Advertisement

Quality of Life Impairment in Anxiety Disorders

  • Margaret A. Koury
  • Mark Hyman Rapaport
Chapter

Abstract

There is a growing consensus that practitioners must broaden the scope of assessment for anxiety disorders from signs and symptoms to include the measurement of quality of life (QOL) appraisals and social functioning. However, there is not a consensus about the definition of quality of life nor is there agreement about how to operationalize the construct of quality of life. Most measures of QOL assess an individual’s perceptions about social relationships, physical health, work and activity functioning, economic status, and an overall sense of well-being. Objective functional impairment can be quantified by measuring work productivity, mental health functioning, and physical health functioning. One of the challenges faced by the field is understanding the relationship between objective measures of functioning and subjective measures of QOL. In this chapter, we will present findings from epidemiologic studies and empirical research investigations on QOL and functional impairment in generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and generalized social phobia. We will discuss the findings, address strengths and weakness of the current research, and suggest future areas of focus to expand our knowledge and competencies including appropriating data from clinical populations in order to better understand and treat this growing population

Key words

Quality of life Functional impairment Anxiety disorders Generalized anxiety disorder Panic disorder Posttraumatic stress disorder Social phobia 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005;62:593–602PubMedCrossRefGoogle Scholar
  2. 2.
    Greenberg PE, Sisitsky T, Kessler RC, et al. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 1999;60(7):427–435PubMedCrossRefGoogle Scholar
  3. 3.
    Stein MB, Roy-Byrne PP, Craske, MG, et al. Functional impact and health utility of anxiety disorders in primary care outpatients. Med Care 2005;43(12)1164–1170PubMedCrossRefGoogle Scholar
  4. 4.
    Rapaport MH, Clary C, Fayyad R, et al. Quality of life impairment in depressive and anxiety disorders. Am J Psychiatry 2005;162:1171–1178PubMedCrossRefGoogle Scholar
  5. 5.
    World Health Organization. World Health Organization constitution: basic documents.1948; Geneva: World Health OrganizationGoogle Scholar
  6. 6.
    Kaplan RM, Anderson JP. The general health policy model: an integrated approach. Quality of Life and Pharmacoeconomics in Clinical Trials. 1996; Lippincott-Raven Publishers, Philadelphia, PAGoogle Scholar
  7. 7.
    Mendlowicz MV, Stein MB. Quality of life in individuals with anxiety disorders. Am J Psychiatry 2000;157(5)669–682PubMedCrossRefGoogle Scholar
  8. 8.
    Patrick DL, Erickson P. What constitutes quality of life? Concepts and dimensions. Clin Nutr 1988;7:53–63Google Scholar
  9. 9.
    Ware JE, Sherbourne CD. The MOS 36-itme short-form health survey (SF-36). I: conceptual framework and item selection. Med Care 1992;30:473–483PubMedCrossRefGoogle Scholar
  10. 10.
    Devins GM, Binik YM, Hutchinson TA, et al. The emotional impact of end-stage renal disease: importance of patients’ perception of intrusiveness and control. Int J Psychiatry Med 1983;13:327–343PubMedCrossRefGoogle Scholar
  11. 11.
    Endicott J, Nee J, Harrison W, et al. Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacol Bull 1993;29:321–326PubMedGoogle Scholar
  12. 12.
    Weissman MM, Bothwell S. Assessment of social adjustment by patient self-report. Arch Gen Psychiatry 1976;33:1111–1115PubMedGoogle Scholar
  13. 13.
    Sheehan DV. The anxiety disease. 1986; Bantam Books, New YorkGoogle Scholar
  14. 14.
    Schneier FR, Heckelman LR, Garfinkel R, et al. Functional impairment in social phobia. J Clin Psychiatry 1994;55:322–331PubMedGoogle Scholar
