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

The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial

BACKGROUND

Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective.

STUDY DESIGN

A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted.

STUDY RESULTS

The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved.

CONCLUSIONS

The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.

Measuring the relationship between body mass index and depression among Saudi adult population: A nationwide cross-sectional study

BACKGROUND

The prevalence of obesity and depression shows an accelerating trend with increased risk of morbidity and disability. The exact underlying relationship between them is unclear. We aimed to evaluate the prevalence of body mass index (BMI) and depression and their associations in a large sample of Saudi adults.

METHODS

We administered a nationwide cross-sectional web-based survey using a snowball sampling method among Saudi adults aged 18-60 years. We used a validated Arabic version of Beck's Depression Inventory-II (BDI-II) for depression assessment. We classified BMI into underweight, normal weight, overweight, and obesity. We used logistic regression analysis to determine the factors associated with depression.

RESULTS

Among 4,683 Saudi adults, different grades of depression were present in 43.3%, most (25.2%) with a mild condition. Overweight and obesity were present in 26.4% and 21%, respectively. We found a positive association between BMI and BDI-II score (ρ = 0.14, p = 0.006). BMI was significantly higher among those who were older, males, married, living in the Eastern region of Saudi Arabia, educated at a pre-university level, employed, at high family-income levels, smokers, and people with chronic diseases. Depression score was significantly higher among married, non-employees, non-smokers, people with chronic diseases, and those with BMI ≥ 25 kg/m2. Non-smoking, presence of chronic diseases, and being overweight or obese were significantly associated with depression.

CONCLUSIONS

Saudi adults were suffering from different grades of depression, overweight, and obesity. A positive association between BMI and BDI-II score was observed. Depression score did not differ by age, sex, geographical region, educational level, or family income. Non-smoking, presence of chronic diseases, and being overweight or obese were significantly associated with depression. Further longitudinal research is required to understand the factors underpinning causal relationships between BMI and depression, the subgroups' variation, and mediating strategies.

Childhood maltreatment and major depressive disorder in well-being: a network analysis of a longitudinal community-based cohort

BACKGROUND

Little has been done to comprehensively study the relationships between multiple well-being constructs at a time. Even less is known about whether child maltreatment and major depressive disorder (MDD) impact different well-being constructs. This study aims to examine whether maltreated or depressed individuals have specific impacts on well-being structures.

METHODS

Data analyzed were from the Montreal South-West Longitudinal Catchment Area Study (N = 1380). The potential confounding of age and sex was controlled by propensity score matching. We used network analysis to assess the impact of maltreatment and MDD on well-being. The centrality of nodes was estimated with the 'strength' index and a case-dropping bootstrap procedure was used to test network stability. Differences in the structure and connectivity of networks between different studied groups were also examined.

RESULTS

Autonomy and daily life and social relations were the most central nodes for the MDD and maltreated groups [MDD group: strength coefficient (SC) autonomy = 1.50; SCdaily life and social relations = 1.34; maltreated group: SCautonomy = 1.69; SCdaily life and social relations = 1.55]. Both maltreatment and MDD groups had statistical differences in terms of the global strength of interconnectivity in their networks. Network invariance differed between with and without MDD groups indicating different structures of their networks. The non-maltreatment and MDD group had the highest level of overall connectivity.

CONCLUSIONS

We discovered distinct connectivity patterns of well-being outcomes in maltreatment and MDD groups. The identified core constructs could serve as potential targets to maximize the effectiveness of clinical management of MDD and also advance prevention to minimize the sequelae of maltreatment.

Responsiveness to change in health status of the EQ-5D in patients treated for depression and anxiety

BACKGROUND

The EQ-5D is a commonly used generic measure of health but evidence on its responsiveness to change in mental health is limited. This study aimed to explore the responsiveness of the five-level version of the instrument, the EQ-5D-5 L, in patients receiving treatment for depression and anxiety.

METHODS

Patient data (N = 416) were collected at baseline and at end of treatment in an observational study in a Norwegian outpatient clinic. Patients were adults of working age (18-69 years) and received protocol-based metacognitive or cognitive therapy for depression or anxiety according to diagnosis. Responsiveness in the EQ-5D was compared to change in the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). Effect sizes (Cohen's d), Standardised response mean (SRM), and Pearson's correlation were calculated. Patients were classified as "Recovered", "Improved", or "Unchanged" during treatment using the BDI-II and the BAI. ROC analyses determined whether the EQ-5D could correctly classify patient outcomes.

