Quality of Life Research

, Volume 9, Issue 1, pp 109–120 | Cite as

Development and testing of a utility measure for major, unipolar depression (McSad)

  • K.J. Bennett
  • G.W. Torrance
  • M.H. Boyle
  • R. Guscott
  • L.A. Moran


Objective: To develop and test a direct utility measure (McSad) for major, unipolar depression. Methods: A depression specific, multi-attribute health state classification system was created; clinical validity was evaluated by experts using specially designed structured exercises; a cross-sectional survey was conducted to obtain directly measured utilities for depression health states. Setting: Tertiary care, university medical centre. Participants: Three psychiatrists, 3 psychiatric nurses and 3 social workers assessed depression health state clinical validity. Survey participants were referred by psychiatrists and consisted of 105 out-patients, currently in remission with at least one episode of major, unipolar depression in the past two years. Survey results: Respondent self-health state utility (mean and 95% confidence interval (CI)) was 0.79 (0.74–0.83). Utilities for hypothetical, untreated depression health states were: mild depression, 0.59 (0.55–0.62); moderate depression, 0.32 (0.29–0.34); severe depression, 0.04 (0.01–0.07). Fifty-six percent of respondents rated severe depression worse than being dead. Utilities for the hypothetical health states were not correlated with self-health utility. The intra-class correlation coefficient (ICC) was satisfactory for 13 of the 14 health states assessed. Conclusions: McSad was feasible and acceptable in patients with a history of major unipolar depression. The utilities for mild, moderate and severe untreated depression show the low health-related quality of life associated with depression. Initial assessments of test–retest reliability and validity yielded satisfactory results but further studies are needed to extend our knowledge of the measurement properties of McSad.

Cross-sectional survey McSad Tertiary care Unipolar depression Utility measures 


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  1. 1.
    Guyatt GH, Feeny D, Patrick DL. Measuring Health-related Quality of Life. Annals of Internal Med 1993; 118: 622.Google Scholar
  2. 2.
    Bennett KJ, Torrance GW. Measuring Health State Preferences and Utilities: Rating Scale, Time Trade-off and Standard Gamble Techniques. In: Spilker B (ed), Quality of Life and Pharmacoeconomics in Clinical Trials. Philidelphia: Lippincott-Raven, 1996.Google Scholar
  3. 3.
    Torrance GW. Designing and Conducting Cost-utility Analysis. In: Spilker B (ed), Quality of Life and Pharmacoeconomics in Clinical Trials. Philidelphia: Lippincott-Raven, 1996.Google Scholar
  4. 4.
    Hamilton M. A Rating Scale for Depression. J Neurolol Neurosurgical Psychiatry 1960; 23: 56.Google Scholar
  5. 5.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An Inventory for Measuring Depression. Arch Gen Psych 1961; 4: 561.Google Scholar
  6. 6.
    Radloff LS. The CES-D Scale: A Self Report Depression Scale for Research in the General Population. App Psych Meas 1977; 1: 385.Google Scholar
  7. 7.
    Feeny DF, Torrance GW, Furlong WJ. Health Utilities Index. In Spilker B (ed), Quality of Life and Pharmacoeconomics in Clinical Trials. Philidelphia: Lippincott-Raven, 1996.Google Scholar
  8. 8.
    Torrance GW, Feeny DH, Furlong WJ, Barr W, Zhang Y, Wang Q. Multi-attribute Preference Functions for a Comprehensive Health Status Classification System: Health Utilities Index Mark 2. Med Care 1996; 34: 702.Google Scholar
  9. 9.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, DSM-III-R. Washington DC, 1987.Google Scholar
  10. 10.
    Statistics, Canada. Life Tables, Canada and the Provinces, 1985–1987. Statistics Canada, Health Division Vital Statistics and Disease Registries Section, September, 1989.Google Scholar
  11. 11.
    Bennett KJ, Torrance GW, Tugwell P. Methodologic Challenges in the Development of Utility Measures of Health Related Quality of Life in Rheumatoid Arthritis. Cont Clinical Trials 1991; 12(Suppl): 118S.Google Scholar
  12. 12.
    Mohide EA, Torrance GW, Streiner DL, Pringle DM, Gilbert R. Measuring the Well-being of Family Care-givers Using the Time Trade-off Technique. J Clin Epidemiol 1988; 41: 475.Google Scholar
  13. 13.
    Drummond MF, O'Brien B, Stoddart G, Torrance GW. Methods for Economic Evaluation of Health Care Programmes. 2nd ed. Oxford: Oxford University Press, 1997.Google Scholar
  14. 14.
    Furlong W, Feeny DH, Torrance GW, Barr R, Horsman J. Guide to Design and Development of Health-State Utility Instrumentation. McMaster University Centre for Health Economics and Policy Analysis Working Paper, No. 90-9, June 1990.Google Scholar
  15. 15.
    Revicki DA, Turner R, Brown R, Martindale JJ. Reliability and Validity of a Health-related Quality of Life Battery for Evaluating Outpatient Antidepressant Treatment. Quality of Life Res 1992; 1: 257.Google Scholar
  16. 16.
    Torrance GW, Furlong W, Feeny D, Boyle M. Multi-attribute Preference Functions – Health Utilities Index. Pharmacoeconomics 1995; 7: 503.Google Scholar
  17. 17.
    Barnes GE, Prosen H. Depression in Canadian General Practice Attenders. Can J Psychiatry 1984; 29: 2.Google Scholar
  18. 18.
    Torrance GW. Health States Worse than Death. In: van Eimeren W, Engelbert R, Flagle CD (eds), Third International Conference on System Science in Health Care. Berline: Springer, 1984.Google Scholar
  19. 19.
    Patrick DL, Starks HE, Cain KC, Ullmann RF, Pearlman RA. Measuring Preferences for Health States Worse than Death. Medical Decis Making 1994; 14: 9.Google Scholar
  20. 20.
    Torrance GW. Measurement of Health State Utilities for Economic Appraisal. A review. J Health Economics 1986; 5: 1.Google Scholar
  21. 21.
    Bartko JJ. The Intraclass Correlation Coeffcient as a Measure of Reliability. Psychol Reports 1966; 19: 3.Google Scholar
  22. 22.
    Bartko JJ. General Methodology II. Measures of Agreement: A Single Procedure. Statistics in Med 1994; 13: 737–745.Google Scholar
  23. 23.
    Dunn G. Design and Analysis of Reliability Studies: The Statistical Evaluation of Measurement Errors. New York: Oxford University Press, 1989.Google Scholar
  24. 24.
    Fleiss JL. Statistical Methods for Rates and Proportions. 2nd edn. Toronto: John Wiley and Sons, 1981.Google Scholar
  25. 25.
    Juniper EF, Guyatt GH, Feeny DH, Griffith LE, Ferrie PJ. Minimum Skills Required by Children to Complete Health-related Quality of Life Instruments for Asthma: Comparison of Measurement Properties. Eur Respir J 1997; 10: 2285–2294.Google Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • K.J. Bennett
    • 1
  • G.W. Torrance
    • 1
    • 2
    • 3
    • 4
  • M.H. Boyle
    • 1
  • R. Guscott
    • 5
  • L.A. Moran
    • 1
  1. 1.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  2. 2.Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonCanada
  3. 3.School of BusinessMcMaster UniversityHamiltonCanada
  4. 4.Innovus Research Inc.BurlingtonCanada
  5. 5.Department of PsychiatryUniversity of TorontoTorontoCanada

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