  15. 15.
    Frisch MB, Cornell J, Villanueva M, et al. Clinical validation of the quality of life inventory: a measure of life satisfaction for use in treatment planning and outcome assessment. Psychological Assessment 1992;4:92–101CrossRefGoogle Scholar
  16. 16.
    McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. 1987; Oxford University Press, New YorkGoogle Scholar
  17. 17.
    Oliver JPJ, Huxley PJ, Priebe S, et al. Measuring the quality of life of severely mentally ill people using the lancashire quality of life profile. Soc Psychiatry Psychiatr Epidemiol 1997;32:76–83PubMedCrossRefGoogle Scholar
  18. 18.
    Spitzer RL, Kroenke K, Linzer M, et al. Health-related quality of life in primary care patients with mental disorders. JAMA 1995;274(19)1511–1517PubMedCrossRefGoogle Scholar
  19. 19.
    Ormel J, VonKorff M, Ustun TB, et al. Common mental disorders and disability across cultures: results from the WHO collaborative study on psychological problems in general health care. JAMA 1994;272:1741–1748PubMedCrossRefGoogle Scholar
  20. 20.
    Karno M, Golding JM, Sorenson SB, et al. The epidemiology of obsessive-compulsive disorder in five U.S. communities. Arch Gen Psychiatry 1988;45(12)1094–1099PubMedGoogle Scholar
  21. 21.
    Mogotsi M, Kaminer D, & Stein DJ. Quality of life in the anxiety disorders. Harvard Rev Psychiatry 2000;8:273–282CrossRefGoogle Scholar
  22. 22.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. 2000; Washington, DCGoogle Scholar
  23. 23.
    Massion AO, Warshaw MG, Keller MB. Quality of life and psychiatric comorbidity in panic disorder and generalized anxiety disorder. Am J Psychiatry 1993;150:600–607PubMedGoogle Scholar
  24. 24.
    Kessler RC, Du Pont RL, Berglund P, et al. Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry 1999;156:1915–1923PubMedGoogle Scholar
  25. 25.
    Wittchen HU, Carter RM, Pfister H, et al. Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey. Int Clin Psychopharmacol 2000;15(6)319–328PubMedGoogle Scholar
  26. 26.
    Stein MB, Heimberg RC. Well-being and life satisfaction in generalized anxiety disorder: comparison to major depressive disorder in a community sample. J Affect Disord 2004; 79:161–166PubMedCrossRefGoogle Scholar
  27. 27.
    Bourland SL, Stanley MA, Snyder AG, et al. Quality of life in older adults with generalized anxiety disorder. Aging and Mental Health 2000;4(4)315–323CrossRefGoogle Scholar
  28. 28.
    Jones GN, Ames SC, Jeffries SK, et al. Utilization of medical services and quality of life among low-income patients with generalized anxiety disorder attending primary care clinics. Int J Psychiatry Med 2001;31(2)183–198PubMedCrossRefGoogle Scholar
  29. 29.
    Wetherell JL, Thorp SR, Patterson TL, et al. Quality of life in geriatric generalized anxiety disorder: a preliminary investigation. J Psychiatr Res 2004;38(3)305–312PubMedCrossRefGoogle Scholar
  30. 30.
    Stanley MA, Beck JG, Novy DM, et al. Cognitive-behavioral treatment of late-life generalized anxiety disorder. J Consult Clin Psychol 2003;71(2)309–319PubMedCrossRefGoogle Scholar
  31. 31.
    Davidson JRT, Bose A, Wang Q. Safety and efficacy of escitalopram in the long-term treatment of generalized anxiety disorder. J Clin Psychiatry 2005;66(11)1441–1446PubMedCrossRefGoogle Scholar
  32. 32.
    Dahl AA, Ravindran A, Allgulander C, et al. Sertraline in generalized anxiety disorder: efficacy in treating the psychic and somatic anxiety factors. Acta Psychiatrica Scandinavica 2005;111(6): 429–435PubMedCrossRefGoogle Scholar
  33. 33.
    Blank S, Lenze EJ, Mulsant BH, et al. Outcomes of late-life anxiety disorders during 32 weeks of citalopram treatment. J Clin Psychiatry 2006;67(3)468–472PubMedCrossRefGoogle Scholar
  34. 34.