RESULTS

Effect sizes were large for the BAI, the BDI-II, the EQ-5D value and the EQ VAS, ranging from d = 1.07 to d = 1.84. SRM were also large (0.93-1.67). Pearson's correlation showed strong agreement between change scores of the EQ-5D value and the BDI-II (r_s -0.54) and moderate between the EQ-5D value and the BAI (r_s -0.43). The EQ-5D consistently identified "Recovered" patients versus "Improved" or "Unchanged" in the ROC analyses with AUROC ranging from 0.72 to 0.84.

CONCLUSION

The EQ-5D showed good agreement with self-reported symptom change in depression and anxiety, and correctly identified recovered patients. These findings indicate that the EQ-5D may be appropriately responsive to change in patients with depression and anxiety disorders, although replication in other clinical samples is needed.

Genomic-Analysis-Oriented Drug Repurposing in the Search for Novel Antidepressants

From inadequate prior antidepressants that targeted monoamine neurotransmitter systems emerged the discovery of alternative drugs for depression. For instance, drugs targeted interleukin 6 receptor (IL6R) in inflammatory system. Genomic analysis-based drug repurposing using single nucleotide polymorphism (SNP) inclined a promising method for several diseases. However, none of the diseases was depression. Thus, we aimed to identify drug repurposing candidates for depression treatment by adopting a genomic-analysis-based approach. The 5885 SNPs obtained from the machine learning approach were annotated using HaploReg v4.1. Five sets of functional annotations were applied to determine the depression risk genes. The STRING database was used to expand the target genes and identify drug candidates from the DrugBank database. We validated the findings using the ClinicalTrial.gov and PubMed databases. Seven genes were observed to be strongly associated with depression (functional annotation score = 4). Interestingly, IL6R was auspicious as a target gene according to the validation outcome. We identified 20 drugs that were undergoing preclinical studies or clinical trials for depression. In addition, we identified sarilumab and satralizumab as drugs that exhibit strong potential for use in the treatment of depression. Our findings indicate that a genomic-analysis-based approach can facilitate the discovery of drugs that can be repurposed for treating depression.

Adapting Peer Researcher Facilitated Strategies to Recruit People Receiving Mental Health Services to a Tobacco Treatment Trial

INTRODUCTION

One of the most challenging aspects of conducting intervention trials among people who experience severe mental illness (SMI) and who smoke tobacco, is recruitment. In our parent "QuitLink" randomized controlled trial (RCT), slower than expected peer researcher facilitated recruitment, along with the impact of COVID-19 pandemic restrictions, necessitated an adaptive recruitment response. The objectives of the present study were to: (i) describe adaptive peer researcher facilitated recruitment strategies; (ii) explore the effectiveness of these strategies; (iii) investigate whether recruitment strategies reached different subgroups of participants; and (iv) examine the costs and resources required for implementing these strategies. Finally, we offer experience-based lessons in a Peer Researcher Commentary.

METHODS

People were included in the RCT if they smoked at least 10 cigarettes a day and were accessing mental health support from the project's two partnering mental health organizations in Victoria, Australia. The majority of people accessing these services will have been diagnosed with SMI. Recruitment occurred over 2 years. We began with peer facilitated recruitment strategies delivered face-to-face, then replaced this with direct mail postcards followed by telephone contact. In the final 4 months of the study, we began online recruitment, broadening it to people who smoked and were accessing support or treatment (including from general practitioners) for mental health and/or alcohol or other drug problems, anywhere in the state of Victoria. Differences between recruitment strategies on key participant variables were assessed. We calculated the average cost per enrolee of the different recruitment approaches.

RESULTS

Only 109 people were recruited from a target of 382: 29 via face-to-face (March 2019 to April 2020), 66 from postcards (May 2020 to November 2020), and 14 from online (November to December 2020 and January to March 2021) strategies. Reflecting our initial focus on recruiting from supported independent living accommodation facilities, participants recruited face-to-face were significantly more likely to be living in partially or fully supported independent living (n = 29, <0.001), but the samples were otherwise similar. After the initial investment in training and equipping peer researchers, the average cost of recruitment was AU$1,182 per participant-~US$850. Face-to-face recruitment was the most expensive approach and postcard recruitment the least (AU$1,648 and AU$928 per participant).

