Health Related Quality of Life in Major Depressive Disorder: evolution in time and factors associated.

Major Depressive Disorder (MDD) is the most prevalent mental disorder. We aimed to analyze which factors were associated to their Health-Related Quality of Life (HRQoL) perception in patients diagnosed of MDD and how they evolved over six months.

La calidad de vida relacionada con la salud en el trastorno depresivo mayor: factores asociados con su evolución / Health-related quality of life in major depressive disorder: factors associated with its evolution

Introducción. La Depresión Mayor (DM) es el trastorno de salud mental más prevalente. Se pretende analizar el peso de los factores asociados a la percepción de la Calidad de Vida Relacionada con la Salud (CVRS) en pacientes con diagnóstico de DM y su evolución durante seis meses. Metodología. Se incluyeron 432 sujetos con DM (DSMIV-TR) de consultas hospitalarias, centros de salud mental y centros de atención primaria en País Vasco, Madrid y Canarias. Se siguió a los pacientes durante 6 meses. Se recogieron variables clínicas, sociodemográficas y de abordaje terapéutico. La CVRS se midió mediante el EQ-5D-5L, expresado como “utilidades”. Se construyeron Modelos Lineales Generalizados para responder los objetivos. Resultados. Las mujeres, las personas de mayor edad, los grupos sociales menos favorecidos y aquellos con mayor comorbilidad “orgánica” expresaron una peor CVRS inicial. A los 6 meses permanecían en seguimiento 305 sujetos. El cambio medio en las “utilidades” fue de 0,033 (IC95%: 0,008-0,059), y de 0,132 (IC95%: 0,093-0,171) en los 109 sujetos (35,51%) que expresaron mejoría en su estado de salud. Se asociaron negativamente con la evolución de la CVRS la comorbilidad “orgánica”, la presencia de trastornos de la conducta alimentaria, una mayor edad, el pertenecer a grupos socioeconómicos desfavorecidos o la necesidad de un mayor esfuerzo terapéutico. Conclusiones. La DM se asocia con un gran impacto en la CVRS, que revierte parcialmente en el grupo con buena evolución clínica. La mayor edad, la comorbilidad y el grupo socioeconómico se asocian a una peor evolución de la CVRS.(AU)

Introduction. Major Depressive Disorder (MDD) is the most prevalent mental disorder. We aimed to analyze which factors were associated to their Health-Related Quality of Life (HRQoL) perception in patients diagnosed of MDD and how they evolved over six months. Methods. We included 432 subjects with MDD (DSM-IVTR) from hospital consultations, mental health centres and primary care centres in Basque Country, Madrid and Canary Islands. Patients were followed for 6 months. Clinical, sociodemographic and therapeutic variables were collected. HRQoL was measured by EQ-5D-5L, expressed as “utilities”. Generalized Linear Models were constructed to meet the objectives. Results. Women, older people, disadvantaged social groups and those with higher “physical comorbidity” expressed a worse HRQoL at inclusion. At 6 months, 305 subjects remained in follow-up. The average change in “utilities” was 0.033 (CI95%: 0.008-0.059), and 0.132 (CI95%: 0.093-0.171) in the 109 subjects (35.51%) who expressed improvement in their health status. “Physical comorbidity”, the presence of eating disorders, older age, belonging to disadvantaged socioeconomic groups or the need for greater therapeutic effort were negatively associated with HRQoL evolution. Conclusion. MDD is associated with a great impact on HRQoL, which partially reverts when the patients showed good clinical evolution. Older age, comorbidity and disadvantaged socioeconomic group are associated with a worse evolution of HRQOoL.(AU)

[Detection of adolescents at risk of suffering eating disorders]. / Detección de adolescentes en riesgo de presentar trastornos de la alimentación.

