Skip to main content

Advertisement

Log in

Impact of depression on quality-adjusted life expectancy (QALE) directly as well as indirectly through suicide

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

To estimate quality-adjusted life expectancy (QALE) loss among US adults due to depression and QALE losses associated with the increased risk of suicide attributable to depression.

Method

We ascertained depressive symptoms using the eight-item Patient Health Questionnaire (PHQ-8) on the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. We estimated health-related quality of life (HRQOL) scores from BRFSS data (n = 276,442) and constructed life tables from US Compressed Mortality Files to calculate QALE by depression status. QALE loss due to depression is the difference in QALE between depressed and non-depressed adults. QALE loss associated with suicide deaths is the difference between QALE from only those deaths that did not have suicide recorded on the death certificate and QALE from all deaths including those with a suicide recorded on the death certificate.

Results

At age 18, QALE was 28.0 more years for depressed adults and 56.8 more years for non-depressed adults, a 28.9-year QALE loss due to depression. For depressed adults, only 0.41 years of QALE loss resulted from deaths by suicide, and only 0.26 years of this loss could be attributed to depression.

Conclusion

Depression symptoms lead to a significant burden of disease from both mortality and morbidity as assessed by QALE loss. The 28.9-year QALE loss at age 18 associated with depression markedly exceeds estimates reported elsewhere for stroke (12.4-year loss), heart disease (10.3-year loss), diabetes mellitus (11.1-year loss), hypertension (6.3-year loss), asthma (7.0-year loss), smoking (11.0-year loss), and physical inactivity (8.0-year loss).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Goodwin FK, Jamison KR (2007) Manic-depressive illness: bipolar disorders and recurrent depression, 2nd edn. Oxford University Press, New York

    Google Scholar 

  2. Kessler RC, Berglund P, Demler O et al (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602

    Article  PubMed  Google Scholar 

  3. Reeves WC, Strine TW, Pratt LA et al (2011) Mental illness surveillance among adults in the United States. MMWR Surveill Summ 60(Suppl 3):1–29

    PubMed  Google Scholar 

  4. Krishnan KR, Delong M, Kraemer H et al (2002) Comorbidity of depression with other medical diseases in the elderly. Biol Psychiatry 52(6):559–588

    Article  PubMed  Google Scholar 

  5. Kupfer DJ, Frank E (2003) Comorbidity in depression. Acta Psychiatr Scand Suppl (Suppl 418):57–60

  6. Saluja G, Iachan R, Scheidt PC, Overpeck MD, Sun W, Giedd JN (2004) Prevalence of and risk factors for depressive symptoms among young adolescents. Arch Pediatr Adolesc Med 158(8):760–765

    Article  PubMed  Google Scholar 

  7. Dickey B, Normand SL, Weiss RD (2002) Medical morbidity, mental illness, and substance use disorders. Psychiatr Serv 53(7):861–867

    Article  PubMed  Google Scholar 

  8. Lokkerbol J, Adema D, de Graaf R et al (2013) Non-fatal burden of disease due to mental disorders in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 48(10):1591–1599

    Article  PubMed  Google Scholar 

  9. Vos T, Flaxman AD, Naghavi M et al (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2163–2196

    Article  PubMed  Google Scholar 

  10. Chang CK, Hayes RD, Perera G et al (2011) Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS One 6(5):e19590. doi:10.1371/journal.pone.0019590

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Fortes C, Mastroeni S, Alessandra S et al (2012) The combination of depressive symptoms and smoking shorten life expectancy among the aged. Int Psychogeriatr 24(4):624–630

    Article  PubMed  Google Scholar 

  12. Sullivan MD, O’Connor P, Feeney P et al (2012) Depression predicts all-cause mortality: epidemiological evaluation from the ACCORD HRQL substudy. Diabetes Care 35(8):1708–1715

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Dembling BP, Chen DT, Vachon L (1999) Life expectancy and causes of death in a population treated for serious mental illness. Psychiatr Serv 50(8):1036–1042

    Article  CAS  PubMed  Google Scholar 

  14. Simon GE, Rutter CM, Peterson D et al (2013) Does response on the PHQ-9 depression questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv 64(12):1195–1202

    Article  PubMed Central  PubMed  Google Scholar 

  15. Hawton K, van Heeringen K (2009) Suicide. Lancet 373(9672):1372–1381. doi:10.1016/S0140-6736(09)60372-X

    Article  PubMed  Google Scholar 

  16. Hawton K, Saunders K, Topiwala A, Haw C (2013) Psychiatric disorders in patients presenting to hospital following self-harm: a systematic review. J Affect Disord 151(3):821–830. doi:10.1016/j.jad.2013.08.020

