1999 - Subjective Quality Of Life In Female In-patients With Depression - A Longitudinal Study

""**.;Tuo;"'.f'll:'?"^'ffif, 'ff#ff;T{#""' PRIEBE HEIDI RIJDOLF & STEFAN SUMMARY

#iiil',r',#iltli*t**:*1i[

r#{itiiln++tt*"

;f$5ili{i#1i1{1i,",:-"1 cnanges

INTRODUCTION

i',::'..#$;,1*i=[;

ffi,iffi*rs*n*$ ";

ii*rmU---nt$ l*,.rui";,lfr _-->4.---d-

H' RI,DOL' & S ?R]!BE

.

::TJ: lii:,"'"il:::ff f li$j#""1'"'ff +# ff :"ff tJi{,.i#,""f Iili"L:j "','*,,'*' -** *. "* :;"i33:;.;'"0-"i :,Ir:J:,:i:;i:;l;:1:;;,':3";; "ili::"" '

h,vea o$erseol.Lhan ouno,o ;;1: l:l'. l";.i,"il;. fi; * r ""* been,

i:;;tiii*il"l{i:.l:""'n:::T;;:;?ffiii'I:ni""r fi!"lJ,+,Tffi

:l'[.1.i+'t''l,iFili*d"t{-",f'i **j;i*fl#*?i[:*i**;:.,:fl ::i,lh';l':j:t;:'tx:,:::lll*;J"'"ffi ;:::,,f liryUlttiffi

jr j*i *i *:+qi *ffi t*irtir*i',,''.*ill t',

": Ti"*jir".,*::#:' i l**\T':i'i'*Hr}f{[ffi n onrhfollowJPPenod-

IIETHODS

ill"iliq;l*i1ffiffifrl l1fn:x ix;i ri"*,: lf3,'3;fl?"'"l"^'. il;iuL:';:::",;""'ll'"il :,#;:;'"r:*lt

s**r*$:rnffi[{'1}*1fr[iii:''1 ":'"",;#**;,**;',*,' *l*:fi#'i**'if{fr"*rlf (BDl; Beck & Steer, 198?)

H*:TiJlJ::: :]*'"j::.'gJl#'" l?#*i:;*lr";";,-;;i:::t'",'j:[:

1 SIEJECTI\'E QUAL]TY OF LIFE

compansonsbetweentwo groups.When cornparingSQOL rn the three diagnoslicgroups, anallses of vanancewere repeatedwilh poleniially influentral vanablesas covanates.For assessing re associationbetween psychopathologvand SQOL sco.es,as weLl as SQOL chanses.corelation coefficjetts (Pearsons t were used T-Lsts for dependert sarnpleswere used for analysing chalrgesover time. Co(elation of stabilitv over dne for psvchocoeficients (Pearson'st were calculated coefficients do tot reflect ihe slabiliry in These lescrelest palhology dnd SQOL scores. their relauaeposition in th€ maintain which individuais to absoluteierms, but the degree for predicdng SQOL analysis was calculaled regression A multiple dist.iburon of scores. model i! a muitivariate cbang€s

RESULTS According !o ICD 10, depr€ssionwas diagnosed i! 42 women (F31 = l. F32 = 19. i n 7 0 w o m e i ( F 1 0 . 1= 1 , F 1 0 . 2 = 2 4 , F l ( ) 3 = 3 ? , F33=20, F34.1=2), alcoholism :4), = and schizophreniain 73-women (F20 0 = 65, F22 = l, F23 ='1, F10.4 9. F10.i chdaclelilrrcs ofthe 3 Sroupsareshownin Table I : and sociodenographic F25 3). Cli cal The thee eroups show significant differencesdn age, montbly income and panne6hip situation.Moreover, womeDwith depressionhave a loiger duraiio. of illn€ss as compared wrth ihe schjzophreniagroup, and a higher degrce of depressivesvmptomsas comparedio both oLbergroups.Their scoreson BPRS sub-scatcsanergia,thought disorderand hostilitv de lower than in the schizophrenugroup. Table 2 sunrmadsesSQOL scoresin rhe three grcups. Depressivewomen had a significantly lower satisfactionwirh tife as a whol€' witb social conracts.leisure activities and mental beahh than tbe otber tlto grouls. The mean SQOL score was also significstly less fa'ourable As conpared with women with nlcoholism, depressivepaiien$ were lesssatisfiedwrih their financial situationalrd wlth accommodatron In a next step we comparedSQOL in the ttuee groups wh€n controllinefor the influence of age and BPRS sub-scaleanxj€i)/deprcssion This was done becauseage ard anxtetv/ depressiondiffered significanrlybet'een the ttree groups ard &e known io b€ faclors of poiential influence on SQOL scores Table 3 strows whrch Cifierenceswer€ statisticallv ;iglificant befo.e and after controlling for the infiuence of age a.d alxietv/depression Differences i! satislactionwith social contacts and with the fi ncial situationfailed lo was con!'olled reachsiatisticalsignificdce when ihe iDfluenceof age and anxiety/depression for. Othef differences,however, including rhe one in th€ SQOL mean score remaLned smtisticallysignilicani. significandv colrelared withir th€ depressivesample, tre SQOL with lhe BPRS sum score (Pearson'sr: .53, p<0001) with BPRS sub scalesanxiet-a/ - '16 depression(.: -.40. p < 0.05), activation (r: - 40, p < 0.05) aad rhoughtdisorder(r: 4 4 p < were 0 ' 0 1 ) ( r : B D I p < 0 0 5 ) a n d 35, {.: p < O . 0 l ) . C o r e l a t i o n sw i i h H A M D with was associated of svmptoms tbat a higher degree ilso statisticallysignificantindicating lower satisfactionscores. Ar 6 montlr follo*-up, 28 depressivewoneD l67qo al the base line sanple) werc .e-interviewed.14 Datienrseither refused a secondinrcrview o. could not be tnced There

