Original articleQuality of life assessments in major depressive disorder: a review of the literature
Introduction
Unipolar depression is currently the leading cause of disability in developed countries [3], and the fourth leading cause of disability worldwide [4]. Projections estimate that Major Depressive Disorder (MDD) will rise to be the second leading cause of disability worldwide by the year 2020 [5]. MDD has also been shown to account for a 23-fold increase in social disability, even after controlling for physical disease [6], as well as an almost 5-fold increase in short-term work-disability days [7]. Patients with MDD were found to score lower than those with a number of medical conditions on physical functioning, role functioning and emotional functioning [8]. Patients with Major Depression were also found to have long-lasting decrements in psychosocial functioning that were equal to or greater than those of patients with chronic medical illness such as diabetes and osteoarthirtis [9]. In a study of 11242 outpatients in three health care provision systems, Wells and colleagues reported worse physical, social, and role functioning in MDD patients than patients with no chronic conditions [10]. A large study of 25916 primary care patients from 14 countries revealed that patients with MDD were more likely to report disability than those without, controlling for the severity of physical disease [11]. In a similar study conducted in Western Europe, the degree of disability was found to be directly related to severity of depression in patients with MDD [12]. This may account for the fact that individuals with a history of a depressive episode are also at increased risk for chronic financial stress [13]. The presence of less severe depressive disorders such as sub-syndromal depression has also been shown to have a negative impact on psychosocial functioning [14]. Finally, the annual cost of depression to society in the US has been estimated at 44 billion dollars [15]. Of this amount, $23.8 billion represent costs stemming from the impact of depression in the workplace [15]. These estimates include costs associated with MDD, bipolar depression, and dysthymia but not minor depression.
Perhaps the most disabling aspect of depression is it's adverse impact in psychosocial functioning and quality of life. A number of studies have compared MDD patients with normal controls on several aspects of social functioning. Women with MDD were found to have more impairment in familial, marital, and occupational roles that nondepressed women [16]. A study comparing social functioning in outpatients with MDD, bipolar depression, or dysthymia revealed disturbances in most areas of functioning, predominantly occupational and leisure activities [17]. Fredman and colleagues [18] reported poorer intimate relationships and less satisfying social interactions in patients with MDD compared to those without in a community sample of nearly 5000 patients. Results stemming from the National Institutes of Mental Health (NIMH) Epidemiological Catchment Area Program [19] revealed that subjects with Major Depression or subsyndromal depression had higher levels of household strain, social irritability, financial strain, limitations in occupational functioning, poor health status [14], and days lost from work [20] than subjects without any depressive disorder or symptoms. Finally, data stemming from the National Comorbidity Survey [21] revealed that patients with depression (defined as either MDD, bipolar depression, or dysthymia) were less likely to complete high school or college [22]; more likely to experience teenage pregnancy [23] and more likely to experience divorce [24] than nondepressed subjects. While patients with MDD were less likely to be satisfied with their marriage [25], and more likely to report poorer quality of interpersonal relationships [26] than subjects without MDD.
Section snippets
The impact of treatment on quality of life in MDD
Although it is widely assumed that the improvement in depressive symptoms during treatment leads to an improvement in the quality of life and a decrease in disability, few antidepressant trials focus on the impact of treatment on quality of life and disability. In the language of the World Health Organization (WHO), health is defined as “a state of complete physical, mental, and social well-being and not merely the absence of infirmity” [27]. From this standpoint, clinical response, and
Conclusion
A number of large, epidemiologically based studies suggest that MDD is associated with significant disability and poorer quality of life. Studies focusing on the impact of the acute phase of treatment on quality of life suggest that antidepressant treatment may lead to significant improvement in quality of life measures. Studies focusing on the maintenance and continuation phase of treatment show a less dramatic improvement in psychosocial function over time for pharmacotherapy compared to
References (64)
- et al.
Alternative projections of mortality and disability by cause, 1990-2020global burden of disease study
Lancet
(1997) - et al.
Global mortality, disability, and the contribution of risk factorsglobal burden of disease study
Lancet
(1997) - et al.
Impairment of work and leisure in depressed outpatientsa preliminary communication
J Affect Disord
(1986) - et al.
Social functioning in community residents with depression and other psychiatric disordersresults of the Newhaven Epidemiologic Catchment Area Study
J Affect Disord
(1988) - et al.
The relationship between quality of interpersonal relationships and major depressive disorderfindings from the National Comorbidity Survey
J Affect Disord
(2000) - et al.
Social functioning in chronic depressioneffect of 6 weeks of antidepressant treatment
Psychiatry Res
(1988) - et al.
Interpersonal improvement in chronically depressed patients treated with desipramine
J Affect Disord
(1996) - et al.
A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine
Biol Psychiatry
(2002) - et al.
Quality of life in geriatric depressiona comparison of remitters, partial responders and non-responders
Am J Geriatr Psychiatry
(2001) - et al.
MAOI treatment responsemultiaxial assessment
J Affect Disord
(1988)
Sociocultural and clinical characteristics of patients with comorbid depressiona comparison of substance abuse and non-substance abuse diagnoses
Compr Psychiatry
Personality disorder symptoms predict declines in global functioning and quality of life in elderly depressed patients
Am J Geriatr Psychiatry
Social adjustment in depressionthe impact of depression severity, personality, and clinic versus community sampling
J Affect Disord
The effect of changes in depression on health related quality of life (HRQoL) in HIV infection
Gen Hosp Psychiatry
Minor depressive disorder and subsyndromal depressive symptomsfunctional impairment and response to treatment
J Affect Disord
Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination
Biol Psychiatry
Six months of desipramine for dysthymiacan dysthymic patients achieve normal social functioning?
J Affect Disord
Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United Statesresults from the National Comorbidity Survey
Arch Gen Psychiatry
Quality of life enjoyment and satisfaction questionnairea new measure
Psychopharmacol Bull
Caring for depressiona RAND study
Onset of disability in depressed and non-depressed primary care patients
Psychol Med
Depression, disability days, and days lost from work in a prospective epidemiological survey
JAMA
Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study
JAMA
Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses
Arch Gen Psychiatry
The functioning and well-being of depressed patients. Results from the Medical Outcomes Study
JAMA
Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care
JAMA
Depression in the communitythe first pan-European study DEPRES [Depression Research in European Society]
Int Clin Psychopharmacol
Self-efficacy as a mediator between stressful life events and depressive symptomsdifferences based on history of prior depression
Br J Psychiatry
Socioeconomic burden of subsyndromal depressive symptoms and major depression in a sample of the general population
Am J Psychiatry
The economic burden of depression in 1990
J Clin Psychiatry
Social adjustment by self-report in a community sample and in psychiatric outpatients
J Nerv Ment Dis
The Epidemiologic Catchment Area Program of the National Institute of Mental Health
Public Health Rep
Cited by (246)
The effect of inflammation markers on cortical thinning in major depressive disorder: A possible mediator of depression and cortical changes
2024, Journal of Affective DisordersA comprehensive review of discovery and development of drugs discovered from 2020–2022
2024, Saudi Pharmaceutical JournalDepression symptom outcomes and re-engagement among VA patients who discontinue care while symptomatic
2023, General Hospital Psychiatry