Determinants of quality of life improvements in anxiety and depressive disorders-A longitudinal study of inpatient psychotherapy

Abstract

Background: Quality of life (QoL) is substantially impaired in patients with anxiety disorders (AD) and depressive disorders (DD) and improvements in symptom burden after psychotherapy are not always paralleled by similar improvements in QoL. So far, little is known about treatment outcome in terms of QoL and predictors of QoL improvements following inpatient psychotherapy with a focus on cognitive behavior therapy (CBT). The current study aimed at investigating the relationship between changes in symptoms and QoL across different life domains. Additionally, predictors of a positive treatment outcome were evaluated.

Methods: 122 patients with AD and/or DD undergoing an 8-weeks inpatient CBT program completed self-report measures of psychopathological symptoms and QoL at pre- and post-treatment. Mixed effects models were used to investigate changes, a confirmatory factor analysis was applied to analyze the latent factor structure of the anxiety sensitivity index and binary logistic regression analyses were performed for predictors of QoL improvements.

Results: Patients showed moderate to strong decreases in anxious and depressive symptoms and moderate to strong improvements in general QoL, particularly in the psychological and physical QoL subdomains. Changes in symptom burden correlated most strongly with psychological and physical QoL. In addition, poor QoL before treatment and low levels of specific anxiety sensitivity symptoms (items 1 and 5) significantly predicted improvement in QoL.

Conclusion: Patients with poor QoL who are not as inhibited to openly express their anxious feelings particularly benefit from inpatient psychotherapy (individual and group) to improve their QoL. In contrast, our research suggests that patients who are too anxious to openly express their nervousness should receive additional social skills training, more focused treatment to build sufficient self-confidence to better engage in the treatment program.

Keywords: anxiety disorder; cognitive behavior therapy; depressive disorder; inpatient psychotherapy; predictors; quality of life; treatment outcome.

FIGURE 1

Changes in general quality of life (QoL) across treatment. The proportion of patients from the total sample is displayed on the y-axis and the different intervals of general QoL between very poor (1) and very good (5) are displayed on the x-axis.

FIGURE 2

Changes in depressive and anxious symptoms for patients across treatment. On the y-axis the symptom severity (BDI/STAI-T) and on the x-axis the time (pre/post-treatment) are displayed. The three groups (AD, DD, and AD + DD) are shown by different lines. BDI, beck depression inventory; STAI-T, state-trait anxiety inventory trait subscale; AD, anxiety disorder; DD, depressive disorder; AD + DD, comorbidity. A total BDI score of 0–9 is considered not depressed, 10–18 indicates mild-moderate depression, 19–29 indicates moderate-severe depression, and 30–63 indicates severe depression. The total STAI-T score varies from 20 to 80. A low score indicates a low level of anxiety and a high score indicates a high level of anxiety. STAI scores of 20–37 are classified as “no or low anxiety,” of 38–44 as “moderate anxiety,” and of 45–80 as “high anxiety”.