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

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Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

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Abbreviations

BAI:

Beck Anxiety Inventory

CS-PTR:

Cedars-Sinai Psychiatric Treatment Outcome Registry

EWPS:

Endicott Work Productivity Scale

GAF:

Global Assessment of Functioning

IRB:

Institutional Review Board

QIDS-SR:

Quick Inventory of Depressive Symptomatology-Self Report

Q-LES-Q:

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

QOL:

Quality of life

MDD:

Major Depressive Disorder

SDS:

Sheehan Disability Scale

WHO:

World Health Organization

WSAS:

Work and Social Adjustment Scale

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Cedars-Sinai Medical Center, 8730 Alden Drive, Thalians W-157, Los Angeles, CA, 90048, USA

    Waguih William IsHak

  2. David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Waguih William IsHak

  3. Department of Psychiatry, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Konstantin Balayan & Scott Christensen

  4. Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Catherine Bresee

  5. Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Jared Matt Greenberg

  6. Department of Psychiatry, Faculty of Medicine, Cairo University, Cairo, Egypt

    Hala Fakhry

  7. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Mark Hyman Rapaport

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  1. Waguih William IsHak
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  2. Konstantin Balayan
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  7. Mark Hyman Rapaport
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Correspondence to Waguih William IsHak.

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IsHak, W.W., Balayan, K., Bresee, C. et al. A descriptive analysis of quality of life using patient-reported measures in major depressive disorder in a naturalistic outpatient setting. Qual Life Res 22, 585–596 (2013). https://doi.org/10.1007/s11136-012-0187-6

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