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The relationship of health-related quality of life and treatment outcome during inpatient treatment of depression

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Abstract

Purpose

Health-related quality of life (HRQoL) is important for long-term social functioning. It is considerably reduced in patients with depression. We studied the impact of HRQoL on treatment outcome in patients with unipolar depression. Furthermore, we analysed factors associated with HRQoL in inpatients with unipolar depression.

Methods

One hundred and eighty patients suffering from major depressive disorder were evaluated during their inpatient treatment by assessing admission and discharge depression severity and their HRQoL, using the Medical Outcomes Study 12-item Short Form (SF-12). Baseline and treatment variables associated with HRQoL were examined by regression analysis. Primary outcome measures were the Hamilton Rating Scale and the Beck Depression Inventory.

Results

HRQoL improved significantly during inpatient treatment. Lower HRQoL outcomes were strongly associated with higher age, somatic comorbidities, a recurrent depressive disorder and stronger depressive symptoms at admission. Additionally, patients with a complex treatment situation (high number of medications, antidepressant switch) showed stronger impairment of HRQoL. Personality disorders and additional psychotherapy did not predict HRQoL.

Conclusion

The inpatient treatment resulted in an increase of the SF-12 scores, although to a lower extent than depressive symptoms. Several factors negatively influence HRQoL, such as the presence of somatic and axis I psychiatric comorbiditites and a recurrent or severe depressive episode. Targeting somatic comorbidities in patients with unipolar depression seem to play an important role for HRQoL.

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References

  1. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.

    Article  PubMed  Google Scholar 

  2. Lopez, A. D., Mathers, C. D., Ezzati, M., Jamison, D. T., & Murray, C. J. (2006). Global and regional burden of disease and risk factors, 2001: Systematic analysis of population health data. Lancet, 367(9524), 1747–1757.

    Article  PubMed  Google Scholar 

  3. Center for Control Disease and Prevention. (2014). Retrieved from http://www.cdc.gov/hrqol/concept.htm.

  4. Hirschfeld, R. M., Montgomery, S. A., Keller, M. B., Kasper, S., Schatzberg, A. F., Moller, H. J., et al. (2000). Social functioning in depression: A review. Journal of Clinical Psychiatry, 61(4), 268–275.

    Article  CAS  PubMed  Google Scholar 

  5. Angermeyer, M. C., Holzinger, A., Matschinger, H., & Stengler-Wenzke, K. (2002). Depression and quality of life: Results of a follow-up study. International Journal of Social Psychiatry, 48(3), 189–199.

    Article  CAS  PubMed  Google Scholar 

  6. Berlim, M. T., Pargendler, J., Brenner, J., & Fleck, M. P. (2007). Significant improvement in the quality of life of Brazilian depressed outpatients 12 weeks following the start of antidepressants. Psychiatry Research, 153(3), 253–259.

    Article  CAS  PubMed  Google Scholar 

  7. Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V., & Ustun, B. (2007). Depression, chronic diseases, and decrements in health: Results from the World Health Surveys. Lancet, 370(9590), 851–858.

    Article  PubMed  Google Scholar 

  8. Lim, L., Jin, A. Z., & Ng, T. P. (2012). Anxiety and depression, chronic physical conditions, and quality of life in an urban population sample study. Social Psychiatry and Psychiatric Epidemiology, 47(7), 1047–1053.

    Article  PubMed  Google Scholar 

  9. Ravindran, A. V., Matheson, K., Griffiths, J., Merali, Z., & Anisman, H. (2002). Stress, coping, uplifts, and quality of life in subtypes of depression: A conceptual frame and emerging data. Journal of Affective Disorders, 71(1–3), 121–130.

    Article  PubMed  Google Scholar 

  10. Sobocki, P., Ekman, M., Agren, H., Runeson, B., & Jonsson, B. (2006). The mission is remission: Health economic consequences of achieving full remission with antidepressant treatment for depression. International Journal of Clinical Practice, 60(7), 791–798.

    Article  CAS  PubMed  Google Scholar 

  11. Pyne, J. M., Bullock, D., Kaplan, R. M., Smith, T. L., Gillin, J. C., Golshan, S., et al. (2001). Health-related quality-of-life measure enhances acute treatment response prediction in depressed inpatients. Journal of Clinical Psychiatry, 62(4), 261–268.

    Article  CAS  PubMed  Google Scholar 

  12. ten Doesschate, M. C., Koeter, M. W., Bockting, C. L., & Schene, A. H. (2010). Health related quality of life in recurrent depression: A comparison with a general population sample. Journal of Affective Disorders, 120(1–3), 126–132.

    Article  PubMed  Google Scholar 

  13. Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2005). Quality-of-life impairment in depressive and anxiety disorders. American Journal of Psychiatry, 162(6), 1171–1178.

