Functional impairment in patients with major depressive disorder: the 2-year PERFORM study

Figures & data

Figure 1 Changes from baseline to month 24 in: (A) SDS total score (range 0–30), (B) WPAI absenteeism and presenteeism scores (range 0–100), (C) PHQ-9 total score (range 0–27), and (D) PDQ-5 total score (range 0–20; analyzable population; N=1,159).

Notes: Data are mean ± standard error; higher scores indicate worse outcomes.
Abbreviations: PDQ-5, five-item Perceived Deficit Questionnaire; PHQ-9, nine-item Patient Health Questionnaire; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.

Table 1 Factors associated with functional impairment at baseline in the final multivariate analysis

Factora	SDS total score (N=560)	WPAI absenteeism score (N=420)	WPAI presenteeism score (N=372)	WPAI overall work impairment score (N=328)	WPAI activity impairment score (N=704)
Country	**	***	**	*	***
Age (years)	NS	NS	NS	*	*
Sex	NS	NS	NS	NS	NS
Educational level	—	—	*	***	—
Elementary school			−5.52±3.44	−5.09±3.92
High school			−7.83±2.95	−10.43±3.25
Non-university degree			−9.65±3.51	−15.04±3.84
University degree			–	–
Switch of antidepressant	*	—	—	—	*
Switch	1.11±0.56				4.07±1.91
Non-switch	–
At least one other concomitant mental disorder	*	—	*	—	—
Yes	1.40±0.63		7.68±3.70
No	–		–
Chronic fatigue	—	—	*	**	—
Yes			8.06±3.64	12.09±4.27
No			–	–
Sick leave within the past 12 months before baseline	**	***	—	**	—
Yes	1.29±0.48	33.70±3.68		8.44±2.90
No	–	–		–
PHQ-9 total score	***	***	***	***	***
0–4	−17.30±2.35	−31.27±20.83	−44.89±11.33	−49.50±13.60	−55.28±9.09
5–9	−9.59±0.96	−26.58±6.78	−24.36±4.62	−28.47±5.19	−31.68±3.37
10–14	−5.58±0.68	−17.56±4.96	−15.53±3.63	−16.32±4.05	−23.54±2.43
15–19	−3.21±0.54	−7.20±4.16	−1.85±2.88	1.17±3.26	−10.84±1.87
20–27	–	–	–	–	–
PDQ-5 score	***	—	***	***	***
0–7	−5.32±0.77		−23.98±3.98	−20.21±4.41	−14.55±2.70
8–11	−2.67±0.64		−10.32±3.49	−7.12±3.90	−8.87±2.25
12–14	−2.15±0.60		−11.78±3.41	−9.87±3.78	−6.24±2.11
15–20	–		–	–	–

Notes: Coefficient (± standard error) is given. Factors with P<0.2 in the univariate ANOVA were retained in the multivariate ANCOVA (final model). Factors highlighted in gray are those forced in the multivariate analysis; — indicates that the factor listed was either not included or not kept in the final model for that outcome; – indicates reference category.

* P<0.05;

** P<0.01;

*** P<0.001.

a Baseline characteristic unless otherwise stated.

Abbreviations: ANCOVA, analyses of covariance; ANOVA, analyses of variance; NS, not significant; PDQ-5, five-item Perceived Deficit Questionnaire; PHQ-9, nine-item Patient Health Questionnaire; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.

Table 4 Factors associated with functional impairment at months 18 and 24 combined in the final multivariate analysis (MMRM)

Factora	SDS total score (N=621)b	WPAI absenteeism score (N=518)b	WPAI presenteeism score (N=459)b	WPAI overall work impairment score (N=403)b	WPAI activity impairment score (N=804)b
Country	NS	NS	NS	NS	NS
Age (years)	NS	NS	NS	NS	NS
Sex	NS	NS	NS	NS	NS
Chronic pain or fibromyalgia	**	—	—	*	*
Yes	2.56±0.85			7.05±3.46	5.34±2.60
No	–			–	–
Suicide attempt before baseline or between baseline and month 2	—	—	—	—	*
Yes					10.66±4.20
No					–
PHQ-9 total score at month 2	***	NS	***	***	***
0–4	−9.75±1.65		−33.89±5.83	−19.41±7.24	−33.31±5.20
5–9	−8.20±1.26		−26.69±4.22	−17.51±5.38	−28.23±3.95
10–14	−7.09±1.20		−22.81±4.22	−10.61±5.32	−24.03±3.75
15–19	−3.14±1.18		−10.18±4.42	−0.17±5.17	−13.36±3.63
20–27	–		–	–	–
PDQ-5 score at month 2	***	—	—	*	***
0–7	−4.60±1.20			−9.59±4.53	−15.72±3.67
8–11	−3.10±1.10			−8.42±4.14	−10.27±3.32
12–14	−1.66±1.05			−1.09±4.09	−4.61±3.15
15–20	–			–	–

Notes: Coefficient (± standard error) is given. Factors with P<0.2 in the univariate ANOVA were retained in the multivariate ANCOVA (final model). Factors highlighted in gray are those forced in the multivariate analysis; — indicates that the factor listed was either not included or not kept in the final model for that outcome; – indicates reference category.

* P<0.05;

** P<0.01;

*** P<0.001.

a Baseline characteristic unless otherwise stated.

b Sum of the number of patients at the two visits.

Abbreviations: ANCOVA, analyses of covariance; ANOVA, analyses of variance; MMRM, mixed model for repeated measurements; NS, not significant; PDQ-5, five-item Perceived Deficit Questionnaire; PHQ-9, nine-item Patient Health Questionnaire; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.