I] RUDOLF& S' PREBE

;on. alcoholisn eresDn' r'd crinic'rchaocteistr'sorr;1n;il?stlof sociod,nosmPhic

3 3? I t 0 . 5

l90l : 930

and schizoph'enit !fter

!(2,182) = l? 6'il

F ( 2 , l l 2 l= 3 3 '

20301360

r2{2,r35)= 120"

ith Pdnet & Clnldr'n

jln'ss (YB) Ase ol ons.tii (Yes) illness oi D;rdion

3 3 . 9 1r 2 . 5

tt o*" iir,ttnt=

3 3 . 9 : 1 03

322::6 8 11.8337

lL.l:31 L O3 : 3 9

II-AMD BDI

:--m'ffimffi"'Sl'n''r*'

F ( 2 , 1 3=n5, 5 5 t ' - ' F r 2 . l 8 0 )l =3 7 i ' " "_ = 18 1'ii F(?,180) !r2l g0l=8 ?1'" t ( 2 1 3 0 = 1 0 69 " ' F ( 2 , 1 8 0 ) = 938i ' 1 _ ! ( r , l l 0 )= 4 09 i "

23.5- 1A2

ldcprc$ion "s s'oup' rs shizoPhrc'a p< 5%):'d:p.ssioD

S-**'*:*r:ii"nl;$#:Hr'r,r'i1i"l*'"".,'*ii{1;t ;*l''r.q**:i",,m::::'i'":":Til'i:':.'J;;:"::r':r::

'fr:#pi#jd#{rl'*1d";ffi r''il..;:il ;$'}$i"H:"l'fi

:t:':' t

242

SUBJICTryE QUAI-]TY OF L]FE Tabl. 2 Subjetiv. qurlity ol lile in lne threr groups Worrcn with alcoholish

\t om€nrilh shizopnreni.

F{2,182)= 0 "9" " t

? . 8 1t . 5

Fe.rsr)=5-5.i'D F ( 2 , 1 8 1 ) =l8i . 1 ' b f(2.182)=r3l'1i'

3.2ar5

F(2.l8l= l 23.5'i' t

i p = 0 . 0 5 , . i ps 0 0 1 , ! ! . t < 0 0 0 1 'delresion vs. schizopbFnE ld.pErsion vs. a london 3,nsl. compdisotr (Sch.ff,.Tcsr p < 5%): 8mup.

sarisfactron with life as a whole, with leisure actili,ries, safely, an{l mental health as well as

in the SQOL mean score. bdividual stability of self'raled depressivesymptoms, of SQOL nem score and of sadsfactionwith some Life domains was rcladvely high. AIr jmproveme't of the SQOL mean scoreb€tweenbasehne and fotlow-up was signilicantly conelatedwilh a reductionof scores on HAMD (r = .49, p < 0.0s) and BDI (r = .54, p < 0.01) over the sane penod of time. BDI cbanseswere the bestpredicror of SQOL cbanges.ln a multivriale dalysis. thls predictiv€ value was not mcrcasedsignificandy when basehre data and changesin vanables other lbd BDI were also consideredas predtciors

