Functional impact of depression

The day-to-day disability of depression

Depression is a clinically heterogeneous condition, with a widely underestimated variety of symptoms spanning emotional, physical and cognitive domains.1,2 Dysfunction across domains of cognition in depression can contribute to wider functional impairments in daily life.3 In fact, depression is ranked as the leading cause of disability worldwide, and is also a major contributor to the global burden of disease.4 Functional disability in daily activities is one of the most important consequences of depression, yet it is also one of the least well understood.3

Depression can increase both absenteeism and presenteeism in the workplace.5  

Depression impacts people in the workplace, increasing both presenteeism (loss of productivity due to attendance despite illness) and absenteeism (failure to attend work due to illness), which in severe cases can result in cessation of employment.5 Abilities to maintain household responsibilities and manage finances can also decline, in addition to a reduction in the quantity and quality of social relationships and community ties.3

The impact of cognition on depressive course
The cognitive symptoms of depression also affects the course of a patient’s condition, and has been associated with earlier onset of depression, longer episode duration and increased risk of relapse.3,6–8 The link between cognitive symptoms and risk of relapse is of particular importance, with one study showing that more than 75% of patients with residual cognitive symptoms relapsed within 10 months of achieving ‘remission’.9 This, coupled with the functional impact of depression, creates a cyclic association between onset of symptoms, functional impairment, and relapse:10–19

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Health Disorders. 5th Washington, DC: American Psychiatric Association; 2013.
  2. Jarema M et al. Psychiatr Pol 2014; 48(6): 1105–1116.
  3. Jaeger J et al. Psychiatry Res 2006; 145(1): 39–48.
  4. Depression Factsheet. WHO. Available at: Accessed August 2015.
  5. Lerner D, Henke RM. J Occup Environ Med 2008; 50(4): 401–410.
  6. Papakostas GI. J Clin Psychiatry 2014; 75(1): 8–14.
  7. Trivedi MH et al. J Affect Discord 2014; 152-154: 19–27.
  8. Majer M et al. Psychol Med 2004; 34(8): 1453–63.
  9. Paykel ES et al. Dialogues Clin Neurosci 2008; 10: 431–437.
  10. Hammar A, Ardal G. Front Hum Neurosci. 2009; 3: 26.
  11. Ebert B et al. ECNP Poster 2015.
  12. Airaksinen et al. Acta Psychiatr Scand 2007; 115(6): 458-465.
  13. Papakostas. J Clin Psychiatry 2014; 75(1): 8-14.
  14. Conradi et al. Psychol Med 2011; 41(6): 1165-1174.
  15. Nierenberg et al. Psychol Med 2010; 40(1): 41-50.
  16. Preiss et al. Psychiatry Res 2009; 169(3): 235-239
  17. Rush AJ, Beck AT. Am J Psychother. 1978; 32(2): 201-219.
  18. Greer TL et al. CNS Drugs. 2010; 24(4): 267-284.
  19. Withall A et al. Psychol Med. 2009; 39(3): 393-402
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