Quality of Life Research

, Volume 26, Issue 5, pp 1177–1186 | Cite as

Does the EQ-5D capture the effects of physical and mental health status on life satisfaction among older people? A path analysis approach

  • Eithne SextonEmail author
  • Kathleen Bennett
  • Tom Fahey
  • Caitriona Cahir



To examine the extent to which EQ-5D utility scores capture the effect of mental and physical health status on life satisfaction (LS) in older adults.


Retrospective cohort study of 884 patients aged ≥70 years from 15 general practices in Ireland, including medical records, pharmacy claims, and self-completion questionnaire. Path analysis was used to evaluate the direct and indirect effects of: (1) chronic disease burden (based on medications data); (2) activity limitation (basic and instrumental activities of daily living); (3) anxiety symptoms and; (4) depressive symptoms (Hospital Anxiety and Depression Scale) on LS (Life Satisfaction Index Z), via a utility score based on responses to the EQ-5D scale. Utility scores were calculated using UK time trade-off utility weights. Covariates included age and socioeconomic status.


The final path model fitted the data well (goodness of fit χ2 = 7.5, df (7), p = 0.37). The direct effects of chronic disease burden and disability on LS were not statistically significant and were excluded from the final model, indicating that EQ-5D score mediated 100% of the total effect on LS. The direct and indirect effects of anxiety and depression on LS were statistically significant, but the size of the indirect effect was small (4% of the total effect for anxiety and 6% of the total effect for depression).


The EQ-5D does not adequately capture the effects of anxiety and depression on LS among older adults, suggesting that it may lead to inaccurate assessments of the effectiveness of interventions in this cohort.


Health-related quality of life Utility Anxiety Depression Life satisfaction Older adults 



This work was supported by the Health Research Board PhD Scholar’s Programme in Health Services Research in Ireland under Grant No. PHD/2007/16 and the Health Research Board Centre for Primary Care Research Grant HRC/2007/1.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11136_2016_1459_MOESM1_ESM.docx (71 kb)
Supplementary material 1 (DOCX 70 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Eithne Sexton
    • 1
    Email author
  • Kathleen Bennett
    • 2
  • Tom Fahey
    • 3
  • Caitriona Cahir
    • 2
  1. 1.Department of PsychologyRoyal College of Surgeons in IrelandDublinIreland
  2. 2.Population and Health SciencesRoyal College of Surgeons in IrelandDublinIreland
  3. 3.Health Research Board (HRB) Centre for Primary Care ResearchRoyal College of Surgeons in IrelandDublinIreland

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