DISCUSSION

Peer researcher facilitated recruitment into a tobacco treatment trial was difficult and expensive. Widely dispersed services and COVID-19 restrictions necessitated non-face-to-face recruitment strategies, such as direct mail postcards, which improved recruitment and may be worthy of further research.

CLINICAL TRIAL REGISTRATION

The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines. The trial sponsor was the University of Newcastle, NSW, Australia.

Associations of Cognitive Complaints and Depressive Symptoms with Health-Related Quality of Life and Perceived Overall Health in Japanese Adult Volunteers

Cognitive complaints, defined as perceived cognitive dysfunction in daily living, are associated with depressive symptoms. The associations of cognitive complaints and depressive symptoms with health-related quality of life (HRQoL) and perceived overall health in Japanese adults remains unknown. To investigate these relationships, we evaluated a convenience sample of 525 Japanese adult volunteers (Mage: 41.3 ± 11.7; 238 male and 287 female). We used the Cognitive Complaints in Bipolar Disorder Rating Assessment (evaluating cognitive complaints), Patient Health Questionnaire-9 (evaluating depressive symptoms), EuroQol-5 Dimension-5 Level (EQ-5D-5L; evaluating HRQoL), and EuroQol-Visual Analogue Scale (EQ-VAS; evaluating perceived overall health). Our path analyses suggested that both cognitive complaints and depressive symptoms had significant total effects on HRQoL and perceived overall health. Furthermore, cognitive complaints were not significantly associated directly with HRQoL and perceived overall health, whereas cognitive complaints were significantly associated with HRQoL and perceived overall health indirectly via depressive symptoms. Depressive symptoms were significantly associated directly with HRQoL and perceived overall health. This study suggests that depressive symptoms may mediate the associations of cognitive complaints with HRQoL and perceived overall health. Thus, to address the HRQoL and perceived overall health associated with cognitive complaints, evaluation and intervention for depressive symptoms may be useful in public health.

Tobacco Use and Health-Related Quality of Life Among Individuals with Depression Who Are Receiving Treatment for HIV in Cape Town, South Africa

BACKGROUND

Tobacco use is the leading cause of preventable death worldwide, and prevalence rates are high among people living with HIV (PLWH), particularly in men. Depression is also common among PLWH, especially among smokers, who may use tobacco to manage mood. Although HIV and depression have been linked to functional impairment and poor health-related quality of life (HRQOL), little research has examined the degree to which smoking impacts these relationships in low- and middle-income countries with high HIV burden.

METHOD

Participants (N = 289) were people living with HIV (PLWH) who were being assessed for inclusion in a study targeting depression as a barrier to HIV medication adherence. Linear regression models measured the effect of gender on tobacco use (assessed by the WHO-ASSIST) and on each of the five HRQOL functional impairment domains (assessed by the SF-21). Separate multivariable regression models examined the relationships between habitual tobacco use, defined as daily, almost daily, or weekly use, and the HRQOL domains.

RESULTS

The prevalence of habitual tobacco use was 23.9% (48.1% among men, 15.5% among women). Habitual tobacco use was associated with decreased cognitive functioning for the whole sample (B = - 8.99, p < 0.05) and with lower levels of pain-related impairment for men (B = 18.1, p < 0.05). Although men reported more tobacco use (B = 8.50, p < 0.001), they reported less pain-related limitations than women (B = 8.70, p < 0.05).

CONCLUSIONS

In our sample, men reported higher rates of habitual tobacco use than women. Smoking was associated with cognitive impairment and with less pain-related impairment among men. Future smoking cessation treatments tailored to PLWH who have symptoms of depression may benefit from strategies that consider pain management as a pathway to habitual smoking and recognize that motivations for use may differ by gender.

Health-related quality of life in adults with profound postlingual hearing loss before and after cochlear implantation

Purpose

In clinical trials and everyday medical practice, health-related quality of life (HRQoL) measures are increasingly being used. That is, in addition to the usual biological health assessment, the impact of disease and treatment on the patient’s functioning in the physical, mental, and social areas is an important parameter. The aim of this study was to assess HRQoL before and after using a cochlear implant (CI) in adults with profound hearing loss.

Methods

There were 104 patients who qualified for the study. All gave informed and free consent. The study involved adults with bilateral hearing loss above 81 dB HL and rated according to the World Health Organization (WHO) classification scheme as having profound hearing loss (which includes deafness). In each participant, the hearing loss was postlingual, that is, it occurred after speech and language had developed. The assessment of quality of life (AQoL-8D) questionnaire was used to assess the health-related quality of life in the study participants.

