Brief report
Quality of life outcomes among patients with depression after 6 months of starting treatment: Results from FINDER

https://doi.org/10.1016/j.jad.2008.05.021Get rights and content

Abstract

Background

Health-related quality of life (HRQoL) data in depression are limited. We studied the impact of antidepressant (AD) treatment on HRQoL outcomes in depressed patients and investigated factors associated with these outcomes in routine practice settings.

Methods

The Factors Influencing Depression Endpoints Research (FINDER) study was a 6-month, European, prospective, observational study, designed to estimate HRQoL in 3468 adult patients with a clinically diagnosed episode of depression at baseline and at 3 and 6-months after commencing AD treatment. HRQoL was assessed by the Medical Outcome Short-Form (36) Health Survey (SF-36) and European Quality of Life-5 Dimensions (EQ-5D). Regression analysis identified baseline and treatment variables independently and significantly associated with HRQoL outcomes.

Results

Most HRQoL improvement occurred within 3 months of starting treatment. Better HRQoL outcomes were strongly associated with fewer somatic symptoms at baseline, AD treatment taken and not switching within AD groups. Education and occupational status were also important. Depression variables (number of previous depressions and current episode duration) were consistently associated with worse HRQoL outcomes. Self-rated depression severity was associated with poorer outcomes on the SF-36 mental component only.

Limitations

As this was an observational study, the important finding that between and within AD group switching impacted HRQoL will need to be investigated in more controlled settings.

Conclusions

Receiving an AD treatment was associated with large improvements in HRQoL, but switching within AD groups was consistently associated with poorer outcomes. Somatic symptoms, including painful symptoms, are often present in depressed patients and appear to negatively impact HRQoL outcomes.

Introduction

Health-related quality of life (HRQoL) is impaired in patients with depression, especially when compared to the general population and patients with other chronic diseases, such as diabetes, arthritis or cardiovascular disease (Hays et al., 1995, Wells et al., 1989, Wells and Sherbourne, 1999). There is increasing interest in HRQoL as a measure of response to antidepressant treatment because it encompasses not only symptoms, but also physical, mental and social functioning as well as role performance (Demyttenaere et al., 2002). Thus, assessment of HRQoL may provide a more comprehensive evaluation of treatment response than one based solely on improvement in emotional symptoms of depression.

Factors Influencing Depression Endpoints Research (FINDER) was a 6-month, observational study to assess the HRQoL of outpatients with a depressive episode in routine primary care and specialist settings (Bauer et al., 2008, Garcia-Cebrian et al., 2008). The aims of the present report are to describe the HRQoL outcomes at three and six months after commencing pharmacotherapy for depression and to determine which factors are associated with HRQoL changes over time.

Section snippets

Study design and subjects

The design and methods of FINDER have been reported in detail elsewhere (Bauer et al., 2008, Garcia-Cebrian et al., 2008). Briefly, primary care physicians or specialists (mostly psychiatrists) enrolled adult patients (≥ 18 years) presenting during the normal course of care with a clinical diagnosis of depression who were about to commence antidepressant treatment. The study was approved in all countries according to local requirements for ethics and/or regulatory approvals for observational

HRQoL scores at baseline and follow-up

The socio-demographic and clinical characteristics of the FINDER study population are reported elsewhere (Garcia-Cebrian et al., 2008). The mean unadjusted scores for SF-36 and EQ-5D at baseline, 3 and 6 months (Fig. 1) show HRQoL improvements at 3 months, with a further smaller improvement at 6 months.

Loss to follow-up analysis

Of the 3468 patients at baseline, 343 (9.9%) had no follow-up data, 271 (7.8%) had data at 3 months only, and 2854 (82.3%) had data at both 3 and 6 months or 6 months only.

Three variables were

Discussion

The results of this large observational study showed that outpatients with an untreated episode of depression experienced improvements in HRQoL after starting antidepressant medication. The majority of this improvement occurred in the first 3 months of follow-up. The SF-36 summary scores show that the HRQoL impairment at baseline and the improvements during treatment were much greater for mental health dimensions than for physical health. Although the study population did not reach HRQoL levels

Conclusions

This study showed that several patient- and treatment-related factors are associated with HRQoL outcomes of depressive episodes in everyday clinical practice. Receiving an AD treatment was associated with large improvements in HRQoL, but switching within AD groups was consistently associated with poorer outcomes. Somatic symptoms, including painful symptoms, are often present in depressed patients and appear to negatively impact HRQoL outcomes.

Role of Funding Source

FINDER was funded by Eli Lilly and Company Limited, Windlesham, Surrey, UK & Boehringer Ingelheim GmbH, Ingelheim, Germany. The sponsors were involved in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of Interest

Catherine Reed, David Perahia, Ana Garcia-Cebrian and Deborah Quail are Lilly employees and Brigitta Monz is a Boehringer Ingelheim employee. Paul Ghandi was employed by Eli Lilly & Company Ltd, Basingstoke, UK at the time the research was performed. Michael Bauer, Nicolas Danchev, Koen Dymettenaere, Luigi Grassi, Angel Luis Montejo and Andre Tylee have received economic compensation for participation in the FINDER Advisory Board.

Acknowledgements

We would like to thank all investigators and patients who participated in the FINDER study, as well as all colleagues from Eli Lilly and Boehringer Ingelheim, especially Mary Lou Furstnau, for implementing FINDER in the various countries. The authors also thank Deirdre Elmhirst for her editorial assistance in preparing the manuscript.

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