T,ble 3 Sr.tislicalsjsrifc,nc. or SQOL dilter.ncs b.r*..n th.lh.t srDdpsbero.elnd atcr conlrulli'g Io. ih. infiue.c. olaAe and sxirtr/dep.djon B€forc cDntrollinC fo. $€ innu€nc€ of4e 8nd 'qi.rr/d.prdion

AIle. controlling Io.lhr inflnence 0fage.od adiety/dep.sion

Fl2,lr8)= 6.,11*

'p= 005r'p=0.01."'p=0ml

H' RUDOLf & S' PRIEBE Trble 4 sm'h lir'r nosprrrlrdmision 'P$cn"pllh log-'and SQOt in d€pro*rr r,"' :ncrudrns'Ehirrt' ur 'ndi' outr ;"i "' .-ii. adeiN

iollo*_up

r(27)

- 1 3 .165 ?

1.5 1.0

I{AMD BD]

1 8 . 0 1l l 3

08 2.3' 2.9*.

1.211.5 3 . 8: 2 . 0

3.1l1.9

3.511.-9

t '

3.5:09 ips 0.05,.+p< 0.0I, ritP < 0 001

.

DISCUSSION

'J," ",:"ilit"""':'"'",i::i:?lJ:.H"'fi :::,:"::"Jil:[ Ttr" i*i*ffi Iff job acdvnies' reisure wrote' as a 'ftct'on scor"s,trosewitirie ;#:;";;;;; "ir",.",'n***

on " g'l'p anexpljcrtdissatisfaction indicated -a -ental healt.h, ll]-"].

sanpres ornost r,i' i, "**r ';* -"rasesco'es l: [:fil:'*J:JJ""ff1]::15""T:l

ordepre"r": sQoL *e avdage :iffliffiilJ::-oJ',i:]:J'"3?#"iffi'H" i"L": orthe]o*cs::"#TliL,l";:il:ii::#iil'":## x one u*. rn"r" trrissrudv, [una"at

nethods (Priebe?r d1 1999) Financ assessment

asurncientrv because !f 'i". ""."i,"irii"a"."rns. i;:l"J:i:'ii'"'i:1T'J;T il": drs(atisfacri' The acnviues lersur€ enjovable ;Hil;

,;.;;o;;;'i;e.

"i ;*.p,"*o

ro$ 'ocomerhe or Dvdnerkeme'v pdtren'\

;J;*r; 3t:.*,'t -**'":i'JJ::li:::T i*,a,"ei; X:ii?:1,il'"::1'#: "r'"';** .'^r"'"i,*u" i'" :ij"ji.,*i'1"i"',1""I;,;;;; 3:l',"H::'J:'-i?;] wiih oiher people and with (her own prsl'

"T;ff$,:i:"zu*igli";if ;"'":ffi:ir'5:$1ff i*"*';rrtl*il Hili#:,TT::.;lTi::Xl'll#il"l1llil''"';orseo'-scoresintherorrowupperiod would be consist€nlwith lhat assumpuon

