Early Improvement in Psychosocial Function Predicts Longer-Term Symptomatic Remission in Depressed Patients

<div><p>The goal of this study was to evaluate the relationship between early change in psychosocial function independent of depression severity and longer-term symptomatic remission. Participants of Combining Medications to Enhance Depression Outcomes trial were randomly selected for model selection (n = 334) and validation (n = 331). Changes in psychosocial function (Work and Social Adjustment Scale, WSAS) from baseline to week 6 were assessed and two data-driven sub-groups of WSAS change were identified in the randomly selected model selection half. Results of analyses to predict symptomatic remission at 3 and 7 months were validated for these sub-groups in the second half (validation sample). From baseline to week 6, psychosocial function improved significantly even after adjusting for depression severity at each visit and select baseline variables (age, gender, race, ethnicity, education, income, employment, depression onset before age 18, anxious features, and suicidal ideation), treatment-arm, and WSAS score. The WSAS change patterns identified two (early improvement and gradual change) subgroups. After adjusting for baseline variables and remission status at week 6, participants with early improvement in the second half (validation sample) had greater remission rates than those with gradual change at both 3 (3.3 times) and 7 months (2.3 times) following acute treatment initiation. In conclusion, early improvement in psychosocial function provides a clinically meaningful prediction of longer-term symptomatic remission, independent of depression symptom severity.</p></div

Parameters of selected model of change in WSAS during the first 6 weeks of CO-MED trial.

<p>Parameters of selected model of change in WSAS during the first 6 weeks of CO-MED trial.</p

Psychosocial function of validation sample participants (n = 331) during CO-MED trial.

<p>Sub-groups (early improvement and gradual change) of participants with different trajectories of Work and Social Adjustment Scale (WSAS) change were identified using latent class analyses during the first 6 weeks (marked by vertical line). Score of WSAS greater than 10 suggest significant functional impairment [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0167901#pone.0167901.ref038" target="_blank">38</a>] (horizontal line). * Continuation Phase was limited to CO-MED trial participants who had a clinical response.</p

Model fit estimates of latent class analyses of WSAS change in the model selection sample (n = 334).

<p>Model fit estimates of latent class analyses of WSAS change in the model selection sample (n = 334).</p

Baseline sociodemographic and clinical characteristics of participants in CO-MED trial.

<p>Baseline sociodemographic and clinical characteristics of participants in CO-MED trial.</p

The final two sub-group model of WSAS change during first 6 weeks of the CO-MED trial.

<p>A. Estimated means of the two sub-groups, gradual change (solid line) and early improvement (broken line or dash), identified by latent class analysis of Work and Social Adjustment Scale (WSAS) changes during the first 6 weeks of the Combining Medications to Enhance Depression Outcomes (CO-MED) trial. B. Estimated mean along with observed values of 20 randomly selected participants from early improvement sub-group of the validation sample (n = 331). C. Estimated mean along with observed values of 20 randomly selected participants from gradual change sub-group of the validation sample (n = 331).</p