Anxiety and depression may amplify self-reported physical health problems: evidence from EQ-5D-5L data

Our previous study has shown that individuals with poor positive mental well-being (measured by the Short Warwick-Edinburgh Mental Well-being Scale, SWEMWBS) tend to report more problems on the EQ-5D-5L. Another study has shown that the anxiety/depression item of the EQ-5D-5L and all items of SWEMWBS loaded onto the same factor in an exploratory factor analysis, suggesting they measure the same construct. This study aims to analyze the potential impact of anxiety/depression on responses to the four physical health dimensions of the EQ-5D-5L. An online survey and face-to-face interviews were conducted to collect data from participants with and without different health conditions. Generalized ordered logistic regression was employed to examine the influence of anxiety/depression on responses to the four physical health dimensions of the EQ-5D-5L. Multiple linear regression analysis was conducted to explore the effects of anxiety/depression on EQ-VAS and utility values. A directed acyclic graph (DAG) was used to identify the minimum set of variables required to adjust for confounding. 500 participants completed online surveys, 509 participated in face-to-face interviews; 237 healthy individuals, 430 individuals with physical conditions, 234 with mental conditions, and 108 with both physical and mental conditions. According to graphical rules applied to the DAG, the final minimally sufficient adjustment set comprised age, carers, education level, sex, and health conditions. Generalized ordered logistic regression indicated that individuals with higher levels of anxiety/depression were more likely to report problems in the four physical health dimensions. Multiple linear regression analysis demonstrated that anxiety/depression was significantly associated with EQ-5D-5L utility values and EQ-VAS scores, with individuals experiencing high levels of anxiety/depression reporting lower values for both measures. Mental health conditions, particularly anxiety and depression, may lead to heightened perceptions of problems in physical health dimensions, potentially biasing self-reported health data. Addressing anxiety and depression in clinical and therapeutic settings may not only improve mental health outcomes but also positively influence perceived physical health. Future research is needed to establish causal relationships.