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Balázs PG, Erdősi D, Zemplényi A, Brodszky V. Time trade-off health state utility values for depression: a systematic review and meta-analysis. Qual Life Res 2023; 32:923-937. [PMID: 36178658 PMCID: PMC10063515 DOI: 10.1007/s11136-022-03253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to systematically review the literature on health utility in depression generated by time trade-off (TTO) method and to compare health state vignettes. METHODS Systematic literature search was conducted following PRISMA guideline in 2020 November (updated in 2022 March) in Pubmed, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews. Random effect meta-analysis was conducted to pool vignette-based utility values of mild, moderate, and severe depression and to compare the preferences of depressed and nondepressed population. RESULTS Overall, 264 records were found, 143 screened by title and abstract after removing duplicates, 18 assessed full text, and 14 original publications included. Majority of the studies (n = 9) used conventional TTO method, and most of the studies (n = 8) applied 10-year timeframe. Eight studies evaluated self-experienced health (own-current depression). Six studies assessed vignette-based health states of remitted, mild, moderate, and severe depression, half of them applied McSad measure based health description. Altogether, 61 different utility values have been cataloged, mean utility of self-experienced depression states (n = 33) ranged between 0.89 (current-own depression) and 0.24 (worst experienced depression). Pooled utility estimates for vignette-based mild, moderate, and severe depression was 0.75, 0.66 and 0.50, respectively. Meta-regression showed that severe depression (β = -0.16) and depressed sample populations (β = -0.13) significantly decrease vignette-based utility scores. CONCLUSION Our review revealed extent heterogeneity both in TTO methodology and health state vignette development. Patient's perception of depression health states was worse than healthy respondents.
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Affiliation(s)
- Péter György Balázs
- Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary
- Institute of Social and Political Sciences, Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - Dalma Erdősi
- Center for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Antal Zemplényi
- Center for Health Technology Assessment and Pharmacoeconomic Research, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
| | - Valentin Brodszky
- Institute of Social and Political Sciences, Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
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Gamper EM, King MT, Norman R, Loth FLC, Holzner B, Kemmler G. The EORTC QLU-C10D discrete choice experiment for cancer patients: a first step towards patient utility weights. J Patient Rep Outcomes 2022; 6:42. [PMID: 35507194 PMCID: PMC9068836 DOI: 10.1186/s41687-022-00430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Utility-Core 10 Dimensions (QLU-C10D) is a novel cancer-specific preference-based measure (PBM) for which value sets are being developed for an increasing number of countries. This is done by obtaining health preferences from the respective general population. There is an ongoing discussion if instead patients suffering from the disease in question should be asked for their preferences. We used the QLU-C10D valuation survey, originally designed for use in the general population, in a sample of cancer patients in Austria to assess the methodology’s acceptability and applicability in this target group before obtaining QLU-C10D patient preferences. Methods The core of the QLU-C10D valuation survey is a discrete choice experiment in which respondents are asked to give preferences for certain health states (described by a relatively large number of 10 quality of life domains) and an associated survival time. They therewith are asked to trade off quality of life against life time. As this might be a very burdensome task for cancer patients undergoing treatment, a cognitive interview was conducted in a pilot sample to assess burden and potential additional needs for explanation in order to be able to use the DCE for the development of QLU-C10D patient preferences. In addition, responses to general feedback questions on the survey were compared against responses from a matched control group from the already completed Austrian general population valuation survey. Results We included 48 patients (mean age 59.9 years; 46% female). In the cognitive interview, the majority indicated that their experience with the survey was positive (85%) and overall clarity as good (90%). In response to the general feedback questions, patients rated the presentation of the health states less clear than matched controls (p = 0.008). There was no difference between patients and the general population concerning the difficulty in choosing between the health states (p = 0.344). Conclusion Despite the relatively large number of DCE domains the survey was manageable for patients and allows going on with the QLU-C10D patient valuation study. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00430-5.
