Quality of Life in Depression Scale

Last updated
Quality of Life in Depression Scale
Purposeassess depression's effect on quality of life

The Quality of Life In Depression Scale (QLDS), originally proposed by Sonja Hunt and Stephen McKenna, is a disease specific patient-reported outcome which assesses the impact that depression has on a patient's quality of life. [1] It is the most commonly used measure of quality of life in clinical trials and studies of depression. [2] The QLDS was developed as a measure to be used in future clinical trials of anti-depressant therapy. [3]

Contents

It is a 34 item self-rated [4] questionnaire which consists of dichotomous response questions, with the response being either True/Not True. [5] It is scored binomially (0-1) with higher scores on the QLDS indicating a lower quality of life. [6] Several tests of construct validity and internal consistency have found the QLDS to be a good measure of quality of life.

Needs-based model

The QLDS is built around the generally accepted assumption that one's quality of life can only be assessed subjectively. Quality of life tends to be greatly influenced by factors such as depression, anxiety, tension or fatigue. [3]

The QLDS is based around the needs-based model of quality of life. This is derived from the assumption that quality of life is dependent on a person's ability to fulfil particular human needs. [3] The QLDS questions centre around a number of needs that were considered crucial in order to suffice a high quality of life. These include but are not limited to; food, sleep, sex, safety, love, enjoyment, self-esteem and self-actualization. [7]

The QLDS uses a two-point response system with either True or Not True. The high number of items in the questionnaire allows the detection of moderately minor changes in quality of life. [8]

Items on the QLDS are given a score of 1 when the question is applicable to the respondent and 0 when it is not applicable. The items are totalled to give a score ranging from 0–34. [8] Low scores act as an indicator towards a high quality of life.

Development

The QLDS was developed by Galen Research in 1992 and was funded by Lilly Industries. [9] It was developed in the United Kingdom in conjunction with the Netherlands. The QLDS was the first quality of life instrument to be developed in 2 languages simultaneously. [3] The development of the QLDS coincided with a rising interest on the impact of illness and its treatment on the quality of life of the patient. McKenna and Hunt constructed the QLDS on the basis of providing a measure for this, as well as attempting to overcome contemporary studies concerning low correlations between patient self-assessment and nurse or therapist evaluations. [7]

The items in the UK English QLDS were derived from statements made in qualitative interviews by 30 depressed or recently recovered patients based in the North West of England and Scotland. Interviews took a conversational approach and lasted between 30 minutes to 2 hours. Interviewees were between the age range of 19–64 years, with 22 females and 8 males. After a refinement process, based on categories of needs proposed by McKenna and Hunt, 426 relevant statements were derived from the interview transcripts. Upon further scrutinization they produced 41 statements for an initial questionnaire. [7]

A further 35 patients were asked to complete the draft questionnaire and review their experience with it. They were composed of 22 females and 13 males in the age range of 24–72 years. Interviewees expressed a great degree of approval with the questionnaire, although a few mentioned how the binomial system caused difficulty, as it required them to make complete choices. [7]

Following this, the questionnaire was revised to 34 items and field tested to determine construct validity and reliability. [7]

International development

The first two languages the QLDS was available in were UK English and Dutch. These were shown to have good reliability, validity and responsiveness. [7] In 1999, McKenna in collaboration with a team of international researchers developed and tested the QLDS in 9 new languages. This involved translation, followed by field testing for content validity and the new measure's construct validity.

