Impact of Cognitive Symptoms on Health-Related Quality of Life and Work Productivity in Chinese Patients with Major Depressive Disorder: Results from the PROACT Study

Figures & data

Table 1 Baseline Patient Demographics and Clinical Characteristics

Characteristic	Patients with MDD (n=986)
Age (years), mean (SD)	35.9 (12.0)
Female sex, % (n)	68.5 (675)
Region in China, % (n)
North	56.9 (561)
South	6.8 (67)
East	17.5 (173)
West	18.8 (185)
Residential area, % (n)
Urban	82.2 (810)
Rural	17.8 (176)
Employed, % (n)	57.0 (562)
Educational level, % (n)
Middle school or lower	23.3 (230)
High school or junior college	31.7 (313)
University or postgraduate	44.9 (443)
Clinical history, % (n)
Previous episode	39.2 (387)
Switching antidepressant at baseline	20.6 (203)
Baseline assessment scores, mean (SD)
HAM-D17 total score	23.2 (4.4)
PHQ-9 total score	16.7 (5.8)
DSST	50.7 (16.8)
PDQ-D total score	33.6 (16.3)
EQ-5D utility index	0.74 (0.14)
SDS absenteeism (work days lost)	2.0 (2.5)
SDS presenteeism (work days underproductive)	3.7 (2.5)
WPAI absenteeism (%)	26.3 (35.7)
WPAI presenteeism (%)	54.5 (26.8)
PDQ-D quartile, % (n)
0–20	24.0 (231)
21–32	25.7 (247)
33–44	24.9 (239)
45–80	25.4 (244)
Missing (n)	25
DSST subgroup, % (n)
Within norm	45.4 (445)
⅓–⅔ SD below norm	13.3 (130)
⅔–1 SD below norm	10.9 (107)
≥1 SD below norm	30.5 (299)
Missing (n)	5
DSST quartile, % (n)
0–37	23.8 (233)
38–51	25.0 (245)
52–62	25.9 (254)
63–133	25.4 (249)
Missing (n)	5

Abbreviations: DSST, Digit Symbol Substitution Test; EQ-5D, EuroQol 5-Dimensions Questionnaire; HAM-D₁₇, 17-item Hamilton Depression Rating Scale; MDD, major depressive disorder; PDQ-D, 20-item Perceived Deficits Questionnaire-Depression; PHQ-9, 9-item Patient Health Questionnaire; SD, standard deviation; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.

Table 2 Association of PDQ-D Total Scores with HRQoL and Work Productivity Scores in Crude and Adjusted^a Analyses

Assessment	Model	PDQ-D Quartiles at Baseline				df	Error df	F	Global P-value	Partial η^2
		0–20	21–32	33–44	45–80
HRQoL	Crude	0.80 (0.78, 0.81)	0.74 (0.73, 0.76)	0.73 (0.72, 0.75)	0.67 (0.66, 0.69)	3	948	33.78	<0.001	0.097
	PHQ-9 adjusted	0.75 (0.74, 0.80)	0.73 (0.72, 0.75)	0.73 (0.72, 0.75)	0.71 (0.69, 0.72)	3	938	4.42	0.004	0.014
	HAM-D17 adjusted	0.78 (0.77, 0.80)	0.73 (0.72, 0.75)	0.74 (0.72, 0.75)	0.68 (0.66, 0.70)	3	942	25.89	<0.001	0.076
SDS absenteeism	Crude	1.52 (1.15, 1.89)	1.85 (1.49, 2.21)	2.33 (1.96, 2.70)	2.40 (2.05, 2.76)	3	724	5.03	0.002	0.020
	PHQ-9 adjusted	2.01 (1.55, 2.46)	2.10 (1.70, 2.50)	2.51 (2.09, 2.93)	2.32 (1.88, 2.76)	3	714	1.21	0.307	0.005
	HAM-D17 adjusted	1.83 (1.41, 2.25)	2.13 (1.73, 2.53)	2.47 (2.05, 2.89)	2.46 (2.05, 2.8)	3	718	2.45	0.063	0.010
SDS presenteeism	Crude	2.60 (2.25, 2.96)	3.55 (3.21, 3.89)	4.06 (3.70, 4.41)	4.37 (4.03, 4.70)	3	718	19.04	<0.001	0.074
	PHQ-9 adjusted	2.87 (2.45, 3.29)	3.44 (3.06, 3.82)	3.79 (3.40, 4.19)	3.75 (3.34, 4.16)	3	708	4.38	0.005	0.018
	HAM-D17 adjusted	2.44 (2.04, 2.84)	3.36 (2.97, 3.74)	3.82 (3.42, 4.23)	4.13 (3.74, 4.52)	3	712	15.69	<0.001	0.062
WPAI absenteeism	Crude	22.81 (16.27, 29.36)	20.12 (13.85, 39.76)	30.36 (23.95, 36.76)	32.05 (26.06, 38.04)	3	489	3.31	0.020	0.020
	PHQ-9 adjusted	29.12 (21.06, 37.19)	21.86 (14.76, 28.95)	32.77 (25.20, 40.34)	30.15 (22.65, 37.65)	3	480	2.09	0.101	0.013
	HAM-D17 adjusted	26.53 (19.05, 34.01)	22.34 (15.30, 29.38)	30.66 (23.15, 38.18)	32.46 (25.38, 39.53)	3	483	1.93	0.124	0.012
WPAI presenteeism	Crude	40.20 (35.46, 44.94)	51.26 (46.72, 55.80)	53.37 (48.60, 58.13)	70.66 (66.3, 74.99)	3	432	30.35	<0.001	0.174
	PHQ-9 adjusted	46.80 (41.35, 52.25)	51.75 (46.94, 56.56)	51.60 (46.34, 56.86)	62.11 (58.89, 67.33)	3	423	6.65	<0.001	0.045
	HAM-D17 adjusted	39.65 (34.30, 45.00)	50.58 (45.51, 55.65)	50.86 (45.32, 56.41)	67.55 (62.29, 72.81)	3	426	24.43	<0.001	0.147

