Subjective cognitive functioning in relation to changes in levels of depression and anxiety in youth over 3 months of treatment

Abstract

Background Subjective cognitive difficulties are common in mental illness and have a negative impact on role functioning. Little is understood about subjective cognition and the longitudinal relationship with depression and anxiety symptoms in young people. Aims To examine the relationship between changes in levels of depression and anxiety and changes in subjective cognitive functioning over 3 months in help-seeking youth. Method This was a cohort study of 656 youth aged 12–25 years attending Australian headspace primary mental health services. Subjective changes in cognitive functioning (rated as better, same, worse) reported after 3 months of treatment was assessed using the Neuropsychological Symptom Self-Report. Multivariate multinomial logistic regression analysis was conducted to evaluate the impact of baseline levels of and changes in depression (nine-item Patient Health Questionnaire; PHQ9) and anxiety symptoms (seven-item Generalised Anxiety Disorder scale; GAD7) on changes in subjective cognitive function at follow-up while controlling for covariates. Results With a one-point reduction in PHQ9 at follow-up, there was an estimated 11–18% increase in ratings of better subjective cognitive functioning at follow-up, relative to stable cognitive functioning. A one-point increase in PHQ9 from baseline to follow-up was associated with 7–14% increase in ratings of worse subjective cognitive functioning over 3 months, relative to stable cognitive functioning. A similar attenuated pattern of findings was observed for the GAD7. Conclusions A clear association exists between subjective cognitive functioning outcomes and changes in self-reported severity of affective symptoms in young people over the first 3 months of treatment. Understanding the timing and mechanisms of these associations is needed to tailor treatment.

The Neuropsychological Symptoms Self‐Report: psychometric properties in an adolescent and young adult mental health cohort

“…Subjective cognitive functioning was assessed at three‐month follow‐up using the NSSR (Allott et al., 2020; Fisher et al., 2016). The NSSR is an eight‐item self‐report questionnaire that assesses an individual’s subjective changes in cognitive functioning (e.g.…”

“…Participants with mild to moderate depression more often perceived their cognitive function to have improved since commencing treatment, compared to those with moderately severe to severe depression (Fisher et al., 2016). More recently, the NSSR was administered to a larger independent cohort of young people aged 12–25 ( N = 656) after they had been enrolled in treatment at a primary care mental health setting (Allott et al., 2020). Approximately a quarter to one‐third of the sample reported subjective improvement in their cognitive functioning after three months of treatment.…”

“…In fact, some studies of people with depression have shown that subjective cognitive functioning better predicts social and occupational functioning than objective cognition (Ott et al., 2016; Sumiyoshi et al., 2019). Subjective cognitive impairments are also known to correlate with affective symptoms (Allott et al., 2020; Srisurapanont et al., 2018) and therefore, often resolve with a reduction in these symptoms. However, residual subjective cognitive impairments are relatively common after a mood episode (Conradi, Ormel, & de Jonge, 2011) and are associated with incomplete recovery and subsequent relapse (Saragoussi et al., 2017).…”

Cognition in mood disorders

“…Less research about subjective cognitive function has been conducted in youth depression samples, whose experience of cognitive problems associated with depression may be different if depression onset is relatively recent. In their analysis of depression symptoms over 3 months, and perceived change in subjective cognitive function, Allott et al 13 (this series) reported that improvement or reduction in self-rated depression symptoms was highly associated with change in subjective ratings of cognitive function in their youth sample. That is, patients who reported improvement in their mood also felt their cognitive functions had strengthened.…”

Hypersensitivity to uncertainty is key feature of subjective cognitive impairment

“…Similarly, people who primarily suffer from these psychiatric disorders often report sub-optimal cognitive performance, further emphasising the intertwined relationship between affective burden and subjective cognitive experience (Millan et al, 2012). Moreover, treating anxiety and depression may improve subjective cognitive complaints in individuals with SCI (Allott et al, 2020). Despite the association between SCI and affective burden being increasingly recognised, little is understood about the underlying cognitive mechanisms and brain networks involved.…”