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Lewis L. Judd, MD; Hagop S. Akiskal, MD; Pamela J. Zeller, PhD; Martin Paulus, MD; Andrew C. Leon, PhD; Jack D. Maser, PhD; Jean Endicott, PhD; William Coryell, MD; Jelena L. Kunovac, MD; Timothy I. Mueller, MD; John P. Rice, PhD; Martin B. Keller, MD

Arch Gen Psychiatry. 2000;57:375-380.

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.

From the National Institute of Mental Health Collaborative Program on the Psychobiology of Depression, Rockville, Md (Drs Judd, Akiskal, Leon, Maser, Endicott, Coryell, Mueller, Rice, and Keller); Department of Psychiatry, University of California–San Diego (Drs Judd, Akiskal, Zeller, Paulus, and Kunovac); and the Psychiatry Service, San Diego Veterans Affairs Medical Center (Drs Akiskal, Paulus, and Kunovac).

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