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