Salud Mental

Moderating effects of executive function between depression severity and work performance: a web-based cross-sectional study


Tamara Alejandra Sierra-Aparicio
Brenda Paulina Magaña-Quijano
Jacquelyn Vargas-Quiñones
Brenda Martínez-García
Aldebarán Toledo-Fernández


Introduction. Depression and dysexecutive functioning share several neurocognitive features, and both often impair areas of everyday life functioning, such as work. The effect of their interaction on this outcome, however, is barely known.

Objective. Was to analyze the moderating effect of executive functioning (EF) on the relation between depression severity and work performance (presenteeism and absenteeism).

Method. Data was collected through a non-probabilistic web-based survey. Hierarchical linear regression analyzes were used for testing the main hypothesis, with depression severity (PHQ-9) and EFs (BRIEF-A) as predictors, and presenteeism (SPS-6) and absenteeism (HPQ) as independent outcome variables.

Results. There were 462 participants analyzed. The regression models showed no significant interaction, only additive effects of depression severity and EF on presenteeism, and no effect of these variables on absenteeism.

Discussion and conclusion. Our main finding disagrees with the moderating effects of EF reported for other psychological variables. We hypothesize that EF alterations may have particular features for depression (e.g., cognitive inflexibility in thought rumination), which are not assessed by the BRIEF-A. Future studies should consider using EF performance tasks to test moderation and using naturalistic indicators of work performance.
Depression, executive functions, work performance, presenteeism, absenteeism


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) (Fifth). Arlington, VA: American Psychiatric Association.

Bonde, J. P. E., & Hovedstaden, R. (2008). Psychosocial Factors at Work and Risk of Depression : A Systematic Review of the Epidemiological Evidence Psychosocial factors at work and risk of depression : a systematic review of the epidemiological evidence. Occupational and Environmental Medicine, 65, 438–445.

Bracht, T., Linden, D., & Keedwell, P. (2015). A review of white matter microstructure alterations of pathways of the reward circuit in depression. Journal of Affective Disorders, 187, 45–53.

Cassiani-Miranda, C. A., Vargas-Hernández, M. C., Pérez-Aníbal, E.,

Herazo-Bustos, M. I., & Hernández-Carrillo, M. (2017). Confiabilidad y dimensión del cuestionario de salud del paciente ( PHQ-9 ) para la detección de síntomas de depresión en estudiantes de ciencias de la salud en Cartagena , 2014. Biomédica, 37(112–120).

Godefroy, O., Azouvi, P., & Robert, P. (2010). Dysexecutive Syndrome : Diagnostic criteria and validation Study. Annals of Neurology, 68(6), 855–864.

Goodwin, G. M. (2016). Neuropsychological and neuroimaging evidence for the involvement of the frontal lobes in depression : 20 years on. Journal of Psychiatric Research, 30(11), 1090–1094.

Hall, P. A., Fong, G. T., Epp, L. J., Elias, L. J., Hall, P. A., Fong, G. T., … Elias, L. J. (2008). Executive function moderates the intention- behavior link for physical activity and dietary behavior. Psychology & Health, 23(3), 309–326.

Hall, P. A., Ph, D., Zehr, C., Sc, M., Paulitzki, J., Ph, D., … Ph, D. (2014). Implementation intentions for physical activity behavior in older adult women : An examination of executive function as a moderator of treatment effects. Annals of Behavioral Medicine, 48, 130–136.

Halleland, H. B., Sørensen, L., Posserud, M., Haavik, J., &

Lundervold, A. J. (2015). Occupational status ss compromised in adults with ADHD and psychometrically defined executive function deficits. Journal of Attention Disorders, 1–12.

Hammar, Å., & Årdal, G. (2009). Cognitive functioning in major depression – a summary. Frontiers in Human Neuroscience, 3(September), 1–7.

Herreras Basuela, E. (2016). BRIEF-A (forma abreviada): Análisis propiedades psicométricas en una muestra española. Archivos de Neurociencias, 21(4), 6–15.

Kalkhoff, W., & Kilmer, A. (2011). Moderators and mediators of the stress-aggression relationship : Executive function and state anger. Emotion, 11(1), 61–73.

Kessler, R. C., Adler, L., Ames, M., Barkley, R. A., Birnbaum, H., Greenberg, P., … Bedirhan, T. U. (2005). The Prevalence and Effects of Adult Attention Deficit / Hyperactivity Disorder on Work Performance in a Nationally Representative Sample of Workers, 47(6), 565–572.

Kessler, R. C., Ames, M., Hymel, P. A., Loeppke, R., Mckenas, D. K., Richling, D. E., & Stang, P. E. (2004). Using the World Health Organization Health and Work Performance Questionnaire ( HPQ ) to evaluate the indirect workplace costs of illness. Journal of Occupational and Environmental Medicine, 46(6), 23–37.

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

Millan, M. J., Agid, Y., Brüne, M., Bullmore, E. T., Carter, C. S., Clayton, N. S., … Young, L. J. (2012). Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. Nature Reviews Drug Discovery, 11(2), 141–168.

Moreno-López, L., Stamatakis, E. A., Fernández-Serrano, M. J., Gómez-Río, M., Rodríguez-Fernández, A., Pérez-García, M., &

Verdejo-García, A. (2012). Neural correlates of hot and cold executive functions in polysubstance addiction: Association between neuropsychological performance and resting brain metabolism as measured by positron emission tomography. Psychiatry Research - Neuroimaging, 203(2–3), 214–221.

Pelletier, K. R. (2002). Stanford Presenteeism Scale : Health status and employee productivity. Journal of Occupational and Environmental Medicine, 44, 14–20.

Regmi, P. R., Waithaka, E., Paudyal, A., Simkhada, P., & van Teijlingen, E. (2016). Guide to the design and application of online questionnaire surveys. Nepal Journal of Epidemiology, 6(4), 640–644.

Riggs, N. R., Jahromi, L. B., Razza, R. P., Dillworth-bart, J. E., & Mueller, U. (2006). Executive function and the promotion of social – emotional competence. Journal of Applied Developmental Psychology, 27, 300–309.

Romo Nava, F., Tafoya, S. A., & Heinze, G. (2013). Estudio comparativo sobre depresión y los factores asociados en alumnos del primer año de la Facultad de Medicina y del Internado. Salud Mental, 36(5), 375–379.

Roth, R. M., Lance, C. E., Isquith, P. K., Fischer, A. S., & Giancola, P. R. (2013). Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function-Adult Version in healthy adults and application to attention-deficit/hyperactivity disorder. Archives of Clinical Neuropsychology, 28(May), 425–434.

Snyder, H. R. (2014). Major depressive disorder is associated with broad impairments on neuropsychological measures of executive funtion: A meta-analysis and review. Psychological Bulletin, 139(1), 81–132.

Stewart, W. F., Ricci, J. A., Chee, E., Hahn, S. R., & Morganstein, D. (2003). Cost of lost productive work time among US workers with depression. JAMA: The Journal of the American Medical Association, 289, 3132–3144.

Villalobos-Gallegos, L., Medina-Mora, M. E., Benjet, C., Ruiz, S., Magis, C., & Marín-Navarrete, R. (2018). Multidimensional patterns of sexual risk behavior and psychiatric disorders in men with substance use disorders. Archives of Sexual Behavior, (0123456789).

Watkins, E., & Brown, R. G. (2002). Rumination and executive function in depression: an experimental study. Journal of Neurology , Neurosurgery and Psychiatry, 72, 400–402.