The impact of fatigue and energy on work functioning and impairment in patients with major depressive disorder treated with desvenlafaxine

A longitudinal study of distress symptoms and work impairment in immune-mediated inflammatory diseases

OBJECTIVE

We investigated the association between distress symptoms (pain, fatigue, depression, anxiety) and work impairment in four patient populations: multiple sclerosis (N = 107), rheumatoid arthritis (N = 40), inflammatory bowel disease (N = 136) and psychiatric disorders (N = 167).

METHODS

Four waves of data collection were completed over three years. The relationship between distress symptoms and overall work impairment was evaluated with univariate and multivariable quantile logistic regression at the 25th, 50th and 75th percentiles. Models were fit to participant average scores and change scores on distress symptom measures. Covariates included sociodemographic factors, comorbidity, physical disability and cognitive function.

RESULTS

In the primary univariate analyses of overall work impairment at the 50th percentile, greater severity of distress symptoms was associated with greater work impairment: pain (average β = 0.27, p < 0.001; change β = 0.08, p < 0.001), fatigue (average β = 0.21, p < 0.001; change β = 0.09, p < 0.001) depression (average, β = 0.35, p < 0.001; change, β = 0.16, p < 0.001), anxiety (average, β = 0.24, p < 0.001; change, β = 0.08, p < 0 0.01). Findings were similar in multivariable analyses.

CONCLUSION

Pain, fatigue, depression, and anxiety symptoms are important determinants of work impairment in persons with immune-mediated diseases and persons with psychiatric disorders. Successful clinical management of these symptoms has potential to improve work-related outcomes across IMIDs.

Patient-Reported Outcome Measures in Mental Health Clinical Research: A Descriptive Review in Comparison with Clinician-Rated Outcome Measures

PURPOSE

To review how patient-reported outcomes measures in mental health clinical research complement traditional clinician-rated outcomes measures.

DATA SOURCES

Medline, Embase, PsycInfo and Scopus.

STUDY SELECTION

Latest update of the literature search was conducted in August 2019, using a specified set of search terms to identify controlled and uncontrolled studies (published since 1996) of pharmacological or non-pharmacological interventions in adults (≥18 years) in hospital-based mental health care.

DATA EXTRACTION

Two authors extracted data independently using a pre-designed extraction form.

RESULTS OF DATA SYNTHESIS

Among the 2962 publications identified, 257 were assessed by full text reading. A total of 24 studies reported in 26 publications were included in this descriptive review. We identified subjective and objective outcome measures, classified these according to the pharmacopsychometric triangle and compared them qualitatively in terms of incremental information added to the clinical study question. The data reviewed here from primarily depression and schizophrenia intervention studies show that results from patient-reported outcome measures and clinician-rated outcome measures generally point in the same direction. There was a relative lack of patient-reported outcome measures on functioning and medication side effects compared with patient-reported outcome measures on symptom burden and health-related quality of life.

CONCLUSION

Patient-reported outcomes and clinician-rate outcomes supplement each other and at most times support identical study conclusions. Future studies would benefit from a more systematic approach towards use of patient-reported outcomes and a clearer rationale of how to weigh and report the results in comparison with clinician-rated outcomes.

Subjective Cognitive Decline Below and Above the Age of 60: A Multivariate Study on Neuroimaging, Cognitive, Clinical, and Demographic Measures

Subjective cognitive complaints in cognitively normal individuals are a relevant predictor of Alzheimer's disease (AD), cerebrovascular disease, and age-related tauopathy. Complaints starting after the age of 60 increase the likelihood of preclinical AD. However, this criterion is arbitrary and current data show that neurodegenerative disorders likely start before that age. Further, data on the role of subjective complaints below the age of 60 in individuals qualifying for subjective cognitive decline (SCD) are lacking. We investigated the association of subjective cognitive complaints with an extensive number of neuroimaging, demographic, clinical, and cognitive measures in individuals fulfilling criteria for SCD below and above the age of 60. Nine complaints were scored in 416 individuals. Complaints were related to a higher load of white matter signal abnormalities, and this association was stronger the more subclinical changes in personality, interest, and drive were reported. In individuals <60 years, complaints were associated with lower global cognitive performance. In individuals ≥60 years, complaints were related to greater global brain atrophy and smaller total intracranial volume, and this association was stronger the more subclinical difficulties in activities of daily living were reported. Also, complaints were associated with increased depressive symptomatology irrespective of age. We conclude that complaints below the age of 60 may be associated with subtle signs of brain pathology. In the community, screening for risk of future cognitive decline should include subjective cognitive complaints, depressive symptomatology, and subclinical reduced cognition (<60 years)/activities of daily living (≥60 years), supported by basic neuroimaging examinations.

