Computer program in the treatment for major depression and cognitive impairment in university students
Introduction
This study makes a proposal to improve cognitive functioning in subjects with Major Depression Disorder (MDD), through a cognitive treatment assisted by a software designed and developed for this purpose.
In Mexico, depression has a prevalence of 7.9% in general population (Secretarı´a de Salud, 2003), and in university students it increases up to 11.8% (Manelic & Ortega-Soto, 1995).
Patients with major depression disorder (MDD) show cognitive deficits (Austin et al., 2001, Austin et al., 1992), for instance, failures in executive functions such as cognitive flexibility, problem solving (Merriam et al., 1999, Paelecke-Habermann et al., 2005), psychomotor speed (Sobin & Sackeim, 1997), deficits in domains in memory (Marcos et al., 1994, Weiland-Fiedler et al., 2004), and deficits in domain of attention (Marcos et al., 1994, Weiland-Fiedler et al., 2004). As a consequence of these failures, depression also causes disabilities in cognitive functioning which will then lead patients to show social, working performance, academic and intellectual impairment. Massel et al. (1990) evaluated work efficiency in 600 subjects with mental disorders and found that there was a significant relationship between the severity of psychiatric symptoms and productivity. Among depressed patients, psychomotor retardation was the most important factor in work reduction. Mintz, Mintz, Arruda, and Hwang (1992) evaluated the effects of anti-depressants and psychotherapy on work impairment in depressed patients. Original databases from 10 published treatment studies were compiled and analyzed (N = 827). Functional work impairment was common at baseline, manifested by unemployment (11%) or on-the-job performance problems (absenteeism, decreased productivity, interpersonal problems, 44%), only 55% fulfilled the criteria required to go back to work after treatment. According to the Global Burden Disease Study (GBD), MDD ranks fourth as a cause for loss of years due to work disability; in the projection towards 2020 it is considered as the second cause (Murray and Lopez, 1996, Murray and López, 1997a, Murray and López, 1997b).
Academic deterioration is evidenced mainly in absenteeism, low academic performance, bad interpersonal relationships and wrong perception of academic competence. Rapport, Denney, Chung, and Hustace (2001) presented a lineal structural model which co-relates children’s school performance with anxiety and depression. They used intellectual quotient as the control variable of the model and conjectured that academic performance is related to the severity of depression and to the child’s isolation due to his/her classroom execution and cognitive functioning. Children who were most depressed presented deficiencies in cognitive functioning and those more introverted had the worst performance in the classroom. On the other hand, depression in university students affects academic performance, satisfaction with studies and social relationships which, in turn, generate stress and thus reinforce the depressive state (De la Peña, Estrada, Almeida, & Paez, 1999); Heiligenstein, Guenther, Hsu, and Herman (1996) found out that 92% of the students diagnosed with depression presented academic impairment. Cognitive damage persists in spite of the remission of depressive symptoms (Paelecke-Habermann et al., 2005, Weiland-Fiedler et al., 2004).
There are some studies that report the efficiency of cognitive rehabilitation through computer programs, for those patients with attention and concentration deficits. Slate, Meyer, Burns, and Montgomery (1998) used the program Captain’s Log Cognitive Training, combining EEG/neurofeedback, to treat children with ADD. There were four cases involved in this study of children aged between 7 and 11, with severe emotional damage, diagnosed with psychosis and ADHD. A pre-test, post-test design was used. Treatment was given for 16 weeks, for a total of 64 sessions. In all the patients symptoms were reduced and they were able to generalize the learned abilities Table 1.
In another case study made by Kotwal, Burns, and Montgomery (1996), it was demonstrated that “Captain’s Log Cognitive Training” program was capable of operating changes in the brain-waves patterns measured by a EEG/neurofeedback equipment. These changes were evaluated in 13 years old patients with a diagnosis of ADDH. A pre-test, post-test design was used. The patient received 35 treatment sessions upon which he attained a very important improvement of the symptoms, and changes remained seven months after having concluded the experimental process.
Sartory, Zorn, Groetzinger, and Widgassen (2005) applied the “Cogpack” program three times a week to schizophrenic patients who, after three months of therapy, improved cognitive functions such as verbal memory and speed processing. Cognitive rehabilitation through computer programs offers great advantages: besides being amusing for the patient, computers do not make mistakes, provide immediate feedback and allow working with several patients at a time, which is beneficial for social assistance institutions.
On behalf of the cognitive impairment due to depression, we propose an intervention in order to reduce it and at the same time, to rehabilitate cognitive impairment.
