Health-related quality of life in recurrent major depressive disorder--a 10-year follow-up study

Associations of antidepressant medication consumption with changes in personality pathology and quality of life among community-dwelling adults

BACKGROUND

Although antidepressant medication (ADM) has produced small advantages over pill placebo in randomized controlled trials, consuming ADM has predicted prospectively increasing depressive symptom severity in samples of community-dwelling adults.

OBJECTIVE

We extended the community literature by testing ADM's relations to changes in personality and quality of life that may underpin depression.

METHOD

In this longitudinal, observational study, community-dwelling adults (N = 601) were assessed twice, 8 months apart on average. Assessments included depressive symptoms, personality, life satisfaction and quality, and prescription medication consumption.

RESULTS

Consuming ADM at time 1 predicted relative increases in depressive symptoms (dysphoria), maladaptive traits (negative affect, negative temperament, disinhibition, low conscientiousness), personality dysfunction (non-coping, self-pathology), and decreases in life satisfaction and quality from time 1 to 2, before and after adjustment for age, gender, race, income, education, physical health problems, and use of other psychotropics. In no analysis did ADM use predict better outcomes.

CONCLUSION

Among community-dwelling adults, ADM use is a risk factor for psychosocial deterioration in domains including depressive symptoms, personality pathology, and quality of life. Until mechanisms connecting ADM to poor outcomes in community samples are understood, additional caution in use of ADM and consideration of empirically supported non-pharmacologic treatments is prudent.

An interdisciplinary multimodal integrative healthcare program for depressive and anxiety disorders

Objective

Although multimodal interventions are recommended in patients with severe depressive and/or anxiety disorders, available evidence is scarce. Therefore, the current study evaluates the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program, delivered within a transdiagnostic framework, for patients with (comorbid) depressive and/or anxiety disorders.

Methods

Participants were 3,900 patients diagnosed with a depressive and/or anxiety disorder. The primary outcome was Health-Related Quality of Life (HRQoL) measured with the Research and Development-36 (RAND-36). Secondary outcomes included: (1) current psychological and physical symptoms measured with the Brief Symptom Inventory (BSI) and (2) symptoms of depression, anxiety, and stress measured with the Depression Anxiety Stress Scale (DASS). The healthcare program consisted of two active treatment phases: main 20-week program and a subsequent continuation-phase intervention (i.e., 12-month relapse prevention program). Mixed linear models were used to examine the effects of the healthcare program on primary/secondary outcomes over four time points: before start 20-week program (T0), halfway 20-week program (T1), end of 20-week program (T2) and end of 12-month relapse prevention program (T3).

Results

Results showed significant improvements from T0 to T2 for the primary variable (i.e., RAND-36) and secondary variables (i.e., BSI/DASS). During the 12-month relapse prevention program, further significant improvements were mainly observed for secondary variables (i.e., BSI/DASS) and to a lesser extent for the primary variable (i.e., RAND-36). At the end of the relapse prevention program (i.e., T3), 63% of patients achieved remission of depressive symptoms (i.e., DASS depression score ≤ 9) and 67% of patients achieved remission of anxiety symptoms (i.e., DASS anxiety score ≤ 7).

Conclusion

An interdisciplinary multimodal integrative healthcare program, delivered within a transdiagnostic framework, seems effective for patients suffering from depressive and/or anxiety disorders with regard to HRQoL and symptoms of psychopathology. As reimbursement and funding for interdisciplinary multimodal interventions in this patient group has been under pressure in recent years, this study could add important evidence by reporting on routinely collected outcome data from a large patient group. Future studies should further investigate the long-term stability of treatment outcomes after interdisciplinary multimodal interventions for patients suffering from depressive and/or anxiety disorders.

