, Volume 8, Issue 4, pp 305–315 | Cite as

Measuring Quality of Life in Patients with Depression or Anxiety

  • Diane Whalley
  • Stephen P. McKenna
Review Article


One-fifth of all disability is caused by psychiatric morbidity, with depression and anxiety the most common conditions. Despite this, and the wide range of pharmaceutical treatments available, few quality-of-life studies have been conducted with depressed or anxious patients. Most studies focus on symptoms and adverse effects, rather than on the impact of these on the patient. Where health status is assessed, inappropriate generic measures have been used.

Recently, a depression-specific measure of quality of life, the Quality of Life in Depression Scale, has been developed and is starting to be used in clinical trials. No equivalent measure for anxiety is available. Given the range and rapid increase in the number of treatments available for depression and anxiety, and issues of compliance and individual response to treatment, much more attention must be given to quality of life in these conditions.


Fluoxetine Panic Disorder Buspirone Alprazolam Primary Care Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987Google Scholar
  2. 2.
    Rickels K. Antianxiety therapy: potential value of long-term treatment. J Clin Psychiatry 1987; 48 Suppl.: 7–11PubMedGoogle Scholar
  3. 3.
    Leckman JF, Weissman MM, Merikangas KR, et al. Panic disorder and major depression: increased risk of depression, alcoholism, panic and phobic disorders of depressed probands in families of depressed probands with panic disorder. Arch Gen Psychiatry 1983; 40: 1055–160PubMedCrossRefGoogle Scholar
  4. 4.
    Robinson DS, Kayser A, Corcella J, et al. Panic attacks in out-patients with depression: response to antidepressant treatment. Psychopharmacol Bull 1985; 21: 562–7PubMedGoogle Scholar
  5. 5.
    Clancy J, Noyes Jr R, Hoenk PR, et al. Secondary depression and anxiety neurosis. J Nerv Ment Dis 1978; 166: 846–50PubMedCrossRefGoogle Scholar
  6. 6.
    Breier A, Charney DS, Heninger GR. Major depression in panic disorder. Arch Gen Psychiatry 1984; 41: 1125–39CrossRefGoogle Scholar
  7. 7.
    Zung WWK. A self-rating depression scale. Arch Gen Psychiatry 1965; 12: 63–70PubMedCrossRefGoogle Scholar
  8. 8.
    Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 561–71PubMedCrossRefGoogle Scholar
  9. 9.
    Carroll BJ, Feinberg M, Smouse PE, et al. The Carroll rating scale for depression: I. Development, reliability and validation. Br J Psychiatry 1981; 138: 194–200PubMedCrossRefGoogle Scholar
  10. 10.
    Radloff LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Measurement 1977; 1: 385–401CrossRefGoogle Scholar
  11. 11.
    Weissman MM, Sholomskas D, Pottenger M, et al. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol 1977; 106: 203–14PubMedGoogle Scholar
  12. 12.
    Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–62PubMedCrossRefGoogle Scholar
  13. 13.
    Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6: 276–96CrossRefGoogle Scholar
  14. 14.
    Montgomery SA, Åsberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry 1979; 134: 382–9PubMedCrossRefGoogle Scholar
  15. 15.
    Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32: 50–5PubMedCrossRefGoogle Scholar
  16. 16.
    Snaith RP, Baugh SJ, Clayden AD, et al. The Clinical Anxiety Scale: a modification of the Hamilton Anxiety Scale. Br J Psychiatry 1982; 141: 518–23PubMedCrossRefGoogle Scholar
  17. 17.
    Beck AT, Epstein N, Brown G, et al. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56: 893–7PubMedCrossRefGoogle Scholar
  18. 18.
    Derogatis LR. SCL-90-R: administration, scoring and procedures manual II. Towson (MD): Clinical Psychometrics Research, 1983Google Scholar
  19. 19.
    Goldberg D. The detection of psychiatric illness by questionnaire. London: Oxford University Press, 1972Google Scholar
  20. 20.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–70PubMedCrossRefGoogle Scholar
  21. 21.