    Article  PubMed  Google Scholar 

  14. Kroenke, K. (2003). Patients presenting with somatic complaints: Epidemiology, psychiatric comorbidity and management. International Journal of Methods in Psychiatric Research, 12(1), 34–43.

    Article  PubMed  Google Scholar 

  15. Tylee, A., & Gandhi, P. (2005). The importance of somatic symptoms in depression in primary care. Primary Care Companion to the Journal of Clinical Psychiatry, 7(4), 167–176.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Judd, L. L., Akiskal, H. S., Maser, J. D., Zeller, P. J., Endicott, J., Coryell, W., et al. (1998). Major depressive disorder: A prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. Journal of Affective Disorders, 50(2–3), 97–108.

    Article  CAS  PubMed  Google Scholar 

  17. Bair, M. J., Robinson, R. L., Eckert, G. J., Stang, P. E., Croghan, T. W., & Kroenke, K. (2004). Impact of pain on depression treatment response in primary care. Psychosomatic Medicine, 66(1), 17–22.

    Article  PubMed  Google Scholar 

  18. Reed, C., Monz, B. U., Perahia, D. G., Gandhi, P., Bauer, M., Dantchev, N., et al. (2009). Quality of life outcomes among patients with depression after 6 months of starting treatment: Results from FINDER. Journal of Affective Disorders, 113(3), 296–302.

    Article  PubMed  Google Scholar 

  19. Matsunaga, M., Okamoto, Y., Suzuki, S., Kinoshita, A., Yoshimura, S., Yoshino, A., et al. (2010). Psychosocial functioning in patients with treatment-resistant depression after group cognitive behavioral therapy. BMC Psychiatry, 10, 22.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Caruso, R., Rossi, A., Barraco, A., Quail, D., & Grassi, L. (2010). The Factors Influencing Depression Endpoints Research (FINDER) study: Final results of Italian patients with depression. Annals of General Psychiatry, 9, 33.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Wells, K. B., Sherbourne, C., Schoenbaum, M., Duan, N., Meredith, L., Unutzer, J., et al. (2000). Impact of disseminating quality improvement programs for depression in managed primary care: A randomized controlled trial. JAMA, 283(2), 212–220.

    Article  CAS  PubMed  Google Scholar 

  22. Bech, P. (2005). Social functioning: Should it become an endpoint in trials of antidepressants? CNS Drugs, 19(4), 313–324.

    Article  PubMed  Google Scholar 

  23. Trivedi, M. H. (2001). Sensitizing clinicians and patients to the social and functional aspects of remission. Journal of Clinical Psychiatry, 62(Suppl 19), 32–35.

    PubMed  Google Scholar 

  24. Wisniewski, S. R., Rush, A. J., Bryan, C., Shelton, R., Trivedi, M. H., Marcus, S., et al. (2007). Comparison of quality of life measures in a depressed population. The Journal of Nervous and Mental Disease, 195(3), 219–225.

    Article  PubMed  Google Scholar 

  25. Frank, E., Prien, R. F., Jarrett, R. B., Keller, M. B., Kupfer, D. J., Lavori, P. W., et al. (1991). Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Remission, recovery, relapse, and recurrence. Archives of General Psychiatry, 48(9), 851–855.

    Article  CAS  PubMed  Google Scholar 

  26. Härter, M., Klesse, C., Bermejo, I., Schneider, F., & Berger, M. (2010). Unipolar depression: Diagnostic and therapeutic recommendations from the current S3/National Clinical Practice Guideline. Deutsches ärzteblatt International, 107(40), 700–708.

    PubMed Central  PubMed  Google Scholar 

  27. Hiller, W., Zaudig, M., & Mombour, W. (2005). IDCL: ICD-10 Checklists. Göttingen: Hogrefe.

    Google Scholar 

  28. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.

    Article  CAS  PubMed  Google Scholar 

  30. Endicott, J., Spitzer, R. L., Fleiss, J. L., & Cohen, J. (1976). The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33(6), 766–771.

    Article  CAS  PubMed  Google Scholar 

  31. Guy, W. (1976). Clinical Global Impressions (CGI). In: ECDEU Assessment Manual for Psychopharmacology US Department of Health, Education, and Welfare Publication (ADM) 76–338 (pp. 218–222). Rockville, MD: National Institute of Mental Health.

  32. First, M., Gibbon, M., & Spitzer, R. (1996). Structured clinical interview for DSM-IV axis II disorders. New York NY: Biometrics Research Dept, NewYork State Psychiatric Institute.

    Google Scholar 

  33. Ware, J, Jr, Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.

    Article  PubMed  Google Scholar 

  34. Collegium Internationale Psychiatriae Scalarum (CIPS). (2005). Internationale Skalen für Psychiatrie. Göttingen: Beltz Test.

