A new measure of quality of life in depression: Testing the reliability and construct validity of the QLDS

doi:10.1016/0168-8510(92)90005-V

Health Policy

Volume 22, Issue 3, October 1992, Pages 321-330

https://doi.org/10.1016/0168-8510(92)90005-V Get rights and content

Abstract

Our previous paper described the development of a new quality of life scale for use with people suffering from depression; the Quality of Life in Depression Scale (QLDS). This paper reports on the testing of the scale for reliability and construct validity. Reliability was assessed by giving the questionnaire to the same set of patients on two occasions 2 weeks apart. This test-retest technique yielded a correlation of 0.94, with high internal consistency at both time 1 and time 2. A test of split-half reliability also indicated vey high reliability. Construct validity was measured by comparing scores on the QLDS with those on an established scale of well-being from the same group of patients. The results gave a correlation between the two measures of 0.79, giving a satisfactory validity. It is concluded that the QLDS is a reliable and valid measure which is easy to use and acceptable to patients. Further tests of discriminative, concurrent and criterion validity are planned.

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Cited by (74)

Improvement in self-reported quality of life with cognitive therapy for recurrent major depressive disorder
2014, Journal of Affective Disorders
Citation Excerpt :
Quality of life (QoL), a measure of well-being, has gained recent attention in treatment of depression (Bech, 2005; Frisch et al., 2005; Grant et al., 1995; Ishak et al., 2011; Kilnkman, 2009; Papakostas et al., 2004; Frisch, 2009). Quality of life can be assessed using a variety of instruments such as Quality of Life in Depression Scale (Mckenna and Hunt, 1992; Tuynman-Qua et al., 1997), Quality of Well-Being Scale (Kaplan et al., 1998), Quality of Life Enjoyment and Satisfaction Questionnaire (Endicott et al., 1993), Quality of Life Inventory (Frisch et al., 2005) and WHO Quality of Life Assessment Instruments (Skevington et al., 2004; Skevington and Wright, 2001). Here we used the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q; (Endicott et al., 1993), a frequently used QoL measure, that evaluates patients׳ enjoyment and satisfaction with different aspects of their lives through its eight summary scales of physical health, subjective feelings, work, household duties, school/course work, leisure time activities, social relationships and general activities (Endicott et al., 1993).
Major depressive disorder (MDD) is common, often recurrent and/or chronic. Theoretically, assessing quality of life (QoL) in addition to the current practice of assessing depressive symptoms has the potential to offer a more comprehensive evaluation of the effects of treatment interventions and course of illness.
Before and after acute-phase cognitive therapy (CT), 492 patients from Continuation Phase Cognitive Therapy Relapse Prevention trial (Jarrett et al., 2013, Jarrett and Thase, 2010) completed the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Inventory of Depressive Symptomatology Self-report (IDS-SR) and Beck Depression Inventory (BDI); clinicians completed Hamilton Rating Scale for Depression-17-items. Repeated measures analysis of variance evaluated the improvement in QoL before/after CT and measured the effect sizes. Change analyses to assess clinical significance (Hageman and Arrindell, 1999) were conducted.
At the end of acute-phase CT, a repeated measure analysis of variance produced a statistically significant increase in Q-LES-Q scores with effect sizes of 0.48–1.3%; 76.9–91.4% patients reported clinically significant improvement. Yet, only 11–38.2% QoL scores normalized. An analysis of covariance showed that change in depression severity (covariates=IDS-SR, BDI) completely accounted for the improvement in Q-LES-Q scores.
There were only two time points of observation; clinically significant change analyses lacked matched normal controls; and generalizability is constrained by sampling characteristics.
Quality of life improves significantly in patients with recurrent MDD after CT; however, this improvement is completely accounted for by change in depression severity. Normalization of QoL in all patients may require targeted, additional, and/or longer treatment.
Development and validation of the Asthma Life Impact Scale (ALIS)
2010, Respiratory Medicine
Citation Excerpt :
Each transcript was read by 2 experienced researchers independently with patients' comments being highlighted and extracted if they represented expressions of how asthma affected their lives. The needs-based quality of life model16–18 was used as the conceptual framework for the ALIS. This model asserts that QoL is dependent on an individual's ability to fulfill fundamental needs and that QoL is high when these needs are met.
Current asthma patient-reported outcome (PRO) measures focus on symptoms and functioning and may not capture the holistic impact of asthma on the quality of life of the patient.