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Affiliation(s)
- Eva-Maria Gamper
- Innsbruck Institute of Patient-Centered Outcome Research (IIPCOR), Dr. Stumpf Straße 47, 6020, Innsbruck, Austria.
| | - Madeleine T King
- School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, 2006, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Fanny L C Loth
- Faculty of Philosophy and Education, Catholic University of Eichstätt-Ingolstadt, Eichtstätt, Germany
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
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Nho JH, Park SK. Factors affecting unmet healthcare needs of low-income overweight and obese women in Korea: analysis of the Korean National Health and Nutrition Examination Survey 2017. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2021; 27:93-103. [PMID: 36313135 PMCID: PMC9334183 DOI: 10.4069/kjwhn.2021.05.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/08/2001] [Accepted: 05/06/2021] [Indexed: 07/29/2023] Open
Abstract
PURPOSE The purpose of this study was to explore unmet healthcare needs among low-income overweight and obese women and to identify the factors affecting unmet healthcare needs. METHODS The study was a secondary analysis of data from the 2017 Korea National Health and Nutrition Examination Survey. A final sample of 388 out of 8,127 participants was analyzed using complex descriptive statistics, the chi-square test, the independent t-test, and logistic regression. RESULTS The mean age of the participants was 66.51±1.05 years. Unmet healthcare needs were experienced by 19.4% of low-income overweight and obese women. Women with depression, stress, and poor self-reported health status were significantly more likely than their counterparts to experience unmet healthcare needs. Poor self-reported health status was confirmed to be related to unmet health needs in low-income overweight and obese women (odds ratio, 2.65; p=.011). CONCLUSION The study provides the novel insight that the unmet healthcare needs of low-income overweight and obese women were influenced by self-reported health status. Healthcare providers should make efforts to develop strategies to reduce unmet healthcare needs among low-income overweight and obese women, who constitute a vulnerable population.
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Affiliation(s)
| | - Sook Kyoung Park
- Corresponding author: Sook Kyoung Park College of Nursing, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea E-mail:
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Implications of response shift for micro-, meso-, and macro-level healthcare decision-making using results of patient-reported outcome measures. Qual Life Res 2021; 30:3343-3357. [PMID: 33651278 PMCID: PMC8602130 DOI: 10.1007/s11136-021-02766-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Results of patient-reported outcome measures (PROMs) are increasingly used to inform healthcare decision-making. Research has shown that response shift can impact PROM results. As part of an international collaboration, our goal is to provide a framework regarding the implications of response shift at the level of patient care (micro), healthcare institute (meso), and healthcare policy (macro). METHODS Empirical evidence of response shift that can influence patients' self-reported health and preferences provided the foundation for development of the framework. Measurement validity theory, hermeneutic philosophy, and micro-, meso-, and macro-level healthcare decision-making informed our theoretical analysis. RESULTS At the micro-level, patients' self-reported health needs to be interpreted via dialogue with the clinician to avoid misinterpretation of PROM data due to response shift. It is also important to consider the potential impact of response shift on study results, when these are used to support decisions. At the meso-level, individual-level data should be examined for response shift before aggregating PROM data for decision-making related to quality improvement, performance monitoring, and accreditation. At the macro-level, critical reflection on the conceptualization of health is required to know whether response shift needs to be controlled for when PROM data are used to inform healthcare coverage. CONCLUSION Given empirical evidence of response shift, there is a critical need for guidelines and knowledge translation to avoid potential misinterpretations of PROM results and consequential biases in decision-making. Our framework with guiding questions provides a structure for developing strategies to address potential impacts of response shift at micro-, meso-, and macro-levels.