Cognitive Impairment and Neurocognitive Profiles in Major Depression-A Clinical Perspective

Increasingly, studies have investigated cognitive functioning from the perspective of acute state- to remitted phases of Major Depressive Disorder (MDD). Some cognitive deficits observed in the symptomatic phase persist in remission as traits or scars. The etiological origin and clinical consequences of the neurocognitive profiles reported in the literature are still unclear and may vary across populations. Deficits are suspected to influence the association between MDD and neurodegenerative disorders and could thus be of particular clinical consequence. The aim of this review is to describe the clinical neuropsychological profile in MDD and how it is related to research during the past decade on cognitive deficits in MDD from a state, trait, and scar perspective. This review, with a clinical perspective, investigates research from the past decade regarding cognitive functioning in MDD in a long-term perspective. We focus on the clinical manifestation of deficits, and the potential neurodegenerative consequences of the neurocognitive profile in MDD. Searches in Medline, PsycINFO and Embase were conducted targeting articles published between 2010 and 2020. Examination of the evidence for long-lasting neurocognitive deficits in major depression within the cognitive domains of Memory, Executive Functions, Attention, and Processing Speed was conducted and was interpreted in the context of the State, Scar and Trait hypotheses. Defining the neurocognitive profiles in MDD will have consequences for personalized evaluation and treatment of residual cognitive symptoms, and etiological understanding of mood disorders, and treatments could potentially reduce or delay the development of neurodegenerative disorders.

Sense of happiness and other aspects of quality of life in patients with obsessive-compulsive disorder

INTRODUCTION

Quality of life (QoL) is the intellectual and emotional wellbeing of an individual, which is determined by many factors. The most measurable are the sense of happiness, occupational satisfaction, quality of interpersonal relationships and sex life. Obsessive-compulsive disorder (OCD) is a chronic mental disorder diagnosed by the presence of obsessions and compulsions that disrupt normal psychosocial functioning. Despite early onset, treatment is delayed (OCD-DTI) and unsatisfactory.

OBJECTIVES

The primary objective of this study is to assess selected correlates of the sense of happiness among patients with OCD. The secondary objective is to compare the sense of happiness with healthy people.

METHODS

Seventyfive OCD patients and equal number of healthy subjects were compared using a Polish adaptation of the Oxford Happiness Questionnaire (OHQ-23).

RESULTS

We found a significant negative correlation between sense of happiness and the severity of OCD (r = -0.479), the number of obsessive-compulsive personality traits (r = -0.323), the number of other comorbid mental disorders (r = -0.272), the level of aggression (r = -0.448), impulsivity (r = -0.301), depressiveness (r = -0.357), and the sexual dysfunctions (r = -0.279). The latter were much more common in individuals with OCD compared to healthy subjects (66.67 vs. 12%). The level of loneliness was over two times higher in the study group compared to controls (27 vs. 12%). The mean delay in treatment onset was 13 years. Conclusions. Assessment of aspects of QoL should be an integral part of the diagnostic and therapeutic process in OCD.

Anxiety, Depression and Quality of Life-A Systematic Review of Evidence from Longitudinal Observational Studies

This review aimed to systematically review observational studies investigating the longitudinal association between anxiety, depression and quality of life (QoL). A systematic search of five electronic databases (PubMed, PsycINFO, PSYNDEX, NHS EED and EconLit) as well as forward/backward reference searches were conducted to identify observational studies on the longitudinal association between anxiety, depression and QoL. Studies were synthesized narratively. Additionally, a random-effects meta-analysis was performed using studies applying the mental and physical summary scores (MCS, PCS) of the Short Form Health Survey. The review was prospectively registered with PROSPERO and a study protocol was published. n = 47 studies on heterogeneous research questions were included, with sample sizes ranging from n = 28 to 43,093. Narrative synthesis indicated that QoL was reduced before disorder onset, dropped further during the disorder and improved with remission. Before onset and after remission, QoL was lower in comparison to healthy comparisons. n = 8 studies were included in random-effects meta-analyses. The pooled estimates of QoL at follow-up (FU) were of small to large effect sizes and showed that QoL at FU differed by disorder status at baseline as well as by disorder course over time. Disorder course groups differed in their MCS scores at baseline. Effect sizes were generally larger for MCS relative to PCS. The results highlight the relevance of preventive measures and treatment. Future research should consider individual QoL domains, individual anxiety/depressive disorders as well as the course of both over time to allow more differentiated statements in a meta-analysis.