Table 2 Factors associated with functional impairment at month 2 in the final multivariate analysis

Factora	SDS total score (N=428)	WPAI absenteeism score (N=299)	WPAI presenteeism score (N=295)	WPAI overall work impairment score (N=251)	WPAI activity impairment score (N=582)
Country	NS	NS	**	*	NS
Age (years)	NS	NS	*	**	NS
Sex	*	NS	NS	NS	NS
At least one other concomitant mental disorder	—	—	**	*	—
Yes			9.42±3.65	10.89±4.34
No			–	–
Hospitalization for depression between baseline and month 2	—	*	—	—	—
Yes		33.60±15.22
No		–
Sick leave within the past 12 months before baseline or at baseline or between baseline and month 2	*	***	—	—	—
Yes	1.15±0.53	17.84±3.98
No	–	–
CGI-S score at month 2	***	*	—	—	*
1–3	−3.88±0.88	−17.79±6.95			−6.61±2.76
4	−2.40±0.87	−14.63±7.05			−4.03±2.74
5–7	–	–			–
PHQ-9 total score at month 2	***	NS	***	***	***
0–4	−13.04±1.42		−39.45±6.29	−36.35±7.34	−46.03±4.14
5–9	−8.63±1.02		−24.00±4.69	−21.95±5.53	−29.08±3.11
10–14	−6.14±0.93		−13.92±4.54	−15.05±5.32	−18.97±2.87
15–19	−1.96±0.88		−4.51±4.53	−5.12±5.39	−9.24±2.77
20–27	–		–	–	–
PDQ-5 score at month 2	***	*	***	***	***
0–7	−6.34±0.91	−20.79±6.94	−25.39±4.05	−24.96±4.67	−22.88±2.84
8–11	−2.88±0.83	−14.53±6.05	−18.59±3.66	−19.16±4.15	−13.30±2.57
12–14	−2.26±0.77	−8.08±5.77	−10.14±3.51	−7.16±4.06	−9.19±2.38
15–20	–	–	–	–	–

Notes: Coefficient (± standard error) is given. Factors with P<0.2 in the univariate ANOVA were retained in the multivariate ANCOVA (final model). Factors highlighted in gray are those forced in the multivariate analysis; — indicates that the factor listed was either not included or not kept in the final model for that outcome; – indicates reference category.

* P<0.05;

** P<0.01;

*** P<0.001;

a Baseline characteristic unless otherwise stated.

Abbreviations: ANCOVA, analyses of covariance; ANOVA, analyses of variance; CGI-S, Clinical Global Impression–Severity of illness scale; NS, not significant; PDQ-5, five-item Perceived Deficit Questionnaire; PHQ-9, nine-item Patient Health Questionnaire; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.

Table 3 Factors associated with functional impairment at months 6 and 12 combined in the final multivariate analysis (MMRM)

Factora	SDS total score (N=703)b	WPAI absenteeism score (N=471)b	WPAI presenteeism score (N=504)b	WPAI overall work impairment score (N=431)b	WPAI activity impairment score (N=921)b
Country	*	NS	NS	NS	***
Age (years)	NS	NS	NS	NS	NS
Sex	*	NS	***	*	NS
Chronic pain or fibromyalgia	*	—	*	**	—
Yes	1.71±0.73		6.48±2.97	9.91±3.52
No	–		–	–
Suicide attempt before baseline or between baseline and month 2	NS	—	—	—	—
Sick leave within the past 12 months before baseline or at baseline or between baseline and month 2	—	**	—	—	—
Yes		6.87±2.60
No		–
CGI-S score at month 2	***	—	—	—	*
1–3	−3.64±0.95				−8.07±3.05
4	−2.90±0.95				−3.56±3.03
5–7	–				–
PHQ-9 total score at month 2	***	***	***	***	***
0–4	−10.66±1.47	−31.58±5.71	−32.27±5.94	−26.64±6.76	−33.92±4.57
5–9	−8.43±1.13	−28.68±4.43	−21.52±4.60	−17.45±5.37	−31.45±3.42
10–14	−6.15±1.04	−27.11±4.39	−12.31±4.43	−8.20±5.16	−23.18±3.15
15–19	−3.15±1.02	−21.57±4.60	−9.74±4.39	−4.54±5.31	−10.66±3.11
20–27	–	–	–	–	–
PDQ-5 score at month 2	***	—	**	**	***
0–7	−5.97±1.04		−15.54±4.10	−16.57±4.64	−15.41±3.19
8–11	−3.06±0.92		−10.86±3.64	−10.23±4.16	−8.49±2.83
12–14	−3.06±0.88		−8.52±3.56	−7.70±4.05	−8.12±2.66
15–20	–		–	–	–

Notes: Coefficient (± standard error) is given. Factors with P<0.2 in the univariate ANOVA were retained in the multivariate ANCOVA (final model). Factors highlighted in gray are those forced in the multivariate analysis; — indicates that the factor listed was either not included or not kept in the final model for that outcome; – indicates reference category.

* P<0.05;

** P<0.01;

*** P<0.001.

a Baseline characteristic unless otherwise stated.

b Sum of the number of patients at the two visits.

Abbreviations: ANCOVA, analyses of covariance; ANOVA, analyses of variance; CGI-S, Clinical Global Impression–Severity of illness scale; MMRM, mixed model for repeated measurements; NS, not significant; PDQ-5, five-item Perceived Deficit Questionnaire; PHQ-9, nine-item Patient Health Questionnaire; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.