    Rudorfer MV, Potter WZ. Antidepressants: a comparative review of the clinical pharmacology and therapeutic use of the ‘newer’ versus the ‘older’ drugs. Drugs 1989; 37: 713–38PubMedCrossRefGoogle Scholar
  22. 22.
    Patrick DL, Erickson P. Health status and health policy. New York: Oxford University Press, 1993Google Scholar
  23. 23.
    Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care 1992; 30: 473–83PubMedCrossRefGoogle Scholar
  24. 24.
    McKenna SP, Hunt SM, Tennant A. Psychological well-being in depressed patients. Int J Methods Psychiatr Res 1993; 3: 245–51Google Scholar
  25. 25.
    Hunt SM, McKenna SP. A British adaptation of the General Well-Being Index: a new tool for clinical research. Br J Med Econ 1992; 2: 49–60Google Scholar
  26. 26.
    Hunt SM, McKenna SP. The QLDS: a scale for the measurement of quality of life in depression. Health Policy 1992; 22: 307–19PubMedCrossRefGoogle Scholar
  27. 27.
    McKenna SP, Hunt SM. A new measure of quality of life in depression: testing the reliability and construct validity of the QLDS. Health Policy 1992; 22: 321–30PubMedCrossRefGoogle Scholar
  28. 28.
    Hunt SM, Kovachich P, McKenna SP. Genital herpes and quality of life. Br J Sex Med 1993; 20: 12–5Google Scholar
  29. 29.
    McKenna SP, Doward L.C. Quality-of-life assessment of adults with growth hormone deficiency: implications for drug therapy. PharmacoEconomics 1994; 6 (5): 434–41PubMedCrossRefGoogle Scholar
  30. 30.
    Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. New York: Oxford University Press, 1989: 113–20Google Scholar
  31. 31.
    Prusoff B, Klerman G, Paykel E. Concordance between clinical assessments and patients’ self report in depression. Arch Gen Psychiatry 1972; 26: 546–52PubMedCrossRefGoogle Scholar
  32. 32.
    Berzon R, Hays RD, Shumaker SA. International use, application and performance of health-related quality of life instruments. Qual Life Res 1993; 2: 367–8PubMedCrossRefGoogle Scholar
  33. 33.
    Rost K, Smith GR, Burnman MA, et al. Measuring the outcomes of care for mental health problems: the case of depressive disorders. Med Care 1992; 30 (5 Suppl.): MS266–73Google Scholar
  34. 34.
    Weiner E, Stewart B. Assessing individuals. Boston: Little Brown, 1984Google Scholar
  35. 35.
    McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. New York: Oxford University Press, 1987: 12–35Google Scholar
  36. 36.
    Cortina JM. What is coefficient alpha? An examination of theory and applications. J Appl Psychol 1993; 78: 98–104CrossRefGoogle Scholar
  37. 37.
    Tuynman-Qua H, de Jonghe F, McKenna SP, et al. Quality of Life in Depression Rating Scale (QLDS). Houten (The Netherlands): Ibero Publications, 1992Google Scholar
  38. 38.
    Grégoire J, de Leval N, Mesters P, et al. Validation of the Quality of Life in Depression Scale in a population of adult depressive patients aged 60 and above. Qual Life Res 1994; 3: 13–9PubMedCrossRefGoogle Scholar
  39. 39.
    Stoker MJ, Dunbar GC, Beaumont G. The SmithKline Beecham ‘quality of life’ scale: a validation and reliability study in patient with affective disorder. Qual Life Res 1992; 1: 385–95PubMedCrossRefGoogle Scholar
  40. 40.
    Joyce CRB. Report from the European Standard for Clinical Trials (ESCT) meeting in Strasbourg 23–24 May 1991, on issues of concern in the standardization and harmonization of drug trials in Europe: health-related quality of life session. Qual Life Newsletter 1992; 3: 10Google Scholar
  41. 41.
    Kelly GA. The psychology of personal constructs. New York: WW Norton, 1955Google Scholar
  42. 42.
    Bergner M, Bobbitt RA, Carter WB, et al. The sickness impact profile: development and final revision of a health status measure. Med Care 1981; 19: 787–805PubMedCrossRefGoogle Scholar
  43. 43.
