A Validation Study of the EQ-5D-5L and ICEpop Capability Measure for Older People Among Older Individuals With Depressive Symptoms in Brazil

Carina Akemi Nakamura*, Paul M Mitchell, TJ Peters, Darío Moreno-Agostino , Ricardo Araya, Marcia Scazufca , William Hollingworth

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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This study aimed to assess the known-groups validity of the EQ-5D-5L and the ICECAP-O, two outcome measures used in economic evaluation, among older adults with depressive symptoms in socio-economically deprived areas of Brazil. We also explored the role of education and income on responses to these measures.

This cross-sectional study used baseline data from PROACTIVE, a cluster randomised controlled trial to evaluate a psychosocial intervention for late life depression among older adults. Participants aged 60 years or over with a Patient Health Questionnaire (PHQ-9) score≥10 were recruited from 20 primary healthcare clinics. Ordered logistic regression models assessed the association between depression severity, income and education and dimension level responses on the EQ-5D-5L and ICECAP-O. Multivariable regression models investigated the ability of EQ-5D-5L and ICECAP-O scores to discriminate between depression severity levels and other characteristics, including education level and household income.

715 participants were included in the study. Depression severity was associated with all EQ-5D-5L and ICECAP-O dimensions, except the ICECAP-O enjoyment attribute. Household income, on the other hand, was only associated with the ICECAP-O security attribute. Higher severity of depressive symptoms (PHQ-9 scores) were also strongly associated with lower (i.e. worse) scores on both measures in all models. Education level and household income showed no association with either EQ-5D-5L or ICECAP-O scores.

This is the first study that investigated the validity of these two measures among older adults in Brazil. Both EQ-5D-5L and ICECAP-O showed evidence of validity in differentiating depressive symptom severity.
Original languageEnglish
Pages (from-to)91-99
Number of pages9
JournalValue in Health
Early online date21 Mar 2022
Publication statusE-pub ahead of print - 21 Mar 2022

Bibliographical note

Funding Information:
Funding/Support: This study was supported by São Paulo Research Foundation (process number 17/50094-2) and the Joint Global Health Trials initiative jointly funded by Medical Research Council , Wellcome Trust , and the UK Department for International Development (MRC, process number MR/R006229/1). Dr Nakamura is supported by a fellowship from São Paulo Research Foundation (2018/19343-0). Dr Mitchell’s time on this study was supported by the Wellcome Trust (205384/Z/16/Z). Dr Scazufca is supported by the CNPq-Brazil (307579/2-19-0). For the purpose of open access, the authors have applied a Creative Commons by public copyright license to any author accepted manuscript version arising from this submission.

Publisher Copyright:
© 2022 International Society for Health Economics and Outcomes Research

Structured keywords

  • HEB


  • EQ-5D-5L
  • low- and middle-income countries
  • mental health
  • older adults


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