    Article  PubMed  Google Scholar 

  17. Sokero TP, Melartin TK, Rytsälä HJ et al (2005) Prospective study of risk factors for attempted suicide among patients with DSM-IV major depressive disorder. Br J Psychiatry 186:314–318

    Article  PubMed  Google Scholar 

  18. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU (2012) Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res 21(3):169–184

    Article  PubMed Central  PubMed  Google Scholar 

  19. Gold MR, Siegel JE, Russell RB, Weinstein MC (1996) Cost-effectiveness in health and medicine. Oxford University Press, New York

    Google Scholar 

  20. Murray CJ, Vos T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223

    Article  PubMed  Google Scholar 

  21. Rosenberg MA, Fryback DG, Lawrence WF (1999) Computing population-based estimates of health-adjusted life expectancy. Med Decis Making 19(1):90–97

    Article  CAS  PubMed  Google Scholar 

  22. Jia H, Zack MM, Thompson WW (2013) The effects of diabetes, hypertension, asthma, heart disease, and stroke on quality-adjusted life expectancy. Value Health 16(1):140–147

    Article  PubMed  Google Scholar 

  23. Brown DS, Jia H, Zack MM, Thompson WW, Haddix AC, Kaplan RM (2013) Using health-related quality of life and quality-adjusted life expectancy for effective public health surveillance and prevention. Expert Rev Pharmacoecon Outcomes Res 13(4):425–427

    Article  PubMed  Google Scholar 

  24. Frazier EL, Franks AL, Sanderson LM (1992) Using behavioral risk factor surveillance data. In: Using chronic disease data: a handbook for public health practitioners. Centers for Disease Control and Prevention, Atlanta, pp 4.1–4.17

  25. Mokdad AH, Stroup DF, Giles WH, Behavioral Risk Factor Surveillance Team (2003) Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the Behavioral Risk Factor Surveillance Team. MMWR Recomm Rep 52((RR–9):1–12

    PubMed  Google Scholar 

  26. Xu F, Town M, Balluz LS et al (2013) Surveillance for certain health behaviors among states and selected local areas—United States, 2010. MMWR Surveill Summ 62(1):1–247

    PubMed  Google Scholar 

  27. Dhingra SS, Kroenke K, Zack MM, Strine TW, Balluz LS (2011) PHQ-8 days: a measurement option for DSM-5 major depressive disorder (MDD) severity. Popul Health Metr 9:11. doi:10.1186/1478-7954-9-11

    Article  PubMed Central  PubMed  Google Scholar 

  28. Kroenke K, Spitzer RL, Williams JBW (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH (2009) The PHQ-8 as a measure of current depression in the general population. J Affect Disord 114(1–3):163–173

    Article  PubMed  Google Scholar 

  30. Corson K, Gerrity MS, Dobscha SK (2004) Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item. Am J Manag Care 10(11 Pt 2):839–845

    PubMed  Google Scholar 

  31. Centers for Disease Control and Prevention (2000) Measuring healthy days: population assessment of health-related quality of life. US Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Division of Adult and Community Health. http://www.cdc.gov/hrqol/pdfs/mhd.pdf

  32. Jia H, Lubetkin EI (2008) Estimating EuroQol EQ-5D scores from Population Healthy Days data. Med Decis Making 28(4):491–499

    Article  PubMed  Google Scholar 

  33. Jia H, Zack MM, Moriarty DG, Fryback DG (2011) Predicting the EuroQol Group’s EQ-5D index from CDC’s “Healthy Days” in a US sample. Med Decis Making 31(1):174–185

    Article  PubMed  Google Scholar 

  34. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB (2003) Years of life lost due to obesity. JAMA 289(2):187–193

    Article  PubMed  Google Scholar 

  35. Chiang CL (1984) Statistical inference regarding life table functions. In: Chiang CL (ed) The life table and its applications. Robert E. Krieger Publishers, Malabar, pp 153–167

    Google Scholar 

  36. Jia H, Zack MM, Thompson WW (2011) State quality-adjusted life expectancy for US adults from 1993 to 2008. Qual Life Res 20(6):853–863

    Article  PubMed  Google Scholar 

  37. Jia H, Zack MM, Thompson WW, Dube SR (2013) Quality-adjusted life expectancy (QALE) loss due to smoking in the United States. Qual Life Res 22(1):27–35

    Article  CAS  PubMed  Google Scholar 

  38. Lee HY, Hwang JS, Jeng JS, Wang JD (2010) Quality-adjusted life expectancy (QALE) and loss of QALE for patients with ischemic stroke and intracerebral hemorrhage: a 13-year follow-up. Stroke 41(4):739–744