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Goodwin E, Green C, Hawton A. What Difference Does It Make? A Comparison of Health State Preferences Elicited From the General Population and From People With Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:242-250. [PMID: 32113630 DOI: 10.1016/j.jval.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/02/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND A major debate in the quality-adjusted life-year (QALY) literature concerns whose preferences should be used to estimate health state values (HSVs) and to calculate QALYs. OBJECTIVES This study explores differences between public and patient values for multiple sclerosis (MS) health states, described using an MS-specific classification system (Multiple Sclerosis Impact Scale-8 Dimensions [MSIS-8D]). METHODS The MSIS-8D is an existing preference-based measure of health-related quality of life in MS, which has 2 tariffs of HSVs, based on the preferences of a representative sample of the UK general population (n = 1702) and of people with MS living in the United Kingdom (n = 1635), elicited using the time trade-off technique. Here, we explore differences between HSVs by sample type, using descriptive statistics and multivariate regression methods. RESULTS Overall, the survey of people with MS produced significantly higher HSVs; estimated values ranged from 0.079 to 0.883 for the general population survey and from 0.138 to 0.894 for the MS survey. Differences in HSVs were more pronounced for severe health states. The difference between patient and public values varied across the dimensions of the MSIS-8D. People with MS placed greater importance on cognition than the general population, leading to lower HSVs when impairment was at a worse level; the reverse was true for the daily activities, fatigue, and depression dimensions. CONCLUSIONS We identified significant differences in HSVs by sample type. Using patient rather than public values may influence the results of economic evaluations, depending on the dimensions of health-related quality of life affected by the intervention being assessed, and may therefore have important consequences for reimbursement decisions.
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Affiliation(s)
- Elizabeth Goodwin
- Health Economics Group, Institute of Health Research, University of Exeter, Exeter, England, UK.
| | - Colin Green
- Health Economics Group, Institute of Health Research, University of Exeter, Exeter, England, UK; South West Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, England, UK
| | - Annie Hawton
- Health Economics Group, Institute of Health Research, University of Exeter, Exeter, England, UK; South West Collaboration for Leadership in Applied Health Research and Care, University of Exeter Medical School, University of Exeter, Exeter, England, UK
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Stigma towards depression in a community-based sample in China. Compr Psychiatry 2020; 97:152152. [PMID: 31838297 DOI: 10.1016/j.comppsych.2019.152152] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Understanding the general public's beliefs about depression is essential if public education and anti-stigma interventions are to be effective. This study aimed to examine Chinese respondents' personal attitudes towards depression and their perceptions about the attitudes of others regarding depression and to identify the correlates of personal stigma and perceived stigma towards depression. METHODS A community survey was conducted among 1697 residents aged between 16 and 89 years of a large city in central China using the Depression Stigma Scale. Participants completed questionnaires assessing experiences of depression and family functioning. RESULTS Participants reported high levels of stigma towards depression, with greater perceived stigma than personal stigma. Increasing age was correlated with greater personal stigma and perceived stigma. Higher personal stigma was also significantly correlated with being male, unemployed and good family function. CONCLUSION Concerningly high levels of stigmatizing beliefs towards depression were prevalent among the public. This may be a reason why people with mental disorders do not seek assistance. This highlights the importance of the need for health education and promotion activities. Findings from this study suggest that targeted, culturally appropriate education programs are needed to improve knowledge about depression in the broader community.
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Niemeyer KM, Gonzales JA, Doan T, Browne EN, Rao MM, Acharya NR. Time Trade-off Utility Values in Noninfectious Uveitis. Am J Ophthalmol 2019; 208:47-55. [PMID: 31201795 DOI: 10.1016/j.ajo.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate time trade-off (TTO) utility values in patients with noninfectious uveitis and determine whether patient demographics and clinical characteristics are associated with utility scores. DESIGN Time trade-off utility analysis. METHODS Setting: A tertiary care uveitis center in San Francisco, California, USA. PATIENT POPULATION One hundred and four consecutive adults with noninfectious uveitis, enrolled between November 2016 and February 2017. MAIN OUTCOME MEASURES TTO utility values, as collected by an interviewer-guided survey. Information regarding general health, ocular symptoms, and religion was also collected and medical record review was conducted to record anatomic location of uveitis, disease activity, visual acuity, and treatments. Multivariable regression analysis with backward selection was used to identify variables associated with TTO values. RESULTS Median TTO score was 0.975 (interquartile range [IQR]: 0.8-1.0), corresponding to trading a median 1.28 years of remaining life for healthy eyes (IQR: 0-6.29). Regression analysis revealed that worse eye visual acuity, >6 months of oral corticosteroid use, and current antidepressant use were associated with lower TTO scores (P = .008, P = .006, P = .008, respectively), controlling for age and sex. In particular, patients who had been taking oral corticosteroids for more than 6 months, regardless of dose, were 10.5 times more likely to trade 20% or more years of remaining life (TTO ≤0.8) than patients not taking oral corticosteroids (95% confidence interval: 2.3, 48.1; P = .002). CONCLUSIONS Patients with noninfectious uveitis had measurable, though modest, reductions in quality of life, as assessed by TTO, and these decreases were significantly associated with visual acuity in the worse eye and long-term oral corticosteroid use.