OBJECTIVES: To analyse which risk factors are related to eating disorders and to identify useful questions for their early detection in primary care. DESIGN: Observational, cross-sectional study. SETTING: Six secondary schools in Leganés, Madrid, Spain. PARTICIPANTS: Adolescents aged between 12 and 18 years old attending secondary school. MAIN MEASUREMENTS: Risk of suffering an eating disorder (Eating Attitudes Test-26) and questions about weight, height, family, attitudes towards body image, use of health services for eating disorders, and mental illness history. RESULTS: An 8.8% of the adolescents were at risk of developing an eating disorder (4.6% male; 11.8% female). Age in males (OR=0.76) and 24-hour fasting to lose weight (OR for males =7.44; OR for females =3.09) were associated with the risk of eating disorders. Early menarche (OR=1.69), having dieted for social or environmental reasons, and self-induced vomiting (OR=5.71) were associated with eating disorders in women. The specificity and negative predictive value of asking about self-induced vomiting and 24-hour fasting in order to detect an eating disorder were around 95%. CONCLUSIONS: Age is a protective factor for eating disorders, especially in males. In women, early menarche is a risk factor. Asking about self-induced vomiting and 24-hour fasting enables eating disorders in women to be ruled out.

Detección de adolescentes en riesgo de presentar trastornos de la alimentación / Detection of adolescents at risk of suffering eating disorders

Objetivo. Analizar qué factores se asocian con el riesgo de presentar un trastorno de la conducta alimentaria (TCA) e identificar preguntas útiles para su detección precoz en atención primaria. Diseño. Observacional, transversal. Emplazamiento. Seis centros de enseñanza de Leganés (Madrid). Participantes. Adolescentes escolarizados de 12 a 18 años. Mediciones principales. Riesgo de presentar TCA (Eating Attitudes Test-26) y cuestionario sobre peso, talla y composición familiar, actitudes hacia la imagen corporal, el uso de servicios de salud relacionados con los TCA y antecedentes de trastorno mental. Resultados. El 8,8% de los adolescentes está en riesgo de presentar un TCA (un 4,6% de varones y un 11,8% de mujeres). Destaca la asociación del riesgo de TCA con la edad de los varones (odds ratio [OR] = 0,76) y haber ayunado 24 h para perder peso (OR en varones = 7,44; OR en mujeres = 3,09). En las mujeres se asocia con la menarquia temprana (OR = 1,69), haber hecho dieta bajo la influencia de factores socioambientales y autoprovocarse el vómito (OR = 5,71). Preguntar respecto a los vómitos autoprovocados y al ayuno de 24 h para detectar TCA posee una especificidad y un valor predictivo negativo en torno al 95%. Conclusiones. La edad protege del riesgo de presentar TCA, más claramente en varones. En mujeres, la menarquia temprana es un factor de riesgo. Interrogar sobre los vómitos autoprovocados y el ayuno de 24 h permite descartar el TCA en mujeres

Objectives. To analyse which risk factors are related to eating disorders and to identify useful questions for their early detection in primary care. Design. Observational, cross-sectional study. Setting. Six secondary schools in Leganés, Madrid, Spain. Participants. Adolescents aged between 12 and 18 years old attending secondary school. Main measurements. Risk of suffering an eating disorder (Eating Attitudes Test-26) and questions about weight, height, family, attitudes towards body image, use of health services for eating disorders, and mental illness history. Results. An 8.8% of the adolescents were at risk of developing an eating disorder (4.6% male; 11.8% female). Age in males (OR=0.76) and 24-hour fasting to lose weight (OR for males =7.44; OR for females =3.09) were associated with the risk of eating disorders. Early menarche (OR=1.69), having dieted for social or environmental reasons, and self-induced vomiting (OR=5.71) were associated with eating disorders in women. The specificity and negative predictive value of asking about self-induced vomiting and 24-hour fasting in order to detect an eating disorder were around 95%. Conclusions. Age is a protective factor for eating disorders, especially in males. In women, early menarche is a risk factor. Asking about self-induced vomiting and 24-hour fasting enables eating disorders in women to be ruled out