The impact of residual symptoms on relapse and quality of life among Thai depressive patients

Thanita Hiranyatheb,1 Daochompu Nakawiro,1 Tinakon Wongpakaran,2 Nahathai Wongpakaran,2 Putipong Bookkamana,3 Manee Pinyopornpanish,2 Nattha Saisavoey,4 Kamonporn Wannarit,4 Sirina Satthapisit,5 Sitthinant Tanchakvaranont6 1Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 2Department of Psychiatry, Faculty of Medicine, 3Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, 4Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, 5Department of Psychiatry Khon Kaen Hospital, Khon Kaen, 6Department of Psychiatry, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand Purpose: Residual symptoms of depressive disorder are major predictors of relapse of depression and lower quality of life. This study aims to investigate the prevalence of residual symptoms, relapse rates, and quality of life among patients with depressive disorder. Patients and methods: Data were collected during the Thai Study of Affective Disorder (THAISAD) project. The Hamilton Rating Scale for Depression (HAMD) was used to measure the severity and residual symptoms of depression, and EQ-5D instrument was used to measure the quality of life. Demographic and clinical data at the baseline were described by mean ± standard deviation (SD). Prevalence of residual symptoms of depression was determined and presented as percentage. Regression analysis was utilized to predict relapse and patients’ quality of life at 6 months postbaseline. Results: A total of 224 depressive disorder patients were recruited. Most of the patients (93.3%) had at least one residual symptom, and the most common was anxiety symptoms (76.3%; 95% confidence interval [CI], 0.71–0.82). After 3 months postbaseline, 114 patients (50.9%) were in remission and within 6 months, 44 of them (38.6%) relapsed. Regression analysis showed that residual insomnia symptoms were significantly associated with these relapse cases (odds ratio [OR] =5.290, 95% CI, 1.42–19.76). Regarding quality of life, residual core mood and insomnia significantly predicted the EQ-5D scores at 6 months postbaseline (B =-2.670, 95% CI, -0.181 to -0.027 and B =-3.109, 95% CI, -0.172 to -0.038, respectively). Conclusion: Residual symptoms are common in patients receiving treatment for depressive disorder and were found to be associated with relapses and quality of life. Clinicians need to be aware of these residual symptoms when carrying out follow-up treatment in patients with depressive disorder, so that prompt action can be taken to mitigate the risk of relapse. Keywords: Thai, residual symptoms, depression, relapse, quality of life, treatmen

Depression and pain: testing of serial multiple mediators

Tinakon Wongpakaran,1 Nahathai Wongpakaran,1 Sitthinant Tanchakvaranont,2 Putipong Bookkamana,3 Manee Pinyopornpanish,1 Kamonporn Wannarit,4 Sirina Satthapisit,5 Daochompu Nakawiro,6 Thanita Hiranyatheb,6 Kulvadee Thongpibul7 1Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand; 2Department of Psychiatry, Queen Savang Vadhana Memorial Hospital, Chonburi, Kingdom of Thailand; 3Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Kingdom of Thailand; 4Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Kingdom of Thailand; 5Department of Psychiatry, Khon Kaen Regional Hospital, Khon Kaen, Kingdom of Thailand; 6Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Kingdom of Thailand; 7Department of Psychology, Faculty of Humanities, Chiang Mai University, Chiang Mai, Kingdom of Thailand Purpose: Despite the fact that pain is related to depression, few studies have been conducted to investigate the variables that mediate between the two conditions. In this study, the authors explored the following mediators: cognitive function, self-sacrificing interpersonal problems, and perception of stress, and the effects they had on pain symptoms among patients with depressive disorders.Participants and methods: An analysis was performed on the data of 346 participants with unipolar depressive disorders. The 17-item Hamilton Depression Rating Scale, Mini-Mental State Examination, the pain subscale of the health-related quality of life (SF-36), the self-sacrificing subscale of the Inventory of Interpersonal Problems, and the Perceived Stress Scale were used. Parallel multiple mediator and serial multiple mediator models were used. An alternative model regarding the effect of self-sacrificing on pain was also proposed.Results: Perceived stress, self-sacrificing interpersonal style, and cognitive function were found to significantly mediate the relationship between depression and pain, while controlling for demographic variables. The total effect of depression on pain was significant. This model, with an additional three mediators, accounted for 15% of the explained variance in pain compared to 9% without mediators. For the alternative model, after controlling for the mediators, a nonsignificant total direct effect level of self-sacrificing was found, suggesting that the effect of self-sacrificing on pain was based only on an indirect effect and that perceived stress was found to be the strongest mediator.Conclusion: Serial mediation may help us to see how depression and pain are linked and what the fundamental mediators are in the chain. No significant, indirect effect of self-sacrificing on pain was observed, if perceived stress was not part of the depression and/or cognitive function mediational chain. The results shown here have implications for future research, both in terms of testing the model and in clinical application. Keywords: depressive disorder, mediator, serial mediation, multiple mediatio