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Affiliation(s)
- Katherine M Niemeyer
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - John A Gonzales
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Thuy Doan
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Erica N Browne
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Maya M Rao
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA; Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
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Clignet F, Houtjes W, van Straten A, Cuijpers P, van Meijel B. Unmet care needs, care provision and patient satisfaction in patients with a late life depression: a cross-sectional study. Aging Ment Health 2019; 23:491-497. [PMID: 29356572 DOI: 10.1080/13607863.2018.1426716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Research has shown that some 30% of total care needs in people with late-life depression (LLD) are unmet. It is not known to what extent patients actually don't receive any care for these needs or consider the care to be insufficient and their satisfaction with the provided care. AIM The aim of this study is to obtain insight into the care provided in relation to the reported unmet care needs and satisfaction with the total care provided is examined. METHOD A cross-sectional study of 99 people with LLD in an ambulatory setting. RESULTS In 67% of patients, at least one unmet need was ascertained. In most cases (80%) care was actually provided for those needs by professionals and/or informal caregivers. Patients were satisfied with the care delivered for 81% of the reported care needs. Satisfaction was lowest for social care needs (67%). For six specific care needs it was demonstrated that dissatisfied patients were significantly more depressed than satisfied patients. CONCLUSION Even though patients might receive care for certain needs, this does not mean that their needs are met. A substantial proportion of patients with LDD feel that they need additional help for unmet needs.
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Affiliation(s)
- Frans Clignet
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands.,b Department of old age psychiatry , Altrecht specialists in Mental Health Care , Zeist , 3705 WH , Netherlands
| | - Wim Houtjes
- c GGZ-VS, Academy for Clinical Nurse Specialists in mental healthcare , Utrecht , 3511 GE , Netherlands
| | - Annemieke van Straten
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands
| | - Pim Cuijpers
- a Department of Clinical-, Neuro- and Developmental Psychology , Vrije Universiteit Amsterdam , 1081 BT , Netherlands
| | - Berno van Meijel
- d Department of Health & Self-management , Inholland University of Applied Sciences , Amsterdam , 1081 HV , Netherlands
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Engel L, Chen G, Richardson J, Mihalopoulos C. The impact of depression on health-related quality of life and wellbeing: identifying important dimensions and assessing their inclusion in multi-attribute utility instruments. Qual Life Res 2018; 27:2873-2884. [DOI: 10.1007/s11136-018-1936-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
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Comparison of health state values derived from patients and individuals from the general population. Qual Life Res 2017; 26:3353-3363. [PMID: 28808840 DOI: 10.1007/s11136-017-1683-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Utility values are critical for cost-utility analyses that guide healthcare decisions. We aimed to compare the utility values of the 5-level EuroQoL-5Dimension (EQ-5D-5L) health states elicited from members of the general public and patients with heart disease or cancer. METHODS In face-to-face interviews with 157 heart disease patients, 169 cancer patients, and 169 members from the general population, participants valued 10 EQ-5D-5L health states using a composite Time Trade-Off method. RESULTS Pooling utility values for all health states, heart disease patients and cancer patients had mean utility values lower by 0.11 points (P value = 0.014) and 0.06 points (P value = 0.148), respectively, compared to the general population. Adjusting for sociodemographic characteristics, differences in health state utility values between the patient and the general populations were rendered non-significant, except that heart disease patients gave higher utility values (mean difference = 0.08; P value = 0.007) to mild health states than the general population. Difference in utility values, defined as utility value of a better health state minus that of a poorer health state, was higher among heart disease patients compared to the general population, before and after adjusting for sociodemographic characteristics. CONCLUSIONS Patients may differ from members of the general population in the strength of their preferences for hypothetical health states. Using utility values derived from the general population may under-estimate the comparative effectiveness of healthcare interventions for certain diseases, such as heart diseases.
