Emotional Health-related Quality Of Life Research Articles

Sexual Assault in the Military and Its Impact on Sexual Satisfaction in Women Veterans: A Proposed Model

Sexual assault in the military (SAIM) is associated with decreased sexual satisfaction. However, mediators of this association have not been fully described. Using a retrospective analysis of cross-sectional data collected for the national Veterans Affairs (VA) Women's Health Survey, we propose a mediator model to explain the association between SAIM and decreased sexual satisfaction among women veterans. Four mediators of the association between SAIM and decreased sexual satisfaction are tested: (1) emotional health-related quality of life, (2) physical health-related quality of life, (3) lack of a close partner, and (4) gynecological illness. These mediators were chosen to encompass independent domains potentially relevant to sexual satisfaction, including emotional, physical, and relational. Of 3161 women (87%) who answered the sexual satisfaction question, the mean age was 45 (SD 15) years; 85% were white. Twenty-four percent reported a history of SAIM, and 39% reported sexual dissatisfaction. In age-adjusted logistic regression analyses, both SAIM and sexual dissatisfaction were strongly associated with each of the proposed mediators. However, of the four mediators, emotional health-related quality of life most strongly attenuated the association between SAIM and sexual dissatisfaction. After including all mediators, the association between SAIM and decreased sexual satisfaction was markedly attenuated. SAIM's negative impact on sexual satisfaction in women veterans operates both directly and through its physical and mental health sequelae. Of the proposed mediators in this association, the most prominent is mental health-related quality of life; the other proposed mediators were minimally related.

Family Caregiver Outcomes in Heart Failure

Family caregivers of patients with heart failure report high stress, burden, and poor emotional and physical health, but less is known about predictors of health among these caregivers. To determine predictors of family caregiving outcomes among caregivers of patients with heart failure and to identify the tasks reported as most difficult and the most negative outcomes. A total of 63 patients with heart failure and their 63 family caregivers were enrolled in this prospective study. Data were collected from medical records and from interviews conducted at baseline and 4 and 8 months later. Caregivers reported moderately poor physical and emotional health-related quality of life. Those with more depressive symptoms at baseline were more likely to report their lives had changed for the worse at 4 months (P=.03). The caregivers' medical health condition (P<.001) and perceived difficulty of caregiving tasks (P=.04) were predictors of physical health-related quality of life at 4 months; at 8 months, medical health condition was the only predictor (P=.004). At 4 and 8 months, depressive symptoms were predictors of emotional health-related quality of life (P<.001 and P=.001, respectively). The most difficult caregiving tasks were those dealing with patients' behavior problems; the most negative outcome was having less time for activities with friends. Studies are needed in larger samples to identify needs of vulnerable populations of caregivers of patients with heart failure and to develop and test interventions for improving caregivers' outcomes.

Determinants of physical activity among women treated for breast cancer in a 5-year longitudinal follow-up investigation.

To estimate the 5-year trajectory of physical activity among women with breast cancer, and to evaluate biopsychosocial variables (health status, physical symptoms, health-related quality of life (HRQL), depressive symptoms, and social support), measured soon after breast cancer diagnosis, as predictors of the 5-year trajectory. Women diagnosed with Stage II or III regional breast cancer (n=227), surgically treated and awaiting the start of adjuvant therapy completed baseline assessments of medical, psychological, and behavioral functioning. Follow-up evaluations were conducted every 4 months during the first year and every 6 months during the subsequent 4 years (12 assessments total during the 5-year study). Mixed-effects modeling was utilized to estimate the baseline level of physical activity as well as rate of change over time. Measures of physical health status, HRQL, depressive symptoms, and social support were included as predictors of the physical activity trajectory. A curvilinear pattern of change in physical activity was evident over the 5-year follow-up (p=0.002). Physical activity increased gradually during the first 18 months, then declined steadily over the subsequent 42 months. Poor physical health, depressive symptoms, and lower emotional HRQL were associated with less physical activity. Higher family support was associated with a slower decline in physical activity in the latter 42 months of the study. Emotional HRQL following diagnosis with breast cancer appears to be important for sustaining physical activity in the first 1-2 years following diagnosis. Physical activity interventions among breast cancer survivors should address depressive symptoms early in the course of treatment.

