23. Choi HS, Choi JH, Park KH, Joo KJ, Ga H, Ko HJ, Kim SR. Standardization of the Korean Version of Patient Health Questionnaire-9 as a screening instrument for major depressive disorder. J Korean Acad Fam Med 2007;28:114-119.
  24. Spitzer RL, Kroenke K, Williams JBW, Patient Health Questionnaire Primary Care Study G. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 1999;282:1737-1744. https://doi.org/10.1001/jama.282.18.1737
  25. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 2001;16:606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  26. Cha DS. Cognitive impairment in major depressive disorder: Clinical relevance, biological substrates, and treatment opportunities: Cambridge University Press;2016.
  27. Lerner D, Adler DA, Chang H, Berndt ER, Irish JT, Lapitsky L, Hood MY, Reed J, Rogers WH. The clinical and occupational correlates of work productivity loss among employed patients with depression. J Occup Environ Med 2004;46:S46-55. https://doi.org/10.1097/01.jom.0000126684.82825.0a
  28. Brooks R, Group E. EuroQol: the current state of play. Health Policy 1996;37:53-72. https://doi.org/10.1016/0168-8510(96)00822-6
  29. Lee YK, Nam HS, Chuang LH, Kim KY, Yang HK, Kwon IS, Kind P, Kweon SS, Kim YT. South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states. Value in Health 2009;12:1187-1193. https://doi.org/10.1111/j.1524-4733.2009.00579.x
  30. Simon GE, Rutter CM, Peterson D, Oliver M, Whiteside U, Operskalski B, Ludman EJ. Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death? Psychiatric Services 2013;64:1195-1202. https://doi.org/10.1176/appi.ps.201200587
  31. Saarni SI, Suvisaari J, Sintonen H, Koskinen S, Harkanen T, Lonnqvist J. The health-related quality-of-life impact of chronic conditions varied with age in general population. J Clin Epidemiol 2007;60:1288-1297.
  32. Lubetkin EI, Jia H, Franks P, Gold MR. Relationship among sociodemographic factors, clinical conditions, and health-related quality of life: examining the EQ-5D in the US general population. Quality of Life Research 2005;14:2187-2196. https://doi.org/10.1007/s11136-005-8028-5
  33. Jiang Y, Hesser JE. Associations between health-related quality of life and demographics and health risks. Results from Rhode Island's 2002 behavioral risk factor survey. Health and Quality of Life Outcomes 2006;4:14. https://doi.org/10.1186/1477-7525-4-14
  34. Iverson GL, Lam RW. Rapid screening for perceived cognitive impairment in major depressive disorder. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists 2013;25:135-140.
  35. Steinerman JR, Hall CB, Sliwinski MJ, Lipton RB. Modeling cognitive trajectories within longitudinal studies: a focus on older adults. Journal of the American Geriatrics Society 2010;58:S313-S318. https://doi.org/10.1111/j.1532-5415.2010.02982.x
  36. Liu H, Zhang Y, Burgard SA, Needham BL. Marital status and cognitive impairment in the united states: Evidence from the national health and aging trends study. Annals of Epidemiology 2019;38:28-34.e2. https://doi.org/10.1016/j.annepidem.2019.08.007
  37. Stern Y. What is cognitive reserve? Theory and research application of the reserve concept;2002.
  38. Baune BT, Miller R, McAfoose J, Johnson M, Quirk F, Mitchell D. The role of cognitive impairment in general functioning in major depression. Psychiatry Research 2010;176:183-189. https://doi.org/10.1016/j.psychres.2008.12.001
  39. Lee L, Harkness KL, Sabbagh MA, Jacobson JA. Mental state decoding abilities in clinical depression. Journal of Affective Disorders 2005;86:247-258. https://doi.org/10.1016/j.jad.2005.02.007
  40. Huang X, Ribeiro JD, Musacchio KM, Franklin JC. Demographics as predictors of suicidal thoughts and behaviors: a meta-analysis. PLoS One 2017;12:e0180793. https://doi.org/10.1371/journal.pone.0180793
  41. Rahman S, Alexanderson K, Jokinen J, Mittendorfer-Rutz E. Risk factors for suicidal behaviour in individuals on disability pension due to common mental disorders-a nationwide register-based prospective cohort study in Sweden. PLoS One 2014;9:e98497. https://doi.org/10.1371/journal.pone.0098497
  42. Westheide J, Quednow BB, Kuhn KU, Hoppe C, Cooper-Mahkorn D, Hawellek B, Eichler P, Maier W, Wagner M. Executive performance of depressed suicide attempters: the role of suicidal ideation. European Archives of Psychiatry and Clinical Neuroscience 2008;258:414-421. https://doi.org/10.1007/s00406-008-0811-1
  43. Pusswald G, Tropper E, Kryspin-Exner I, Moser D, Klug S, Auff E, Dal-Bianco P, Lehrner J. Health-related quality of life in patients with subjective cognitive decline and mild cognitive impairment and its relation to activities of daily living. Journal of Alzheimer's Disease 2015;47:479-486. https://doi.org/10.3233/JAD-150284
  44. DeBattista C, Lembke A, Solvason HB, Ghebremichael R, Poirier J. A prospective trial of modafinil as an adjunctive treatment of major depression. Journal of Clinical Psychopharmacology 2004;24:87-90. https://doi.org/10.1097/01.jcp.0000104910.75206.b9
  45. Svendsen AM, Kessing LV, Munkholm K, Vinberg M, Miskowiak KW. Is there an association between subjective and objective measures of cognitive function in patients with affective disorders? Nordic Journal of Psychiatry 2012;66:248-253. https://doi.org/10.3109/08039488.2011.626870
  46. Stenfors CUD, Marklund P, Hanson LLM, Theorell T, Nilsson LG. Are subjective cognitive complaints related to memory functioning in the working population? BMC Psychology 2014;2:3. https://doi.org/10.1186/2050-7283-2-3