Health-Related Quality of Life of Outpatients with Depression Treated with Antidepressants at King Chulalongkorn Memorial Hospital

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Jirada Prasartpornsirichoke
Nuttorn Pityaratstian
Naphat Sirinimnualkul
Chayanit Poolvoralaks
Tanaporn Ormtavesub
Sasitorn Phonsit
Nimmavadee Hiranwattana
Teerayuth Rungnirundorn


Objective: To explore health-related quality of life (HRQoL) among outpatients with depression treated with antidepressants who visited King Chulalongkorn Memorial Hospital during March-July 2022 and to investigate the difference in health-related quality of life between patients with treatment-resistant depression and patients with treatment-response depression.

Methods: This descriptive study included a cross-sectional survey of 500 depressed patients using the Thai-language short-form 36 health-related quality of life questionnaire and a retrospective review of patient medical records to evaluate if patients responded to depression treatment. The distinction between the two categories of depressed patient's quality of life was examined using an independent T-test.

Results: The health-related quality of life of treatment-resistant depressive patients was significantly worse than that of treatment-response depressive patients in dimensions of role limitations due to physical health (mean difference = -13.581, P<0.001, Cohen’s d = -0.380), general health (mean difference = -7.070, P = 0.003, Cohen’s d = -0.332), role limitations due to emotional problems (mean difference = -14.358, P<0.001, Cohen’s d = -0.432), vitality (mean difference = -13.479, P<0.001, Cohen’s d = -0.858), social functioning (mean difference = -20.514, P<0.001, Cohen’s d = -0.801), and mental health (mean difference = -13.855, P < 0.001, Cohen’s d = -0.907).

Conclusion: This study confirmed that the health-related quality of life of treatment-resistant depressive patients was statistically significantly worse than that of treatment-response depressed patients in almost every aspect. Understanding treatment-resistant depression can have a positive impact on long-term quality of life for depressed patients.


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Prasartpornsirichoke, J., Pityaratstian, N., Sirinimnualkul, N., Poolvoralaks, C. ., Ormtavesub, T., Phonsit, S., Hiranwattana, N. ., & Rungnirundorn, T. (2023). Health-Related Quality of Life of Outpatients with Depression Treated with Antidepressants at King Chulalongkorn Memorial Hospital. Journal of the Psychiatric Association of Thailand, 68(3), 254–264. Retrieved from
Original Articles


Lotrakul M, Sukanich P. Ramathibodi essential psychiatry. 4th ed. Bangkok: Department of Psychiatry Faculty of Medicine Ramathibodi Hospital; 2015.

World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: World Health Organization; 2017.

Sooksompong S, Kwansanit P, Supanya S, Chutha W, Kittirattanapaiboon P, Udomittipong D, et al. The Thai national mental health survey 2013: prevalence of mental disorders in megacities: Bangkok. J Psychiatr Assoc Thailand 2016;61:75-88.

Kongsuk T, Supanya S, Kenbubpha K, Phimtra S, Sukhawaha S, Leejongpermpoon J. Services for depression and suicide in Thailand. WHO South East Asia J Public Health 2017;6:34-8.

Cramer AO, van Borkulo CD, Giltay EJ, van der Maas HL, Kendler KS, Scheffer M, et al. Major depression as a complex dynamic system. PLoS One 2016;11:e0167490.

World Health Organization. WHO methods and data sources for global burden of disease estimates 2000-2019. Geneva: World Health Organization; 2020.

Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med 2003;163:2433-45.

Tiller JW. Depression and anxiety. Med J Aust 2013;199: S28-S31.

Bennett S, Thomas AJ. Depression and dementia: cause, consequence or coincidence? Maturitas 2014;79:184-90.

Ribeiro JD, Huang X, Fox KR, Franklin JC. Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies. Br J Psychiatry 2018;212:279-86.

Azeem R, Zubair UB, Jalil A, Kamal A, Nizami A, Minhas F. Prevalence of suicide ideation and its relationship with depression among transgender population. J Coll Physicians Surg Pak 2019;29:349-52.

Gill SK, Muñoz RF, Leykin Y. The influence of perceived stress and depression on suicide-related beliefs in Caucasian and Indian adults. Crisis 2018;39:127-136.

Marver JE, Galfalvy HC, Burke AK, Sublette ME, Oquendo MA, Mann JJ, et al. Friendship, depression, and suicide attempts in adults: exploratory analysis of a longitudinal follow-up study. Suicide Life Threat Behav 2017;47:660-71.

Simon GE, Barber C, Birnbaum HG, Frank RG, Greenberg PE, Rose RM, et al. Depression and work productivity: the comparative costs of treatment versus nontreatment. J Occup Environ Med 2001;43:2-9.

Lerner D, Henke RM. What does research tell us about depression, job performance, and work productivity? J Occup Environ Med 2008;50:401-10.

Beck A, Crain LA, Solberg LI, Unützer J, Maciosek MV, Whitebird RR, et al. The effect of depression treatment on work productivity. Am J Manag Care 2014;20:e294-301.

