Psychopathology and academic performance, social well-being, and social preference at school: the TRAILS study.

Psychopathology during adolescence has been associated with poor academic performance, low social well-being, and low social preference by peers at school. However, previous research has not accounted for comorbid psychopathology, informant-specific associations between psychopathology and functioning, and gender and age differences. This study addresses these limitations by examining adolescents' psychopathology and functioning at school, reported by child, parent, teacher, and peers during primary and secondary school in a large Dutch longitudinal cohort study (N = 2230). Teacher reports of psychopathology, especially regarding attention problems and withdrawn/depressed problems, followed by parent reports regarding hyperactivity, were most strongly associated with academic performance. The same held for social preference which was associated with teacher and parent ratings of withdrawn/depressed problems and hyperactivity. In contrast, social well-being was best predicted by child reports (at primary school) of affective problems. In girls, the association between ADHD problems and poor academic performance was stronger than in boys and conduct problems were more often associated with poor school functioning in general. These findings can help identify adolescents at risk for poor functioning and design interventions that effectively reduce or prevent poor school functioning.

Moderators of the synchrony of change between decreasing depression severity and disability.

OBJECTIVE: To identify moderators of synchrony of change between depression severity and disability. METHOD: From a large cohort study with 2 years of follow-up, patients with major depressive disorder at baseline who decreased at least 25% in depression severity after 2 years (n = 245) were selected. We measured overall and domain-specific disability at baseline, and at 1- and 2-year follow-up. Possible moderators, among which several demographic, clinical, personality, and contextual factors, were measured at baseline. We used linear mixed models to analyze the data. RESULTS: Decrease in depression severity correlated strongly with reductions of overall disability (r = 0.54). Synchrony of change for the disability domains ranged from 0.13 for self-care to 0.47 for participation. From the possible moderators, only age and work stress moderated the association between change in depression severity and disability, with stronger synchrony of change among younger patients and patients who experienced moderate work stress. CONCLUSION: Strong synchrony of change exists between depression severity and disability. Perhaps, because of the strength of this synchrony, few contextual characteristics moderated the association. Clinicians should be aware of the risk of slower or incomplete functional recovery in older people and those without a job or those experiencing low work stress.

Explaining heterogeneity in disability with major depressive disorder: effects of personal and environmental characteristics.

BACKGROUND: Major depressive disorder (MDD) is associated with disability, yet some patients function surprisingly well. The reason for this heterogeneity between patients is unclear. Building on the International Classification of Functioning (ICF) model, this study aims to examine effects of personal and environmental characteristics on disability with MDD, over and above illness characteristics. METHODS: Data were obtained from 573 patients with a current diagnosis of MDD. Three measures for disability were used, varying in objectivity and specificity: 'WHODAS disability', 'days out of role', and 'work absence'. Univariate and stepwise multivariate regression analyses were conducted. RESULTS: WHODAS disability was best explained by the study variables. Illness characteristics were clearly the strongest correlates of WHODAS disability, whereas personal and environmental characteristics were less influential. Personal and, more restrictedly, environmental characteristics were almost equally important to illness characteristics in explaining days out of role and work absence. High conscientiousness, high neuroticism, low level of physical activity, and high work stress were the strongest predictors of disability among MDD patients. LIMITATIONS: Due to the cross-sectional design of the present study we could not draw conclusions about causal relationships between our predictor variables and disability. CONCLUSIONS: Personal characteristics appeared to be almost equally important to illness characteristics in explaining heterogeneity in disability when measured objectively and specifically (i.e., days out of role and work absence). However, personal characteristics turned out to be considerably less important to disability measured in a broad and subjective way (i.e., WHODAS disability). Environmental characteristics appeared to have little impact.

Explaining heterogeneity in disability associated with current major depressive disorder: effects of illness characteristics and comorbid mental disorders.

BACKGROUND: Although major depressive disorder (MDD) is associated with disability, some persons do function well despite their illness. Aim of the present study was to examine the effect of illness characteristics and comorbid mental disorders on various aspects of disability among persons with a current MDD episode. METHODS: Data were derived from 607 participants with a current MDD based on the Composite International Diagnostic Interview (CIDI). Severity was assessed via the Inventory of Depressive Symptoms self-report (IDS-SR). For disability three outcome measures were used: World Health Organization Disability Assessment Schedule II (WHODAS) disability and its 7 dimensions, days out of role, and work absence. Using multiple regression analysis the effects of MDD characteristics and comorbid mental disorders were estimated. RESULTS: The IDS-SR score was the best predictor of all disability outcomes. Of the comorbid mental disorders, agoraphobia was significantly associated with overall disability. Collectively, all illness characteristics accounted for 43% of variance in WHODAS disability, 13% in days out of role and 10% in work absence, suggesting substantial unexplained variance. LIMITATIONS: Only self-report measures of disability were used. There were no assessments of other diagnoses than depressive, anxiety and alcohol use disorders. CONCLUSIONS: Although heterogeneity in disability of persons with current MDD is partially explained by illness characteristics of MDD (especially symptom severity) and comorbid mental disorders, most of the variance is not accounted for.