Review
Psychosocial features of depression: A systematic literature review

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Abstract

Background

Despite the great burden of depression on sufferers and society, there is a lack of reliable information regarding the full range of psychosocial difficulties associated with depression and their related variables. This systematic review aimed to demonstrate the utility of the International Classification of Functioning, Disability and Health (ICF) in describing the psychosocial difficulties that shape the lived experience of persons with depression.

Methods

An electronic search that included publications from 2005 to 2010 in the MEDLINE and PsycHINFO databases was conducted to collect psychosocial outcomes. Quality of studies was also considered.

Results

103 studies were included. 477 outcomes referring psychosocial difficulties were extracted and grouped into 32 ICF related categories. Emotional functions (19% of studies), followed by energy and drive (17% of studies), were the most frequent psychosocial outcomes. The onset, course, determinants, and related variables of the most important psychosocial difficulties, reported in at least 10% of studies, were described. Medication played a dual role as determinant of onset and change in some psychosocial areas, e.g. in pain, sleep, and energy and drive.

Limitations

The search was limited by year of publication and focused only on minor and major depression diagnoses: other depressive disorders were not included. Some underresearched, but relevant psychosocial areas could have not been analyzed.

Conclusions

The present systematic review provides information on the psychosocial difficulties that depressive patients face in their daily lives. Future studies on depression should include outcome instruments that cover these relevant areas in order to comprehensively describe psychosocial functioning.

Introduction

In health, psychosocial difficulties (PSDs) are functioning problems that involve both psychological and social problems that people experience in their daily lives and are associated with the health condition. As PSDs are a core experience of depression, some of the diagnostic criteria of depression are themselves PSDs (e.g. feeling of sadness or lack of concentration). Other PSDs, such as unemployment, absenteeism and social functioning problems, have also been reported in the literature on depression (Lerner et al., 2004, Rytsala et al., 2006, Van der Werff et al., 2010). Since PSDs constitute a substantial component of the personal, economic and social burden of depression (Salvador-Carulla et al., 2011, Sobocki et al., 2006), it is essential to investigate the full range and extent of PSDs associated with depression.

Several literature reviews have analyzed PSDs in depression. One example is the Barnet's study (1988) that described PSDs that appear before, during or after a depressive episode. Another example is the Langlieb's study (2010) that systematically provides information on how depression is associated with an extensive range of psychosocial difficulties from family life to work functioning.

However, no study review to our knowledge has systematically analyzed the determinants and related variables of PSDs that are experienced in depression. In fact, most of study reviews tend to define the PSDs as consequences of depression, ignoring the impact of the physical, social and attitudinal environment that constitute people's actual circumstances, and may have a direct effect on creating the PSDs. It is therefore important, if we are to understand the actual lived experience of people with depression, to look closely at PSDs, their course, onset and determinants. That is the motivation for this paper.

Recent evidence suggests that determinants of PSDs in depression depend not only on specific health condition variables such as the severity of the disorder, but also on social and personal variables such as gender, health satisfaction and social stigma (Gadelrab et al., 2010). In addition, the role of these factors may differ depending on the psychosocial area under consideration; for example, they might be more relevant for work than other areas of life (Verboom et al., 2011).

The present study proposes a construct of PSDs that is based on the WHO's International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001), and uses it to structure a comprehensive narrative synthesis of the literature, including not only a comprehensive mapping of PSDs in depression, but also a mapping of their determinants and other correlated variables.

Using the ICF as a reference and standard, psychosocial problems can be more precisely defined as impairments of mental functions, activity limitations and participation restrictions that include both the individual's mental capacities and his or her social interactions (such as in work, family life and leisure activities). Additionally, psychosocial difficulties include pain (b280) and sexual interest problems (b640), as the literature indicates that these are a substantial psychological component of the experience of depression (Levine, 2003, Turk et al., 2010).

The objective of this systematic review is to demonstrate the effectiveness and value of the ICF construct to understand the lived experience of depression in terms of the PSDs that are experienced as well as to begin the task of mapping out the onset of these PSDs and their determinants. It is hypothesized, as predicted by the ICF model, that the determinants and related variables that have been reported in the literature will not only be linked to the health condition, and variables such as severity or chronicity, but also to personal and environmental factors. Specifically, our objectives are to, first, collect the range PSDs that the literature reports on people with depression; secondly, to describe the basic structure of the onset and change of PSDs over time; thirdly, to analyze determinants of the changes over time and other correlated factors; and finally, to provide information about methodological problems and limitations in the literature.

A systematic study of the full range of PSDs in depression and their determinants will make it possible, we believe, to report useful information for a deeper understanding of the experience of depression, helping all stakeholders involved in the treatment decision-making process with the ultimate aim of reducing the economic and social burden of depression.

Section snippets

Methods

This paper is part of the coordination action called Psychosocial fActors Relevant to brAin DISorders in Europe (PARADISE EC project, 2010). The aim of PARADISE is to seek evidence to confirm the hypothesis that there is a considerable degree of commonality in psychosocial difficulties across a range of neuropsychiatric disorders (dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson's disease, schizophrenia, stroke, and substance abuse). In order to support this hypothesis

Results

An electronic search strategy located 1090 studies. Of these, 347 were preliminarily selected by an initial review of the abstracts. 103 fulfilled the eligibility criteria based on a screening of the original papers (in 15% of the retrieved studies). The most frequent exclusion criteria were: cross-sectional design, for 20% (N = 227); depression considered as a secondary comorbid condition, for a 16% of papers (N = 184); articles not reporting psychosocial difficulties, for 15% (N = 171); depression

Discussion

The present systematic review reported a general overview of the main PSDs – those that were reported in at least 10% of the studies – and provided information on the onset and change over time of the PSDs as well as their determinants and other associated variables. The definition, structuring, and analysis of the PSDs, and their related variables were conducted using the ICF as framework. Consequently, this study is useful in demonstrating the utility of the ICF model to describe and examine

Role of funding source

No external funds were sought or received for this manuscript.

Conflict of interests

None of the authors has any conflict of interest in the context of this work.

Acknowledgments

This study was partially supported by the PARADISE project trough Coordination Theme 1 (Health) of the European Community's FP7, Grant Agreement no. HEALTH-F2-2009-241572 and by the Instituto de Salud Carlos III; VI Plan Nacional de I + D + I 2008–2011, (CIBERSAM).

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