Across the majority of translations, no major difficulties arose excluding Morocco. Cultural differences between Morocco and the UK provided challenge, alongside a lack of literal equivalents between the two languages. An example of this is the absence of an equivalent for the verb 'to enjoy' in Arabic. Researchers also faced further difficulty due to the contemporarily high rate of illiteracy, as the test could not be self-administrative on as large a scale as anticipated. As a result, although the data demonstrated both reliability and construct validity, they were unable to place confidence in the Arabic adaptation's equivalence to the other developed versions. [8]

Reliability, validity and responsiveness

Testing the Anglo-Dutch project

Following the collaborative Anglo-Dutch project, researchers had to compare the QLDS' success with established measures of the same concept. No measure of quality of life in depression was available so both versions had to be matched to related measures. In the UK this was the General Well-Being Index (GWBI) whilst in the Netherlands the Sickness Impact Profile (PS-SIP) acted as a comparison. [3]

Reliability and internal consistency

For use in a clinical trial, an instrument like the QLDS should have a test-retest reliability coefficient of minimum 0.85. Internal consistency also requires a minimum of 0.85 and is assessed using Cronbach’s alpha-coefficient. [3]

In the UK, the test-retest correlation coefficient for patients with stable depression was 0.94 (n=37). The test-retest correlation coefficient in the Netherlands was 0.87 (n=33). [3]

For internal consistency the UK recorded a value of 0.95 and the Netherlands a value of 0.92. These results suggested the QLDS produced a low degree of measurement error and high internal consistency. [3]

Content and construct validity

No missing items applicable to participants were recognised. The relevancy and ease of completion indicated by field-test interviews suggested the high content validity of the QLDS.

The QLDS and GWBI had a correlation score of 0.79 in the UK (n=65). The Dutch adaptation had a correlation of 0.71 with the PS-SIP (n=77). These measurements were anticipated to be slightly lower due to the difference of purpose between measures. [3]

Responsiveness

The QLDS’ responsiveness was analysed in a general practice population of 540 patients with major depression. Over a 6-month period, substantial progress in the level of depression was seen. [3]

8 weeks into treatment the mean QLDS score rose by 68%, with patients who continued treatment for the full 6-months recording an increase of 78%. The QLDS was concluded by the researchers to be responsive to change in quality of life throughout successful pharmacological depression treatment. [3]

International use

Since its development, the QLDS has been adapted and validated in 17 languages other than UK English, [2] including Norwegian, [5] Spanish, Danish, French, German and Italian. [8] This has allowed the QLDS to be used in research and clinical studies worldwide.

Studies utilizing the QLDS include investigations into venlafaxine, [10] duloxetine [11] [12] [13] and bupropion. [14]

Related Research Articles

<span class="mw-page-title-main">Beck Depression Inventory</span> 21-question multiple-choice self-report inventory.

The Beck Depression Inventory, created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. Its development marked a shift among mental health professionals, who had until then, viewed depression from a psychodynamic perspective, instead of it being rooted in the patient's own thoughts.

The Liebowitz Social Anxiety Scale (LSAS) is a short questionnaire developed in 1987 by Michael Liebowitz, a psychiatrist and researcher at Columbia University and the New York State Psychiatric Institute. Its purpose is to assess the range of social interaction and performance situations feared by a patient in order to assist in the diagnosis of social anxiety disorder. It is commonly used to study outcomes in clinical trials and, more recently, to evaluate the effectiveness of cognitive-behavioral treatments. The scale features 24 items, which are divided into two subscales. 13 questions relate to performance anxiety and 11 concern social situations. The LSAS was originally conceptualized as a clinician-administered rating scale, but has since been validated as a self-report scale.

A patient-reported outcome (PRO) is a health outcome directly reported by the patient who experienced it. It stands in contrast to an outcome reported by someone else, such as a physician-reported outcome, a nurse-reported outcome, and so on. PRO methods, such as questionnaires, are used in clinical trials or other clinical settings, to help better understand a treatment's efficacy or effectiveness. The use of digitized PROs, or electronic patient-reported outcomes (ePROs), is on the rise in today's health research setting.

The Montgomery–Åsberg Depression Rating Scale (MADRS) is a ten-item diagnostic questionnaire which psychiatrists use to measure the severity of depressive episodes in patients with mood disorders. It was designed in 1979 by British and Swedish researchers as an adjunct to the Hamilton Rating Scale for Depression (HAMD) which would be more sensitive to the changes brought on by antidepressants and other forms of treatment than the Hamilton Scale was. There is, however, a high degree of statistical correlation between scores on the two measures.

