Improvements in Health-Related Quality of Life With Electroconvulsive Therapy: A Meta-analysis.

INTRODUCTION: Although the antidepressant efficacy of ECT is well documented, patient-reported outcomes after this treatment are less well characterized. The aims of the current meta-analysis are to quantify the impact of an acute course of ECT on health-related quality of life (HRQoL) and to identify related moderators, specifically post-ECT depressive symptom remission and patient age. METHODS: We searched PubMed, PsycINFO, and Web of Science databases for randomized and nonrandomized studies that report on changes in HRQoL measures after an acute course of ECT. Only studies that used the Medical Outcomes Study Short Form 36 (SF-36) instrument were included. A random effects model using the Hedges' g effect size was used in calculating the pre-post ECT outcomes on all 8 SF-36 subscales and the SF-36 total scores including the physical and mental composite scores. Subgroup analyses were conducted using remission status and age as moderators. RESULTS: Four studies contributed to this analysis. Significant improvements across all subscales of the SF-36 were observed. Large and very large effect sizes were present for both the SF-36 physical component score (PCS) and mental health component score (MCS), with the change in MCS being statistically superior to the PCS (MCS, Hedges' g = 1.28; 95% confidence interval, 1.15-1.42; PCS, Hedges' g = 0.97; 95% confidence interval, 0.86-1.07). Medium, large, and very large effect sizes were observed for SF-36 subscales scores. Post-ECT depression remission status was related to HRQoL improvement, with statistically significant differences present between remitters and nonremitters for PCS, MCS, and most SF-36 subscale scores. No significant differences were observed in improvement in HRQoL with ECT based on patient age. CONCLUSIONS: An acute course of ECT for depressive symptoms produces medium to very large effect size improvements in HRQoL across multiple components and subscales measured by the SF-36. The magnitude of the effects reported by ECT patients is greater than those that have been reported in other open-label studies of brain stimulation techniques. This study confirms that ECT plays a vital role in the treatment of the most severely ill patients with depressive disorders.

Reductions in quality of life associated with common mental disorders: results from a nationally representative sample.

OBJECTIVE: Traditional burden-of-disease estimates often exclude personality disorders, which are associated with significant mortality and morbidity. The aim of this study was to estimate the health-related quality of life (HRQoL) and annual population-level quality-adjusted life-year (QALY) losses associated with different mental and physical health conditions. In particular, it sought to quantify the impact of personality disorders on quality of life, at an individual and population level. METHOD: This was a secondary analysis of data from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of the US general population collected from 2001 to 2005 (N = 34,653). Health-related quality of life (measured using the Short-Form Health Survey-6D) was the main outcome of interest. Regression analysis assessed the impact of various mental (based on DSM-IV criteria) and physical health conditions on HRQoL scores, and this impact was combined with the prevalence of disorders to estimate the population-level burden of disease. RESULTS: Mood disorders were associated with the highest decrease in HRQoL scores, followed by strokes, psychotic illness, and arthritis (P < .01). The greatest annual population QALY losses were caused by arthritis, mood disorders, and personality disorders. CONCLUSIONS: Quality-adjusted life year losses associated with personality disorders ranked behind only mood disorders and arthritis. Personality disorders were associated with significant reductions in quality of life, despite the fact that they are often excluded from traditional burden of disease estimates.

Quality of life in older patients with chronic obstructive pulmonary disease (COPD) in Hong Kong: a case-control study.

PURPOSE: To date, there have been few studies examining quality of life (QOL) in older patients with chronic obstructive pulmonary disease (COPD) in China. The aim of the study was to assess QOL in Chinese older patients with COPD and explore its demographic and clinical correlates. DESIGN AND METHODS: Case-control study of 142 outpatients with COPD and 218 matched control subjects without COPD. COPD patients were recruited from a prospective study sample hospitalized in Hong Kong for acute COPD exacerbation (≥ 2 major COPD symptoms or > 1 major + minor COPD symptoms for ≥ 2 consecutive days). Controls were recruited from social centers in Hong Kong. Activity of daily living was assessed with the Instrumental Activities of Daily Living Scale (IADL), life events were evaluated with the Life Event Scale, depressive disorders were diagnosed using the Geriatric Depression Scale (GDS), and QOL was measured using the Medical Outcomes Study Short Form-12 (SF-12) and St. George's Respiratory Questionnaire (SGRQ). FINDINGS: Compared to controls, patients had significantly lower scores in the physical (PCS score), but not in the mental (MCS score) QOL domain. Multivariate analyses showed that more hospitalizations in the past year significantly contributed to higher PCS score (p = .03), while higher GDS total score contributed to lower MCS score (p = .003). Severe and very severe COPD, more physical illnesses, and higher IADL total score each independently contributed to higher SGRQ total score, explaining 40.0% of the variance (p < .001). PRACTICE IMPLICATIONS: Our results suggest that therapeutic and psychosocial interventions alleviating depressive symptoms, severe COPD, comorbidities, and improving IADL in Chinese patients with COPD are likely of considerable benefit for improving QOL in patients with COPD.