SUAJECIIV€ QUAL]TY OF LI]'E

\umerous studies have reponed thar a nigber degree of depressjve symDromsrs asso . i J r e du r r r . o k e rr O O L . - " r e . e . g S L . . - n p r d . . t o o l . hne a at r*,'n, .,,. ^., i J r y r s i n ! r t r J ,a . , r - x . dr o r e , a r , o n oepresi\r $or-n n,r.( .,,"i ;";;,.;. it appearcstnkrng ftar SeOL difierences belweer the diasnoslic c,""pr;;inJ;irl r i c a l . ',,. s n , . c e n r . h e n' h e I n f l L e n coer a e p . e s s , \ e , , " , " . " ; ,_ - ; rr: ;^.;;;",i; f o r . s r g e P 5 r j n rg} a r l o s e r S Q O L i n o e p e s , r v e dre ro a bet". o-lree ol d r o r e l s r r er ) r p r o r r s T h c F a r e \ e \ e , J o o r s . b r ee r p t " n 3 L),l s . o r l r l t , Lh.e.AS ,ui.",r" anxiety/deFessjonmjgbr b€ an insuficienr measur€for capruring$ose deD*""i"" ,"_,_ loms, whrch are mosr innue'tial for SeOL ratings. Attemativety, one mighr a.g". ,r,"i it't, lot onty fie quantrralivedegreeof depressiveslnptoms, bur .arhe. iheir quaLill"" notu." r h i L s r l e v a n r f o r \ a r r \ t b c u o 0r d t r n g . p a | l e r t 5u i r n a e p r e s s r om l i g n ri a , e u n O e yr r n e d e p ' e si r ' e c o s n . r o r s L l r a rd F n o r " h d e d b ) d r c o n o . . m n r . . r u z o p l . o i u *,t!L. *i!; depressivesymptorrs,bur rhat do delermine a p.iicularly regative asisessne"i"iii.l. tr'r" o n e t u s h . d t , o + e c u i d r e a r r o w n e f i e , d e p , e . . , v es o m c r ; ^ * * " . . r,".pi"i "0.i.J", d . t l e r e n r l v, h a i r h e o r h e rl w o g J o u o sd n d r e .p o n a u . | } d m o r en e g a u \ ev . e q ot bei, lire. r r e e 5 u l ( rs u g g p s |rh a r d r a g n o ( . \i s a r r r e v a n rh 3 r u r e l s s o c . a . e*d h SOOL ral'ns\ D , . p n o n \ s h o u l o .r r e r e f o r " .b e a s s e s " " dI n . r d r e . u " . r s S e o r ! o r e \ ,,a i*,j"*""1 .elevanl facror, rhe rnffuenceof which sboutd beiaonlroled for. Thrs applies as tons as fi€ prec'se mediarirg factors explalmng the asscra(ib.nberwcn Atagnostiana SOOt_ir" no, fully uDderstoodand can, therefore,nor ue exac.iiymeasured.i diasrosrjc j;i.;;;; seemsnecessaryin addirionro an ass€ssmenr of depressivesymDroms. Depressiveparienis SQOL did improve wrthin rbe 6 nonthfoitow up. Thrs changeon the g r o L pl e v e rw a sa L c o m p a n ibe)ds o m e n d r r . d L r ' . t a b i t r ,errine.Then"drrss )of,rlng u n J e r l . n er h . r S O O L r r r . n g . c t n g e a n d n . r U - u - e o u . o , r " o m ec ; 1 " j " ln studies€valuaiing trearmenrof depression(Lonnqvjst e, at 1994,Russo di al. 1997,priebe et at. 1999). Inlrnpq.rhrne-esu)boforher{ud.e..apo.rUvech"nSe.nSeO d .Lr Lu ., d , e d w i . h d n r m p r o { e r n ( n lo , d e o e o \ r v es } m p r o m s .T h F . o n " t J I o n u e r e r r " L r \ u c , . i g r t} f i c a n ra n o \ u b , r d n r i J r: n r e C h d n s e .i r a e o r e . s i \ e . J m p , o n . w - - e r h " oe.r pF;i-r;_.o, 5eoL . h J n g c . e \ D l d i n ' n 3d o p r o t . m a r c l )j u , / o i r h e . r a n l e m , . o r n m s r h e : m p o n a r .e o l depressrvesymptomsfor SQOL changes,bur also indicatest}ratimprovemert h SeOL is aor Jus! an epipheoomenonofposrrive changesi! depression. study demonstrateda very low SeOL in depressivewonen after hospjraladnjssior .Thjs i , " g , e \ p t a i n e db y r n e o e s r e eo f o e p P s , e : , 1o:rh( o r F M ir "houed an rmp'ovrmeno r . SeOt w,,hina o mo|h f,iiow-u! penoown;b war mode.ately conetaled wirh an jmprovement of aeprexive symproms Thi ,,uay lua , natu.alistic design,and fultirer expe.jmentatsrudiesshoutd be conducredto idertify whch r n r e p e l , " * m v e d e r n o s ro o . i . r v e" i . e c r o _ b o l l d e p , e , \ , , e. ) _ p , ; , , ; ; ; : rvr :u' :Lr .y r r L 5 M o r - o v r r t. L . u r er u d j e r m : n l c s r a D" h i n s h r ( l u a \ i , o . v r d u d5lO O L i " r ; r 8 s . " n b€ usedfor designjrg specificaUybeneficialpsychosociatiDresendonsin de;*;* *""_".. RIFERENCES AKIRIND, I & HORNeLT]ST,J.O.(1992)Loneljn6s md !.tcoholabus.: A EVic*,ofevidences oaan inierptay s.cial scrcnu and Medicine, 34. 4054)4

& S PR1EBE H RLTDOLF

^'",}'"i"i;lL;i'lii,,l"'i"ffYfl?#'li':Jl.:iil"fffTf";:11'ii:,5?x}"1',Iil'i'"IilI a 8 2 ' Q u ' r r \ o , r ' e r ' , e a L L x rro- on n m l t u l \ u P p o r ' ! ' R ta' o ' M r c -

u ^ , . ? ii o l , t o . ' . ^ r ^ - ,

. n a P r a e t a nr b n n t n S , 5 . \ - t J

"":l f :;"*:ll-XJl;;i:.?x;f,"iLi{ i.:":l;l;i,'-::":::, :.1."::;j:l:: St'dias.^ Aicahol. 54, ?83 296

