Cognitive impairment as measured by the THINC-integrated tool (THINC-it): Association with psychosocial function in major depressive disorder

Danielle S Cha; Nicole E Carmona; Mehala Subramaniapillai; Rodrigo B Mansur; Yena Lee; Jae Hon Lee; JungGoo Lee; Joshua D Rosenblat; Margarita Shekotikhina; Caroline Park; Carola Rong; Tracy L Greer; Raymond Lam; Bernhard T Baune; John Harrison; Roger S McIntyre

doi:10.1016/j.jad.2017.06.036

Cognitive impairment as measured by the THINC-integrated tool (THINC-it): Association with psychosocial function in major depressive disorder

J Affect Disord. 2017 Nov:222:14-20. doi: 10.1016/j.jad.2017.06.036. Epub 2017 Jun 23.

Authors

Danielle S Cha¹, Nicole E Carmona¹, Mehala Subramaniapillai¹, Rodrigo B Mansur¹, Yena Lee², Jae Hon Lee³, JungGoo Lee⁴, Joshua D Rosenblat², Margarita Shekotikhina¹, Caroline Park¹, Carola Rong⁵, Tracy L Greer⁶, Raymond Lam⁷, Bernhard T Baune⁸, John Harrison⁹, Roger S McIntyre¹⁰

Affiliations

¹ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
² Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
³ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Psychiatry, Samsung Seoul Hospital, Sungkyunkwan University, School of medicine, Seoul, Republic of Korea.
⁴ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea.
⁵ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; American University of Integrative Sciences, School of Medicine, Sint Maarten.
⁶ Associate Professor, Center for Depression Research and Clinical Care, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁷ Associate Head for Research, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Director, Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada; Executive Chair, Canadian Network for Mood and Anxiety Treatments (CANMAT), Vancouver, BC, Canada.
⁸ Professor and Chair, Head of Discipline of Psychiatry, University of Adelaide, Adelaide, Australia.
⁹ Associate Professor, Alzheimer Center, VU Medical Center, Amsterdam, The Netherlands; Principal Consultant, Metis Cognition Ltd., Warminster, UK.
¹⁰ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Professor, Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Professor, Department of Pharmacology, University of Toronto, Toronto, ON, Canada. Electronic address: Roger.McIntyre@uhn.ca.

PMID: 28667888
DOI: 10.1016/j.jad.2017.06.036

Abstract

Background: Psychosocial impairment represents an important treatment target in major depressive disorder (MDD). The majority of patients with MDD do not regain premorbid levels of psychosocial functioning despite the resolution of core depressive symptoms. This study aimed to investigate the respective effects of cognitive function and depression severity on impaired psychosocial function in MDD.

Methods: Adults aged 18-65 with moderate-to-severe MDD (n = 100) and age-, sex-, and education-matched healthy controls participated in a cross-sectional study validating the THINC-integrated tool (THINC-it), a cognitive screening tool comprised of objective and subjective measures of cognitive function. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale and psychosocial function was assessed using the Sheehan Disability Scale (SDS).

Results: Subjects with MDD reported greater impairment in psychosocial function than healthy controls, with significant differences in SDS total and domain scores (ps < .01) after controlling for age, sex, and education. Generalized linear models indicated that subjective cognitive function was most strongly associated with SDS total score (RR = .14, p = .01) and SDS domains of work/school (RR = .15, p = .03), family and home responsibilities (RR = .15, p = .02), and economic days lost (RR = .18, p =.03). Depression severity was most strongly associated with SDS social life (RR = .08, p < .01) and economic days underproductive (RR = .07, p < .01). Objective cognitive function was not significantly associated with any SDS outcomes.

Limitations: The cross-sectional, observational study design limits temporal inferences. The self-report nature of measures included may have influenced associations observed. Potential medication effects are not noted.

Conclusions: Cognitive deficits, as measured by the THINC-it, are associated with significant psychosocial impairment in MDD. These results provide empirical support for the assessment of both subjective and objective measures of cognition, as they are not associated with each other and have differential effects on functional trajectory.

Keywords: Cognition; Major depressive disorder; Measurement-based care; Psychosocial impairment.

MeSH terms

Adolescent
Adult
Aged
Cognition Disorders / diagnosis
Cognitive Dysfunction / diagnosis*
Cognitive Dysfunction / psychology
Cross-Sectional Studies
Depression / diagnosis
Depressive Disorder, Major / diagnosis*
Depressive Disorder, Major / psychology
Female
Humans
Male
Middle Aged
Neuropsychological Tests
Self Report
Social Behavior