To develop a PRO measure capturing the overall impact of asthma on patient's quality of life.
Items for the Asthma Life Impact Scale (ALIS) were generated from patients with asthma during interviews in the UK and focus groups in the US. The ALIS was tested with UK and US asthma patients during cognitive debriefing interviews and included in large, two-administration, validation studies in the UK and US.
Issues raised by asthma patients during interviews (n = 39 patients) and focus groups (n = 16 patients) were included in the draft ALIS. Cognitive debriefing interviews with 29 UK and US asthma patients showed that the scale was relevant and comprehensive. 140 UK and 185 US asthma patients participated in the validation study. The analysis showed that the ALIS measures a single construct, namely the overall impact of asthma on patients' quality of life. Internal consistency (Cronbach's Alpha) was high (UK = 0.94; US = 0.92) as was test-retest reliability (UK = 0.93; US = 0.83). Patients reporting worse general health or more severe asthma had significantly higher ALIS scores (p < 0.001) (indicating greater negative impact of asthma). Correlations with the Asthma Quality of Life Questionnaire were moderate to high.
The final 22-item ALIS is unidimensional, reliable and valid, and a valuable tool for comprehensively assessing the holistic impact of asthma from the patient's perspective.
Gender differences in major depressive disorder: Somatic symptoms and quality of life
2009, Revista de Psiquiatria y Salud Mental
Existen pocos hallazgos tan estudiados y comprobados en la literatura como la mayor prevalencia de la depresión en las mujeres. Sin embargo, todavía son muchas las dudas acerca de las características propias y diferenciales de la depresión en la mujer. Se sabe que hay mayor frecuencia de síntomas somáticos en este grupo, pero parece subestimado el impacto que estos síntomas tienen en la calidad de vida de las pacientes. Estos aspectos se han estudiado en una muestra de enfermos depresivos.
Se trata de un estudio epidemiológico de corte transversal no intervencionista. La muestra final es representativa y consta de 1.164 pacientes (629 mujeres y 535 varones) con el diagnóstico de trastorno depresivo mayor (DSM-IV) reclutados en centros de salud mental de España. Se aplican las escalas de Hamilton (HAM-D17), de calidad de vida para la depresión (QLDS) y PHQ-15 para síntomas somáticos. Se analizan las diferencias mediante la prueba de la χ² y ANOVA o test de la t de Student según el caso.
Hay diferencias significativas en los síntomas somáticos de la depresión entre varones y mujeres, más frecuentes en ellas. Se observa una correlación positiva entre estos síntomas y un empeoramiento de la calidad de vida. En cuanto a las diferencias clínicas medidas con la escala de Hamilton, sólo ciertos ítems son significativos, sin que se pueda extraer conclusiones. Estos datos indican diferencias en la depresión según el sexo que se debe replicar y estudiar en otras muestras. Sería interesante asimismo estudiar otros aspectos clínicos o factores de riesgo relacionados.
Few findings in the literature have been as widely studied and consistently verified as the higher prevalence of depression among women. However, doubts remain on the distinguishing features of female depression. The available studies concur in the higher prevalence of somatizations among women and in the possibility that the impact of these symptoms on quality of life could be underestimated. In this study, all these aspects were analyzed in a sample of depressive patients.
We performed an epidemiologic, cross-sectional, non-intervention study. The final sample of 1164 patients with major depressive disorder (DSM-VI) (629 women and 535 men) was recruited in outpatient Mental Health Services in Spain. Assessments were performed using the Hamilton (HAM-D17), the Quality of Life for Depression Scale (QLDS) and the Patient Health Questionnaire 15-Item Somatic Symptom Severity Scale (PHQ-15) to measure somatic symptoms. Differences were analyzed by Chi-square and ANOVA or Student's t-test, depending on the variable.
Somatic symptoms were significantly more prevalent among women. A positive correlation was found between somatic symptoms and worse quality of life. Clinical variables measured by the Hamilton scale showed significant differences in some items but no strong conclusions could be drawn. These results suggest gender differences in depression, which should be replicated in other samples. Other risk or clinical factors could also be included.
Evaluation of the psychometric properties of the Hungarian quality of life in depression scale
2008, European Psychiatry
Citation Excerpt :
The quality of life in depression scale (QLDS) was designed to assess the impact of depression on the quality of life (QoL) of patients. It is a self-report questionnaire developed in parallel in the UK and The Netherlands employing the ‘needs-based model’ of QoL [4,6]. In recent years conceptually equivalent versions of the instrument have been developed for several languages [7,2,1].
