Quality of life in major depressive disorder before/after multiple steps of treatment and one-year follow-up

Acta Psychiatr Scand. 2015 Jan;131(1):51-60. doi: 10.1111/acps.12301. Epub 2014 Jun 23.


Objective: This study examines the impact of major depressive disorder (MDD) and its treatment on quality of life (QOL).

Method: From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial, we analyzed complete data of 2280 adult MDD out-patients at entry/exit of each level of antidepressant treatments and after 12 months of entry to follow-up. QOL was measured using the QOL Enjoyment and Satisfaction Questionnaire (Q-LES-Q). The proportions of patients scoring 'within-normal' QOL (within 10% of Q-LES-Q community norms) and those with 'severely impaired' QOL (>2 SD below Q-LES-Q community norms) were analyzed.

Results: Before treatment, no more than 3% of MDD patients experienced 'within-normal' QOL. Following treatment, statistically significant improvements were detected; however, the proportion of patients achieving 'within-normal' QOL did not exceed 30%, with >50% of patients experiencing 'severely impaired' QOL. Although remitted patients had greater improvements compared with non-remitters, 32-60% continued to experience reduced QOL. 12-month follow-up data revealed that the proportion of patients experiencing 'within-normal' QOL show a statistically significant decrease in non-remitters.

Conclusion: Symptom-focused treatments of MDD may leave a misleading impression that patients have recovered when, in fact, they may be experiencing ongoing QOL deficits. These findings point to the need for investigating specific interventions to ameliorate QOL in MDD.

Trial registration: ClinicalTrials.gov NCT00021528.

Keywords: antidepressants; functional outcomes; major depression; patient-reported outcomes; quality of life.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antidepressive Agents / therapeutic use
  • Cognitive Behavioral Therapy / methods
  • Combined Modality Therapy / methods
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales / statistics & numerical data
  • Quality of Life / psychology*
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome
  • Young Adult


  • Antidepressive Agents

Associated data

  • ClinicalTrials.gov/NCT00021528