The Narcissistic Personality Inventory (NPI) was developed in 1979 by Raskin and Hall, and since then, has become one of the most widely utilized personality measures for non-clinical levels of the trait narcissism. Since its initial development, the NPI has evolved from 220 items to the more commonly employed NPI-40 (1984) and NPI-16 (2006), as well as the novel NPI-1 inventory (2014). Derived from the DSM-III criteria for Narcissistic personality disorder (NPD), the NPI has been employed heavily by personality and social psychology researchers.

The Health Dynamics Inventory (HDI) is a 50 item self-report questionnaire developed to evaluate mental health functioning and change over time and treatment. The HDI was written to evaluate the three aspects of mental disorders as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM): "clinically significant behavioral or psychological syndrome or pattern...associated with present distress...or disability". This also corresponds to the phase model described by Howard and colleagues Accordingly, the HDI assesses (1) the experience of emotional or behavioral symptoms that define mental illness, such as dysphoria, worry, angry outbursts, low self-esteem, or excessive drinking, (2) the level of emotional distress related to these symptoms, and (3) the impairment or problems fulfilling the major roles of one's life.

The Migraine Specific Quality of Life (MSQoL) is a patient-reported outcome measure which assesses the quality of life of migraineurs. It is a 25-item questionnaire which is filled out by the patient and is used to determine how the patient's life has been affected by their migraines.

The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a patient-reported outcome (PRO) measure which assesses the quality of life of patients with ankylosing spondylitis. The ASQoL is based on the needs-based quality of life model. It is a self-administered questionnaire which contains 18 items and takes up to four minutes to complete.

The Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) is a disease-specific patient-reported outcome measure which determines the effect rheumatoid arthritis has on a patient’s quality of life. The RAQoL has 30 items with a yes and no response format and takes about six minutes to complete.

The Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) is a disease specific patient-reported outcome measure which assesses quality of life of patients with pulmonary hypertension (PH). It was the first pulmonary hypertension specific questionnaire for assessing patient reported symptoms, quality of life and functioning.

The Psoriatic Arthritis Quality of Life (PsAQoL) measure is a disease specific patient-reported outcome measure which measures the effect that psoriatic arthritis has on a patient’s quality of life.

The Recurrent Genital Herpes Quality of Life (RGHQoL) measure is a patient-reported outcome measure which determines the impact that recurrent genital herpes has on a patient’s quality of life. It is a 20 item questionnaire with items such as “Herpes makes it difficult for me to plan ahead” and “I worry that sex will trigger an outbreak.”. Lower scores on the RGHQoL indicate a higher negative impact on quality of life.

The Unidimensional Fatigue Impact Scale (U-FIS) is a disease-specific patient-reported outcome measure which measures the impact of multiple sclerosis related fatigue. It is a 22-item unidimensional scale which is based on needs-based quality of life theory.

The Somatic Symptom Scale - 8 (SSS-8) is a brief self-report questionnaire used to assess somatic symptom burden. It measures the perceived burden of common somatic symptoms. These symptoms were originally chosen to reflect common symptoms in primary care but they are relevant for a large number of diseases and mental disorders. The SSS-8 is a brief version of the popular Patient Health Questionnaire - 15 (PHQ-15).

<span class="mw-page-title-main">Mood Disorder Questionnaire</span>

The Mood Disorder Questionnaire (MDQ) is a self-report questionnaire designed to help detect bipolar disorder. It focuses on symptoms of hypomania and mania, which are the mood states that separate bipolar disorders from other types of depression and mood disorder. It has 5 main questions, and the first question has 13 parts, for a total of 17 questions. The MDQ was originally tested with adults, but it also has been studied in adolescents ages 11 years and above. It takes approximately 5–10 minutes to complete. In 2006, a parent-report version was created to allow for assessment of bipolar symptoms in children or adolescents from a caregiver perspective, with the research looking at youths as young as 5 years old. The MDQ has become one of the most widely studied and used questionnaires for bipolar disorder, and it has been translated into more than a dozen languages.