The paper describes the adaptation and psychometric evaluation of the Hungarian version of the quality of life in depression scale. The adaptation procedure involved: bilingual translation; field-testing for face and content validity; and assessment of instrument's reliability and construct validity. The new language version was shown to be well-accepted by respondents and to have excellent psychometric properties.
A randomized, double-blind, placebo-controlled trial of duloxetine in the treatment of women with fibromyalgia with or without major depressive disorder
2005, Pain
This was a 12-week, randomized, double-blind, placebo-controlled trial to assess the efficacy and safety of duloxetine, a selective serotonin and norepinephrine reuptake inhibitor, in 354 female patients with primary fibromyalgia, with or without current major depressive disorder. Patients (90% Caucasian; mean age, 49.6 years; 26% with current major depressive disorder) received duloxetine 60 mg once daily (QD) (N=118), duloxetine 60 mg twice daily (BID) (N=116), or placebo (N=120). The primary outcome was the Brief Pain Inventory average pain severity score. Response to treatment was defined as ≥30% reduction in this score. Compared with placebo, both duloxetine-treated groups improved significantly more (P<0.001) on the Brief Pain Inventory average pain severity score. A significantly higher percentage of duloxetine-treated patients had a decrease of ≥30% in this score (duloxetine 60 mg QD (55%; P<0.001); duloxetine 60 mg BID (54%; P=0.002); placebo (33%)). The treatment effect of duloxetine on pain reduction was independent of the effect on mood and the presence of major depressive disorder. Compared with patients on placebo, patients treated with duloxetine 60 mg QD or duloxetine 60 mg BID had significantly greater improvement in remaining Brief Pain Inventory pain severity and interference scores, Fibromyalgia Impact Questionnaire, Clinical Global Impression of Severity, Patient Global Impression of Improvement, and several quality-of-life measures. Both doses of duloxetine were safely administered and well tolerated. In conclusion, both duloxetine 60 mg QD and duloxetine 60 mg BID were effective and safe in the treatment of fibromyalgia in female patients with or without major depressive disorder.
OAKHQOL: A new instrument to measure quality of life in knee and hip osteoarthritis
2005, Journal of Clinical Epidemiology
Citation Excerpt :
The concept of the OAKHQOL is based on the WHO definition of QoL. Content analysis of the tape-recorded transcripts elucidated different facets of the functionalist approach to QoL and of the needs-based model [38–42] and confirmed that patients expressed the impact of disease in terms of the needs they were unable to meet. When comparing the OAKHQOL to the SF36, many themes were exclusive to the OAKHQOL (e.g.: social support, sleep, side effects of drugs, plan for the future, the embarrassment to be seen by people, the use of public transportation, the difficulty to move after staying in the same position, and sexuality).
To develop a questionnaire with which to measure quality of life (QoL) in patients with knee and hip osteoarthritis (OA).
Thirty-two caregivers and 96 OA patients were interviewed individually (using cognitive and face-to-face techniques) and in focus groups. A group of experts working independently at first and then consensually used the interview transcripts to generate a 46-item questionnaire.
Analysis of questionnaires completed by 263 patients with hip or knee OA resulted in the exclusion of three items (two because of low reliability and one because of a low response rate). Principal component analysis revealed four factors: physical activity, mental health, social functioning, and social support. A pain dimension was individualized. Preliminary testing showed the reliability of the five dimensions to be satisfactory (intraclass correlation coefficients: 0.70–0.85), construct validity was adequate when correlated with the SF36 (Spearman correlation coefficients: 0.43–0.75), and discrimination was satisfactory. The osteoarthritis knee and hip quality of life questionnaire (OAKHQOL) consists of 43 items in five dimensions and three independent items.
The OAKHQOL is the first specific knee and hip OA quality of life instrument. Its development followed an a priori structured strategy to ensure content validity. It meets psychometric requirements for validity and reliability.

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ReviewA new measure of quality of life in depression: Testing the reliability and construct validity of the QLDS

Abstract

The QLDS: A scale for the measurement of quality of life in depression

Health Policy

Principles of Psychological Measurement

Depth of depression

Archives of General Psychiatry

A self-rating depression scale

Archives of General Psychiatry

The Detection of Psychiatric Illness by Questionnaire

Rating scales

British Journal of Psychiatry

Standardised assessment and recording of depressive symptoms

Psychiatrica Neurologia Neurochirugia

A new depression scale designed to be sensitive to change

British Journal of Psychiatry

Review
A new measure of quality of life in depression: Testing the reliability and construct validity of the QLDS