Depression Severity, Quality of Life, and Economic Burden: Informing Individualised Support for People with Psychosocial Disabilities

Abstract

Background: Depression is a leading cause of psychosocial disability worldwide, substantially affecting functioning, participation, health-related quality of life (HRQoL), and economic well-being. Beyond its clinical symptoms, depression limits individuals' ability to engage in education, employment, family life, and community participation. Understanding the relationship between depression severity, HRQoL, and economic burden is essential for developing individualised support strategies for people with psychosocial disabilities.

Methods: A prospective, observational, cross-sectional study was conducted among 357 adults diagnosed with clinical depression according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Participants were recruited from the Department of Psychiatry at Teerthanker Mahaveer University Hospital, Moradabad, India. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). Health-related quality of life was evaluated using the WHOQOL-BREF and EQ-5D-5L instruments. Cost-of-illness data, including direct medical, direct non-medical, and indirect costs, were collected through patient interviews and medical records. Statistical analyses were performed using IBM SPSS Statistics version 31.0.

Results: Greater depression severity was significantly associated with poorer HRQoL across multiple domains. PHQ-9 scores showed a significant inverse correlation with the WHOQOL-BREF total score (r = −0.212, p < 0.001) and EQ-5D-5L utility values (r = −0.311, p < 0.001). Indirect costs demonstrated a significant positive correlation with WHOQOL-BREF total scores (r = 0.120, p = 0.023), while total cost of illness was also positively associated with HRQoL scores (r = 0.126, p = 0.017). Among the sociodemographic variables, only occupational status showed a significant association with EQ-5D-5L utility values (p < 0.001), indicating the importance of employment in functional well-being.

Conclusion: Depression severity is closely associated with reduced health-related quality of life and increased economic burden among people with psychosocial disabilities. These findings highlight the importance of integrating routine assessment of symptom severity, functional outcomes, and economic burden to identify individuals requiring greater support. Individualised, multidisciplinary interventions that combine mental health care with psychosocial rehabilitation, educational and vocational support, and community-based services may enhance participation, improve quality of life, and promote inclusion for people living with depression.