A descriptive analysis of quality of life using patient-reported measures in major depressive disorder in a naturalistic outpatient setting

ArticleinQuality of Life Research 22(3) · April 2012with40 Reads
DOI: 10.1007/s11136-012-0187-6 · Source: PubMed
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.
    • "been the most studied disorder to date. Numerous studies suggest that the presence of depressive symptoms in one partner is related to a lower level of quality of life (QoL; IsHak et al., 2013) and dyadic adjustment (Beach, Katz, Kim, & Brody, 2003; Whisman, Uebelacker, & Weinstock, 2004), as well as the partner's emotional distress (Benazon & Coyne, 2000; Heene et al., 2007; Idstad, Ask, & Tambs, 2010; Wittmund , Wilms, Mory, & Angermeyer, 2002). It is also associated with poorer QoL (Angermeyer , Kilian, Wilms, & Wittmund, 2006) and poorer dyadic adjustment (Beach et al., 2003; Coyne, Thompson, & Palmer, 2002; Heene et al., 2007; Whisman et al., 2004). "
    [Show abstract] [Hide abstract] ABSTRACT: Within the context of mental health disorders, the research examining the association between attachment and couples’ adjustment in general has been disappointingly lean. This includes consideration of the attachment representations of both members, as well as the dyadic attachment styles. This study analyzed the association between attachment and patient and partner’s individual and dyadic adjustment, as well as the associations between dyad attachment styles and patient and partner’s adjustment. The sample consisted of 54 couples, in which 1 member had been diagnosed with a mental health disorder (clinical groups), and 54 couples from the general population (control group). Participants completed the following self-report measures: Brief Symptom Inventory (BSI), the quality of life (QoL) questionnaire EUROHIS-QOL-8, the Revised Dyadic Adjustment Scale (RDAS), and the Experiences in Close Relationship-Short Form (ECR-SF). The results depict that couples from the clinical groups presented lower levels of QoL and dyadic adjustment and higher levels of depressive and anxious symptoms as compared to couples from the general population. Couples from the clinical groups also showed higher scores on attachment anxiety and avoidance. Women who possessed a clinical diagnosis, in particular reported higher scores in attachment anxiety whereas men with a clinical diagnosis were found to engage in attachment avoidance. Regarding both dyadic attachment styles, dyads in which the 2 partners were insecurely attached had significantly poorer individual and dyadic adjustment compared with dyads in which both partners were secure. The clinical implications of the results are considered, as well as some key directives for future research. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
    Article · Oct 2015
    • "Considering that the patients in the borderline personality disorder group had a history of two or more suicide attempts and that the participants in that study were assessed after a period of increased symptoms, this underlines the severity of the situation for the patients in our Burnout group. Further, studies on congestive heart failure and depression (Hays et al. 1995; Ishak et al. 2013) have shown an approximate 50 % decrease in QoL, which is less than in our Burnout group. "
    [Show abstract] [Hide abstract] ABSTRACT: To explore the health-related quality of life (HRQoL), the cause of being ill, and the pharmacological treatment in patients on sick leave because of Burnout. The HRQoL among these patients was also compared with that of individuals who were working full time. HRQoL was measured using the SWED-QUAL questionnaire, comprising 67 items grouped into 13 subscales, scored from 0 (worst) to 100 (best) points, and covering aspects of physical and emotional well-being, cognitive function, sleep, general health, social, and sexual functioning. The Burnout group (n = 94), mean age 43 years, were on 50 % sick leave or more. The comparison group consisted of healthy persons (n = 88) of similar age and educational level who were working full time. The Burnout group had markedly low scores in general. The cause of illness was mainly work-related. Psychotropic medication was prescribed for 55 %. Significantly lower scores were found in the Burnout group than in the comparison group in all subscales, p < 0.001. The median differences in scores ranged from 10 to 56 points. Differences rated by effect size were large, 0.85-2.01. Patients on sick leave because of Burnout rated their HRQoL as very low in general, their cause of being ill was mainly work-related, and psychotropic medication was prescribed for a majority. Their scores were markedly lower in all subscales in comparison with healthy individuals working full time. The study adds to our understanding of the situation of patients with Burnout. The results can be useful in clinical work and future research.
    Full-text · Article · Jul 2015
    • "Some methodological reasons may explain the discrepancy with previous results in patients with MDD. Subjective QoL was assessed by different instruments that probably capture distinct concepts related to QoL: the Health Survey Form (SF-36) [4] seems to measure health-related QOL focusing mainly on health-related functioning and objective capabilities36373839 , that are partly taken into account also in the GAF scale, whereas WHOQOL- BREF appears to measure a broad range of perception about life, focusing mainly on self-reported subjective satisfaction with capacities and functioning ; the Quality of Life, Enjoyment, and Satisfaction Questionnaire—Short Form (Q-LES-Q) [5] measures global QoL [40] similarly to WHOQOL-BREF, but previous studies showed that, although these two instruments share some domains, they may be not fully interchangeable [41, 42]. Finally, our sample, including inpatients hospitalized for a psychiatric rehabilitation program, may be not fully comparable for clinical characteristics, such as illness severity or duration, to those of the two previous studies that included outpatients seeking treatment. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Dec 2013
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