How do depressed patients evaluate their quality of life? A qualitative study

Abstract

Background: This is a qualitative study that aims to investigate the effect of depressive status on responses to items on the WHO quality of life assessment instrument (WHOQOL-Bref), comparing which aspects of the individual’s life he or she takes into account in responding to the items related to quality of life when depressed and when euthymic. Results: Six adult women were interviewed prior to initiating treatment for a depressive episode and were then interviewed again six months later when in remission from the episode. The ‘think aloud’ method of cognitive interviewing was used. Based on the Wilcoxon test, the seven items that exhibited a significant change with the improvement of the depressive condition were examined in depth, and the think aloud method was used to reveal the subjects’ cognitive processes. Depressive symptoms were associated with different interpretations of some items and the response scale. Also, for some items, patients chose the same response for the item both times but justified their choice differently during the depressive episode and in euthymia. Conclusions: We found that, in addition to the impact caused by depression on quality of life, there are peculiarities in the way the depressed individual makes subjective assessments. We believe that qualitative studies such as the present one may provide important support in the interpretation of quantitative results.