Quality of Life in Depressed Patients in UK Primary Care: The FINDER Study

Abstract

Objectives: To investigate the impact of depression and its treatment on health-related quality of life (HRQoL) in a naturalistic, primary care setting in the UK.

Methods: The Factors Influencing Depression Endpoints Research (FINDER) study was a European, 6-month, prospective, observational study designed to estimate HRQoL in patients with a clinical diagnosis of depression. This paper examines primary care patients recruited in the UK. HRQoL was measured at baseline and at 3 and 6 months after starting antidepressant therapy using the Short Form 36 Health Status Survey and the European Quality of Life-5 Dimensions (EQ-5D). Regression analysis was used to identify baseline and treatment variables independently and significantly associated with HRQoL. Further analyses included the effect of caseness for depression on HRQoL, the effect of moderate/severe pain at baseline on HRQoL, changes in overall pain, pain interference scores, and the use of different antidepressants by pain cohort.

Results: A total of 608 patients was recruited from 58 centres and mean HRQoL was significantly below reported population norms at baseline. Most improvement in HRQoL was seen at 3 months for EQ-5D, with small additional improvement at 6 months. Worse HRQoL outcomes at 6 months were associated with higher somatic symptoms score, duration of depression at baseline, and switching within antidepressant classes. Patients meeting the criteria for caseness for depression, or with significant pain at baseline showed less improvement in HRQoL scores at 6 months.

Conclusion: Patients presenting with depression in primary care show reduced HRQoL compared to population norms. HRQoL improves during antidepressant treatment particularly within the first 3 months. Nonpainful somatic symptoms, socioeconomic factors, depression variables and switching within antidepressant class predict poor HRQoL outcome. Pain is a common symptom in depressed patients and remains after 6 months' treatment. Pain and somatic symptoms should be assessed in all patients with depression in primary care.

Keywords: Antidepressant; Depression; Pain; Primary care; Quality of life.

Fig. 1

Mean (SD) SF-36 and EQ-5D scores at baseline, 3 and 6 months. SF-36 MCS and PCS scores were normalized to a mean of 50 (SD 10). The solid line represents the SF-36 general US population norm (mean 50) and the dotted line represents the clinical depression norms (MCS mean 34.8; PCS mean 45.0) [25]. Mean EQ-5D HSI scores were converted from a 0–1 scale to a 0–100 scale. The solid line represents the UK general population norms (EQ-5D VAS mean 82.5; EQ-5D HSI mean 86) [26]. EQ-5D European Quality of Life-5 Dimensions, HSI health status index, HRQoL health-related quality of life, MCS mental component summary, PCS physical component summary, SD standard deviation, SF-36 Short Form 36 Health Status Survey, VAS visual analog scale

Fig. 2

Mean HRQoL scores at baseline, 3 and 6 months by caseness for depression (based on HADS-D score at baseline: score ≥8 = case; score <8 = noncase). SF-36 MCS and PCS scores were normalized to a mean of 50 (SD 10). The solid line represents the SF-36 general US population norm (mean 50) and the dotted line represents the clinical depression norms (MCS mean 34.8; PCS mean 45.0) [25]. Mean EQ-5D HSI scores were converted from a 0–1 scale to a 0–100 scale. The solid line represents the UK general population norms (EQ-5D VAS mean 82.5; EQ-5D HSI mean 86) [26]. EQ-5D European Quality of Life-5 Dimensions, HADS-D Hospital Anxiety and Depression Scale-depression, HSI health status index, HRQoL health-related quality of life, MCS mental component summary, PCS physical component summary, SD standard deviation, SF-36 Short Form 36 Health Status Survey, VAS visual analog scale

Fig. 3

Mean HRQoL scores at baseline, 3 and 6 months by pain cohort. SF-36 MCS and PCS scores were normalized to a mean of 50 (SD 10). The solid line represents the SF-36 general US population norm (mean 50) and the dotted line represents the clinical depression norms (MCS mean 34.8; PCS mean 45.0) [25]. Mean EQ-5D HSI scores were converted from a 0–1 scale to a 0–100 scale. The solid line represents the UK general population norms (EQ-5D VAS mean 82.5; EQ-5D HSI mean 86) [26]. EQ-5D European Quality of Life-5 Dimensions, EX/P explained pain, HSI health status index, HRQoL health-related quality of life, MCS mental component summary, N/MP no/mild pain, PCS physical component summary, SD standard deviation, SF-36 Short Form 36 Health Status Survey, UNEX/P unexplained pain, VAS visual analog scale

Fig. 4

Antidepressant use in the first 3 months (0–3 months) and second 3 months (3–6 months) of treatment by pain cohort. Clinically significant pain was defined as overall pain VAS greater than 30 mm at baseline. SNRI serotonin noradrenaline reuptake inhibitor, SSRI selective serotonin reuptake inhibitor, TCA tricyclic antidepressant, VAS visual analog scale