The association between different domains of quality of life and symptoms in primary care patients with emotional disorders

www.nature.com/scientificreports OPEN Received: 12 April 2018 Accepted: 22 June 2018 Published: xx xx xxxx The association between different domains of quality of life and symptoms in primary care patients with emotional disorders César González-Blanch1,2, Fernando Hernández-de-Hita1, Roger Muñoz-Navarro Paloma Ruíz-Rodríguez4, Leonardo Adrián Medrano5 & Antonio Cano-Vindel 6 3 , Despite the importance of quality of life (QoL) in primary care patients with emotional disorders, the specific influence of the symptoms of these disorders and the sociodemographic characteristics of patients on the various QoL domains has received scant attention. The aim of the present study of primary care patients with emotional disorders was to analyse the associations between four different QoL domains and the most prevalent clinical symptoms (i.e., depression, anxiety and somatization), while controlling for sociodemographic variables. A total of 1241 participants from 28 primary care centres in Spain were assessed with the following instruments: the Patient Health Questionnaire (PHQ)-9 to evaluate depression; the Generalized Anxiety Disorder Scale (GAD)-7 for anxiety; PHQ-15 for somatization; and the World Health Organization Quality of Life Instrument-Short Form (WHOQOLBref) to assess four broad QoL domains: physical health, psychological health, social relationships, and environment. The associations between the symptoms and QoL domains were examined using hierarchical regression analyses. Adjusted QoL mean values as a function of the number of overlapping diagnoses were calculated. The contribution of sociodemographic variables to most QoL domains was modest, explaining anywhere from 2% to 11% of the variance. However, adding the clinical variables increased the variance explained by 12% to 40% depending on the specific QoL domain. Depression was the strongest predictor for all domains. The number of overlapping diagnoses adversely affected all QoL domains, with each additional diagnosis reducing the main QoL subscales by 5 to 10 points. In primary care patients with a diagnostic impression of an emotional disorders as identified by their treating GP, clinical symptoms explained more of the variance in QoL than sociodemographic factors such as age, sex, level of education, marital status, work status, and income. Given the strong relationship between depressive symptoms and QoL, treatment of depression may constitute a key therapeutic target to improve QoL in people with emotional disorders in primary care. The WHO defines quality of life (QoL) as an individual’s perception of their position in life embedded in a cultural, social, and environmental context1. The concept of QoL is broad and is composed of numerous domains, including the physical, psychological, social, family and environmental domains. Evaluation of these domains can reveal the overall impact of illness on a patient’s life. Importantly, QoL has been shown to contribute more to an individual’s perception of their wellbeing, health, and life satisfaction than objective measures of life conditions2. In the last three decades, there has been an exponential rise in the number of studies performed to investigate QoL in nearly all areas of medicine3. This growing interest has been especially notable in the fields of psychiatry and psychology to assess the role of QoL in mental disorders. Studies have been conducted to assess the impact of QoL in schizophrenia4,5, depression6 and anxiety disorders7, for general health8 and to determine the role of QoL 1 Mental Health Centre, University Hospital “Marqués de Valdecilla”- IDIVAL, Santander, Spain. 2Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain. 3Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain. 4Castilla La Nueva Primary Care Centre, Health Service of Madrid, Madrid, Spain. 5Faculty of Psychology, University Siglo 21, Córdoba, Argentina. 6Department of Basic Psychology, Faculty of Psychology, University Complutense of Madrid, Madrid, Spain. Correspondence and requests for materials should be addressed to C.G.-B. (email: ) SCIENtIFIC RePorts | (2018) 8:11180 | DOI:10.1038/s41598-018-28995-6 1 www.nature.com/scientificreports/ for mental health services recommendations9. In parallel, mental health services have shifted away from focusing on symptom reduction towards a more holistic approach encompassing other factors such as wellbeing and functioning. This shift has occurred largely due to the publication of studies on the impact of mental disorders in QoL. For example, QoL has shown to be a better predictor of sustained remission than symptom resolution in depression, leading some authors to suggest that QoL should be the ultimate goal of treatment in these patients10. Studies have shown that QoL is associated with the psychopathology severity11, and QoL is known to worsen as a function of the number of comorbid mental disorders12,13. Common mental disorders in primary care such as mood, anxiety, and somatoform disorders are associated with a greater decline in QoL than medical disorders such as diabetes or heart disease14–16. Previous studies have described the relationship between various QoL domains and a range of sociodemographic factors, including age, gender, occupation, income, marital status, and educational level17–22. However, most of those studies were conducted in elderly populations or in patients with severe medical conditions such as cancer, rheumatological diseases, or kidney conditions. Moreover, those studies have reported conflicting results, probably due to the heterogeneity of the populations assessed. Although QoL correlates closely with severe mental illness, particularly schizophrenia23–26, in people with common mental disorders, the impact of symptoms or sociodemographic characteristics on QoL is not well-understood. In order to promote the health and wellbeing of patients with common mental disorders, it is crucial to understand how the various sociodemographic factors and specific symptoms effect the various QoL domains. For example, it would be highly beneficial to known whether specific clinical symptoms have a unique contribution— beyond the influence of sociodemographic variables—to specific QoL domains, as such information could have far-reaching clinical implications with regard to assessment and treatment of common mental disorders in primary care. Indeed, this would provide a compelling reason to ensure that primary care services should be modified so as to greatly augment the provision of the effective treatments, according to clinical guidelines, as soon as possible. Emotional disorders —which in this study include depressive, anxiety, and somatoform disorders— are highly prevalent in primary care patients. Although the prevalence of emotional disorders can vary substantially between studies even when the same diagnostic instrument is used, one of the (...truncated)