    Revicki DA, Turner R, Brown R, et al. Reliability and validity of health-related quality of life battery for evaluating out-patient antidepressant treatment. Qual Life Res 1992; 1: 257–66PubMedCrossRefGoogle Scholar
  44. 44.
    Stewart AL, Ware JE. Measuring functioning and well-being: the Medical Outcomes Study approach. Durham (NC): Duke University Press, 1992Google Scholar
  45. 45.
    Omvik P, Thaulow E, Herland OB, et al. Double-blind, parallel, comparative study on quality of life during treatment with amlodipine or enalapril in mild or moderate hypertensive patients: a multicenter study. J Hypertens 1993; 11: 103–13PubMedCrossRefGoogle Scholar
  46. 46.
    Wells KB, Stewart A, Hays RD, et al. The functioning and well-being of depressed patients: results from the medical outcomes study. JAMA 1989; 262: 914–9PubMedCrossRefGoogle Scholar
  47. 47.
    Broadhead WE, Blazer DG, George LK, et al. Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 1990; 264: 2524–8PubMedCrossRefGoogle Scholar
  48. 48.
    Campbell A, Converse PE, Rogers WL. The quality of American life. New York: Russell Sage Foundation, 1976Google Scholar
  49. 49.
    Endicott J, Nee J, Harrison W, et al. Quality of life enjoyment and satisfaction questionnaire: a new measure. Department of Psychiatry, Columbia University and New York State Psychiatric Institute. Psychopharmacol Bull 1993; 29: 321–6PubMedGoogle Scholar
  50. 50.
    Salamon MJ, Conte VA. The life satisfaction in the elderly scale. Odessa (FL): Psychological Assessment Resources, 1984Google Scholar
  51. 51.
    Schooler N, Hogarty G, Weissman MM. Social Adjustment Scale II (SASII). In: Hargreaves WA, Attkisson CC, Sorensen JE, editors. Resource materials for community health program evaluators. Publ. No. (ADM) 79–328. Washington, DC: US Department of Health, Education and Welfare, 1979: 290–330Google Scholar
  52. 52.
    Gershon S. The conduct of clinical trials in the impaired elderly. Psychopharmacol Bull 1981; 17: 108–16PubMedGoogle Scholar
  53. 53.
    Hill S, Harries U. Assessing the outcome of health care for older people in community settings: should we use the SF-36? Outcomes Briefing 1994 Aug; 4: 26–7Google Scholar
  54. 54.
    Brazier J, Harper R, Jones N, et al. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMl 1992; 305: 160–4CrossRefGoogle Scholar
  55. 55.
    Ienkinson C, Coutler A, Wright L. Short form 36 (SF 36) health survey questionnaire: normative data for adults of working age. BMJ 1993; 306: 1437–40CrossRefGoogle Scholar
  56. 56.
    Mesters P, Cosyns P, Dejaiffe G, et al. Assessment of quality of life in the treatment of major depressive disorder with fluoxetine, 20 mg, in ambulatory patients aged over 60 years. Int Clin Psychopharmacol 1993; 8: 337–40PubMedCrossRefGoogle Scholar
  57. 57.
    Hunt SM, McEwen J, McKenna SP. Measuring health status. London: Croom Helm, 1986Google Scholar
  58. 58.
    Massion AO, Warshaw MG, Keller MB. Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. Am J Psychiatry 1993; 150: 600–7PubMedGoogle Scholar
  59. 59.
    Stewart AL, Hays RD, Ware JE. The MOS Short-Form General Health Survey: reliability and validity in a patient population. Med Care 1988; 26: 724–35PubMedCrossRefGoogle Scholar
  60. 60.
    Keller MB, Lavori PW, Friedman B, et al. The longitudinal interval follow-up evaluation: a comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry 1987; 44: 540–8PubMedCrossRefGoogle Scholar
  61. 61.
    Markowitz JS, Weissman MM, Ouellette R, et al. Quality of life in panic disorder. Arch Gen Psychiatry 1989; 46: 984–92PubMedCrossRefGoogle Scholar
  62. 62.
