A Longitudinal Study of Quality of Life in Persons with Depression
Date Issued
2009
Date
2009
Author(s)
Yun-Ling Chen
Abstract
Background The number of persons with depression has been increasing in the recent 30 years in Taiwan (商志雍, 廖士程, & 李明濱, 民92). Depression is a chronic disorder that substantially impairs a client’s psychosocial and occupational functioning, as well as resulted in significant morbidity and mortality (Bakish, 2001; Trivedi et al., 2006; World Heath Organization, 2007). Although many longitudinal studies have investigated the predictors of Quality of Life (QOL) in persons with depression (Pyne et al., 2003; Ruggeri, Bisoffi, Fontecedro, & Warner, 2001), few of these studies have emphasized on the contribution of psychosocial factors. Results from the longitudinal studies have demonstrated that healthy lifestyle and active coping skills are strong predictors of QOL in physical health and psychological health domain, respectively (Sherbourne, Hays, & Wells, 1995). A study by Goldberg and Harrow (2005) found a significant relationship between objective social functioning and social aspect of QOL among persons with depression (J. F. Goldberg & Harrow, 2005). Several cross-sectional studies suggested that occupational competence, mastery, environmental affordance and social support may have contribution to enhance QOL for persons with depression (Carpiniello, Lai, Pariante, Carta, & Rudas, 1997; Chan, Chiu, Chien, Thompson, & Lam, 2006; Chung, Pan, & Hsiung, 2008 Accepted; Kuehner & Buerger, 2005; Pan, Chan, Chung, Chen, & Hsiung, 2006; 陳韻玲, 熊秉荃, 陳詞章, & 潘璦琬, 民97). The severity of depression and the demographic characteristics have been proposed to predict clients’ long-term QOL but the results of studies investigating these factors have been inconsistent. To date, there are few internationally published studies on the factors affecting QOL for Taiwanese or eastern people with depression and these studies delineated the predictors of QOL were restricted in using the cross-sectional study design (Chan et al., 2006; Hung, 2006; Pan et al., 2006; 陳韻玲 et al., 民97). As QOL in depression may have cultural differences, we deemed it worthwhile to conduct a study in Taiwan (Berzon, Hays, & Shumaker, 1993).Thus, the aim of this study is to examine the change in QOL and predictive factors of QOL in persons with depression from longitudinal perspective.ethods The study is a naturalistic longitudinal study and the subjects were adult outpatients with depression recruited from the psychiatric outpatient clinic of the National Taiwan University Hospital (NTUH) in Taipei, Taiwan. All subjects met the ICD-10 system (F32, F33, F34) (World Health Organization, 1992) or DSM-IV system (296.2, 296.3, 300.4, 311) (American Psychiatric Association, 1994) for a diagnosis of Depressive Disorder. Diagnosis was established by an attending psychiatrist during the subject’s first visit to the clinic. A total of 237 subjects agreed to participate in the study at baseline (T1) that obtained from the studies of Yu and Chen by purposive sampling method (余春娣, 民94; 陳靜紋, 民94). The subjects were followed up twice during the period of three years. The data from the 1st follow up (T2) were existing data from a previous project of my advisor Dr. Pan (潘璦琬, 民94a, 民94b). The data from the 2nd follow up (T3) were collected by the principal researcher of this study. Subjects were contacted by telephone and assessed using a standardized procedure. Ethical clearance for this study was approved by the Institutional Review Board of the NTUH. Following consent to participate in the study, subjects were screened for cognitive function using the Mini-Mental State Examination-Chinese version (MMSE-C) and were excluded from the study if they had a score of 24 or below. Afterwards, they were administered other self-rated questionnaires to examine their QOL, occupational competence, sense of mastery, environmental affordance, social support, and severity of depression. The measures included The World Health Organization Quality of Life-BREF-Taiwan version (WHOQOLBREF-TW), the Occupational Self Assessment-Chinese version (OSA-C), Mastery scale-Chinese version (Mastery-C), Social Support Questionnaire-Chinese version (SSQ-C), Center of Epidemiology Study-Depression Scale-Chinese version (CESD-C). Raw data obtained from all self-rated instruments was transformed for Rasch analysis using WINSTEPS 3.56 (Linacre, 2006). All data was analyzed using SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA) and Statistical Analysis System (SAS), version 9.1 (SAS Institute, Cary, NC). The level of significance was set at two-tailed with an alpha level of 0.05. The measured scores in the overall QOL, overall health, 4 domains of QOL and related 26 items between T2 and T3 were fitted with linear mixed-effects model with covariates, including 5 demographic variables, 5 disease-related variables and 4 psychosocial variables. We chose the random intercept and slope model to establish these 32 predictive models of QOL. esults The average length of involvement in this study was 44.9 months (SD=5.2, range=36.0-54.5). The average length from T1 to T2 was 19.5 months (SD=9.8, range=5.8-43.6) and the average length from T2 to T3 was 26.1 months (SD=7.4, range=7.8-35.9). 