Longitudinal health-related quality of life outcomes and related factors after pediatric SCT

Our purpose was to investigate longitudinally health-related quality of life (HRQOL) outcomes and related factors up to 2 years post-pediatric SCT. A total of 99 mothers of patients, aged 1.5-17 years, completed two standardized HRQOL questionnaires, generic and disease specific (DS), about the child, and reported on their own symptoms of depression and family function pre-SCT, 12 and 24 months post-SCT. Clinical (diagnosis, radiation), child (age) and family (maternal depression) information was also obtained. Significant improvement in physical and psychosocial HRQOL from pre-SCT to 1 or 2 years post-SCT was reported. Survivors of ALL were reported to have poorer physical and psychosocial HRQOL than survivors of solid tumors on the DS measure. Maternal depression was negatively associated with physical and psychosocial HRQOL. Maternal education (higher) at pre-SCT predicted improvements in physical domains 2 years post-SCT; mother's age (older) and child's age (younger) also predicted improvements of physical and emotional HRQOL. We conclude that survivors of pediatric SCT improved physical and psychosocial HRQOL by 1 and 2 years post-SCT. Older survivors whose mothers are younger and distressed, with lower education at SCT have compromised HRQOL compared to other survivors. This study has important implications for the care of SCT survivors and their families.

Illness and treatment cognitions and health related quality of life in end stage renal disease

Patients' beliefs regarding illness and treatment are important to understand responses to chronic disease. The present study aimed (i) to assess the illness representations and treatment disruption beliefs of patients with end stage renal disease (ESRD), (ii) to determine whether beliefs about illness and treatment differ between different renal replacement therapies, and (iii) to examine whether these beliefs are associated with health related quality of life (HQoL). A cross-sectional sample of 262 ESRD patients, 145 dialysis and 117 kidney transplant recipients completed the illness perceptions questionnaire, the illness effects questionnaire, the treatment effects questionnaire and the short form 36 health survey. Measures of ESRD severity/co-morbidity and biochemistry were also collected. HQoL levels were higher in transplant patients. Dialysis patients reported more symptoms associated with ESRD (p<.001), stronger chronic timeline beliefs (p<.001), lower control beliefs (p<.05), and more illness and treatment disruptiveness (ps<.01). Illness and treatment disruptiveness, consequences and identity were inversely associated with HQoL whereas control was positively associated with HQoL. Multiple regressions indicated that treatment and illness disruptiveness, identity and consequences beliefs accounted for 22.9-67.6% of the variance HQoL although specific multivariate correlates differed across physical and emotional HQoL and between dialysis and transplantation. The beliefs that patients hold about their illness and treatment appear to be related to the type renal replacement therapy being undertaken. These cognitions have associations with HQoL in dialysis and transplantation that are independent of those of socio-demographic and clinical factors.

Coping and social support and health related quality of life in women with breast cancer in Turkey

This study aims to investigate the role of social support and coping in explaining health related quality of life (HRQoL) among Turkish breast cancer patients. A cross-sectional sample of 188 women from three hospitals in Turkey completed the Multidimensional Scale of Perceived Social Support, the Ways of Coping Inventory, and the Short Form 36 Health Survey. Socio-demographic and medical information was also collected. Results indicated high HRQoL levels, with 7 of the 10 SF-36 scores being within 1 SD of population mean. Correlations showed that helplessness coping was inversely associated with HRQoL whereas social support, religious coping, optimistic coping and problem focused coping were positively associated with HRQoL. Multiple regressions indicated that time since diagnosis, time since operation, stage of cancer, post-operative treatment, social support and problem solving coping were significant predictors of HRQoL accounting for 54.7% to 46.4% of the variance in physical and emotional HRQoL. Coping and social support have an independent effect on HRQoL over and above sociodemographic and medical variables and should be targeted by appropriate interventions.

Impact of Cancer-Related Symptom Synergisms on Health-Related Quality of Life and Performance Status

To identify the impact of multiple symptoms and their co-occurrence on health-related quality of life (HRQOL) dimensions and performance status (PS), 115 outpatients with cancer, who were not receiving active cancer treatment and were recruited from a university hospital in Sao Paulo, Brazil completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, the Beck Depression Inventory, and the Brief Pain Inventory. Karnofsky Performance Status scores also were completed. Application of TwoStep Cluster analysis resulted in two distinct patient subgroups based on 113 patient experiences with pain, depression, fatigue, insomnia, constipation, lack of appetite, dyspnea, nausea, vomiting, and diarrhea. One group had multiple and severe symptom subgroup and another had less symptoms and with lower severity. Multiple and severe symptoms had worse PS, role functioning, and physical, emotional, cognitive, social, and overall HRQOL. Multiple and severe symptom subgroup was also six times as likely as lower severity to have poor role functioning; five times more likely to have poor emotional; four times more likely to have poor PS, physical, and overall HRQOL; and three times as likely to have poor cognitive and social HRQOL, independent of gender, age, level of education, and economic condition. Classification and Regression Tree analyses were undertaken to identify which co-occurring symptoms would best determine reduction in HRQOL and PS. Pain and fatigue were identified as indicators of reduction on physical HRQOL and PS. Fatigue and insomnia were associated with reduction in cognitive; depression and pain in social; and fatigue and constipation in role functioning. Only depression was associated with reduction in overall HRQOL. These data demonstrate that there is a synergic effect among distinct cancer symptoms that result in reduction in HRQOL dimensions and PS.

