Health-related Quality of Life and Well-being Impact of Depression in Ethiopia

Assefa, Esubalew Ayalew (2021). Health-related Quality of Life and Well-being Impact of Depression in Ethiopia. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.00013e78

Abstract

Depression is a common mental disorder with significant health, economic and social effects. Despite being ranked among the leading causes of disability, little is known about its impact on quality of life in Ethiopia. This thesis aims to examine the burden of depression in Ethiopia by assessing its impact on quality of life. Specifically, it examines the impact of depression on health related quality of life, health status and subjective well-being; it develops and validates a multidimensional quality of life instrument using the capability approach; and, it examines how depression affects multidimensional quality of life applying the data collected through the instrument.

With a secondary data analysis of a national health survey, the thesis first investigates the burden of depression on health-related quality of life and subjective well-being. Specifically, applying recently available information on EQ-5D preference weights for Ethiopian population, it estimates health utility values and analyses the impact of depression on health utilities. In addition, it examines the impact of depression on self-assessed health and satisfaction with health. By developing a contextually relevant instrument using the capability approach, the thesis then provides an analysis of the impact of depression on broader well-being. Specifically, building on works that attempt to operationalise the Sen-Nussbaum’s capability approach, a new capability well-being instrument was designed and validated for use in Ethiopia. The thesis then provides empirical evidence on the impact of depression on well-being by collecting survey data with the new instrument. Working with the limits of the data, studies in the thesis apply statistical methods, such as propensity score matching and instrumental variables, to estimate the potential impact of depression on the outcomes of interest.

The empirical results show depression is associated with decrements in health outcomes. Depression is associated with lower health-related quality of life, lower self-rated health and lower health satisfaction. The results are robust to adjustments to socioeconomic, demographic factors and the presence of other common chronic physical illnesses. Depression is associated with lower health outcomes on its own and even lower decrements in health outcomes when comorbid with other chronic illnesses. Additional analyses were also conducted using propensity score matching methods, by matching respondents experiencing depression with respondents who are not depressed but are comparable on the distribution of the socioeconomic, demographic factors and health condition profile. The results can be interpreted as the causal impact of depression, and they show a significant negative impact of depression on health-related quality of life and subjective well-being outcomes. Similarly, the results show that depression is negatively and significantly associated with broader well-being. There is a negative association between depression and wide range of capabilities as well as overall well-being as measured by an aggregate capability index. Accounting for potential endogeneity, the results also show a ceteris paribus impact of depression on well-being.

The analyses in this thesis are based on cross-sectional data and may not provide information on causation despite the best attempts to use alternative estimation techniques to address such issues. Further longitudinal work will be needed. However, the thesis tells a story, albeit a snapshot. It tells an untold story on the burden of depression in Ethiopia. It describes how depression is associated with lower health and non-health outcomes. It shows how depression is associated with limitations on broader dimensions and aspects of life. The results will have an important implication in designing intervention and evaluating the impact of policy and program interventions. It will vital to consider the interplay of health and non-health dimensions in assessing the burden of depression, in designing interventions to address mental health problems and in evaluating the effectiveness of such interventions.

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