Level of agreement between self-rated and clinician-rated instruments when measuring major depressive disorder in the Thai elderly: a 1-year assessment as part of the THAISAD study

Nahathai Wongpakaran,1 Tinakon Wongpakaran,1 Kamonporn Wannarit,2 Nattha Saisavoey,2 Manee Pinyopornpanish,1 Peeraphon Lueboonthavatchai,3 Nattaporn Apisiridej,4 Thawanrat Srichan,5 Ruk Ruktrakul,5 Sirina Satthapisit,6 Daochompu Nakawiro,7 Thanita Hiranyatheb,7 Anakevich Temboonkiat,8 Namtip Tubtimtong,9 Sukanya Rakkhajeekul,9 Boonsanong Wongtanoi,10 Sitthinant Tanchakvaranont,11 Putipong Bookkamana,12 Usaree Srisutasanavong,1 Raviwan Nivataphand,3 Donruedee Petchsuwan4 1Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand; 2Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Kingdom of Thailand; 3Faculty of Medicine, Chulalongkorn University, Bangkok, Kingdom of Thailand; 4Trang Hospital, Trang, Kingdom of Thailand; 5Lampang Hospital, Lampang, Kingdom of Thailand; 6Khon Kaen Hospital, Khon Kaen, Kingdom of Thailand; 7Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Kingdom of Thailand; 8Phramongkutklao Hospital, Bangkok, Kingdom of Thailand; 9Faculty of Medicine Naresuan University, Pitsanulok, Kingdom of Thailand; 10Srisangwal Hospital, Mae Hong Son, Kingdom of Thailand; 11Queen Savang Vadhana Memorial Hospital, Chonburi, Kingdom of Thailand; 12Faculty of Science, Chiang Mai University, Chiang Mai, Kingdom of Thailand Purpose: Whether self-reporting and clinician-rated depression scales correlate well with one another when applied to older adults has not been well studied, particularly among Asian samples. This study aimed to compare the level of agreement among measurements used in assessing major depressive disorder (MDD) among the Thai elderly and the factors associated with the differences found. Patients and methods: This was a prospective, follow-up study of elderly patients diagnosed with MDD and receiving treatment in Thailand. The Mini International Neuropsychiatric Inventory (MINI), 17-item Hamilton Depression Rating Scale (HAMD-17), 30-item Geriatric Depression Scale (GDS-30), 32-item Inventory of Interpersonal Problems scale, Revised Experience of Close Relationships scale, ten-item Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support were used. Follow-up assessments were conducted after 3, 6, 9, and 12 months. Results: Among the 74 patients, the mean age was 68±6.02 years, and 86% had MDD. Regarding the level of agreement found between GDS-30 and MINI, Kappa ranged between 0.17 and 0.55, while for Gwet's AC1 the range was 0.49 to 0.91. The level of agreement was found to be lowest at baseline, and increased during follow-up visits. The correlation between HAMD-17 and GDS-30 scores was 0.17 (P=0.16) at baseline, then 0.36 to 0.41 in later visits (P<0.01). The PSS-10 score was found to be positively correlated with GDS-30 at baseline, and predicted the level of disagreement found between the clinicians and patients when reporting on MDD. Conclusion: The level of agreement between the GDS, MINI, and HAMD was found to be different at baseline when compared to later assessments. Patients who produced a low GDS score were given a high rating by the clinicians. An additional self-reporting tool such as the PSS-10 could, therefore, be used in such under-reporting circumstances. Keywords: late-life depression, measurement, correlatio