J Affect Disord. 2025 Oct 26:120541. doi: 10.1016/j.jad.2025.120541. Online ahead of print.
ABSTRACT
BACKGROUND: Generic Health-Related Quality of Life (HRQoL) assessments and disability measures are widely used as outcome measures in healthcare. For these tools to be useful, they must be sensitive to clinically relevant changes. We investigated the sensitivity of two generic instruments, EQ-5D-5L and WHODAS 2.0, to detect changes among primary care outpatients with depression.
METHODS: The pragmatic study sample comprised 4945 primary care outpatients diagnosed with depression. Following a physician consultation, participants simultaneously completed two sets of questionnaires: one containing the EQ-5D-5L and WHODAS 2.0, and another featuring the depression-specific Patient Health Questionnaire (PHQ-9), which has demonstrated responsiveness within this population. Minimal important difference was set at 4 points for the PHQ-9. Standardized response means (SRM) were calculated, and changes in EQ-5D-5L and WHODAS 2.0 scores were compared to changes in PHQ-9 scores (used as the anchor) using Receiver Operating Characteristics (ROC) analysis.
RESULTS: The SRM was higher for the PHQ-9 compared to both the EQ-5D-5L and WHODAS 2.0, indicating better signal-to-noise ratio. The EQ-5D-5L and WHODAS 2.0 showed at best fair performance in improvements as measured by the disease-specific PHQ-9, with area under the ROC curve (AUC) values at or below 0.75. Their ability to detect deterioration was slightly lower, with AUC values at or below 0.70. Their sensitivity to detect changes varied between 0.40 and 0.73.
CONCLUSIONS: The EQ-5D-5L and WHODAS 2.0 demonstrated limited sensitivity to detect relevant changes in primary health care outpatients diagnosed with depression. In this patient population, a disease-specific outcome measure appears to be more effective than generic instruments.
PMID:41151726 | DOI:10.1016/j.jad.2025.120541
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