104 subjects (response rate: 43.9%) were assessed at T2 and 90 subjects (response rate: 38.0%) were assessed at T3. The most significant differences of variables at T1 between respondents and nonrespondents were subjects’ demographic characteristics, including marital status, gender, age, employment and onset age. In addition, the subjects who had not taken antidepressants tended to participate in the follow-up study. The results of this 3-year longitudinal study of QOL among adults with chronic depression suggested that the majority of subjects were satisfied with their environmental domain of QOL, followed by the physical health, social relationships and the psychological health was the least satisfied aspect. The subjects’ QOL in the physical health and psychological health domains were poorer than that of the healthy populations in Taiwan. Also, there were slightly decreasing in these two domains of QOL between T2 and T3. The persons with depression had slightly poorer QOL in the social relationships domain than the healthy populations but had better QOL in the environmental domain but the changes in these two domains were relative stable. For the persons with chronic depression lived in Taiwan, we suggested that our treatments should be more intensive and pay much more attention on the enhancement of their QOL in the physical health, psychological health and social relationships domains than in the environmental domain. The present study provides a broad but detailed inquiry to understand the predictors of QOL longitudinally in persons with chronic depression in Taiwan. After the analyses on the domains and items of QOL with mixed-effects model, we found that the subjects’ age, onset age and onset duration had no significant effect on the QOL in persons with depression. Rather, occupational competence, environmental affordance, sense of mastery, severity of depression, the antidepressants and several demographic characteristics were the important predictors of QOL over time and the predictive model of QOL in persons with chronic depression was validated. Importantly, we proved the positive effect of psychosocial factors, including occupational competence, sense of mastery and environmental affordance, on the QOL in different aspects over time. When a person perceived higher occupational competence and environmental affordance, he or she tends to feel better overall QOL. In addition, the occupational competence had positive effect on the items of QOL across all the domains. Subjects with higher occupational competence tended to have the sense of capacity and efficacy in personal performance on the ADL, work and leisure as well as have positive perceptions of social support and interpersonal relationships with others. Except for the environmental domain of QOL, environmental affordance also had positive effect on the item of the psychological health domain. Subjects with higher environmental affordance would feel positive perception for the meanings of life. The sense of mastery also had positive effect on the items of QOL across all the domains. Subjects with higher sense of mastery tended to feel positive perception of the performance of ADL and leisure as well as enjoy in meaningful life. The study confirmed that severity of depression had significant impact on overall QOL and the items in the physical health, psychological health and social relationships domains. In addition, subjects with higher occupational competence and less severity of depression tended to have less demand on medical treatment and decrease the social burden. We also found that the antidepressants were the significant predictors of the items of QOL across all the domains. The subject’s demographic characteristics, including the gender, educational level, marital status and working status had different effect on the items of QOL. The present findings provide some suggestions as to what can be done by occupational therapists in persons with depression for the QOL enhancement. In order to advance the treatment outcome for persons with chronic depression, except for symptom reduction, we should pay much more attention on the enhancement of their occupational competence and perceptions of environmental affordance as well as strengthen their sense of mastery to improve their QOL. The study emphasized that the occupational therapists should help the subjects to design balanced lifestyle based on their different demographic backgrounds and improve the performance on roles they valued, such as the family members and workers. The educations of medication compliance were important. However, we should also take notice of the negative impact of different types of antidepressants on the subjects’ QOL, such as the SSRI’s might have negative impact on the perception of individuals’ ADL performance. We suggested that engaging in activities clients are valued and interested in might be the suitable way to reduce their severity of depression and improve their sense of efficacy, balanced lifestyle, adaptive skills, and resulted in the positive interaction with the environment around them. Our study suggested several activities which might have positive effect on OQL in persons with depression and provided some principles to help them engaging in the activities easier. The occupation-oriented treatment programs were needed to be examined from longitudinal studies in the future.
Subjects
Occupational therapy
Depression
Quality of life
Medication
SDGs
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