Rost KM, Meng H, Xu S. Work productivity loss from depression: evidence from an employer survey. BMC Health Serv Res 2014;14:597.

König H, König HH, Konnopka A. The excess costs of depression: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2019;29:1-16.

Asami Y, Goren A, Okumura Y. Work productivity loss with depression, diagnosed and undiagnosed, among workers in an internet-based survey conducted in Japan. J Occup Environ Med 2015;57:105-10.

Zomer E, Rhee Y, Liew D, Ademi Z. The health and productivity burden of depression in South Korea. Appl Health Econ Health Policy 2021;19:941-51.

Hysenbegasi A, Hass SL, Rowland CR. The impact of depression on the academic productivity of university students. J Ment Health Policy Econ 2005;8:145-51.

Clark M, DiBenedetti D, Perez V. Cognitive dysfunction and work productivity in major depressive disorder. Expert Rev Pharmacoecon Outcomes Res 2016;16:455-63.

Jain G, Roy A, Harikrishnan V, Yu S, Dabbous O, Lawrence C. Patient-reported depression severity measured by the PHQ-9 and impact on work productivity: results from a survey of full-time employees in the United States. J Occup Environ Med 2013;55:252-8

Fröjd SA, Nissinen ES, Pelkonen MU, Marttunen MJ, Koivisto AM, Kaltiala-Heino R. Depression and school performance in middle adolescent boys and girls. J Adolesc 2008;31:485-98.

Tran BX, Ha GH, Nguyen DN, Nguyen TP, Do HT, Latkin CA, et al. Global mapping of interventions to improve quality of life of patients with depression during 1990-2018. Qual Life Res 2020;29:2333-43.

Mittal D, Fortney JC, Pyne JM, Edlund MJ, Wetherell JL. Impact of comorbid anxiety disorders on health-related quality of life among patients with major depressive disorder. Psychiatr Serv 2006;57:1731-7.

Gao K, Su M, Sweet J, Calabrese JR. Correlation between depression/anxiety symptom severity and quality of life in patients with major depressive disorder or bipolar disorder. J Affect Disord 2019;244:9-15.

Han K, Yang S, Jia W, Wang S, Song Y, Cao W, et al. Health-related quality of life and its correlation with depression among Chinese centenarians. Front Public Health 2020;8:1-8.

Engel L, Chen G, Richardson J, Mihalopoulos C. The impact of depression on health-related quality of life and wellbeing: identifying important dimensions and assessing their inclusion in multi-attribute utility instruments. Qual Life Res 2018;27:2873-84.

Daly EJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Gaynes BN, Warden D, et al. Health-related quality of life in depression: a STAR*D report. Ann Clin Psychiatry 2010;22:43-55.

Chan SW, Chiu HF, Chien WT, Thompson DR, Lam L. Quality of life in Chinese elderly people with depression. Int J Geriatr Psychiatry 2006;21:312-8.

Faller H, Störk S, Schuler M, Schowalter M, Steinbüchel T, Ertl G, et al. Depression and disease severity as predictors of health-related quality of life in patients with chronic heart failure-a structural equation modeling approach. J Card Fail 2009; 15:286-92.

Goodman SH, Gotlib IH. Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 1999;106:458-90.

Choi KW, Houts R, Arseneault L, Pariante C, Sikkema KJ, Moffitt TE. Maternal depression in the intergenerational transmission of childhood maltreatment and its sequelae: testing postpartum effects in a longitudinal birth cohort. Dev Psychopathol 2019;31:143-56.

Sohr-Preston SL, Scaramella LV. Implications of timing of maternal depressive symptoms for early cognitive and language development. Clin Child Fam Psychol Rev 2006;9:65-83.

Russotti J, Swerbenski H, Handley ED, Michl-Petzing LC, Cicchetti D, Toth SL. Intergenerational effects of maternal depression and co-occurring antisocial behaviors: the mediating role of parenting-related processes. J Fam Psychol 2023;37:408-19.

Ethridge P, Freeman C, Sandre A, Banica I, Dirks MA, Weinberg A. Intergenerational transmission of depression risk: mothers' neural response to reward and history of depression are associated with daughters' neural response to reward across adolescence. J Psychopathol Clin Sci 2022;131:598-610.

Pilowsky DJ, Wickramaratne PJ, Rush AJ, Hughes CW, Garber J, Malloy E, et al. Children of currently depressed mothers: a STAR*D ancillary study. J Clin Psychiatry 2006;67:126-36.

Goodman SH. Depression in mothers. Annu Rev Clin Psychol 2007; 3:107-35.

Evans J, Melotti R, Heron J, Ramchandani P, Wiles N, Murray L, et al. The timing of maternal depressive symptoms and child cognitive development: a longitudinal study. J Child Psychol Psychiatry 2012; 53:632-40.

Fife D, Feng Y, Wang MY, Chang CJ, Liu CY, Juang HT, et al. Epidemiology of pharmaceutically treated depression and treatment resistant depression in Taiwan. Psychiatry Res 2017;252:277-83.