<span class="mw-page-title-main">Child Mania Rating Scale</span>

The Child Mania Rating Scales (CMRS) is a 21-item diagnostic screening measure designed to identify symptoms of mania in children and adolescents aged 9–17 using diagnostic criteria from the DSM-IV, developed by Pavuluri and colleagues. There is also a 10-item short form. The measure assesses the child's mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month. Clinical studies have found the CMRS to be reliable and valid when completed by parents in the assessment of children's bipolar symptoms. The CMRS also can differentiate cases of pediatric bipolar disorder from those with ADHD or no disorder, as well as delineating bipolar subtypes. A meta-analysis comparing the different rating scales available found that the CMRS was one of the best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses. The CMRS has also been found to provide a reliable and valid assessment of symptoms longitudinally over the course of treatment. The combination of showing good reliability and validity across multiple samples and clinical settings, along with being free and brief to score, make the CMRS a promising tool, especially since most other checklists available for youths do not assess manic symptoms.

<span class="mw-page-title-main">General Behavior Inventory</span> Overview of the clinical use of the GBI a clinical assessment for bipolar disorder symptoms.

The General Behavior Inventory (GBI) is a 73-question psychological self-report assessment tool designed by Richard Depue and colleagues to identify the presence and severity of manic and depressive moods in adults, as well as to assess for cyclothymia. It is one of the most widely used psychometric tests for measuring the severity of bipolar disorder and the fluctuation of symptoms over time. The GBI is intended to be administered for adult populations; however, it has been adapted into versions that allow for juvenile populations, as well as a short version that allows for it to be used as a screening test.

The Social Support Questionnaire (SSQ) is a quantitative, psychometrically sound survey questionnaire intended to measure social support and satisfaction with said social support from the perspective of the interviewee. Degree of social support has been shown to influence the onset and course of certain psychiatric disorders such as clinical depression or schizophrenia. The SSQ was approved for public release in 1981 by Irwin Sarason, Henry Levine, Robert Basham and Barbara Sarason under the University of Washington Department of Psychology and consists of 27 questions. Overall, the SSQ has good test-retest reliability and convergent internal construct validity.

The 9-question Patient Health Questionnaire (PHQ-9) is a diagnostic tool introduced in 2001 to screen adult patients in a primary care setting for the presence and severity of depression. It rates depression based on the self-administered Patient Health Questionnaire (PHQ). The PHQ is part of Pfizer's larger suite of trademarked products, called the Primary Care Evaluation of Mental Disorders (PRIME-MD). The PHQ-9 takes less than 3 minutes to complete and simply scores each of the 9 DSM-IV criteria for depression based on the mood module from the original PRIME-MD. Primary care providers frequently use the PHQ-9 to screen for depression in patients.