    Google Scholar 

  35. Ware, J. E., Kosinski, M., & Keller, S. D. (1995). SF-12: How to score the SF-12 physical and mental health summary scales (2nd ed.). Boston: The Health Institute, New England Medical Center.

    Google Scholar 

  36. CIPS. (2005). International scales for psychiatry. Göttingen: Beltz Test GmbH.

    Google Scholar 

  37. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.

    Article  CAS  PubMed  Google Scholar 

  38. Seemüller, F., Riedel, M., Obermeier, M., Bauer, M., Adli, M., Kronmüller, K., et al. (2010). Outcomes of 1014 naturalistically treated inpatients with major depressive episode. European Neuropsychopharmacology, 20(5), 346–355.

    Article  PubMed  Google Scholar 

  39. Daly, E. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Gaynes, B. N., Warden, D., et al. (2010). Health-related quality of life in depression: A STAR*D report. Annals of Clinical Psychiatry, 22(1), 43–55.

    PubMed  Google Scholar 

  40. Garcia-Campayo, J., Ayuso-Mateos, J. L., Caballero, L., Romera, I., Aragones, E., Rodriguez-Artalejo, F., et al. (2008). Relationship of somatic symptoms with depression severity, quality of life, and health resources utilization in patients with major depressive disorder seeking primary health care in Spain. Primary Care Companion to the Journal of Clinical Psychiatry, 10(5), 355–362.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Bauer, M., Monz, B. U., Montejo, A. L., Quail, D., Dantchev, N., Demyttenaere, K., et al. (2008). Prescribing patterns of antidepressants in Europe: Results from the Factors Influencing Depression Endpoints Research (FINDER) study. European Psychiatry, 23(1), 66–73.

    Article  PubMed  Google Scholar 

  42. Peveler, R., Kendrick, T., Buxton, M., Longworth, L., Baldwin, D., Moore, M., et al. (2005). A randomised controlled trial to compare the cost-effectiveness of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine. Health Technol Assess, 9(16), 1–134, iii.

  43. Dunner, D. L., Kwong, W. J., Houser, T. L., Richard, N. E., Donahue, R. M., & Khan, Z. M. (2001). Improved health-related quality of life and reduced productivity loss after treatment with bupropion sustained release: A study in patients with major depression. Primary Care Companion to the Journal of Clinical Psychiatry, 3(1), 10–16.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Kruijshaar, M. E., Hoeymans, N., Bijl, R. V., Spijker, J., & Essink-Bot, M. L. (2003). Levels of disability in major depression: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Journal of Affective Disorders, 77(1), 53–64.

    Article  CAS  PubMed  Google Scholar 

  45. Kennedy, N., Foy, K., Sherazi, R., McDonough, M., & McKeon, P. (2007). Long-term social functioning after depression treated by psychiatrists: A review. Bipolar Disorders, 9(1–2), 25–37.

    Article  PubMed  Google Scholar 

  46. Trivedi, M. H., Rush, A. J., Wisniewski, S. R., Warden, D., McKinney, W., Downing, M., et al. (2006). Factors associated with health-related quality of life among outpatients with major depressive disorder: A STAR*D report. Journal of Clinical Psychiatry, 67(2), 185–195.

    Article  PubMed  Google Scholar 

  47. Köhler, S., Unger, T., Hoffmann, S., Steinacher, B., Fydrich, T., & Bschor, T. (2013). Comparing augmentation with non-antidepressants over sticking to antidepressants after treatment failure in depression: A naturalistic study. Pharmacopsychiatry, 46(2), 69–76.

    PubMed  Google Scholar 

  48. Ruhe, H. G., Huyser, J., Swinkels, J. A., & Schene, A. H. (2006). Switching antidepressants after a first selective serotonin reuptake inhibitor in major depressive disorder: A systematic review. Journal of Clinical Psychiatry, 67(12), 1836–1855.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

There are no competing financial interests in relation to the work described.

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Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, Kliniken im Theodor-Wenzel-Werk, Berlin, Germany

    Stephan Köhler, Theresa Unger, Sabine Hoffmann, Arthur Mackert & Barbara Ross

  2. Department of Psychology, Humboldt-University, Berlin, Germany

    Thomas Fydrich

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  1. Stephan Köhler
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  2. Theresa Unger
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  3. Sabine Hoffmann
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Correspondence to Stephan Köhler.

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Köhler, S., Unger, T., Hoffmann, S. et al. The relationship of health-related quality of life and treatment outcome during inpatient treatment of depression. Qual Life Res 24, 641–649 (2015). https://doi.org/10.1007/s11136-014-0811-8

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