    Article  PubMed  Google Scholar 

  39. Chapman DP, Perry GS, Strine TW (2005) The vital link between chronic disease and depressive disorders. Prev Chronic Dis 2(1):A14

    PubMed Central  PubMed  Google Scholar 

  40. Manderscheid R, Druss B, Freeman E (2008) Data to manage the mortality crisis. Intl J Ment Health 37(2):49–68

    Article  Google Scholar 

  41. Colton CW, Manderscheid RW (2006) Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis 3(2):A42

    PubMed Central  PubMed  Google Scholar 

  42. Jia H, Lubetkin EI (2014) Comparing quality-adjusted life expectancy at different levels of physical activity. J Phys Act Health 11(2):278–284

    Article  PubMed  Google Scholar 

  43. Sullivan PW, Lawrence WF, Ghushchyan V (2005) A national catalog of preference-based scores for chronic conditions in the United States. Med Care 43(7):736–749

    Article  PubMed  Google Scholar 

  44. National Association of State Mental Health Program Directors (2006) Morbidity and mortality in people with serious mental illness. Thirteenth in a series of technical reports, Alexandria. http://www.nasmhpd.org/Publications/NASMHPDMedicalDirectorsCouncil.aspx. Accessed 27 July 2014

  45. Zheng D, Macera CA, Croft JB, Giles WH, Davis D, Scott WK (1997) Major depression and all cause mortality among white adults in the United States. Ann Epidemiol 7(3):213–218

    Article  CAS  PubMed  Google Scholar 

  46. Cuijpers P, Smit F (2002) Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 72(3):227–236

    Article  PubMed  Google Scholar 

  47. Cavanagh JT, Carson AJ, Sharpe M, Lawrie SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychol Med 33:395–405

    Article  CAS  PubMed  Google Scholar 

  48. Harris EC, Barraclough B (1997) Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry 170:205–228

    Article  CAS  PubMed  Google Scholar 

  49. Dickey B, Dembling B, Azeni H, Normand SL (2004) Externally caused deaths for adults with substance use and mental disorders. J Behav Health Serv Res 31(1):75–85

    Article  PubMed  Google Scholar 

  50. Hoyert DL, Xu J (2012) Deaths: preliminary data for 2011. National vital statistics reports, vol 61 no 6. National Center for Health Statistics, Hyattsville

  51. Rockett IR, Kapusta ND, Coben JH (2014) Beyond suicide: action needed to improve self-injury mortality accounting. JAMA Psychiatry 71(3):231–232

    Article  PubMed Central  PubMed  Google Scholar 

  52. Rockett IR, Kapusta ND, Bhandari R (2011) Suicide misclassification in an international context: revisitation and update. Suicidol Online 2:48–61

    Google Scholar 

  53. Hays RD, Kim S, Spritzer KL, Kaplan RM, Tally S, Feeny D, Liu H, Fryback DG (2009) Effect of mode and order of administration on generic health-related quality of life scores. Value Health 12:1035–1039

    Article  PubMed Central  PubMed  Google Scholar 

  54. National Research Council and Institute of Medicine (2009) Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Committee on the prevention of mental disorders and substance abuse among children, youth, and young adults: research advances and promising interventions. In: O’Connell ME, Boat T, Warner KE (eds) Board on children, youth, and families, division of behavioral and social sciences and education. National Academies Press, Washington

    Google Scholar 

  55. Institute of Medicine (2009) Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. National Academies Press, Washington

    Google Scholar 

  56. Cicchetti D (2010) Resilience under conditions of extreme stress: a multilevel perspective. World Psychiatry 9(3):145–154

    PubMed Central  PubMed  Google Scholar 

  57. Snowden M, Steinman L, Frederick J (2008) Treating depression in older adults: challenges to implementing the recommendations of an expert panel. Prev Chronic Dis 5(1):A26

    PubMed Central  PubMed  Google Scholar 

  58. Courtet P, Gottesman II, Jollant F, Gould TD (2011) The neuroscience of suicidal behaviors: what can we expect from endophenotype strategies? Transl Psychiatry. doi:10.1038/tp.2011.6

    Google Scholar 

Download references

Acknowledgments

This study (Jia) is supported by a CDC contract (No. 200-2011-M-41977).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Haomiao Jia.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jia, H., Zack, M.M., Thompson, W.W. et al. Impact of depression on quality-adjusted life expectancy (QALE) directly as well as indirectly through suicide. Soc Psychiatry Psychiatr Epidemiol 50, 939–949 (2015). https://doi.org/10.1007/s00127-015-1019-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-015-1019-0

Keywords

Navigation