First-Episode Patients Report Cognitive Difficulties in Executive Functioning 1 Year After Initial Episode of Major Depressive Disorder

Objective: Major Depressive Disorder (MDD) is associated with cognitive impairment in general, and Executive Functioning (EF) in particular, even in remitted phase of the disorder, suggesting residual cognitive symptoms. The aim of the present study was to investigate self-reported EF 1 year after the first episode of MDD and to explore this in relation to depressive mood symptoms, remission and relapse. Method: The study included data from 24 patients and 23 healthy control subjects 1 year after the patients' initial first episode of MDD. All participants completed the Behavior Rating Inventory of Executive Functioning-Adult version (BRIEF-A), a standardized self-report measure of perceived EF in everyday life, measuring nine different EF. Total index scores for metacognitive functions, behavior/emotional regulation functions and a global EF score is also calculated. Results: The patient group in total, independent of symptom status, reported significantly lower EF in all indexes compared to the healthy controls 1 year after the initial episode. However, higher depressive mood symptom load correlated with self-reported difficulties in metacognitive functions and poor global EF scores. Regulatory control of behavior and emotional responses did not show such strong association with mood symptoms, but low self-report scores on this measure was associated with relapse during the first year after the initial episode. Conclusion: First-episode patients report significant lower executive functioning in everyday life compared to individually matched healthy controls, 1 year after onset, independent of symptom load. Residual cognitive symptoms seem to be evident and associated with risk of relapse and should be targeted in treatment and prevention of recurrence in MDD.

Restoration of psychosocial functioning in remitted major depressive disorder patients: A 1-year longitudinal study

BACKGROUND

The recovery of psychosocial functioning is an important treatment goal for patients with depression. The aim of the present study is to investigate psychosocial functioning restoration 1 year after major depressive disorder (MDD) remission.

METHODS

Depression symptoms and psychosocial functioning were assessed in 167 remitted MDD patients at baseline, as well as 1, 2, 6, 9, and 12 months following remission, according to the Hamilton Depression Scale (HAMD-17) and Generic Quality of Life Inventory (GQOLI-74).

RESULTS

Of the 167 MDD patients, 85 completed the final evaluation at 1 year, 32 relapsed, and 50 dropped out. The total relapse rate over 1 year was 27%. A rapid increase in psychosocial functioning was found in the first 2 months after remission in the non-relapse group. In the non-relapse group, psychosocial functioning was higher at 2 months than at baseline. At baseline and 2 months, psychosocial functioning was lower in the relapse group patients compared to those in the non-relapse group.

CONCLUSIONS

Patients with MDD showed continuous improvement in psychosocial functioning during the first year after remission, though psychosocial functioning in the relapse group remained the same during the first two months, suggesting possible further relapse.

Four-year course of quality of life and obsessive-compulsive disorder

OBJECTIVE

Patients with obsessive compulsive disorder (OCD) have high disease burden. It is important to restore quality of life (QoL) in treatment, so that patients become able to live a fulfilling life. Little is known about the longitudinal course of QoL in patients with OCD, its association with remission from OCD, and about factors that contribute to an unfavourable course of QoL in remitting patients.

METHODS

Study on the 4-year course of QoL of patients with chronic (n = 144), intermittent (n = 22), and remitting OCD (n = 73) using longitudinal data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA; complete data: n = 239; imputed data n = 382). The EuroQol five-dimensional questionnaire (EQ-5D) utility score was used to assess QoL. In patients with remitting OCD, we examined patient characteristics that contributed to an unfavourable course of QoL, including sociodemographics, OCD characteristics, psychiatric comorbidity, and personality traits.

RESULTS

Course of QoL was associated with course of OCD. QoL improved in those who remitted from OCD; however, even in these patients, QoL remained significantly below the population norms. The correlation between QoL and severity of OCD was only moderate: r = - 0.40 indicating that other factors besides OCD severity contribute to QoL. In remitters, more severe anxiety and depression symptoms were related to a lower QoL. Results were similar in complete and imputed data sets.

CONCLUSIONS

Remission from OCD is associated with improvement of QoL, but comorbid anxiety and depression symptoms hamper the improvement of QoL. QoL could be improved by reducing OCD symptoms in patients with OCD and by treating comorbid anxiety and depression symptoms in remitting patients.