Results

Quality of life significantly increased (p < 0.001) after cochlear implantation in almost all domains (except the pain dimension). The mean increase in overall quality of life was 0.16, the greatest improvement was found in the dimensions senses (mean change of 0.17) and self-worth (mean change of 0.16).

Conclusion

Cochlear implantation improves the health-related quality of life of the postlingually deaf.

Overlap of Depressive Symptoms with Health-Related Quality-of-Life Measures

Because depressive symptoms are a part of health-related quality-of-life (HRQOL) measures, measures of depression will be empirically associated with HRQOL. We discuss examples of published research where authors ignored or did not fully account for overlap between depressive symptom and HRQOL measures. Future researchers need to recognize when their models include conceptually similar variables on the same side or both sides of the equation. This awareness will lead to more accurate conclusions about the prognostic value of depression and other HRQOL measures for health care utilization, mortality, and other outcomes. It will also result in fewer incorrect claims about the effect of depression on HRQOL.

Relationship between health-related quality of life and subjective wellbeing in asthma

OBJECTIVE

Poor health-related quality of life (HRQoL) is associated with a high risk of acute exacerbations in patients with asthma. The use of health state utility instruments to measure HRQoL is common, but it has been criticised for failing to adequately capture the impact of the condition from the patient perspective. We aimed to assess the ability of subjective wellbeing and health state utility instruments to capture important HRQoL dimensions for asthma patients.

METHODS

Regression analyses were conducted using data (n = 856 asthma patients) from a large multi-national cross-sectional survey to explore the relationship between subjective wellbeing (ONS4, PWI, SWLS), health state utility (15D, AQoL-8D, EQ-5D-5L, HUI3, SF-6D, SF-6Dv2), and an asthma-specific instrument (AQLQ-S). The latent structure of different instruments was investigated using an exploratory factor analysis.

RESULTS

All instruments could distinguish the impact of asthma on HRQoL. Among health utility instruments, 15D, SF-6D and AQoL-8D were more sensitive based on the average standardised regression coefficients. AQOL-8D had the strongest correlation with subjective wellbeing. Nevertheless, the exploratory factor analysis showed a complementary relationship between subjective wellbeing and HRQoL instruments. The most important subjective wellbeing domains were standard of living, achieving in life, and personal relationships; although contributions of these domains to overall life satisfaction differed among asthma patients identified by a latent class analysis.

CONCLUSION

The use of subjective wellbeing alongside AQLQ-S and health state utility instruments provides a comprehensive approach to assess the impact of asthma on the patient's life. Further research is needed to incorporate these measures in health care evaluation.

Can machine learning be useful as a screening tool for depression in primary care?

Depression is a widespread disease with a high economic burden and a complex pathophysiology disease that is still not wholly clarified, not to mention it usually is associated as a risk factor for absenteeism at work and suicide. Just 50% of patients with depression are diagnosed in primary care, and only 15% receive treatment. Stigmatization, the coexistence of somatic symptoms, and the need to remember signs in the past two weeks can contribute to explaining this situation. In this context, tools that can serve as diagnostic screening are of great value, as they can reduce the number of undiagnosed patients. Besides, Artificial Intelligence (AI) has enabled several fruitful applications in medicine, particularly in psychiatry. This study aims to evaluate the performance of Machine Learning (ML) algorithms in the detection of depressive patients from the clinical, laboratory, and sociodemographic data obtained from the Brazilian National Network for Research on Cardiovascular Diseases from June 2016 to July 2018. The results obtained are promising. In one of them, Random Forests, the accuracy, sensibility, and area under the receiver operating characteristic curve were, respectively, 0.89, 0.90, and 0.87.

Psychometric properties of the EQ-5D-5L: a systematic review of the literature

PURPOSE

Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L.

METHODS

Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models.

RESULTS

Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health.

CONCLUSIONS

The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.

Empirical Validity of a Generic, Preference-Based Capability Wellbeing Instrument (ICECAP-A) in the Context of Spinal Cord Injury

BACKGROUND

Assessing the validity of generic instruments across different clinical contexts is an important area of methodological research in economic evaluation and outcomes measurement.

OBJECTIVE

Our objective was to examine the empirical validity of a generic, preference-based capability wellbeing instrument (ICECAP-A) in the context of spinal cord injury.