    Fifer SK, Mathias SD, Patrick DL, et al. Untreated anxiety among adult primary care patients in a health maintenance organization. Arch Gen Psychiatry 1994; 51: 740–50PubMedCrossRefGoogle Scholar
  63. 63.
    Lonnqvist J, Sintonen H, Syvalahti E, et al. Antidepressant efficacy and quality of life in depression: a double-blind study with moclobemide and tluoxetine. Acta Psychiatr Scand 1994; 89 (6): 363–9PubMedCrossRefGoogle Scholar
  64. 64.
    Silverstone T. Moclobemide placebo-controlled trials. Int Clin Psychopharmacol 1993; 7 (3–4): 133–6PubMedCrossRefGoogle Scholar
  65. 65.
    Hall J. Fluoxetine: efficacy against placebo and by dose — an overview. Br J Psychiatry 1988; 153 (3 Suppl.): 59–63Google Scholar
  66. 66.
    Sintonen H, Pekurinen M. A generic 15 dimensional measure of health-related quality of life (15D). J Social Med 1989; 26: 85–96Google Scholar
  67. 67.
    Evans OW, McCartney CF, Haggerty JJ, et al. Treatment of depression in cancer patients is associated with better life adaptation: a pilot study. Psychosom Med 1988; 50 (1): 72–6Google Scholar
  68. 68.
    Derogatis LR. The psychosocial adjustment to illness scale (PAIS). J Psychosom Res 1986; 30 (1): 77–91PubMedCrossRefGoogle Scholar
  69. 69.
    Katon W, Sullivan M. Depression and chronic medical illness. J Clin Psychiatry 1990; 51 (6 Suppl.): 3–14PubMedGoogle Scholar
  70. 70.
    Schulberg H, Coulehan J, Block M, et al. Strategies for evaluating treatments for major depression in primary care patients. Gen Hosp Psychiatry 1991; 13: 9–18PubMedCrossRefGoogle Scholar
  71. 71.
    Thompson C, Thompson CM. The prescribing of antidepressants in general practice: I. A critical review. Human Psychopharmacol 1989; 4: 190Google Scholar
  72. 72.
    Paykel ES, Freeling P, Hollyman JA. Are tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry 1988; 21: 15–8PubMedCrossRefGoogle Scholar
  73. 73.
    Katon W, von Korff M, Lin E, et al. Adequacy and duration of antidepressant treatment in primary care. Med Care 1992; 30: 67–76PubMedCrossRefGoogle Scholar
  74. 74.
    Johnson DAW. Treatment of depression in general practice. BMJ 1973; 2: 18–20PubMedCrossRefGoogle Scholar
  75. 75.
    Thompson J, Rankin H, Ashcroft CW, et al. The treatment of depression in general practice. Psychol Med 1982; 12: 741–51CrossRefGoogle Scholar
  76. 76.
    Doogan DP, Caillard V. Sertraline in the prevention of depression. Br J Psychiatry 1992; 160: 217–22PubMedCrossRefGoogle Scholar
  77. 77.
    Klerman GL, Dimascio A, Weissman A, et al. Treatment of depression by drugs and psychotherapy. Am J Psychiatry 1974; 131: 186–91PubMedGoogle Scholar
  78. 78.
    Montgomery SA, Dunbar GC. Paroxetine is better than placebo in relapse prevention and the prophylaxis of recurrent depression. Int J Psychopharmacol 1993; 8: 189–95CrossRefGoogle Scholar
  79. 79.
    Lader M. Dependence on benzodiazepines. J Clin Psychiatry 1983; 44: 121–7PubMedGoogle Scholar
  80. 80.
    Winokur A, Rickels K, Greenblatt DJ. Withdrawal reaction from long-term, low dosage administration of diazepam. Arch Gen Psychiatry 1980; 37: 101–5PubMedCrossRefGoogle Scholar
  81. 81.
    Rickels K, Csanalosi I, Greisman P, et al. A controlled clinical trial of alprazolam for the treatment of anxiety. Am J Psychiatry 1983; 140: 82–5PubMedGoogle Scholar
  82. 82.