Quality of Life across Mental Disorders in Psychiatric Outpatients

Introduction: Literature has shown that individuals with various psychiatric disorders experience a lower quality of life (QoL). However, few have examined QoL across disorders. The current study explored differences in QoL and symptom severity across 4 psychiatric diagnostic groups: anxiety disorders (including obsessive compulsive disorder [OCD]), depressive disorders, schizophrenia, and pathological gambling. Materials and Methods: Data analysed was from a previous study that examined the prevalence of hoarding symptoms among outpatients (n = 500) in a tertiary psychiatric hospital in Singapore. Measures utilised included the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II) and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). Sociodemographic information and details on type and number of comorbidities were also collected. Results: The depressive disorder group had the highest level of depressive and anxiety symptoms and the lowest QoL whereas; the schizophrenia group had the lowest level of depressive symptoms and the highest QoL. Age and employment status were the only sociodemographic correlates which were significantly associated with QoL. After controlling for sociodemographic factors, only the type of mental disorder was found to have a significant effect in explaining BAI, BDI-II and Q-LES-Q-SF. Conclusion: Findings offer insight in terms of the burden associated with the various disorders. Key words: Anxiety, Comorbid, Depression, Symptom severity

Role of Personality Functioning in the Quality of Life of Patients with Depression

Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.

The Correlates of Quality of Life Among Jordanian Patients With Schizophrenia

BACKGROUND

Addressing the quality of life (QOL) of patients with schizophrenia is of special importance in the Arab world, where little knowledge is available about their well-being, and most of them experience stigma and living in poverty.

AIMS

The purpose of this study was to examine the association of sociodemographic characteristics, severity of depressive symptoms, and various aspects of public stigma against mental illness, with QOL among Jordanian patients with schizophrenia.

METHOD

In this descriptive correlational study, 160 Jordanian outpatients diagnosed with schizophrenia completed measures of demographic characteristics, perceived public stigma against mental illness, severity of depression, and QOL.

RESULTS

Participants had poor QOL. Age, marital status, relapse, education level, stigma against mental illness, and severity of depression were significantly associated with QOL among Jordanian patients with schizophrenia. Data analysis revealed that the severity of depression accounted for an additional 27% of the variance above and beyond the 36.7% accounted for by age of the participants and perceived public stigma against mental illness.

CONCLUSIONS

Health care professionals should develop culturally competent nursing practice considering the specific factors associated with QOL among Arab patients with schizophrenia.

Psychological predictors of mental health and health-related quality of life after bariatric surgery: a review of the recent research

BACKGROUND

Improvement of mental health and health-related quality of life (HRQOL) is an important success criterion for bariatric surgery. In general, mental health and HRQOL improve after surgery, but some patients experience negative psychological reactions postoperatively and the influence of pre-surgical psychological factors on mental wellbeing after surgery is unclear. The aim of the current article therefore is to review recent research investigating psychological predictors of mental health and HRQOL outcome.

METHODS

We searched PubMed, PsycInfo and Web of Science for studies investigating psychological predictors of either mental health or HRQOL after bariatric surgery. Original prospective studies published between 2003 and 2012 with a sample size >30 and a minimum of 1 year follow-up were included.

RESULTS

Only 10 eligible studies were identified. The findings suggest that preoperative psychological factors including psychiatric symptoms, body image and self-esteem may be important for mental health postoperatively. Predictors of postoperative HRQOL seem to include personality, severe psychiatric disorder at baseline and improvement of depressive symptoms. In addition, psychiatric symptoms that persist after surgery and inappropriate eating behaviour postoperatively are likely to contribute to poor health-related quality of life outcome.

CONCLUSION

Certain psychological factors appear to be important for mental health and HRQOL after bariatric surgery. However, the literature is extremely sparse and further research is highly needed.

Symptoms of depression as reported by Norwegian adolescents on the Short Mood and Feelings Questionnaire

The present study investigated sex-differences in reports of depressive symptoms on a Norwegian translation of the short version of the Mood and Feelings Questionnaire (SMFQ). The sample comprised 9702 Norwegian adolescents (born 1993-1995, 54.9% girls), mainly attending highschool. A set of statistical analyses were run to investigate the dimensionality of the SMFQ. Girls scored significantly higher than boys on the SMFQ and used the most severe response-category far more frequently. Overall, the statistical analyses supported the essential unidimensionality of SMFQ. However, the items with the highest loadings according to the bifactor analysis, reflecting problems related to tiredness, restlessness and concentration difficulties, indicated that some of the symptoms may both be independent of and part of the symptomatology of depression. Measurement invariance analysis showed that girls scored slightly higher on some items when taking the latent variable into account; girls had a lower threshold for reporting mood problems and problems related to tiredness than boys, who showed a marginally lower threshold for reporting that no-one loved them. However, the effect on the total SMFQ score was marginal, supporting the use of the Norwegian translation of SMFQ as a continuous variable in further studies of adolescents.