Reductions in Fatigue Predict Occupational Re-engagement in Individuals with Work-Related Musculoskeletal Disorders

Background Symptoms of fatigue have been shown to be associated with heightened levels of disability in patients suffering from a wide range of debilitating health and mental health conditions. The role of fatigue as a determinant of work disability in individuals with work-related musculoskeletal disorders (WRMD) has received little attention. The present study examined the role of fatigue as a determinant of work-disability in individuals with WRMDs. Methods Participants included 117 individuals with WRMDs who completed measures of pain severity, fatigue, depression and disability before and after participating in a behavioral activation rehabilitation intervention. Results Cross-sectional analyses on pre-treatment measures revealed that fatigue contributed significant variance to the prediction of self-reported disability, beyond the variance accounted for by pain severity and depression. Prospective analyses revealed that reductions in fatigue through the course of treatment predicted occupational re-engagement following termination of the intervention. Conclusions The results of the present study suggest fatigue contributes to occupational disability, independent of the effects of pain and depression. The findings also suggest that meaningful reductions in fatigue might be achieved through psychosocial interventions that promote gradual re-integration into discontinued activities, increase participants' exposure to success and achievement experiences, and reduce the severity of depressive symptoms. Behavioural activation interventions such as the one used in the present study might contribute to more positive occupational outcomes in work-disabled individuals who report high levels of fatigue.

Moxibustion at 'Danzhong' (RN17) and 'Guanyuan' (RN4) for fatigue symptom in patients with depression: Study protocol clinical trial (SPIRIT Compliant)

BACKGROUND

Fatigue is one of the most prevalent and debilitating symptoms of major depressive disorder (MDD). The effective management of depression-related fatigue has an important impact on the patient's abilities, functioning, and quality of life (QOL). Moxibustion has been widely used in Traditional Chinese Medicine to manage fatigue. Recent studies have also demonstrated that moxibustion is effective for treating cancer-related fatigue and chronic fatigue syndrome. However, there is not sufficient data supporting the effect of moxibustion for depression-related fatigue. Therefore, this randomized, assessor-blinded, wait-list controlled trial is designed to evaluate the effectiveness, safety, and feasibility of moxibustion treatment for depression-related fatigue.

METHODS

One hundred and seventy-six participants who meet the diagnostic criteria for depression in the International Classification of Diseases, tenth revision (ICD-10), and who also have a score of ≥1 on the 13 item of the Hamilton Depression Rating Scale-17 (HAMD-17), will be enrolled. At study entry, participants will undergo anti-depressant treatment for at least 1 month. Then those who still have a score of ≥1 on the 13 item of the HAMD-17 will be randomly allocated to either a moxibustion group or wait-list control group in a ratio of 1:1. Anti-depressants will be provided for both groups during the whole process of the study period. Participants in the moxibustion group will undergo 14 sessions of moxibustion (over 2 weeks) with anti-depressant treatment, and participants in the wait-list control group will receive only anti-depressant treatment. Subsequently, participants in the moxibustion group will be followed-up for 4 weeks. The primary outcome measure will be the Fatigue Severity Scale (FSS). The secondary outcome measure will be the HAMD-17. Safety will be assessed by monitoring adverse events during the study. Trial feasibility will also be assessed in this study.

DISCUSSION

The results of this study may provide evidence for the efficacy of moxibustion as an adjunct to antidepressants for depression-related fatigue, and promote a more widespread foundation for the selection of moxibustion in the clinical setting as well as for future research in moxibustion therapy.

TRIAL REGISTRATION

This study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR1800016905).