Functioning and Utility for Current Health of Patients With Depression or Chronic Medical Conditions in Managed, Primary Care Practices

Wells, Kenneth B.; Sherbourne, Cathy D.

doi:10.1001/archpsyc.56.10.897

Cited by 208 publications

(160 citation statements)

References 22 publications

(22 reference statements)

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“…However, most prior estimates of health utility in type 2 diabetes have failed to account for depression, thus producing biased estimates of health utility. Patients with depression rate their quality of life lower than those with other chronic diseases [29]. Our models show that depression decreases health utility by 0.37-0.38, an estimate that is consistent with prior studies in other disease models [30,31].…”

Section: Discussionsupporting

confidence: 88%

Correlates of health-related quality of life in type 2 diabetes

et al. 2006

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Aims/hypothesis: We assessed the impact of medical comorbidities, depression, and treatment intensity on quality of life in a large primary care cohort of patients with type 2 diabetes. Methods: We used the Health Utilities Index-III, an instrument that measures healthrelated quality of life based on community preferences in units of health utility (scaled from 0=death to 1.0=perfect health), in 909 primary care patients with type 2 diabetes. Demographic and clinical correlates of health-related quality of life were assessed. Results: The median health utility score for this population was 0.70 (interquartile range 0.39-0.88). In univariate analyses, older age, female sex, low socioeconomic status, cardiovascular disease, microvascular complications, congestive heart failure, peripheral vascular disease, chronic lung disease, depression, insulin use and number of medications correlated with decreased quality of life, while obesity, hypertension and hypercholesterolaemia did not. In multiple regression analyses, microvascular complications, heart failure and depression were most strongly related to decreased healthrelated quality of life, independently of duration of diabetes; in these models, diabetes patients with depression had a utility of 0.59, while patients without symptomatic comorbidities did not have a significantly reduced quality of life. Treatment intensity remained a significant negative correlate of quality of life in multivariable models. Conclusions/interpretation: Patients with type 2 diabetes have a substantially decreased quality of life in association with symptomatic complications. The data suggest that treatment of depression and prevention of complications have the greatest potential to improve health-related quality of life in type 2 diabetes.

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Section: Discussionsupporting

confidence: 88%

Correlates of health-related quality of life in type 2 diabetes

et al. 2006

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“…Lower quality of life in women compared with men has been attributed to (among other factors) depression, hormonal changes and self perception of health. [29][30][31] The influence of treatment of hypertension on quality of life has been scarcely investigated in population-based surveys. 12 We determined that quality of life was lower in participants with controlled hypertension under drug treatment than in participants with uncontrolled hypertension using or not using BP drugs.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life is worse in individuals with hypertension under drug treatment: results of population-based study

et al. 2011

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Patients with hypertension usually report lower healthrelated quality of life (HRQoL), but it is unclear whether this is secondary to high blood pressure (BP) per se, drug treatment or awareness of disease. In a crosssectional study using a multistage population-based sample, participants were interviewed and examined at home. Hypertension was defined by BP X140/90 mm Hg or use of BP-lowering drugs. HRQoL was assessed through the Short-Form Health Survey (SF-12) and presented as the physical component summary (PCS), mental component summary (MCS) and the SF-12 eightdomain scale. In total, 1858 individuals were evaluated, being 60.1% women, aged 52.5 ± 4.1 years old, and 39.9% men, aged 47.2±9.1 years old. Prevalence of hypertension was 34.2% (95% CI 31.5-36.9). The PCS scores for hypertensive and normotensive participants were 49.4 (CI 48.6-50.2) and 51.06 (CI 50.4-51.7) (P ¼ 0.01), respectively, and the MCS scores were 49.1 (CI 47.9-50.3) and 50.5 (CI 49.6-51.2) (P ¼ 0.06), respectively. Participants with hypertension and not using BP drugs had higher HRQoL scores (PCS 49.6; MCS 51.9) than those using BP drugs either with uncontrolled (PCS 45.3; MCS 49.4) or controlled BP (PCS 46.2; MCS 47.7; Po0.05). We concluded that individuals with hypertension have worse quality of life, particularly when their BP is controlled by drugs. This perception may lead to lower rates of adherence to treatment.

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“…[5][6][7] Furthermore, severity of depressive symptoms is inversely related to patients' health-related quality of life, even after controlling for age, sex, and medical comorbidities. 8,9 Many older persons, however, have more than one chronic illness that may differentially impair health status.…”

Section: Depression and Comorbid Illnessmentioning

confidence: 99%

Depression and Comorbid Illness in Elderly Primary Care Patients: Impact on Multiple Domains of Health Status and Well-being

Noël

Williams

Unützer

et al. 2004

The Annals of Family Medicine

223

136

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PURPOSE Our objective was to examine the relative association of depression severity and chronicity, other comorbid psychiatric conditions, and coexisting medical illnesses with multiple domains of health status among primary care patients with clinical depression. METHODSWe collected cross-sectional data as part of a treatment effectiveness trial that was conducted in 8 diverse health care organizations. Patients aged 60 years and older (N = 1,801) who met diagnostic criteria for major depression or dysthymia participated in a baseline survey. A survey instrument included questions on sociodemographic characteristics, depression severity and chronicity, neuroticism, and the presence of 11 common chronic medical illnesses, as well as questions screening for panic disorder and posttraumatic stress disorder. Measures of 4 general health indicators (physical and mental component scales of the SF-12, Sheehan Disability Index, and global quality of life) were included. We conducted separate mixed-effect regression linear models predicting each of the 4 general health indicators.RESULTS Depression severity was signifi cantly associated with all 4 indicators of general health after controlling for sociodemographic differences, other psychological dysfunction, and the presence of 11 chronic medical conditions. Although study participants had an average of 3.8 chronic medical illnesses, depression severity made larger independent contributions to 3 of the 4 general health indicators (mental functional status, disability, and quality of life) than the medical comorbidities.CONCLUSIONS Recognition and treatment of depression has the potential to improve functioning and quality of life in spite of the presence of other medical comorbidities. 2004;2:555-562. DOI: 10.1370/afm.143. Ann Fam Med INTRODUCTIONE pidemiological and clinical studies consistently indicate that depression adversely affects the lives of older adults. The relative contribution to adverse effects is not entirely clear, because depression often occurs in conjunction with other psychiatric illnesses, such as anxiety disorders; somatic symptoms, such as pain; and chronic medical illnesses, such as diabetes. The latter is particularly of concern, because it is often diffi cult to know whether a particular symptom, such as lethargy, is caused by depression, a coexisting medical illness, or both. Patients with chronic medical illness are known to have a high prevalence of comorbid depression.1 Furthermore, both major depressive disorder and subsyndromal depression have been associated with increased somatic symptoms, morbidity, mortality, health care utilization, and costs in the presence of comorbidities. 5-7 Furthermore, severity of depressive symptoms is inversely related to patients' health-related quality of life, even after controlling for age, sex, and medical comorbidities. 8,9 Many older persons, however, have more than one chronic illness that may differentially impair health status. Elders with multiple comorbidities may be particularly vulne...

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Functioning and Utility for Current Health of Patients With Depression or Chronic Medical Conditions in Managed, Primary Care Practices

Cited by 208 publications

References 22 publications

Correlates of health-related quality of life in type 2 diabetes

Correlates of health-related quality of life in type 2 diabetes

Health-related quality of life is worse in individuals with hypertension under drug treatment: results of population-based study

Depression and Comorbid Illness in Elderly Primary Care Patients: Impact on Multiple Domains of Health Status and Well-being

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