METHODS

This study consisted of a secondary analysis of data collected using an online cross-sectional survey. The survey included questions regarding demographics, injury classifications and characteristics, secondary health conditions, quality of life and wellbeing, and functioning in activities of daily living. Analysis comprised the descriptive assessment of Spearman's rank correlations between item-/dimension-level data for the ICECAP-A and four preference-based health-related quality of life (HRQoL) instruments, and discriminant and convergent validity approaches to examine 21 evidence-informed or theoretically derived constructs. Constructs were defined using participant and injury characteristics and responses to a range of health, wellbeing and functioning outcomes.

RESULTS

Three hundred sixty-four individuals completed the survey. Mean index score for the ICECAP-A was 0.761; 12 (3%) individuals reported full capability (upper anchor; score = 1), and there were no reports of zero capabilities (lower anchor; score = 0). The strongest correlations were dominated by items and dimensions on the comparator (HRQoL) instruments that are non-health aspects of quality of life, such as happiness and control over one's life (including self-care). Of 21 hypothesised constructs, 19 were confirmed in statistical tests, the exceptions being the exploratory hypotheses regarding education and age at injury.

CONCLUSION

The ICECAP-A is an empirically valid outcome measure for assessing capability wellbeing in people with spinal cord injury living in a community setting. The extent to which the ICECAP-A provides complementary information to preference-based HRQoL instruments is dependent on the comparator.

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature

PURPOSE

Given increasing interest in using the capability approach for health economic evaluations and a growing literature, this paper aims to synthesise current information about the characteristics of capability instruments and their application in health economic evaluations.

METHODS

A systematic literature review was conducted to assess studies that contained information on the development, psychometric properties and valuation of capability instruments, or their application in economic evaluations.

RESULTS

The review identified 98 studies and 14 instruments for inclusion. There is some evidence on the psychometric properties of most instruments. Most papers found moderate-to-high correlation between health and capability measures, ranging between 0.41 and 0.64. ASCOT, ICECAP-A, -O and -SCM instruments have published valuation sets, most frequently developed using best-worst scaling. Thirteen instruments were originally developed in English and one in Portuguese; however, some translations to other languages are available. Ten economic evaluations using capability instruments were identified. The presentation of results show a lack of consensus regarding the most appropriate way to use capability instruments in economic evaluations with discussion about capability-adjusted life years (CALYs), years of capability equivalence and the trade-off between maximisation of capability versus sufficient capability.

CONCLUSION

There has been increasing interest in applying the capability-based approach in health economic evaluations, but methodological and conceptual issues remain. There is still a need for direct comparison of the different capability instruments and for clear guidance on when and how they should be used in economic evaluations.

A Systematic Review of the Feasibility and Psychometric Properties of the ICEpop CAPability Measure for Adults and Its Use So Far in Economic Evaluation

OBJECTIVES

Development of the ICEpop CAPability measure for Adults (ICECAP-A) was reported in 2012; use of certain capability measures was suggested in the context of social or long-term care soon afterward by decision-making organizations in the United Kingdom and The Netherlands. Despite enthusiasm for the ICECAP-A, this study represents the first attempt to collate evidence on its psychometric properties and its use in economic analysis.

METHODS

A systematic review of studies published between January 2012 and February 2019 that have either explored the psychometric properties of the ICECAP-A (validity, reliability, and responsiveness) or report its use in economic analysis.

RESULTS

Twenty-seven studies were identified, 11 undertaking some form of economic analysis (including pilot and feasibility studies) and 16 assessing psychometric properties (7 assessing construct validity). The ICECAP-A has mainly been used in the United Kingdom, but also in other English-speaking countries and in Europe, across a wide range of healthcare contexts. There is promising evidence on content validity, construct validity, and responsiveness. Although there was consistently strong associations between the ICECAP-A and the Assessment of Quality of Life-Eight Dimension, associations with the EuroQol 5-dimension 3-level and EuroQol 5-dimension 5-level were inconsistent. In some cases, it was found that a switch in evaluative space from health to capability well-being would alter resource allocation decisions.

CONCLUSION

The ICECAP-A is correlated with health-related quality of life but is most appropriately regarded as a complement for and not a substitute to the EuroQol 5-dimension 3-level and EuroQol 5-dimension 5-level in particular. Positive evidence of the measure's content and construct validity is beginning to accumulate, but further conceptual and policy debate is needed regarding the equity implications of switching between evaluative spaces.