Quality of Life Research

, Volume 27, Issue 11, pp 2873–2884 | Cite as

The impact of depression on health-related quality of life and wellbeing: identifying important dimensions and assessing their inclusion in multi-attribute utility instruments

  • Lidia Engel
  • Gang Chen
  • Jeffrey Richardson
  • Cathrine Mihalopoulos



Wellbeing measures have been proposed for inclusion in economic evaluation to measure the effect of depression and compensate for shortcomings of existing multi-attribute utility instruments (MAUIs). The aims of this study were to identify dimensions of health-related quality of life (HRQoL) and wellbeing that are most affected by depression and to examine the extent to which these are captured by MAUIs.


Data were used from the Multi-Instrument Comparison study. Dimensions of HRQoL (SF-36v2 and AQoL-8D dimensions), capability wellbeing (ICECAP-A), and subjective wellbeing (including PWI, SWLS, and IHS) were identified that distinguished most individuals with depression from a healthy public. The extent to which these dimensions explain the content of five existing MAUIs (15D, AQoL-8D, EQ-5D-5L, HUI-3, and SF-6D) was examined using regression analyses. Additionally, the sensitivity of all MAUIs was also assessed towards depression-specific symptoms measured by DASS-21 and K-10.


The sample consisted of 917 individuals with self-reported depression and 1760 healthy subjects. Dimensions that distinguished most individuals with depression from the healthy group (effect size > 2) included AQoL-8D coping, AQoL-8D happiness, AQoL-8D self-worth, ICECAP-A, SF-36 mental health, and SF-36 social functioning. The AQoL-8D was most sensitive to the dimensions above as well as towards the depression-specific measures, the K10, DASS-S, and DASS-D.


This study has shown that psychosocial dimensions of HRQoL have the greatest ability to capture the impact of depression when compared with dimensions of capability wellbeing and SWB. Some MAUIs, such as the AQoL-8D, are sensitive to most distinguishing dimensions of HRQoL and wellbeing, which may obviate the need for supplementary wellbeing instruments.


Health-related quality of life Multi-attribute utility Subjective wellbeing Capability wellbeing Depression 



This study was conducted without financial support. Data used in this research study were derived from the Multi-Instrument Comparison study, which was funded by a project grant from the Australian National Health and Medical Research Council (NHMRC) (Project Grant ID 1006334 ‘A cross national comparison of eight generic quality of life instruments’).

Compliance with ethical standards

Conflict of interest

JR developed the AQoL-8D. The authors report no other conflict of interest.

Ethical approval

The study was approved by the Monash University Human Research Ethics Committee (Project Numbers: CF11/1758-2011000974 and CF11/3192-2011001748). All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11136_2018_1936_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 KB)


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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.School of Health and Social Development, Deakin Health EconomicsDeakin UniversityGeelongAustralia
  2. 2.Centre for Health Economics, Monash Business SchoolMonash UniversityClaytonAustralia

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