Notes: Data are presented as means with 95% confidence intervals. F statistic, global P-value and partial η² were obtained via Type III sum of squares. ^aAge, sex, residential area and educational level also included as adjustment variables in the adjusted analyses.

Abbreviations: df, degrees of freedom; HAM-D₁₇, 17-item Hamilton Depression Rating Scale; HRQoL, health-related quality of life; PDQ-D, 20-item Perceived Deficits Questionnaire-Depression; PHQ-9, 9-item Patient Health Questionnaire; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.

Table 3 Association of DSST Scores (by Subgroup) with HRQoL and Work Productivity Scores in Crude and Adjusted^a Analyses

Assessment	Model	DSST Subgroup at Baseline				df	Error df	F	Global P-value	Partial η^2
		Within Norm	⅓ to ⅔ SD Below Norm	⅔ to 1 SD Below Norm	1 SD or More Below Norm
HRQoL	Crude	0.75 (0.74, 0.77)	0.73 (0.70, 0.75)	0.74 (0.72, 0.77)	0.71 (0.70, 0.73)	3	965	5.42	0.001	0.017
	PHQ-9 adjusted	0.74 (0.73, 0.76)	0.72 (0.70, 0.74)	0.74 (0.71, 0.76)	0.72 (0.71, 0.74)	3	954	1.72	0.162	0.005
	HAM-D17 adjusted	0.75 (0.73, 0.77)	0.73 (0.70, 0.75)	0.73 (0.71, 0.76)	0.72 (0.71, 0.74)	3	959	2.17	0.090	0.007
SDS absenteeism	Crude	1.97 (1.71, 2.23)	1.89 (1.40, 2.38)	1.99 (1.39, 2.58)	2.20 (1.86, 2.54)	3	737	0.49	0.687	0.002
	PHQ-9 adjusted	2.22 (1.86, 2.58)	2.08 (1.56, 2.61)	2.21 (1.59, 2.83)	2.34 (1.96, 2.72)	3	726	0.24	0.870	0.001
	HAM-D17 adjusted	2.22 (1.86, 2.57)	2.10 (1.58, 2.63)	2.25 (1.63, 2.87)	2.31 (1.94, 2.69)	3	731	0.16	0.921	0.0007
SDS presenteeism	Crude	3.75 (3.50, 4.01)	3.60 (3.11, 4.08)	3.29 (2.71, 3.87)	3.65 (3.32, 3.98)	3	732	0.73	0.533	0.003
	PHQ-9 adjusted	3.55 (3.21, 3.89)	3.45 (2.96, 3.95)	3.18 (2.59, 3.76)	3.54 (3.19, 3.89)	3	721	0.52	0.671	0.002
	HAM-D17 adjusted	3.45 (3.10, 3.80)	3.43 (2.92, 3.94)	3.12 (2.51, 3.72)	3.59 (3.23, 3.95)	3	726	0.65	0.583	0.003
WPAI absenteeism	Crude	26.14 (21.64, 30.64)	24.39 (15.79, 32.99)	26.36 (16.60, 36.12)	27.76 (21.77, 33.75)	3	498	0.14	0.936	0.0008
	PHQ-9 adjusted	29.86 (23.41, 36.31)	25.20 (16.10, 34.30)	28.36 (17.96, 38.76)	27.38 (20.62, 34.15)	3	489	0.32	0.814	0.002
	HAM-D17 adjusted	29.30 (22.96, 35.64)	26.98 (17.95, 36.00)	29.04 (18.74, 39.35)	26.24 (19.55, 32.93)	3	492	0.22	0.880	0.001
WPAI presenteeism	Crude	54.93 (51.37, 58.49)	48.95 (41.97, 55.92)	57.92 (50.32, 65.52)	55.17 (50.36, 59.97)	3	440	1.12	0.341	0.008
	PHQ-9 adjusted	53.82 (49.20, 58.44)	47.80 (41.27, 54.32)	56.60 (49.43, 63.76)	53.90 (49.14, 58.66)	3	431	1.41	0.239	0.01
	HAM-D17 adjusted	50.74 (45.68, 55.80)	48.14 (40.91, 55.38)	55.40 (47.48, 63.32)	53.66 (48.41, 58.90)	3	434	0.97	0.409	0.007

Notes: Data are presented as means with 95% confidence intervals. F statistic, global P-value and partial η² were obtained via Type III sum of squares. ^aAge, sex, residential area and educational level also included as adjustment variables in the adjusted analyses.

