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Complex coevolution of depression and health-related quality of life in old age

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Abstract

Purpose

To investigate the coevolution of depression and health-related quality of life (HRQoL) in old age.

Methods

In a representative survey of the German general population aged 75 years and older, the course of HRQoL and depression was observed over 4.5 years (3 waves). HRQoL was assessed by the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, while the Geriatric Depression Scale was used to measure depression. A panel vector autoregressive model was used to account for the complex coevolution of depression and HRQoL. Unobserved heterogeneity was taken into account by taking the first differences.

Results

We revealed a robust negative association between an initial change in HRQoL and a subsequent change in depression score, with substantial sex differences: In women there was a robust association, while in men the significance of this association depended on the model specification. Surprisingly, in the total sample and in both sexes, no robust association between an initial increase in depression and a subsequent change in HRQoL was found.

Conclusion

Findings indicate that the direction of evolution from HRQoL to depression deserves more attention. Furthermore, treatment of depression in late life should aim at improving HRQoL in which remission of depressive symptoms is necessary but not sufficient.

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Notes

  1. In contrast to exogenous variables, endogenous variables are related to the error term.

  2. First differences were generated by the Time series operator “D.” in Stata 13.1.

  3. However, Allison [63] recently proposed structural equation models with fixed effects. This might be a fruitful approach in future research.

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Acknowledgments

The authors thank three anonymous reviewers who provided insightful comments to strengthen the manuscript. This publication is part of the German Research Network on Dementia (KND), the German Research Network on Degenerative Dementia (KNDD) and the Study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) and was funded by the German Federal Ministry of Education and Research (Grants KND 01GI0102, 01GI0420, 01GI0422, 01GI0423, 01GI0429, 01GI0431, 01GI0433 and 01GI0434; Grants KNDD 01GI0710, 01GI0711, 01GI0712, 01GI0713, 01GI0714, 01GI0715, 01GI0716 and 01ET1006B; and Grants AgeQualiDe 01GY1322A, 01GY1322B, 01GY1322C, 01GY1322D, 01GY1322E, 01GY1322F, 01GY1322G).

Conflict of interest

The authors declare that they have no conflict of interest.

Members of the AgeCoDe Study Group

Principal Investigators*: Wolfgang Maier, Martin Scherer. Heinz-Harald Abholz, Cadja Bachmann, Horst Bickel, Wolfgang Blank, Hendrik van den Bussche, Sandra Eifflaender-Gorfer, Marion Eisele, Annette Ernst, Angela Fuchs, Kathrin Heser, Frank Jessen, Hanna Kaduszkiewicz, Teresa Kaufeler, Mirjam Köhler, Hans-Helmut König, Alexander Koppara, Carolin Lange, Hanna Leicht, Tobias Luck, Melanie Luppa, Manfred Mayer, Edelgard Mösch, Julia Olbrich, Michael Pentzek, Jana Prokein, Anna Schumacher, Steffi Riedel-Heller, Janine Stein, Susanne Steinmann, Franziska Tebarth, Michael Wagner, Klaus Weckbecker, Dagmar Weeg, Jochen Werle, Siegfried Weyerer, Birgitt Wiese, Steffen Wolfsgruber, Thomas Zimmermann. *Hendrik van den Bussche (2002–2011). We want to thank both all participating patients and their general practitioners for their good collaboration.

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    Authors and Affiliations

    1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

      André Hajek, Christian Brettschneider & Hans-Helmut König

    2. Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

      Annette Ernst, Carolin Lange & Martin Scherer

    3. Institute of General Practice, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

      Birgitt Wiese & Jana Prokein

    4. Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany

      Siegfried Weyerer & Jochen Werle

    5. Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

      Michael Pentzek & Angela Fuchs

    6. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany

      Janine Stein & Steffi G. Riedel-Heller

    7. Department of Psychiatry, Technical University of Munich, Arcisstr. 21, 80333, Munich, Germany

      Horst Bickel & Edelgard Mösch

    8. Department of Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany

      Kathrin Heser & Wolfgang Maier

    9. Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany

      Frank Jessen

    10. German Center for Neurodegenerative Diseases, Ludwig-Erhard-Allee 2, 53175, Bonn, Germany

      Frank Jessen & Wolfgang Maier

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    Correspondence to André Hajek.

    Additional information

    For the AgeCoDe Study Group.

    Steffi G. Riedel-Heller and Hans-Helmut König have contributed equally to this work.

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    Hajek, A., Brettschneider, C., Ernst, A. et al. Complex coevolution of depression and health-related quality of life in old age. Qual Life Res 24, 2713–2722 (2015). https://doi.org/10.1007/s11136-015-1005-8

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