Section snippets
Subjects
In the study, participants were university students of the Universidad Nacional de México who presented a MDD diagnosis according to the DSM-IV criteria (American Psychiatric Association, 1995), and were assessed through the MINI Spanish computer version of the International Neuropsychiatric Interview (Heinze and Cortés, 2000, Sheehan et al., 1998), based on the DSM-IV and the CIE 10. Patients who presented psychotic disorders, bipolar disorder or suicidal risk were excluded. From a total of 34
Beck Depression Inventory (BDI)
The severity of depression assessed through BDI resulted to be significant in the interaction Evaluation-Group [F(3.58, 50.17) = 2.845, p = 0.038, η = 0.169]; interaction shows significance in the initial vs. final comparison [F(2, 28) = 3.462, p = 0.045, η = 0.198]; the post hoc comparison in the final evaluation shows a difference between the cognitive treatment and the anti-depressant treatment [LSD = 6.42, p = 0.033]. All the patients, except for three, two of the group with anti-depressant treatment and one
Discussion
Pharmacological treatment and cognitive treatment were capable of improving the depressive state in patients, although those who only received the former, in spite of the remission of their depressive state, continued to show externalized problems associated with impulsivity and attention deficit. Also, those patients working with the cognitive treatment showed a slight decrease in the level of anxiety, while patients receiving only pharmacological treatment had no change in this regard.
Limitations
This study lacks external validity; it is necessary to duplicate research with this program using more refined tests for the neuropsychological evaluation.
References (41)
- et al.
Cognitive function in major depression
Journal of Affective Disorders
(1992) - et al.
Cognitive dysfunctions in recovered melancholic patients
Journal of Affective Disorders
(1994) - et al.
Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study
Lancet
(1997) - et al.
Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study
Lancet
(1997) - et al.
Attention and executive functions in remitted major depression patients
Journal of Affective Disorders
(2005) - et al.
Computarized cognitive remediation improves verbal and processing speed in schizophrenia
Schizofrenia Research
(2005) - et al.
Evidence for continuing neuropsychological impairments in depression
Journal of Affective Disorders
(2004) Manual de Diagnóstico y Estadı´stico de los Trastornos Mentales
(1995)- et al.
Cognitive deficits in depression: possible implications for functional neuropathology
British Journal of Psychiatry
(2001) - et al.
An inventory for measuring depression
Archives of General Psychiatry
(1961)
Anorgasmia y depresión
Psiquiatrı´a
Selective serotonin reuptake inhibitor treatment in the UK: Risk of relapse or recurrence of depression
British Journal of Psychiatry
Statistical Power Analysis for Behavioral Sciences
Prevalencia de los trastornos depresivos y su relacion con el bajo aprovechamiento escolar en estudiantes de secundaria. /Prevalence of depressive disorders and its relation to low academic achievement in secondary school students
Salud Mental
Neurogénesis in the adult Hippocampus
Nature Medicine
Depressive symptoms and intellectual functioning in anxiety patients treated with clorazepate
Journal of Clinical Psychiatry
Neurogenesis in the neocortex of adult primates
Science
Depression and academic impairment in college students
Journal of American College Health
Cited by (39)
Evaluating cognitive control training on symptoms of depression over time: Three potential mechanisms
2021, Journal of Affective Disorders ReportsCitation Excerpt :Cognitive Control Training (CCT) is a promising psychiatric and neurological treatment (Alvarez et al., 2008; Anguera et al., 2013; Calkins et al., 2011; Calkins and Otto, 2013; Onraedt and Koster, 2014; Segrave et al., 2014; Siegle et al., 2007, 2014) drawing on models that suggest that depression is caused, in part, by deficits in working memory (Levens and Gotlib, 2010) and cognitive control (De Raedt et al., 2010).
The Efficacy of Cognitive Remediation in Depression: A Systematic Literature Review and Meta-Analysis
2021, Journal of Affective DisordersCitation Excerpt :While some authors positively replied to our inquiry, four either refused, did not reply to our emails, or reported no longer having the data (see Appendix 4 in Supplementary Material). Hence, we retained eight eligible articles for the current meta-analysis (i.e., Alvarez et al., 2008; Bowie et al., 2013; Dong et al., 2017; Elgamal et al., 2007; Morimoto et al., 2020; Naismith et al., 2011; Semkovska et al. 2015; Trapp et al., 2016). Global cognition was computed by aggregating effect size scores across all measures for all cognitive domains within each study.
Cognitive remediation therapy for partially remitted unipolar depression: A single-blind randomized controlled trial
2020, Journal of Affective DisordersGoal management training as a cognitive remediation intervention in depression: A randomized controlled trial
2020, Journal of Affective DisordersComputerized cognitive training in young adults with depressive symptoms: Effects on mood, cognition, and everyday functioning
2019, Journal of Affective DisordersCitation Excerpt :Indeed, in one study, CCT failed to augment the therapeutic effects of behavioral activation suggesting that behavioral activation and CCT share some common therapeutic factors (Moshier and Otto, 2017). In contrast, CCT does appear to augment biological treatments such as medication (Alvarez et al., 2008) or transcranial stimulation (Segrave et al., 2014a). The relationship between CCT and medication/psychotherapy for depression either alone or in combination is an area ripe for future research.