Ng CH, Kato T, Han C, Wang G, Trivedi M, Ramesh V, et al. Definition of treatment-resistant depression - Asia Pacific perspectives. J Affect Disord 2019;245:626-36.

Kubitz N, Mehra M, Potluri RC, Garg N, Cossrow N. Characterization of treatment resistant depression episodes in a cohort of patients from a US commercial claims database. PLoS One 2013;8: e76882.

Kim N, Cho SJ, Kim H, Kim SH, Lee HJ, Park CHK, et al. Epidemiology of pharmaceutically treated depression and treatment resistant depression in South Korea. PLoS One 2019;14:e0221552.

Amos TB, Tandon N, Lefebvre P, Pilon D, Kamstra RL, Pivneva I, et al. Direct and indirect cost burden and change of employment status in treatment-resistant depression: a matched-cohort study using a US commercial claims database. J Clin Psychiatry 2018;79:17m11725.

Gibson TB, Jing Y, Smith Carls G, Kim E, Bagalman JE, Burton WN, et al. Cost burden of treatment resistance in patients with depression. Am J Manag Care 2010;16:370-7.

Ivanova JI, Birnbaum HG, Kidolezi Y, Subramanian G, Khan SA, Stensland MD. Direct and indirect costs of employees with treatment-resistant and non-treatment-resistant major depressive disorder. Curr Med Res Opin 2010;26:2475-84.

Mrazek DA, Hornberger JC, Altar CA, Degtiar I. A review of the clinical, economic, and societal burden of treatment-resistant depression: 1996-2013. Psychiatr Serv 2014;65:977-87.

Rathod S, Denee T, Eva J, Kerr C, Jacobsen N, Desai M, et al. Health-related quality of life burden associated with treatment-resistant depression in UK patients: quantitative results from a mixed-methods non-interventional study. J Affect Disord 2022;300:551-62.

Corral R, Alessandria H, Agudelo Baena LM, Ferro E, Duque X, Quarantini L, et al. Suicidality and quality of life in treatment-resistant depression patients in Latin America: secondary interim analysis of the TRAL study. Front Psychiatry 2022;13: 812938.

Johnston KM, Powell LC, Anderson IM, Szabo S, Cline S. The burden of treatment-resistant depression: a systematic review of the economic and quality of life literature. J Affect Disord 2019;242:195-210.

Jaffe DH, Rive B, Denee TR. The humanistic and economic burden of treatment-resistant depression in Europe: a cross-sectional study. BMC Psychiatry 2019;19: 247.

Qiao J, Qian LJ, Zhao HF, Gong GH, Geng DQ. The relationship between quality of life and clinical phenotype in patients with treatment resistant and non-treatment resistant depression. Eur Rev Med Pharmacol Sci 2017;21:2432-6.

Woo JM, Jeon HJ, Noh E, Kim HJ, Lee SW, Lee KK, et al. Importance of remission and residual somatic symptoms in health-related quality of life among outpatients with major depressive disorder: a cross-sectional study. Health Qual Life Outcomes 2014;12: 188.

Cao Y, Li W, Shen J, Malison RT, Zhang Y, Luo X. Health-related quality of life and symptom severity in Chinese patients with major depressive disorder. Asia Pac Psychiatry 2013;5:276-83.

Dennehy EB, Marangell LB, Martinez J, Balasubramani GK, Wisniewski SR. Clinical and functional outcomes of patients who experience partial response to Citalopram: secondary analysis of STAR*D. J Psychiatr Pract 2014;20:178-87.

Bair MJ, Robinson RL, Eckert GJ, Stang PE, Croghan TW, Kroenke K. Impact of pain on depression treatment response in primary care. Psychosom Med 2004;66:17-22.

Bewernick BH, Kayser S, Sturm V, Schlaepfer TE. Long-term effects of nucleus accumbens deep brain stimulation in treatment-resistant depression: evidence for sustained efficacy. Neuropsychopharmacology 2012;37:1975-85.

Angermeyer MC, Holzinger A, Matschinger H, Stengler-Wenzke K. Depression and quality of life: results of a follow-up study. Int J Soc Psychiatry 2002;48:189-99.

Cho Y, Lee JK, Kim DH, Park JH, Choi M, Kim HJ, et al. Factors associated with quality of life in patients with depression: a nationwide population-based study. PLoS One 2019;14:e0219455.

Dunner DL, Rush AJ, Russell JM, Burke M, Woodard S, Wingard P, et al. Prospective, long-term, multicenter study of the naturalistic outcomes of patients with treatment-resistant depression. J Clin Psychiatry 2006;67:688-95.

Fekadu A, Wooderson SC, Markopoulo K, Donaldson C, Papadopoulos A, Cleare AJ. What happens to patients with treatment-resistant depression? A systematic review of medium to long term outcome studies. J Affect Disord 2009;116:4-11.

Rathod S, Denee T, Eva J, Kerr C, Jacobsen N, Desai M, et al. Health-related quality of life burden associated with treatment-resistant depression in UK patients: quantitative results from a mixed-methods non-interventional study. J Affect Disord 2022;300:551-62.