Quality of life across domains among individuals with treatment-resistant depression

JOURNAL OF AFFECTIVE DISORDERS

卷:243

Article

Lex, Heidemarie¹  Ginsburg, Yarden²  Sitzmann, Adam F.²  Grayhack, Clara²  Maixner, Daniel F.²  Mickey, Brian J.^1,2 

[1] Univ Utah, Sch Med, Dept Psychiat, Salt Lake City, UT 84108 USA

[2] Univ Michigan, Dept Psychiat, Med Sch, Ann Arbor, MI 48109 USA

关键词: Treatment-resistant depression;    Quality of life;    Functional impairment;    Childhood adversity;    Major depressive disorder;    Bipolar disorder;   

DOI  :  10.1016/j.jad.2018.09.062

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

Free