Overlap of Depressive Symptoms with Health-Related Quality-of-Life Measures
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CURRENT OPINION
Overlap of Depressive Symptoms with Health‑Related Quality‑of‑Life Measures Ron D. Hays1 · Peter M. Fayers2 Accepted: 17 October 2020 © Springer Nature Switzerland AG 2020
Abstract 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.
Key Points Failure to recognize overlap between stand-alone depressive symptom measures and health-related quality-of-life (HRQOL) instruments leads to tautological inferences about the “impact” of depression on HRQOL. Overlap can also result in inaccurate conclusions about the prognostic value of these measures for health care utilization, mortality, and other outcomes. The fact that depressive symptoms are part of preference-based measures used to estimate utilities in costutility evaluations needs to be explicit.
1 Introduction Health-related quality of life (HRQOL) is a subset of quality of life that refers to functioning and well-being in physical, mental, and social health aspects of life. HRQOL includes functioning such as ability to carry out a range of activities * Ron D. Hays [email protected] 1
Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, Los Angeles, CA, USA
Institute of Applied Health Sciences, King’s College, University of Aberdeen, Aberdeen, UK
2
of daily living such as bathing or dressing (physical functioning). It also includes whether the person can climb stairs, walk, or run. Other aspects of functioning include the extent to which one can interact with family, friends, and others (social functioning). HRQOL also refers to internal, subjective perceptions such as vitality, pain, anxiety, depressive symptoms, and general health perceptions. HRQOL instruments can yield scores for multiple domains (profile measures) and/or a single preference-based summary score anchored by dead (0) and “perfect health” (1). HRQOL instruments should be designed using a formal process starting with input from patients and health care providers who have relevant experience [1]. This should be followed by a conceptual model specifying the items representing the underlying domains. Subsequent studies need to be done to ensure that items are only retained if they correlate sufficiently with the constructs they represent [2, 3] and are not redundant or “locally dependent” (i.e., substantially correlated with one another after controlling for the underlying commo
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