Abbreviations: df, degrees of freedom; DSST, Digit Symbol Substitution Test; HAM-D₁₇, 17-item Hamilton Depression Rating Scale; HRQoL, health-related quality of life; PHQ-9, 9-item Patient Health Questionnaire; SD, standard deviation; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.

Table 4 Association of DSST Scores (by Quartile) with HRQoL and Work Productivity Scores in Crude and Adjusted^a Analyses

Assessment	Model	DSST Quartile at Baseline				df	Error df	F	Global P-value	Partial η^2
		0–37	38–51	52–62	63–133
HRQoL	Crude	0.71 (0.69, 0.73)	0.73 (0.72, 0.75)	0.75 (0.73, 0.77)	0.75 (0.73, 0.77)	3	965	4.82	0.002	0.015
	PHQ-9 adjusted	0.72 (0.70, 0.74)	0.73 (0.71, 0.75)	0.74 (0.73, 0.76)	0.74 (0.72, 0.76)	3	954	1.40	0.242	0.004
	HAM-D17 adjusted	0.72 (0.70, 0.74)	0.73 (0.71, 0.75)	0.75 (0.73, 0.77)	0.74 (0.72, 0.77)	3	959	1.43	0.233	0.004
SDS absenteeism	Crude	2.05 (1.62, 2.47)	2.05 (1.70, 2.40)	2.14 (1.80, 2.49)	1.88 (1.54, 2.22)	3	737	0.38	0.767	0.002
	PHQ-9 adjusted	2.27 (1.79, 2.75)	2.28 (1.88, 2.67)	2.32 (1.91, 2.73)	2.08 (1.63, 2.54)	3	726	0.32	0.811	0.001
	HAM-D17 adjusted	2.22 (1.74, 2.70)	2.29 (1.90, 2.68)	2.31 (1.90, 2.72)	2.11 (1.66, 2.56)	3	731	0.25	0.860	0.001
SDS presenteeism	Crude	3.55 (3.14, 3.97)	3.37 (3.03, 3.71)	3.72 (3.38, 4.06)	3.95 (3.61, 4.28)	3	732	2.01	0.112	0.008
	PHQ-9 adjusted	3.59 (3.14, 4.04)	3.26 (2.89, 3.64)	3.52 (3.14, 3.91)	3.69 (3.26, 4.11)	3	721	1.10	0.348	0.005
	HAM-D17 adjusted	3.63 (3.16, 4.10)	3.26 (2.87, 3.64)	3.46 (3.06, 3.87)	3.59 (3.15, 4.03)	3	726	0.87	0.456	0.004
WPAI absenteeism	Crude	27.81 (20.43, 35.18)	27.73 (21.61, 33.86)	25.55 (19.71, 31.40)	24.95 (18.88, 31.03)	3	498	0.21	0.891	0.001
	PHQ-9 adjusted	26.58 (18.34, 34.82)	28.45 (21.42, 35.48)	28.13 (21.00, 35.27)	29.28 (21.20, 37.37)	3	489	0.08	0.969	0.0005
	HAM-D17 adjusted	24.27 (16.05, 32.48)	29.35 (22.42, 36.27)	27.97 (20.94, 35.01)	29.86 (21.87, 37.85)	3	492	0.43	0.731	0.003
WPAI presenteeism	Crude	53.82 (47.76, 59.88)	53.68 (48.79, 58.56)	54.48 (49.76, 59.20)	55.87 (51.17, 60.58)	3	440	0.16	0.922	0.001
	PHQ-9 adjusted	54.27 (48.32, 60.21)	53.05 (48.09, 58.01)	52.75 (47.56, 57.95)	52.68 (47.12, 58.24)	3	431	0.06	0.979	0.0004
	HAM-D17 adjusted	53.56 (46.96, 60.16)	52.41 (46.97, 57.85)	50.76 (45.05, 56.47)	50.64 (44.51, 56.77)	3	434	0.20	0.895	0.001

Notes: Data are presented as means with 95% confidence intervals. F statistic, global P-value and partial η² were obtained via Type III sum of squares. ^aAge, sex, residential area and educational level also included as adjustment variables in the adjusted analyses.

Abbreviations: df, degrees of freedom; DSST, Digit Symbol Substitution Test; HAM-D₁₇, 17-item Hamilton Depression Rating Scale; HRQoL, health-related quality of life; PHQ-9, 9-item Patient Health Questionnaire; SDS, Sheehan Disability Scale; WPAI, Work Productivity and Activity Impairment.