Quality of Life Research

, Volume 22, Issue 3, pp 585–596 | Cite as

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

  • Waguih William IsHakEmail author
  • Konstantin Balayan
  • Catherine Bresee
  • Jared Matt Greenberg
  • Hala Fakhry
  • Scott Christensen
  • Mark Hyman Rapaport



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.


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).


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.


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.


Major depressive disorder Quality of life Major depression Health-related quality of life 



Beck Anxiety Inventory


Cedars-Sinai Psychiatric Treatment Outcome Registry


Endicott Work Productivity Scale


Global Assessment of Functioning


Institutional Review Board


Quick Inventory of Depressive Symptomatology-Self Report


Quality of Life, Enjoyment, and Satisfaction Questionnaire—Short Form


Quality of life


Major Depressive Disorder


Sheehan Disability Scale


World Health Organization


Work and Social Adjustment Scale



The authors would like to thank the Cedars-Sinai Medical Center Psychiatry residents, trainees, staff, and faculty for their exceptional work with patients over the years, and for their contributions in building and maintaining the psychiatric treatment outcome registry cited in this work. The authors would also like to thank Ms. Gitta Morris for her exceptional help during the various stages of development of this manuscript. This research was supported by NARSAD Young Investigator Award Grant#CSMC215387 (Dr. IsHak) and by NIMH Grant#R01 MH073765 (Dr. Rapaport, Polier Endowed Chair in Schizophrenia and Related Disorders). Dr. IsHak received research support from NARSAD, Pfizer (ziprasidone monotherapy for major depression). Dr. Rapaport received research support from NIMH and NCCAM, and is an unpaid consultant for Pax Neuroscience.

Conflict of interest

Dr. Greenberg, Ms. Bresee, Dr. Balayan, Dr. Fakhry, and Mr. Christensen report no conflict of interest and have no relevant financial disclosure to report.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Waguih William IsHak
    • 1
    • 2
    Email author
  • Konstantin Balayan
    • 3
  • Catherine Bresee
    • 4
  • Jared Matt Greenberg
    • 5
  • Hala Fakhry
    • 6
  • Scott Christensen
    • 3
  • Mark Hyman Rapaport
    • 7
  1. 1.Cedars-Sinai Medical CenterLos AngelesUSA
  2. 2.David Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Department of PsychiatryCedars-Sinai Medical CenterLos AngelesUSA
  4. 4.Samuel Oschin Comprehensive Cancer InstituteCedars-Sinai Medical CenterLos AngelesUSA
  5. 5.Department of Psychiatry and Biobehavioral ScienceDavid Geffen School of Medicine at UCLALos AngelesUSA
  6. 6.Department of Psychiatry, Faculty of MedicineCairo UniversityCairoEgypt
  7. 7.Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaUSA

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