    Markowitz JS, Weissman MM, Ouellette R, et al. Quality of life in panic disorder. Arch Gen Psychiatry 1989;46:984–922PubMedGoogle Scholar
  35. 35.
    Katerndahl DA, Realini JP. Quality of life and panic-related work disability in subjects with infrequent panic and panic disorder. J Clin Psychiatry 1997;58(4)153–158PubMedGoogle Scholar
  36. 36.
    Alonso J, Angermeyer MC, Bernert S, et al. Disability and quality of life impact of mental disrders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, Supplementum 2004;420:38–46Google Scholar
  37. 37.
    Sherbourne CD, Wells KB, Judd LL. Functioning and well-being of patients with panic disorder. Am J Psychiatry 1996;153:213–218PubMedGoogle Scholar
  38. 38.
    Hollifield M, Katon W, Skipper B, et al. Panic disorder and quality of life: variables predictive of functional impairment. Am J Psychiatry 1997;154(6)766–772PubMedGoogle Scholar
  39. 39.
    Candilis PJ, McLean RY, Otto MW, et al. Quality of life in patients with panic disorder. J Nerv Ment Dis 1999;187:429–434PubMedCrossRefGoogle Scholar
  40. 40.
    Rubin HC, Rapaport MH, Levin B, et al. Quality of well being in panic disorder: the assessment of psychiatric and general disability. J Affect Disord 2000;57:217–221PubMedCrossRefGoogle Scholar
  41. 41.
    Gregor KL, Zvolensky MJ, Yartz AR. Perceived health among individuals with panic disorder: associations with affective vulnerability and psychiatric disability. J Nerv Ment Dis 2005;193(10): 697–699PubMedCrossRefGoogle Scholar
  42. 42.
    Telch MJ, Schmidt NB, Jaimez TL, et al. Impact of cognitive-behavioral treatment on quality of life in panic disorder patients. J Consult Clin Psychol 1995;63(5)823–830PubMedCrossRefGoogle Scholar
  43. 43.
    Rollman BL, Belnap BH, Mazumdar S, et al. A randomized trial to improve the quality of treatment for panic and generalized anxiety disorders in primary care. Arch Gen Psychiatry 2005;62:1332–1341PubMedCrossRefGoogle Scholar
  44. 44.
    Jacobs RJ, Davidson JR, Gupta S, et al. The effects of clonazepam on quality of life and work productivity in panic disorder. Am J Managed Care 1997;3(8)1187–1196Google Scholar
  45. 45.
    Rapaport MH, Pollack M, Wolkow R, et al. Is placebo response the same as drug response in panic disorder? Am J Psychiatry 2000;157:1014–1016PubMedCrossRefGoogle Scholar
  46. 46.
    Davidson JR. Trauma: the impact of posttraumatic stress disorder. J Psychopharmacol 2000;14: S5–S12PubMedGoogle Scholar
  47. 47.
    Zatzik DF, Marmar CR, Weiss DS, et al. Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry. 1997a;154(12):1690–1695Google Scholar
  48. 48.
    Zatzick DF, Weiss DS, Marmar CR, et al. Posttraumatic stress disorder and functioning and quality of life outcomes in female Vietnam veterans. Mil Med 1997b;162:661–665Google Scholar
  49. 49.
    Warshaw MG, Fierman E, Pratt L, et al. Quality of life and dissociation in anxiety disorder patients with histories of trauma or PTSD. Am J Psychiatry 1993;150:1512–1516PubMedGoogle Scholar
  50. 50.
    Zayfert C, Dums AR, Ferguson RJ, et al. Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression. J Nerv Ment Dis 2002;190:233–240PubMedCrossRefGoogle Scholar
  51. 51.
    Ouimette P, Cronkite R, Henson BR, et al. Posttraumatic stress disorder and health status among female and male medical patients. J Trauma Stress 2004;17:1–9PubMedCrossRefGoogle Scholar
  52. 52.
    Schnurr PP, Green BL. Understanding relationships among trauma, post-traumatic stress disorder, and health outcomes. Adv Mind Body Med 2004;20(1)18–29PubMedGoogle Scholar
  53. 53.
    Muesser KT, Essock SM, Haines M, et al. Posttraumatic stress disorder, supported employment, and outcomes in people with severe mental illness. CNS Spectrums 2004;9(12)913–925Google Scholar
  54. 54.
