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Citation
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Lex H, Ginsburg Y, Sitzmann AF, Grayhack C, Maixner DF, Mickey BJ. J. Affect. Disord. 2018; 243: 401-407. |
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Affiliation
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Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: brian.mickey@utah.edu. |
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Abstract
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BACKGROUND: Treatment-resistant depression affects millions of people worldwide and is a leading cause of disability and suicide. Studies of treatment-resistant depression outcomes have traditionally focused on depressive symptoms and functional impairment. Quality of life (QoL) has not been well described. We aimed to measure QoL in individuals with treatment-resistant depression and to determine how QoL was related to traditional measures of symptoms and social functioning.
METHODS: We used a reliable, cross-culturally validated questionnaire, the abbreviated World Health Organization Quality of Life scale (WHOQOL-BREF), to prospectively measure QoL in 79 patients with treatment-resistant depression who were referred for electroconvulsive therapy at a United States tertiary-care medical center. QoL was characterized in four domains: physical, psychological, social, and environmental. QoL domains were examined for association with demographic variables, patient-reported depressive symptoms, functional impairment, and childhood adversity, as well as clinician-rated scales.
RESULTS: Relative to published international norms, mean QoL scores were low in physical (standardized score, z = -2.0), psychological (z = -2.6), and social (z = -1.0) domains, but not in the environmental domain (z = 0.2). After controlling for age and income, patient-rated depressive symptoms correlated with physical (Pearson correlation, r = -0.26) and psychological (r = -0.43) QoL, whereas adverse childhood experiences correlated with environmental QoL (r = -0.33). Patient-rated functional impairment correlated modestly with all domains (r = -0.25 to -0.39). Surprisingly, QoL correlated very weakly with clinician-rated measures. These modest associations of QoL with other clinical scales were confirmed in multiple regression analyses. LIMITATIONS: We used a single QoL instrument, which did not allow us to directly compare the WHOQOL-BREF scale with other commonly used instruments. Our sample was recruited from a single academic medical center in the Midwest region of the United States and was largely Caucasian. These factors may limit generalizability to other settings and ethnicities.
CONCLUSION: Among individuals with treatment-resistant depression, QoL is lowest in the psychological and physical domains. QoL is only modestly correlated with patient-rated symptoms and functioning, and even more weakly correlated with clinician-rated scales, indicating that measures of symptoms and functioning cannot serve as QoL proxies. QoL should be assessed when caring for patients with treatment-resistant depression. When developing novel biological, psychological, and social interventions for treatment-resistant depression, QoL should be targeted as a distinct clinical outcome.
Copyright © 2018. Published by Elsevier B.V.
Language: en |