A descriptive analysis of quality of life using patient-reported measures in major depressive disorder in a naturalistic outpatient setting.
ABSTRACT PURPOSE: Major depressive disorder (MDD) negatively impacts different aspects of an individual's life leading to grave impairments in quality of life (QOL). We performed a detailed analysis of the interaction between depressive symptom severity, functioning, and QOL in outpatients with MDD in order to better understand QOL impairments in MDD. METHODS: This cross-sectional study was conducted with 319 consecutive outpatients seeking treatment for DSM-IV-diagnosed MDD at an urban hospital-based outpatient clinic from 2005 to 2008 as part of the Cedars-Sinai Psychiatric Treatment Outcome Registry, a prospective cohort study of clinical, functioning, and patient-reported QOL outcomes in psychiatric disorders using a measurement-based care model. This model utilizes the following measures: (a) Depressive symptom severity: Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR); (b) Functioning measures: Global Assessment of Functioning (GAF), Sheehan Disability Scale (SDS), Work and Social Adjustment Scale, and the Endicott Work Productivity Scale; and (c) Quality of Life measure: Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (Q-LES-Q). RESULTS: QOL is significantly impaired in MDD, with a mean Q-LES-Q score for this study population of 39.8 % (SD = 16.9), whereas the community norm average is 78.3 %. Regression modeling suggested that depressive symptom severity, functioning/disability, and age all significantly contributed to QOL. QIDS-SR (measuring depressive symptom severity), GAF, and SDS (measuring functioning/disability) scores accounted for 48.1, 17.4, and 13.3 % (semi-partial correlation values) of the variance in Q-LES-Q, respectively. CONCLUSIONS: Our results show that impairment of QOL increases in a monotonic fashion with depressive symptom severity; however, depression symptom severity only accounted for 48.1 % of the QOL variance in our patient population. Furthermore, QOL is uniquely associated with measures of Functioning. We believe these results demonstrate the need to utilize not only Symptom Severity scales, but also Functioning and Quality of Life measures in MDD assessment, treatment, and research.
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ABSTRACT: Studies have found that up to two-thirds of patients with major depressive disorder (MDD) do not fully respond to the first antidepressant. While switching antidepressants is a common strategy for antidepressant non-responders, there is still a lack of consensus about the optimal timing of a switch. Many clinicians wait for 6-12 weeks before considering a switch. The objectives of this paper are to (1) review the evidence for positive and negative predictive value (NPV) of early improvement at 2-4 weeks to predict final antidepressant response; (2) review randomized controlled trials (RCTs) that examine early switching strategies; and (3) provide future research directions and clinical recommendations for timing of antidepressant switching. We conducted a literature search for English-language studies via PubMed and Google Scholar, from 1984 to May 2013, with the following terms: 'antidepressants', 'MDD', 'time course', 'trajectory', 'early response', 'onset', 'delayed response', 'early improvement', 'predictors', 'switch', 'combination therapy', and 'augmentation'. Replicated evidence indicates that lack of early improvement (e.g. <20 % reduction in a depression scale score) at 2-4 weeks can be an accurate predictor to identify eventual non-responders. The NPVs suggest that only about one in five patients with lack of improvement at 4 weeks will have a response by 8 weeks. Three RCTs examined early switch strategies, but results are inconsistent and comparisons limited by methodological differences. Future studies should incorporate a standard consensus definition of early improvement, discern whether the effect of early switching is specific to certain types of antidepressants, and determine whether early switch is superior to other strategies such as augmentation or combination. Notwithstanding these limitations, there is reasonable evidence to recommend earlier assessment for improvement. If there is no indication of early improvement at 2-4 weeks after starting an antidepressant, and taking into account other patient and clinical factors, a change in management can be considered.CNS Drugs 05/2014; · 4.38 Impact Factor
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ABSTRACT: This study aimed to investigate 1) the relationship between subjective perception of quality of life (QoL) and clinician-rated levels of psychosocial functioning and 2) the relationship of these indicators with neuropsychological performances, in a sample of 117 subjects with mood and anxiety disorders hospitalized for a 4-week psychiatric rehabilitation program. At the beginning of the hospitalization, QoL and clinician-rated functioning were respectively measured by the World Health Organization Quality of Life Assessment-Brief Form (WHOQOL-BREF) and the Global Assessment of Functioning (GAF) scale, and subjects were administered a neuropsychological battery evaluating verbal and visual memory, working memory, attention, visual-constructive ability, language fluency and comprehension. We did not find any association between WHOQOL-BREF and GAF scores and between cognitive impairment and lower QoL or clinician-rated functioning. Our results suggest that 1) the individuals' condition encompasses different dimensions that are not fully captured by using only clinician-rated or self-administered evaluations; 2) the GAF scale seems unable to indicate the cognitive impairments of our subjects and the WHOQOL-BREF does not appear to be influenced by these deficits. Overall, our findings suggest the need of simultaneously use of multiple assessment tools, including objective evaluations of functioning and different measures of QoL, in order to obtain a more complete clinical picture of the patients. This may allow to identify more specific targets of therapeutic interventions and more reliable measures of outcome.Comprehensive psychiatry 12/2013; · 2.08 Impact Factor
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ABSTRACT: Patient reported outcomes (PROs) of quality of life (QoL), functioning, and depressive symptom severity are important in assessing the burden of illness of major depressive disorder (MDD) and to evaluate the impact of treatment. We sought to provide a detailed analysis of PROs before and after treatment of MDD from the large Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. This analysis examines PROs before and after treatment in the second level of STAR*D. The complete data on QoL, functioning, and depressive symptom severity, were analyzed for each STAR*D level 2 treatment. PROs of QoL, functioning, and depressive symptom severity showed substantial impairments after failing a selective serotonin reuptake inhibitor trial using citalopram (level 1). The seven therapeutic options in level 2 had positive statistically (P values) and clinically (Cohen's standardized differences [Cohen's d]) significant impact on QoL, functioning, depressive symptom severity, and reduction in calculated burden of illness. There were no statistically significant differences between the interventions. However, a substantial proportion of patients still suffered from patient-reported QoL and functioning impairment after treatment, an effect that was more pronounced in nonremitters. PROs are crucial in understanding the impact of MDD and in examining the effects of treatment interventions, both in research and clinical settings.Dialogues in clinical neuroscience 06/2014; 16(2):171-83.