Factors associated with health-related quality of life among outpatients with major depressive disorder: a STAR*D report.
ABSTRACT Major depressive disorder (MDD) is often chronic and is often associated with significant morbidity and mortality. The importance of assessing disability and health-related quality of life (HRQOL) in patients with MDD has only recently been recognized. The aim of this study was to examine sociodemographic and clinical correlates of HRQOL in a large cohort of outpatients with MDD.
Baseline assessments were completed for 1500 consecutive patients enrolled in the Sequenced Treatment Alternatives to Relieve Depression trial, including sociodemographic characteristics and measures of depressive symptom severity, clinical features, and HRQOL. Multiple domains of HRQOL were assessed with the 12-item Short Form Health Survey, the Work and Social Adjustment Scale, and the Quality of Life Enjoyment and Satisfaction Questionnaire. The current analyses were conducted on HRQOL data available for 1397 of the 1500 subjects.
Greater symptom severity was associated with reduced HRQOL by all measures. Even after age and symptom severity were controlled for, a number of clinical features and sociodemographic characteristics were independently associated with HRQOL in multiple domains, including age at onset of MDD, ethnicity, marital status, employment status, education level, insurance status, and monthly household income.
Results strongly suggest the need to assess HRQOL in addition to symptoms in order to gauge the true severity of MDD. This study also highlights the necessity of measuring HRQOL in multiple domains. These results have implications for the assessment of remission and functional recovery in the treatment of MDD.
[Show abstract] [Hide abstract]
ABSTRACT: In recent years, the development and extensive use of optogenetics resulted in impressive findings on the neurobiology of anxiety and depression in animals. Indeed, it permitted to depict precisely the role of specific cell populations in various brain areas, including the amygdala nuclei, the auditory cortex, the anterior cingulate, the hypothalamus, the hippocampus and the bed nucleus of stria terminalis in specific aspects of fear and anxiety behaviors. Moreover, these findings emphasized the involvement of projections from the ventral tegmental area to the nucleus accumbens and the medial prefrontal cortex in eliciting depressive-like behaviors in stress-resilient mice or in inhibiting the expression of such behaviors in stress-vulnerable mice. Here we describe the optogenetic toolbox, including recent developments, and then review how the use of this technique contributed to dissect further the circuit underlying anxiety- and depression-like behaviors. We then point to some drawbacks of the current studies, particularly a) the sharp contrast between the sophistication of the optogenetic tools and the rudimentary aspect of the behavioral assays used, b) the fact that the studies were generally undertaken using normal rodents, that is animals that have not been subjected to experimental manipulations shifting them to a state relevant for pathologies and c) that the opportunity to explore the potential of these techniques to develop innovative therapeutics has been fully ignored yet. Finally, we discuss the point that these findings frequently ignore the complexity of the circuitry, as they focus only on a particular subpart of it. We conclude that users of this cutting edge technology could benefit from dialog between behavioral neuroscientists, psychiatrists and pharmacologists to further improve the impact of the findings.Pharmacology Biochemistry and Behavior 04/2014; DOI:10.1016/j.pbb.2014.04.002 · 2.82 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Objective This study examines the impact of major depressive disorder (MDD) and its treatment on quality of life (QOL).Method From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, we analyzed complete data of 2280 adult MDD out-patients at entry/exit of each level of antidepressant treatments and after 12 months of entry to follow-up. QOL was measured using the QOL Enjoyment and Satisfaction Questionnaire (Q-LES-Q). The proportions of patients scoring ‘within-normal’ QOL (within 10% of Q-LES-Q community norms) and those with ‘severely impaired’ QOL (>2 SD below Q-LES-Q community norms) were analyzed.ResultsBefore treatment, no more than 3% of MDD patients experienced ‘within-normal’ QOL. Following treatment, statistically significant improvements were detected; however, the proportion of patients achieving ‘within-normal’ QOL did not exceed 30%, with >50% of patients experiencing ‘severely impaired’ QOL. Although remitted patients had greater improvements compared with non-remitters, 32–60% continued to experience reduced QOL. 12-month follow-up data revealed that the proportion of patients experiencing ‘within-normal’ QOL show a statistically significant decrease in non-remitters.Conclusion Symptom-focused treatments of MDD may leave a misleading impression that patients have recovered when, in fact, they may be experiencing ongoing QOL deficits. These findings point to the need for investigating specific interventions to ameliorate QOL in MDD.Acta Psychiatrica Scandinavica 06/2014; 131(1). DOI:10.1111/acps.12301 · 5.55 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Purpose Health-related quality of life (HRQoL) is important for long-term social functioning. It is considerably reduced in patients with depression. We studied the impact of HRQoL on treatment outcome in patients with unipolar depression. Furthermore, we analysed factors associated with HRQoL in inpatients with unipolar depression. Methods One hundred and eighty patients suffering from major depressive disorder were evaluated during their inpatient treatment by assessing admission and discharge depression severity and their HRQoL, using the Medical Outcomes Study 12-item Short Form (SF-12). Baseline and treatment variables associated with HRQoL were examined by regression analysis. Primary outcome measures were the Hamilton Rating Scale and the Beck Depression Inventory. Results HRQoL improved significantly during inpatient treatment. Lower HRQoL outcomes were strongly associated with higher age, somatic comorbidities, a recurrent depressive disorder and stronger depressive symptoms at admission. Additionally, patients with a complex treatment situation (high number of medications, antidepressant switch) showed stronger impairment of HRQoL. Personality disorders and additional psychotherapy did not predict HRQoL. Conclusion The inpatient treatment resulted in an increase of the SF-12 scores, although to a lower extent than depressive symptoms. Several factors negatively influence HRQoL, such as the presence of somatic and axis I psychiatric comorbiditites and a recurrent or severe depressive episode. Targeting somatic comorbidities in patients with unipolar depression seem to play an important role for HRQoL.Quality of Life Research 09/2014; DOI:10.1007/s11136-014-0811-8 · 2.86 Impact Factor