Abstract
Quality of life (QOL) is an important health-related concept. Identifying factors that affect QOL can help develop and improve health-promotion interventions. Previous studies suggest that behavioral activation fosters subjective QOL, including well-being. However, the mechanism by which behavioral activation improves QOL is not clear. Considering that QOL improves when depressive symptoms improve post-treatment and that behavioral activation is an effective treatment for depression, it is possible that behavioral activation affects QOL indirectly rather than directly. To clarify the mechanism of the influence of behavioral activation on QOL, it is necessary to examine the relationships between factors related to behavioral activation, depressive symptoms, and QOL. Therefore, we attempted to examine the relationship between these factors. Participants comprised 221 Japanese undergraduate students who completed questionnaires on behavioral activation, QOL, and depressive symptoms: the Japanese versions of the Behavioral Activation for Depression Scale-Short Form (BADS-SF), WHO Quality of Life-BREF (WHOQOL-26), and Center for Epidemiologic Studies Depression Scale (CES-D). The BADS-SF comprises two subscales, Activation and Avoidance, and the WHOQOL-26 measures overall QOL and four domains, Physical Health, Psychological Health, Social Relationships, and Environment. Mediation analyses were conducted with BADS-SF activation and avoidance as independent variables, CES-D as a mediator variable, and each WHO-QOL as an outcome variable. Results indicated that depression completely mediated the relationship between Avoidance and QOL, and partially mediated the relationship between Activation and QOL. In addition, analyses of each domain of QOL showed that Activation positively affected all aspects of QOL directly and indirectly, but Avoidance had a negative influence on only part of QOL mainly through depression. The present study provides behavioral activation strategies aimed at QOL enhancement.
Highlights
Quality of life (QOL) is defined as “individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns,”, and includes concepts of subjective well-being and happiness
In order to examine the hypothesis that depression mediates the relationship between a behavioral activation-related factor and QOL, mediation analysis was conducted
The present study examined whether depression mediates the influence of a behavioral activation factor on QOL
Summary
Quality of life (QOL) is defined as “individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns,” (see [1]), and includes concepts of subjective well-being and happiness. Behavioral activation treatment for depression has attracted attention. According to behavioral theory underlying behavior activation treatment, avoidance behavior plays an important role in the occurrence and maintenance of depression [5]. Adaptive behaviors related to a healthy lifestyle are decreased, and depression develops and is maintained. Behavioral activation for depression attempts to increase adaptive behavior and decrease avoidance behaviors [6] by using simple activation methods such as short-term goals and activity schedules, and avoidance interventions such as monitoring of avoidance behavior and engaging in alternative behaviors instead of avoidance. The Behavioral Activation for Depression Scale [7] and its short version (BADS-SF) [8] were developed to assess changes in behavior resulting from behavioral activation. The BADS-SF comprises two subscales, Activation (trait assumed to vary by simple activation technique) and Avoidance (trait assumed to vary by interventions for avoidance behavior)
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