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Paans NPG, Bot M, Gibson-Smith D, Spinhoven P, Brouwer IA, Visser M, Penninx BWJH. Which biopsychosocial variables contribute to more weight gain in depressed persons? Psychiatry Res 2017; 254:96-103. [PMID: 28457991 DOI: 10.1016/j.psychres.2017.04.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/14/2017] [Accepted: 04/22/2017] [Indexed: 12/31/2022]
Abstract
Depression appears to be associated with weight gain. Little is known about whether this association is independent of, or partly due to, several biopsychosocial variables. This study aims to investigate which biopsychosocial variables contribute to weight gain over a 4-year period in persons with major depressive disorder (MDD) or high depressive symptoms. Data from 1658 adults who participated in the Netherlands Study of Depression and Anxiety were used. Baseline depression was measured with a DSM-IV based psychiatric interview and with a depressive symptom measure. Four year weight gain was classified as stable weight (within 5% gain or loss) versus weight gain (>5% gain). Twenty-one baseline psychological, lifestyle and biological variables and antidepressant use were considered as potential contributing variables. In sociodemographic adjusted models, MDD and depressive symptoms were associated with subsequent weight gain. None of the biopsychosocial variables or antidepressants was associated with weight gain, thus did not contribute to the observed increased weight gain risk in depression, except for alcohol intake and TCA use. Future research should explore other potential factors that may be responsible for the increased risk for subsequent weight gain in depression, e.g. unhealthy dietary patterns or eating styles, or underlying intrinsic factors such as genetics.
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Affiliation(s)
- Nadine P G Paans
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands.
| | - Mariska Bot
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands
| | - Deborah Gibson-Smith
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University and Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingeborg A Brouwer
- Department of Health Sciences, Faculty of Earth and Life Sciences, and Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Earth and Life Sciences, and Amsterdam Public Health Research Institute, VU University, Amsterdam, The Netherlands; Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, and Amsterdam Public Health research institute, VU University, Amsterdam, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands
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Sexton E, Bennett K, Fahey T, Cahir C. Does the EQ-5D capture the effects of physical and mental health status on life satisfaction among older people? A path analysis approach. Qual Life Res 2016; 26:1177-1186. [PMID: 27866315 DOI: 10.1007/s11136-016-1459-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the extent to which EQ-5D utility scores capture the effect of mental and physical health status on life satisfaction (LS) in older adults. METHODS Retrospective cohort study of 884 patients aged ≥70 years from 15 general practices in Ireland, including medical records, pharmacy claims, and self-completion questionnaire. Path analysis was used to evaluate the direct and indirect effects of: (1) chronic disease burden (based on medications data); (2) activity limitation (basic and instrumental activities of daily living); (3) anxiety symptoms and; (4) depressive symptoms (Hospital Anxiety and Depression Scale) on LS (Life Satisfaction Index Z), via a utility score based on responses to the EQ-5D scale. Utility scores were calculated using UK time trade-off utility weights. Covariates included age and socioeconomic status. RESULTS The final path model fitted the data well (goodness of fit χ2 = 7.5, df (7), p = 0.37). The direct effects of chronic disease burden and disability on LS were not statistically significant and were excluded from the final model, indicating that EQ-5D score mediated 100% of the total effect on LS. The direct and indirect effects of anxiety and depression on LS were statistically significant, but the size of the indirect effect was small (4% of the total effect for anxiety and 6% of the total effect for depression). CONCLUSION The EQ-5D does not adequately capture the effects of anxiety and depression on LS among older adults, suggesting that it may lead to inaccurate assessments of the effectiveness of interventions in this cohort.
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Affiliation(s)
- Eithne Sexton
- Department of Psychology, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer St, Dublin, 2, Ireland.
| | - Kathleen Bennett
- Population and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tom Fahey
- Health Research Board (HRB) Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Caitriona Cahir
- Population and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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