title: Importance of remission and residual somatic symptoms in health-related quality of life among outpatients with major depressive disorder: a cross-sectional study.
abstract: BACKGROUND
  Major depressive disorder (MDD) is strongly associated with an impaired quality of life (QoL), which is itself affected by various factors. Symptom-oriented ratings poorly reflect the impact of disease on the QoL and level of functioning of the mental health of subjects. The purpose of this study was to assess health-related QoL (HRQoL) using preference-based measures in outpatients with MDD with regard to their remission achievement and clinical factors affecting the HRQoL.
  
  
  METHODS
  This was a cross-sectional observational study. We recruited 811 patients with MDD from 14 psychiatric outpatient clinics in Korea. They were divided into three groups as follows: a new visit group (n = 287), a remitted group (n = 235), and a non-remitted group (n = 289). The 17-item Hamilton Depression Rating Scale was used to assign patients to the remitted or non-remitted group. The general HRQoL was assessed with the EuroQol 5D (EQ-5D), using both the EQ-5D index score and the EuroQol Visual Analog Scale (EQ-VAS). The disease-specific HRQoL was assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF).
  
  
  RESULTS
  The non-remitted group showed a significant impairment of HRQoL in view of the subscales of EQ-5D index scores, EQ-VAS, and Q-LES-Q-SF. The EQ-5D index score in the remitted group was 0.77 ± 0.10, while it was 0.57 ± 0.23 in the non-remitted group and 0.58 ± 0.24 in the new visit group (p < 0.0001). The EQ-VAS scores for the remitted and non-remitted groups were 72.5 ± 16.6 and 50.9 ± 20.3, respectively (p < 0.0001). Likewise, patients with remission had the Q-LES-Q-SF total score of 46.5 ± 8.8, whereas those with non-remission reported 36.7 ± 7.7 (p < 0.0001). The symptom severity measured by the Depression and Somatic Symptoms Scale was significantly correlated with the HRQoL. Furthermore, patients with severe somatic symptoms showed a significantly lower EQ-5D index score (0.54 ± 0.24) than those with mild/moderate somatic symptoms (0.75 ± 0.12; p = 0.002).
  
  
  CONCLUSIONS
  Non-remitted MDD patients, especially those with more severe somatic symptoms, show a distinct impairment of HRQoL and more clinical symptoms, suggesting the importance of achieving remission in the treatment of MDD.
authors.affiliation: Department of Psychiatry, Seoul Paik Hospital, Inje University School of Medicine, Seoul, Korea. jongmin.woo@gmail.com.|Stress Research Institute, Inje University, Seoul, Korea. jongmin.woo@gmail.com.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Woo
authors.affiliation: Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jhj.jeon@samsung.com.|Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA. jhj.jeon@samsung.com.
authors.forename: Hong Jin
authors.initials: HJ
authors.lastname: Jeon
authors.affiliation: Veterans Affairs Medical Center, Providence, Rhode Island, USA. eunsun_noh@my.uri.edu.|Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA. eunsun_noh@my.uri.edu.
authors.forename: Eunsun
authors.initials: E
authors.lastname: Noh
authors.affiliation: OR/RWD Team, Health and Value Division, Pfizer Pharmaceuticals Korea Limited, Seoul, Korea. hyo-jin.kim2@pfizer.com.
authors.forename: Hyo-Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Chungnam National University School of Medicine, Chungnam, Korea. leesw@cnu.ac.kr.
authors.forename: Sun Woo
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Dankook University School of Medicine, Cheonan, Korea. kykylee@chol.com.
authors.forename: Kyung Kyu
authors.initials: KK
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Dong-A University School of Medicine, Busan, Korea. zapcho@yahoo.co.kr.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, Asan Medical Center, Ulsan University College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, South Korea. jphong@amc.seoul.kr.
authors.forename: Jin Pyo
authors.initials: JP
authors.lastname: Hong
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000523:psychology*; D005221:Fatigue / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D010146:Pain / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D056910:Republic of Korea; D011795:Surveys and Questionnaires