Quality of life in euthymic patients with unipolar major depressive disorder and bipolar disorder
OR I G I N A L R E S E A R C H
Quality of life in euthymic patients with unipolar major depressive disorder and bipolar disorder
This article was published in the following Dove Press journal: Neuropsychiatric Disease and Treatment
Qijing Bo1–4,* Lu Tian1–4,* Feng Li1–4
Zhen Mao1–4
Zhimin Wang1–4
Xin Ma1–4
Chuanyue Wang1–4
1The National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China; 2Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China; 3Beijing Institute for Brain Disorders Center of Schizophrenia, Beijing Anding Hospital, Capital Medical University, Beijing 100088, People’s Republic of China; 4Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, People’s Republic of China
*These authors contributed equally to this work
Objective: This study aimed to compare quality of life (QOL) between patients with major
depressive disorder (MDD) in remission and patients with bipolar disorder (BD) in remis-
sion, and to explore the relationship between QOL and demographic, clinical, and cognitive
variables.
Methods: This study included 49 euthymic patients with MDD, 59 euthymic patients with
BD, and 52 healthy controls (HC). The 17-item Hamilton Depression Rating Scale (HAMD-
17), Hamilton Anxiety Rating Scale (HAMA), and Young Mania Rating Scale (YMRS) were
used to assess symptoms of depression, anxiety, and mania respectively. QOL was assessed
with the Chinese version of the World Health Organization Quality of Life Scale Brief
(WHOQOL-BREF). Cognitive function was assessed with the repeated neuropsychological
assessment scale (RBANS).
Results: Compared with HC, patients with MDD had lower overall and subdomain scores
(except ENVIR) on the WHOQOL-BREF (p<0.05). The BD group had decreased overall
WHOQOL-BREF scores and decreased PHYS and SOCIL subdomain scores (p<0.05).
PSYCH scores were lower in patients with MDD, compared with patients with BD
(p1 hr; (3)
history or current significant drug/alcohol abuse; and (4)
pregnancy.
The clinical research ethics committees of Beijing
Anding Hospital approved the study protocol. Each parti-
cipant provided his or her written informed consent.
Assessments Each participant’s socio-demographic data were collected
with a questionnaire designed for the study. All partici-
pants were diagnosed with Structured Clinical Interview
for DSM-IV-TR Axis I Disorder-patient Edition (SCID-I/
P).16,17 The 17-item Hamilton Depression Rating Scale
(HAMD-17),18 Hamilton Anxiety Rating Scale
(HAMA),19 and Young Mania Rating Scale (YMRS)20
were used to assess depressive, anxiety-related, and
manic symptoms, respectively. Therefore, QOL was
assessed with Chinese version of WHOQOL-BREF,
which had four subdomains: physical health (PHYS); psy-
chological health (PSYCH); social relationship (SOCIL)
and environment (ENVIR), the total score was
a comprehensive subjective score of overall QOL.21
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Neurocognitive functioning was assessed with the
Repeatable Battery for The Assessment of
Neuropsychological Status (RBANS),22,23 which has 5
domains (12 tests): attention (digital span, coding); language
(picture naming, semantic fluency); visuospatial/construc-
tional (figure copy, line orientation); immediate memory
(list learning, story memory); and delayed memory (list
recall, list recognition, story recall, figure recall). The raw
scores of each domain were summed to yield a total score
representing overall level of cognitive function. Executive
function was assessed with the Stroop Color Test (SCT). The
SCT consists of three conditions: word, color, and
interference.24 Under one set of conditions, total time
required to perform the task is used as a measure of perfor-
mance. For the word task (Sword time), the participant is
asked to read out the names of various color words, written in
black ink. For the color task (Scolor time), the participant is
asked to state the color of a block of colored ink. For the
interference task, the participant must determine the correct
word, despite conflicting information, in terms of letter color
(Dword time) and then must determine the correct color,
despite conflicting information, in terms of word meaning
(Dcolor time).
Procedure Sociodemographic data were obtained for all participants
included in the study. Eligible participants continued to
complete symptom scales, WHOQOL self-assessment
scales, and neurocognitive functions assessment. The self-
designed questionnaire used a unified instruction and fill in
a form. The subjects were completed independently.
Clinical assessments were completed by trained psychia-
trists. Inter-rater reliability remained within acceptable
limits.
Statistical analysis Data were entered using Epidata software version 3.1 and
were analyzed using SPSS 25.0 for Windows (SPSS, Inc.,
Chicago, IL, USA). The one-way ANOVA was used to
compare the demographic, clinical, QOL, and neuropsy-
chological tests among the three groups, Bonferroni cor-
rection was used to measure multiple group differences.25
QOL and cognitive function were subjected to analysis of
covariance with significant demographic variables. Chi-
Square test was used to analyze gender difference, marital
status, and current drugs using among the three groups.
Pearson or Spearman rank correlation analysis was per-
formed to measure the associations of QOL with socio-
demographic and clinical characteristics and performance
on other neurocognitive tests. Stepwise Multiple
Regression Analysis was used to identify factors that
were independently associated with QOL. For all analyses,
the level of statistical significance was set at p<0.05.
Results Demographic and clinical characteristics A total of 49 patients with MDD and 59 patients with BD in
remission, 52 HCs who met the study criteria entered the
study. The three groups did not differ with respect to gender,
educational level, marital status, or current use of drugs.
Members of the MDD group were significantly older than
those of the other two groups (F=8.96, p<0.001). In the
other hand, the patient groups did not differ with respect
to duration of illness, but the age at onset of illness and
recurrence times. In addition, patients showed significantly
higher scores of HAMD and HAMA than HC. Patients with
BD in remission scored higher on the YMRS than did
patients with MDD or HC. Table1 shows the demographics
characteristic and the score of HAMD-17, HAMA, YMRS.
Comparison of QOL and cognitive function among MDD and BD patients and HCs Compared with HC, the MDD group had lower scores for
the total WHOQOL-BREF and its subdomains (except
ENVIR) (p<0.05). The BD group had decreased scores
for WHOQOL-BREF overall, as well as the PHYS and
SOCIL subdomains (p<0.05). MDD patients scored sig-
nificantly lower on PSYCH than did BD patients (p<0.05).
Figure 1 presents differences in QOL domain scores
among the groups. Because age differed significantly
among groups, we used age as a covariate for analysis of
QOL. This had no impact on the results.
Performance differed among the three groups only for
tests of delayed memory in the RBANS subdomain
(p<0.05). However, after Bonferroni correction, this dif-
ference was not significant. Compared with the HC group,
the BD group had increased Scolor time on SCT (p<0.05).
When age was used as a covariate, the significance of the
result remained unchanged.
Variables associated with QOL among MDD and BD patients Table 2 shows the correlations between demographic and
clinical characteristics, neurocognitive function, and
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