Abstract
Despite the importance of quality of life (QoL) in primary care patients with emotional disorders, the specific influence of the symptoms of these disorders and the sociodemographic characteristics of patients on the various QoL domains has received scant attention. The aim of the present study of primary care patients with emotional disorders was to analyse the associations between four different QoL domains and the most prevalent clinical symptoms (i.e., depression, anxiety and somatization), while controlling for sociodemographic variables. A total of 1241 participants from 28 primary care centres in Spain were assessed with the following instruments: the Patient Health Questionnaire (PHQ)-9 to evaluate depression; the Generalized Anxiety Disorder Scale (GAD)-7 for anxiety; PHQ-15 for somatization; and the World Health Organization Quality of Life Instrument-Short Form (WHOQOL-Bref) to assess four broad QoL domains: physical health, psychological health, social relationships, and environment. The associations between the symptoms and QoL domains were examined using hierarchical regression analyses. Adjusted QoL mean values as a function of the number of overlapping diagnoses were calculated. The contribution of sociodemographic variables to most QoL domains was modest, explaining anywhere from 2% to 11% of the variance. However, adding the clinical variables increased the variance explained by 12% to 40% depending on the specific QoL domain. Depression was the strongest predictor for all domains. The number of overlapping diagnoses adversely affected all QoL domains, with each additional diagnosis reducing the main QoL subscales by 5 to 10 points. In primary care patients with a diagnostic impression of an emotional disorders as identified by their treating GP, clinical symptoms explained more of the variance in QoL than sociodemographic factors such as age, sex, level of education, marital status, work status, and income. Given the strong relationship between depressive symptoms and QoL, treatment of depression may constitute a key therapeutic target to improve QoL in people with emotional disorders in primary care.
Highlights
The WHO defines quality of life (QoL) as an individual’s perception of their position in life embedded in a cultural, social, and environmental context[1]
The mean values for the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder Scale (GAD)-7 and PHQ-15 ranged from 10–14 points, indicating moderate symptom intensity based on the cut-off points[45]
−0.23** −0.14** −0.03 0.107 0.118 F16,1219 = 22.13**. These results are consistent with findings from previous studies that have investigated the association between common mental disorders and QoL in primary care[14,15,48] and general population samples[49,50]. Our study extends these findings to a sample of primary care patients with a suspected diagnosis of an emotional disorder not sufficiently severe to require specialized care
Summary
The WHO defines quality of life (QoL) as an individual’s perception of their position in life embedded in a cultural, social, and environmental context[1]. Mental health services have shifted away from focusing on symptom reduction towards a more holistic approach encompassing other factors such as wellbeing and functioning This shift has occurred largely due to the publication of studies on the impact of mental disorders in QoL. Previous studies have described the relationship between various QoL domains and a range of sociodemographic factors, including age, gender, occupation, income, marital status, and educational level[17,18,19,20,21,22] Most of those studies were conducted in elderly populations or in patients with severe medical conditions such as cancer, rheumatological diseases, or kidney conditions. QoL correlates closely with severe mental illness, schizophrenia[23,24,25,26], in people with common mental disorders, the impact of symptoms or sociodemographic characteristics on QoL is not well-understood
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