References

  1. ↑ Amir, Marianne; Lewin-Epstein, Noah; Becker, Gideon; Buskila, Dan (2002). "Psychometric Properties of the SF-12 (Hebrew Version) in a Primary Care Population in Israel". Medical Care . 40 (10): 918–28. doi:10.1097/00005650-200210000-00009. PMID   12395025. S2CID   25950087.
  2. 1 2 McKenna, SP; Whalley, D; Doward, LC (3 November 2002). "Improving the measurement properties of the quality of life in depression scale". Value in Health. 5 (6): 522. doi: 10.1016/S1098-3015(10)61383-6 .
  3. 1 2 3 4 5 6 7 8 9 10 11 Tuynman-Qua, H; de Jonghe, F; McKenna, SP (1997). "Quality of Life in Depression Scale (QLDS). Development, reliability, validity, responsiveness and application". Eur Psychiatry. 12 (4): 199–202. doi:10.1016/S0924-9338(97)89105-5. PMID   19698532. S2CID   12089426.
  4. ↑ Doraiswamy, P. M.; Khan, Z. M.; Donahue, R. M.J.; Richard, N. E. (2002). "The Spectrum of Quality-of-Life Impairments in Recurrent Geriatric Depression". The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 57 (2): M134-7. doi: 10.1093/gerona/57.2.M134 . PMID   11818434.
  5. 1 2 Berle, J.Ø.; McKenna, S.P. (2004). "Quality of Life in Depression Scale (QLDS): Adaptation and evaluation of the psychometric properties of the Norwegian version". Nordic Journal of Psychiatry. 58 (6): 439–46. doi:10.1080/08039480410006070. PMID   16195087. S2CID   22371401.
  6. ↑ Callaghan, Patrick; Khalil, Elizabeth; Morres, Ioannis; Carter, Tim (2011). "Pragmatic randomised controlled trial of preferred intensity exercise in women living with depression". BMC Public Health. 11: 465. doi:10.1186/1471-2458-11-465. PMC   3128029 . PMID   21663696.
  7. 1 2 3 4 5 6 Hunt, Sonja M.; McKenna, Stephen P. (1992). "The QLDS: A scale for the measurement of quality of life in depression". Health Policy. 22 (3): 307–19. doi:10.1016/0168-8510(92)90004-U. PMID   10122730.
  8. 1 2 3 4 McKenna, S.P.; Doward, L.C.; Kohlman, T.; Mercier, C.; Niero, M.; Paes, M.; Patrick, D.; Ramirez, N.; Thorsen, H.; Whalley, D. (2001). "International development of the Quality of Life in Depression Scale (QLDS)". Journal of Affective Disorders. 63 (1–3): 189–199. doi:10.1016/S0165-0327(00)00184-1. PMID   11246095.
  9. ↑ McKenna, Stephen P.; Hunt, Sonja M. (1992). "A new measure of quality of life in depression: Testing the reliability and construct validity of the QLDS". Health Policy. 22 (3): 321–30. doi:10.1016/0168-8510(92)90005-V. PMID   10122731.
  10. ↑ Baca Baldomero, Enrique; Cervera Enguix, Salvador; Grupo De Estudio, Teseo (2003). "Calidad de vida en pacientes con depresión tratados en Atención Primaria. Efectividad y seguridad de la venlafaxina retard" [Quality of life, in depressed patients in Primary Health Care setting. Effectiveness and safety of venlafaxine extended release]. Actas Españolas de Psiquiatría (in Spanish). 31 (6): 331–8. PMID   14639509.
  11. ↑ Detke, Michael J.; Lu, Yili; Goldstein, David J.; McNamara, Robert K.; Demitrack, Mark A. (2002). "Duloxetine 60 mg once daily dosing versus placebo in the acute treatment of major depression". Journal of Psychiatric Research. 36 (6): 383–90. doi:10.1016/S0022-3956(02)00060-2. PMID   12393307.
  12. ↑ Hudson, James I; Perahia, David G; Gilaberte, Inmaculada; Wang, Fujun; Watkin, John G; Detke, Michael J (2007). "Duloxetine in the treatment of major depressive disorder: An open-label study". BMC Psychiatry. 7: 43. doi:10.1186/1471-244X-7-43. PMC   2018694 . PMID   17725843.
  13. ↑ Kornstein, Susan G.; Wohlreich, Madelaine M.; Mallinckrodt, Craig H.; Watkin, John G.; Stewart, Donna E. (2006). "Duloxetine Efficacy for Major Depressive Disorder in Male vs. Female Patients: Data From 7 Randomized, Double-Blind, Placebo-Controlled Trials". Journal of Clinical Psychiatry. 67 (5): 761–70. doi:10.4088/JCP.v67n0510. PMID   16841626.
  14. ↑ Dunner, David L.; Kwong, W. Jacqueline; Houser, Trisha L.; Richard, Nathalie E.; Donahue, Rafe M. J.; Khan, Zeba M. (2001). "Improved Health-Related Quality of Life and Reduced Productivity Loss After Treatment with Bupropion Sustained Release: A Study in Patients with Major Depression". Primary Care Companion to the Journal of Clinical Psychiatry. 3 (1): 10–16. doi:10.4088/PCC.v03n0103. PMC   181153 . PMID   15014623.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.