Relationship between health-related quality of life, depression, and anxiety in older primary care patients and their family members

Figures & data

Figure 1. Actor–partner interdependence model (APIM) for patient and family member depression and anxiety on quality of life.

Table 1. Baseline characteristics of patient-family member dyads.

Characteristic	Primary Care Patients n = 1809	Family Members n = 1809
Age in years, mean (SD)	73.7 (5.7)	64.2 (12.9)
Sex, n (%)
Male	849 (47.0)	583 (32.2)
Race, n (%)
Black	240 (13.3)	242 (13.4)
White	1536 (85.1)	1523 (84.6)
Other	28 (1.6)	36 (2.0)
Ethnicity, n (%)
Non-Hispanic	1787 (98.9)	1789 (99.2)
Education level, n (%)
High school degree, equivalent, or less	329 (18.2)	274 (15.2)
Some college or College degree	957 (52.9)	1030 (57.0)
Postgraduate education	522 (28.9)	503 (27.8)
Self-reported income level, n (%)
Comfortable	1454 (81.3)	1466 (82.8)
Just enough to make ends meet	283 (15.8)	260 (14.7)
Not enough to make ends meet	51 (2.9)	44 (2.5)
Relationship to the patient, n (%)
Spouse/Partner		1171 (64.8)
Child		503 (27.8)
Other		134 (7.4)
Charlson Comorbidity Index Scores of Patients, mean (SD)	2.6 (2.8)
Area Deprivation Index of Patients, mean (SD)	47.0 (23.7)
Depression (PHQ-9) and Anxiety (GAD-7)^a, n (%)
No depression or anxiety	1268 (70.1)	1329 (73.5)
Depression only	321 (17.8)	211 (11.7)
Anxiety only	49 (2.7)	83 (4.6)
Depression and anxiety	170 (9.4)	185 (10.2)
Mild, moderate, or severe depression^b, n (%)	491 (27.2)	396 (21.9)
PHQ-9 score, mean (SD)	3.3 (3.6)	2.9 (3.4)
Health Related Quality of Life, mean (SD)
SF-36 Physical Health Component Score	45.4 (10.8)	48.8 (9.4)
SF-36 Mental Health Component Score	55.3 (7.2)	54.7 (7.2)

Note. N = 3,616 (n = 1,808 patient-family member dyads). GAD-7 = Generalized Anxiety Disorder-7; PHQ-9 = Patient Health Questionnaire-9; SF-36 = Short Form Health Survey.

^a Depression is defined as PHQ-9 score of ≥ 5. Anxiety is defined as GAD-7 score of ≥ 5.

^b Mild, moderate, severe depression defined as PHQ-9 score of ≥ 5.

Table 2. Actor-partner effects of patient and family member depression and anxiety on quality of life.

Patient SF-36 PCS			Family Member SF-36 PCS		Patient SF-36 MCS		Family Member SF-36 MCS
	β (SE)	P-value	β (SE)	P-value	β (SE)	P-value	β (SE)	P-value
Actor
No depression or anxiety (ref)	0.00		0.00		0.00		0.00
Depression (PHQ-9 5+) only	−9.03 (0.59)	<0.001	−5.31 (0.67)	<0.001	−4.36 (0.38)	<0.001	−4.61 (0.43)	<0.001
Anxiety (GAD-7 5+) only	0.49 (1.34)	0.713	−0.28 (1.02)	0.786	−5.52 (0.86)	<0.001	−3.88 (0.66)	<0.001
Anxiety and Depression	−7.04 (0.78)	<0.001	−5.34 (0.73)	<0.001	−12.93 (0.51)	<0.001	−12.86 (0.47)	<0.001
Partner
No depression or anxiety (ref)	0.00		0.00		0.00		0.00
Depression (PHQ-9 5+) only	−0.49 (0.69)	0.477	−0.96 (0.57)	0.092	−0.02 (0.44)	0.958	−0.62 (0.37)	0.091
Anxiety (GAD-7 5+) only	−0.04 (1.06)	0.970	−1.75 (1.27)	0.168	−1.48 (0.68)	0.030	−1.17 (0.81)	0.150
Anxiety and Depression	−1.76 (0.74)	0.018	−1.30 (0.76)	0.086	−0.67 (0.48)	0.158	−0.47 (0.49)	0.334
Age	−0.14 (0.04)	0.001	−0.17 (0.02)	<0.001	0.08 (0.03)	0.003	0.13 (0.02)	<0.001
Male	0.94 (0.48)	0.051	0.38 (0.47)	0.412	0.28 (0.31)	0.365	−0.15 (0.30)	0.621
Spouse Dyad	−0.60 (0.54)	0.268	−0.06 (0.67)	0.931	0.44 (0.35)	0.205	−0.52 (0.43)	0.227
Income
Comfortable	5.24 (1.40)	<0.001	5.09 (1.45)	0.001	0.05 (0.90)	0.956	4.21 (0.93)	<0.001
Just enough to make ends meet	3.44 (1.44)	0.017	1.92 (1.49)	0.200	−0.43 (0.93)	0.640	4.10 (0.96)	<0.001
Not enough to make ends meet (ref)	0.00		0.00		0.00		0.00
Race
Black	1.24 (0.72)	0.085	−1.34 (0.70)	0.055	0.75 (0.47)	0.107	0.68 (0.45)	0.132
Other	−3.44 (1.79)	0.055	0.16 (1.48)	0.915	2.04 (1.15)	0.078	1.39 (0.95)	0.145
White (ref)	0.00		0.00	0.00	0.00		0.00	0.00
Education level
High school degree, equivalent, or less	−3.45 (0.70)	<0.001	−2.50 (0.71)	0.001	−0.08 (0.45)	0.863	0.37 (0.46)	0.421
Some college or College degree	−2.03 (0.51)	<0.001	−0.40 (0.49)	0.413	0.82 (0.33)	0.013	0.56 (0.32)	0.080
Postgraduate education (ref)	0.00		0.00		0.00		0.00
Patient Charlson Comorbidity Index	−0.93 (0.08)	<0.001	−0.16 (0.08)	0.040	0.05 (0.05)	0.328	0.02 (0.05)	0.722
Patient Area Deprivation Index	−0.03 (0.01)	0.002	−0.02 (0.01)	0.059	−0.02 (0.01)	0.006	−0.004 (0.01)	0.526

Note. SF-36 = Short Form Health Survey; PCS = Physical Component Score; MCS = Mental Component Score; GAD-7 = Generalized Anxiety Disorder-7; PHQ-9 = Patient Health Questionnaire-9.

Data availability

The data that support the findings of this study are available from the corresponding author, [N.R.F], upon reasonable request.