    Holbrook TL, Hoyt DB, Coimbra R, et al. Long-term posttraumatic stress disorder persists after major trauma in adolescents: new data on risk factors and functional outcome. J Trauma 2005;58:764–771PubMedCrossRefGoogle Scholar
  55. 55.
    d’Ardenne P, Capuzzo N, Fakhoury WKH, et al. Subjective quality of life and posttraumatic stress disorder. J Nerv Ment Dis 2005;193(1)62–65PubMedCrossRefGoogle Scholar
  56. 56.
    Malik ML, Connor KM, Sutherland SM, et al. Quality of life and posttraumatic stress disorder: a pilot study assessing changes in SF-36 scores before and after treatment in a placebo-controlled trial of fluoxetine. J Trauma Stress 1999;12:387–393PubMedCrossRefGoogle Scholar
  57. 57.
    Rapaport MH, Endicott J, Clary C. Posttraumatic stress disorder and quality of life: results across 64 weeks of sertraline treatment. J Clin Psychiatry 2002;63(1)59–65PubMedGoogle Scholar
  58. 58.
    Wittchen HU, Fehm L. Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Psychiatr Clin North Am 2001;24(4)617–641PubMedCrossRefGoogle Scholar
  59. 59.
    Fehm L, Pelissolo A, Furmark T, et al. Size and burden of social phobia in Europe. Eur Neuropsychopharmacol 2005;15(4)453–462PubMedCrossRefGoogle Scholar
  60. 60.
    Lipsitz JD, Schneier FR. Social phobia. Epidemiology and cost of illness. Pharmacoeconomics 2000;18(1)23–32PubMedCrossRefGoogle Scholar
  61. 61.
    Walker JR, Kjernisted KD. Fear: the impact and treatment of social phobia. J Psychopharmacol 2000;14(2 Suppl 1):S13–S23PubMedGoogle Scholar
  62. 62.
    Stein MB, Kean YM. Disability and quality of life in social phobia: epidemiological findings. Am J Psychiatry 2000;157:1606–1613PubMedCrossRefGoogle Scholar
  63. 63.
    Schneier FR, Johnson J, Hornig CD, et al. Social phobia: comorbidity and morbidity in an epidemiologic sample. Arch Gen Psychiatry 1992;49:282–288PubMedGoogle Scholar
  64. 64.
    Magee WJ, Eaton WW, Wittchen HU, et al. Agoraphobia, simple phobia, and social phobia in the National Comborbidity Survey. Arch Gen Psychiatry 1996;53:159–168PubMedGoogle Scholar
  65. 65.
    Wittchen HU, Beloch E. The impact of social phobia on quality of life. Int Clin Psychopharmacol 1996;11:S15–S23CrossRefGoogle Scholar
  66. 66.
    Antony MM, Roth D, Swinson RP, et al. Illness intrusiveness in individuals with panic disorder, obsessive-compulsive disorder, or social phobia. J Nerv Ment Dis 1998;186(5)311–315PubMedCrossRefGoogle Scholar
  67. 67.
    Wittchen HU, Fuetsch M, Sonntag H, et al. Disability and quality of life in pure and comorbid social phobia: findings from a controlled study. Eur Psychiatry 2000;15(1):46–58CrossRefGoogle Scholar
  68. 68.
    Yonkers KA, Dyck IR, Keller MB. An eight-year longitudinal comparison of clinical course and characteristics of social phobia among men and women. Psychiatr Serv 2001;52(5): 637–643PubMedCrossRefGoogle Scholar
  69. 69.
    Simon NM, Otto MW, Korbly NB, et al. Quality of life in social anxiety disorder compared with panic disorder and the general population. Psychiatr Serv 2002;53(6)714–718PubMedCrossRefGoogle Scholar
  70. 70.
    Safren SA, Heimberg RG, Brown EJ, et al. Quality of life in social phobia. Depress Anxiety 1996;4(3)126–133PubMedCrossRefGoogle Scholar
  71. 71.
    Stein MB, Fyer AJ, Davidson JRT, et al. Fluvoxamine treatment of social phobia (social anxiety disorder): a double-blind, placebo-controlled study. Am J Psychiatry 1999;156:756–760PubMedGoogle Scholar
  72. 72.
    Rapaport MH. Enhancing Precision in Clinical Trials: Using Quality of Life to Differentiate True Drug Response from Placebo Response. 2001; NCDEU Presentation Google Scholar

Copyright information

© springer 2007

Authors and Affiliations

  • Margaret A. Koury
    • 1
  • Mark Hyman Rapaport
    • 1
  1. 1.Department of PsychiatryCedars-Sinai Medical Center 8730 Alden DriveC-301 Los Angeles

Personalised recommendations