    Jonas JM, Cohon MS. A comparison of the safety and efficacy of alprazolam versus other agents in the treatment of anxiety, panic, and depression: a review of the literature. J Clin Psychiatry 1993; 54 Suppl.: 25–48PubMedGoogle Scholar
  83. 83.
    Goa KL, Ward A. Buspirone: a preliminary review of its pharmacological properties and therapeutic efficacy as an anxiolytic. Drugs 1986; 32: 114–29PubMedCrossRefGoogle Scholar
  84. 84.
    Rickels K, Cohen D, Csanalosi I, et al. Alprazolam and imipramine in depressed outpatients: a controlled study. Curr Ther Res 1982; 32 (6): 157–64Google Scholar
  85. 85.
    Cole JO, Orzack MH, Beake B, et al. Assessment of the abuse liability of buspirone in recreational sedative users. J Clin Psychiatry 1982; 43 (12 Sect. 2): 69–74PubMedGoogle Scholar
  86. 86.
    Murphy SM, Owen RT, Tyrer PJ. Withdrawal symptoms after six weeks treatment with diazepam [abstract]. Lancet 1984; 2: 1389PubMedCrossRefGoogle Scholar
  87. 87.
    Feighner JP. A double-blind comparison of paroxetine, imipramine and placebo in depressed outpatients. In: Ashcroft GW, editor. Depression — a once in a lifetime event? Oxford: Clinical Neuroscience Publishers, 1991Google Scholar
  88. 88.
    Johnson J, Weissman MM, Klerman GL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA 1992; 267: 1478–83PubMedCrossRefGoogle Scholar
  89. 89.
    Kind P, Sorensen J. The costs of depression. Third international symposium: RIMAs in subtypes of depression: focus on moclobemide; 1992: Vienna. Int Clin Psychopharmacol 1993; 7 (3–4): 191–5PubMedCrossRefGoogle Scholar
  90. 90.
    Souêtre E, Lozet H, Cimarosti I. Cost of anxiety disorders: impact of comorbidity. J Psychosom Res 1994; 38 (1 Suppl.): 151–60PubMedCrossRefGoogle Scholar
  91. 91.
    Keller MB, Shapiro RW, Lavori PW, et al. Relapse in major depressive disorder: analysis with life table. Arch Gen Psychiatry 1982; 39: 911–5PubMedCrossRefGoogle Scholar
  92. 92.
    Henry JA. Debits and credits in the management of depression. Br J Psychiatry 1993; 163 Suppl. 20: 33–9Google Scholar
  93. 93.
    Murphy GRE. The physician’s responsibility for suicide: 1. An error of commission; and 2. Errors of omission. Ann Intern Med 1975; 82: 301–9PubMedGoogle Scholar
  94. 94.
    Katon W, Roy-Byrne PP. Antidepressants in the medically ill: diagnosis and treatment in primary care. Clin Chem 1988; 34 (5): 829–36PubMedGoogle Scholar
  95. 95.
    Prescott LF, Highley MS. Drugs prescribed for self-poisoners. BMJ 1985; 290: 1633–6PubMedCrossRefGoogle Scholar
  96. 96.
    Weissman MM. The epidemiology of suicide attempts, 1960- 1971. Arch Gen Psychiatry 1974; 30: 737–46PubMedCrossRefGoogle Scholar
  97. 97.
    Gerner R, Estabrook W, Steuer J, et al. Treatment of geriatric depression with trazodone, imipramine and placebo: a double-blind study. J Clin Psychiatry 1980; 41: 216–20PubMedGoogle Scholar
  98. 98.
    Henry JA. The safety of antidepressants. Br J Psychiatry 1992; 160: 439–41PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1995

Authors and Affiliations

  • Diane Whalley
    • 1
  • Stephen P. McKenna
    • 2
  1. 1.Galen ResearchManchesterEngland
  2. 2.Care Outcomes Group, Rheumatology and Rehabilitation Research UnitThe University of LeedsLeedsEngland

Personalised recommendations