)l::ffi:"*:,"ff [Hi', :l'fiii'tr;-'l#:::;:;ffi *i**4,"#.?:ffi :ntg"rrug',t* aul Al'dl'ol pNivig or *od'D 'lcoholics oonrfii;, u...t. & sc]{Iltr. R 1l9s5ls*idl i$lauonand anddvstnvruaA"a . VERMAs K {ree8)Quarit}or tire m schizoPhcnia "#f:i:1'?;'Ji1,ti"

?3 N.'rc'lre" andps,chiarry' ,*d;5'i'5: iiililH^.?#;3i;3?i,""",""" ralnotar^elroLo."'. 56-62. I Psvchos@alourcom' u (19s6)F.mile alcoboLics HAv;i';.

v'd

atu' eam'n!

act' P'chiotnco

*";;:;li;'"*?'l:';','.a*,:Hli.":l _:1"{iT1.1,1..!.il1"jl,}',:i,ilTlili'j,T-""

* i;:#ttr#,[*sl*

ymry"'"1;l"T"'.HT i. Yxflr;].1;'.

ohl!.JjdntlTenLd]chro1[rl|v']-oo..cnrfid|'"3h)p€t' N

w ; . , , . , " . . " " , . . , , . A c ' .p n .\ , o d t . s .a r a , a a a

I

T":;i-i;:"""

" "--,

"q.n,"'c..0 3oa ,r

f

iEtrtiliil-3f,:,ff1-ri?i':'"'iilffff:''"*'.1'6.n\^,!l,t Evatu,ionandptusnnPLoMiry' u' l!l^,ul"oo*

' o'v irpaue16 TP & BULosK\c M r4ooQur')o rr' 'nc\on'cd!fre.r'rrv

rcatne . Pechvlozt..l

Lo'.';d';tj;r';..;ii.ol

M.dti,.,

ve

20 r0l-'10

cot''t'on. cl a'oo\+)

N L r o o ! o L d r ' F o r r ' h a \ ao u r c o l r

-,., :::',:?'"",,"., kfi ,l'*g rl9ruff*;J:ffi1,'l'jxfi:;'"?fir;'.:T::.\#'; "-'i1"",ffs,?'^;1: i";,i; i1"',F o.: .*'::l s Enue ^,,;l;";ln'r:", L:ltl'-,ffi :''.'"","" ;l ill;i.illi'; fl,ffiffJi"ft# ;i:::ff; l: ::;-" *,,;, ;'':"" i*ii+l' "'"-;;;;;;;;,;;;;"rr; Pstrhiatry'4r' .ir;re oi ckonic $bizoph*nic pan'as HosPn,lan'! connunin

*lfi"l'iJ;T,Yl.i';l;:1tr*"Eii,,t"H",',.-;*ll'3;lfn;,T'",9t';;.",,#:'#;iH,"i:li ';j 'J.'.r"; nl; t*-f"'I;ltl,mjt:'**m:,*;^f ;:';';z:x"-;'L'" 892-89?

?6-81 ouec^^-iltrcona^voPilqo)rlreoelos)tr'rr'_ir1!\:l_P-cmrasdrR"or'10-oo-81)

"-,u'"'fl';l,tlJ,1Li:

& KrJsER w (eds)(teee)Q'o)i, aJLiJ' ondMentatH'atthc'r' Pacsierd

$hizophrenic r-"Yijiil"iolli?:S',i^STlt"'u * *'.u* *. ,, o-$)euhvorrrein66.adhined Asessn'nt 1(ree7) "^Ell?: ii#k{6i'1Y:Jl'[i]r*. "." . ou-r^., . KocHwL &cRANr'

**".,' "",1'-h*w:;':;';'*u.,1i$;T:il;;''"#Hx';,'d'i?#'l'"i"1'i.,*"'"" 'or,""ftx1{,i; ;." 5';p1-;1i;1':';HJii

.''rcotura. e*. oy.u,J,Liro'ffe',.tr

fld' ^."-*,':x,:^lIii',il#;;:"1;_r::*"." som"D r d n". A emoin.ar

*";;#J.J,iWANNER,U-U & PRIEBE.S (1993)Objectir RODEIi "t r"v"n'"v t ,in"i iip"i ;i;;.;;;

"",."

;nd ctL;ic'L Neuroscie^cd 24a 250-r:B