Article

OBJECTIVE: To assess the role that treatment response plays in a randomized
controlled trial of an antidepressant among people with spinal cord injury (SCI)
diagnosed with major depressive disorder (MDD) in explaining quality of life
(QOL), assessed both globally as life satisfaction and in terms of physical and
mental health-related QOL. DESIGN: Multivariable analyses were conducted,
controlling for demographic, neurologic, and participatory factors and perceived
functional limitations. SETTING: Rehabilitation centers. PARTICIPANTS: Of the 133
persons who were randomized into the Project to Improve Symptoms and Mood after
Spinal Cord Injury randomized controlled trial, 124 participated in this study.
All participants were between the ages of 18 and 64 years, at least 1 month
post-SCI, met the Diagnostic and Statistical Manual of Mental Disorders, 4th
edition, criteria for MDD, and completed the core measures used in this study.
INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Satisfaction with Life
Scale and the physical and mental component summary scores of the Medical
Outcomes Study 12-Item Short-Form Health Survey. RESULTS: Reduction in depressive
symptoms over the course of a 12-week trial was predictive of increased QOL,
which was measured as life satisfaction and mental well-being, within the context
of other explanatory factors. However, reduction in symptoms did not explain
differences in physical well-being among those with MDD. Perceived functional
disability explained all 3 indices of QOL. CONCLUSIONS: Greater recognition has
been given to QOL outcomes as endpoints of clinical trials because these often
reflect participants' reported outcomes. Our findings support the association of
QOL to the reduction of depression symptoms among trial participants. This
association differs depending on how QOL is defined and measured, with stronger
relations observed with life satisfaction and mental well-being among those
diagnosed with MDD. The lack of association between depression and physical
well-being may be explained by participants' subjective interpretation of
physical well-being after SCI and their expectations and perceptions of improved
physical health-related QOL based on the use of assistive technology. Consistent
with our findings, pain is likely to play a role in decreasing physical QOL among
those with incomplete injuries. Practicing caution is suggested in using physical
well-being as an endpoint in trials among people with SCI.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS