Author
CABELLO Maria; et al.;
Title
Psychosocial features of depression: a systematic literature review.
Journal citation/publication details
Journal of Affective Disorders, 141(1), December 2012, pp.22-33.
Summary
One-hundred-and-three observational studies and intervention trials were selected for inclusion in this review. A wide range of psychosocial difficulties are examined using the WHO ICF (International Classification of Functioning, Disability and Health) model. The main aim was to provide a general overview (only psychosocial difficulties reported in at least 10% of the studies are included in the analysis) and to test the value of the ICF construct as a means of looking at the importance of psychosocial difficulties in the lives of people with depression, which was confirmed.
Context
Psychosocial difficulties (PSDs) are a core experience of depression that is yet to be fully investigated. They include limitations in an individual’s mental capacities as well as social interactions in work, family life and leisure activities. The aim of this study was to examine the course, onset and determinants of psychosocial difficulties in people with depression using the WHO International Classification of Functioning, Disability and Health (ICF) as a reference and standard. The study is part of the PARADISE project, an investigation into the degree of commonality in psychosocial difficulties across a range of neuropsychiatric disorders.
Methods
What sources were searched?
Searches were conducted in the electronic databases Medline and PsycINFO between 1 January 2005 and 19 May 2010.
What search terms/strategies were used?
Thesaurus terms for depression, customised to each database, were combined with a broad range of keywords for psychosocial difficulties. All the search terms employed are listed, but specific search strategies are not. Searches were limited to articles published in English.
What criteria were used to decide on which studies to include?
Studies of participants with major depressive disorder, double depression, or minor depression, diagnosed using a standardised tool, were eligible for inclusion. The following study designs were acceptable: randomised controlled trials, controlled clinical trials, open intervention trials, longitudinal observational studies, and qualitative studies. Studies of participants with depression as a secondary diagnosis, or including only young people under 18 years of age, were excluded.
Who decided on their relevance and quality?
Articles were initially selected by examination of the abstracts. Two named reviewers screened a randomly selected sample of 20% of the abstracts to examine the rate of agreement which was found to be =.80, expressed by Kappa of Cohen. Study quality was assessed by the first author using the National Institute for Mental Health and Clinical Excellence guidelines 2009. The level of evidence of the results was graded using an adaptation of the method of Van Tulder, 2000, and rated from I to IV (where I indicates a strong level of evidence and IV suggests conflicting evidence).
How many studies were included and where were they from?
The electronic database search produced a total of 1,090 studies. Following a review of the abstracts, 347 were selected for further examination; 103 papers fulfilled the inclusion criteria and 98 were subsequently included in the review. The country settings of the studies are not reported.
How were the study findings combined?
Data was extracted from the studies and subjected to a narrative synthesis. Psychosocial difficulties were grouped into broad categories based on ICF classification, and then grouped by similarity of content. The results are discussed under the two main components of ICF, namely body functions and, activity and participation factors. Findings are restricted to the psychosocial difficulties reported in at least 10% of the studies. Full data is available on request.
Findings of the review
The majority of studies were either intervention trials (46%) or observational studies (45%); sample size ranged from four to over 17,000. The most commonly reported psychosocial categories were: emotional function problems, energy and drive functioning problems, pain, cognitive problems, relationship with people, community life problems, and work problems. Overall, the quality of the studies was deemed “not very high” and the level of evidence was “limited in many cases”.
In terms of the onset of psychosocial difficulties, there was some evidence that neuroticism, spousal relationships, leisure activities, and work problems may already be impaired before depression although there was also evidence that depression may be a cause of these problems as well as a determinant of onset of difficulties, such as lower physical fitness.
Most studies reported that psychosocial difficulties were reduced over time, except for areas such as feelings of stress, executive functions, lack of confidence, feelings of guilt, appetite and libido problems. Determinants of psychosocial difficulties were found to be linked to diagnostic features of the health condition and were also themselves determined by personal and environmental factors. The latter also maintain, relieve, or enhance the development of psychosocial difficulties over time. Medication was found to play a dual role as a determinant of onset, as well as a determinant of improvement of some difficulties. On the other hand comorbidity, depressive symptoms, and clinical severity of depressive symptoms were always reported to have a negative effect on all psychosocial difficulties.
Authors' conclusions
The review shows “the value of the ICF construct as a reference structure for understanding the importance of PSDs in the lived experience of depression, as well as the need to consider environmental and personal factors when investigating the onset and determinants of the course of PSDs”. It is also “useful in identifying the principal PSDs associated with depression as reported in the recent literature”.
Implications for policy or practice
None are discussed.