Quality of life in depression: An important outcome measure in an outpatient cognitive–behavioural therapy group programme?

Abstract

Studies have shown that psychiatric patients have significantly impaired quality of life (QOL) in comparison to community samples who are not suffering a mental illness. Despite an increase in research in the mental health field, there still remains little consensus as to the merit of using such questionnaires within a mental health population. There is a concern that QOL is redundant with affective state and symptomatology. We investigated the usefulness of the Quality of Life Enjoyment and Satisfaction Questionnaire-short form (QLESQ-SF) in a depressed outpatient sample receiving time-limited, standardized group cognitive-behavioural therapy. QLESQ-SF ratings were examined at admission and 10-week endpoint in an intention-to-treat (N = 212) and completers (N = 164) sample. QLESQ-SF ratings and symptom ratings (Beck Depression Inventory-II; Beck Anxiety Inventory) improved significantly over time. Hierarchical regression analyses revealed that, although affective state and change in symptomatology were significantly correlated with QOL and change in QOL, a large proportion of variance was unexplained. These results are inconsistent with the theory of measurement redundancy. QOL appears to be a useful measure that provides additional treatment outcome information distinct from affective state and symptomatology.

Improvement in self-reported quality of life with cognitive therapy for recurrent major depressive disorder

“…In a like manner, Q-LES-Q scores increase with both pharmacological (Demyttenaere et al, 2008, Keitner et al, 2009, Kocsis, 1997, Lydiard RB, 1997, Miller et al, 1998, Shelton RC, 2006, Trivedi et al, 2004a, Versiani et al, 2005) and psychosocial (Drymalski and Washburn, 2011, Swan et al, 2009) treatment interventions.…”

“…Toward this end to evaluate the clinical significance of this increase in Q-LES-Q score, Swan et al (Swan et al, 2009) used the two-fold criteria proposed by Jacobson and Truax (Jacobson and Truax, 1991) and Cohen's d effect size. As a measure of clinical significance, Jacobson and Truax (Jacobson and Truax, 1991) proposed a two-fold criterion of post-treatment score being more than cut off score (CS) and reliable change index (RCI) > 1.96 to determine the extent to which a treatment intervention moves a patient out of dysfunctional range or within functional range and beyond the range of measurement error (Jacobson et al, 1984).…”

“…Endicott et al (Endicott et al, 1993) estimated correlation coefficients of change in Q-LES-Q with change in Hamilton Rating Scale for Depression17-items (HRSD-17) which ranged from -0.34 to -0.54 suggesting Q-LES-Q is sensitive to change in depressive symptom but may not be totally redundant. Using hierarchical multiple regression analysis, Swan et al (Swan et al, 2009) reported that between 37% and 53% variance in Q-LES-Q SF is not accounted for by the change in depression severity measured by Beck Depression Inventory (BDI) II. Defining “normal” quality of life as within 10% of community norm of Q-LES-Q SF score of 58 {per (Rapaport et al, 2005)}, Demyttenaere et al (Demyttenaere et al, 2008) found that 40% individuals who attained remission of depressive symptoms {defined as Montgomery Asberg Depression Rating Score (Montgomery and Asberg, 1979) less than or equal to 12} did not have a “normal” quality of life.…”

“…Compared to discontinued pharmacotherapy, CT significantly reduces the risk of relapse/recurrence of MDD (Vittengl et al, 2007). Only a limited number of studies have evaluated effect of CT on QoL (Jarrett et al, 2013, Swan et al, 2009, Vittengl et al, 2007, Watson and Nathan, 2008), although the findings of these studies suggest that QoL in depressed patients improves with effective treatment. For a detailed quality of life assessment, Jarrett and Thase used long form of Q-LES-Q in Continuation Phase Cognitive Therapy Relapse Prevention (C-CT-RP) and included acute phase CT provided to adults presenting with recurrent MDD (Jarrett et al, 2013, Jarrett and Thase, 2010).…”

“…Here we provide a comprehensive and multidimensional evaluation of QoL (Jarrett et al, 2013, Jarrett and Thase, 2010) by relying on a large sample (N= 492) who completed the long form of Q-LES-Q complete with summary scales (i.e., physical health, subjective feelings, work, household duties, school/course work, leisure time activities, social relationships and general activities). We also rely upon the use of multiple measures of depression severity making replication of previously published reports possible (Endicott et al, 1993, Swan et al, 2009) in a general attempt to better understand of the influence of change in depression severity on change in QoL in recurrent MDD patients.…”