Mittal D (HSR&D CeMHOR; VISN 16 MIRECC)
Pyne JM (HSR&D CeMHOR; VISN 16 MIRECC)
Edlund MJ (HSR&D CeMHOR; VISN 16 MIRECC)
Fortney JC (HSR&D CeMHOR; VISN 16 MIRECC)
To examine the impact of anxiety disorders among patients with major depressive disorder (MDD) on health related quality of life (HRQOL).
Primary care patients (n=279) with MDD were enrolled in the Telemedicine Enhanced Antidepressant Management (TEAM) study, a multi-site randomized effectiveness trial. Patients with schizophrenia, bipolar disorder, alcohol and drug dependence, alcohol abuse, and minor depression were excluded. HRQOL at baseline was measured using the Quality of Well Being scale (QWB) which includes four subscales: symptom/problem complex, physical activity, mobility, and social activity. Presence of comorbid anxiety disorders was assessed using the Mini-International Neuropsychiatric Interview. T-tests were used to compare the impact of comorbid anxiety disorders on HRQOL. Patients who had only MDD were compared to those with MDD plus only generalized anxiety disorder (GAD), MDD plus only panic disorder (PD), MDD plus only posttraumatic disorder (PTSD), and MDD with any anxiety disorder. In addition, multivariate regression analyses were conducted to estimate the additive effect of comorbid anxiety disorders on HRQOL, controlling for demographics, pain, and number of chronic physical health conditions.
The mean age of the sample (n=279) was 59.3 years. Most were male (89.9%), married (62.7%), Caucasian (75.6%), and had HS diploma (75.2%). Two thirds of the sample (68.8%) had at least one comorbid anxiety disorder. T-tests indicated that patients who had comorbid GAD (p=.01) or comorbid PTSD (p=.04), but not comorbid PD (p=.07), had significantly worse QWB scores. Regression analyses revealed that comorbid GAD, PTSD, and PD all significantly contributed to lower QWB scores (p<.01). Regression results also indicated that the number of chronic health conditions and self-reported pain significantly contributed to worse QWB scores. Among the QWB subscales, comorbid anxiety disorders had the greatest impact on the symptom/problem complex subscale.
MDD patients with comorbid anxiety disorders have worse HRQOL compared to those with MDD alone. The effect of anxiety disorders is independent of physical illnesses and pain.
The clinical implication of these results is that interventions targeting MDD should be evaluated for their effectiveness on comorbid anxiety disorders to ascertain if additional intervention components are needed to target comorbid anxiety disorders.