Surviving meningococcal septic shock: Health consequences and quality of life in children and their parents up to 2 years after pediatric intensive care unit discharge

To assess health consequences and health-related quality of life (HR-QoL) in children with meningococcal septic shock up to 2 yrs after discharge from the pediatric intensive care unit and to assess their parents. To determine major predictors of that outcome. A prospective cohort study. Follow-up of all consecutive children with septic shock and purpura requiring intensive care treatment between 2001 and 2005, and their parents. HR-QoL was assessed with the Child Health Questionnaire (children) and Medical Outcomes Study 36-item Short-Form Health Survey (parents). Of 53 eligible families, 47 participated (28 boys/19 girls; median age at the time of pediatric intensive care unit admission, 3.7 yrs; median Pediatric Risk of Mortality score, 21). A total of 26 children (55%) had scars as a result of skin necrosis; two (4%) had amputation of a digit or digits. In 21 children (45%), chronic complaints were reported. Children with and without chronic complaints did not differ significantly with regard to severity of illness and age at the time of pediatric intensive care unit admission. Significantly lower scores were found on HR-QoL scales concerning mainly physical functioning and health perception in comparison with normative data. There was a significant negative association between severity of illness and the HR-QoL scale concerning physical functioning. Children with chronic complaints had significantly lower scores on the HR-QoL scale concerning pain. Eight of 47 mothers (17%) at the time of the study had anxiety or depression requiring professional help. Mothers with and without these problems differed significantly with regard to age of their child at the time of pediatric intensive care unit admission. Parents showed significantly higher scores on HR-QoL scales concerning physical functioning and bodily pain in comparison with normative data. There was a significantly negative association between the presence of emotional problems and HR-QoL scores in mothers. Up to 2 yrs after discharge from the pediatric intensive care unit, there is still a considerable effect on health and HR-QoL in children, especially on the physical scales. Severity of illness and chronic complaints negatively affected HR-QoL scales in children. Quite a few mothers suffered from emotional problems.

The Health-Related Quality of Life Trajectory in Patients After Percutaneous Coronary Intervention

The purpose of this study was to describe the trajectory of cardiac patient's perceptions of health-related quality of life (HRQoL) during a 24-month period in a community-based population. After obtaining informed consent, a self-administered questionnaire was mailed to participants. Using the MacNew questionnaire, which assesses the emotional, physical, social, and global domains, HRQoL outcomes were assessed. Completed questionnaires were received from 202 participants (75%). Improvements in the emotional, physical, social, and global HRQoL scores were observed until 15 to 17 months after the index percutaneous coronary intervention, after which a decline was observed. However, the scores in all HRQoL domains remained high when compared with the scores at 12 months. No clinical or sociodemographic predictors for HRQoL were identified. The information obtained from this study will enable clinicians to further understand the process of recovery and adjustment of patients after percutaneous coronary intervention and the development of tailored strategies for patient management.

The impact of angina and cardiac history on health-related quality of life and depression in coronary heart disease patients

To prospectively examine the contribution of angina and cardiac history to health-related quality of life (HRQoL) and depression in cardiac patients, over 6 months post-hospitalization. Participants were myocardial infarction (MI), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) outpatients under the age of 70 years. One hundred and seventy-one patients consented to participate, with 121 patients being retained 6 months later (71% response rate). The impact of the patient's cardiac history and the presence of angina on physical, social and emotional HRQoL and depression was examined. At baseline, cardiac history was not significantly related to any of the dimensions of HRQoL or depression. At 6-month follow-up, cardiac history significantly predicted a higher level of depression, and angina was predictive of a significantly worse emotional, physical and social HRQoL and a higher level of depression. The presence of a cardiac history is associated with depression 6 months post-cardiac event, and angina is associated with both an adverse HRQoL and higher levels of depression. As past research has demonstrated that depression is a risk factor for mortality in patients with established heart disease, it is important from both a clinical and a research perspective to address these issues.

Health-related quality of life among children and adolescents: associations with obesity

To assess the impact of obesity on health-related quality of life (HRQOL) of children, and to compare HRQOL scores of obese children in a hospital versus community setting. A cross-sectional study in two clinical samples. A total of 182 children and adolescents recruited from the community pediatric clinics and a hospital-based obesity clinic. Obesity was defined as body mass index (BMI) >95th percentile for age and gender. Subjects were divided into quartiles of BMI Z-scores each containing 45 or 46 children. The first two quartiles correspond to normal BMI, 3rd and 4th quartiles represent moderate and severe obesity, respectively. HRQOL was assessed by the Pediatric Quality of Life Inventory (PedsQL) questionnaire submitted by both children and their parents. Obese children reported significantly lower HRQOL in physical, social and school domains compared with normal weight children (P<0.01). Analyzing results of HRQOL by BMI quartiles showed that the emotional and school domains scores of the moderately obese children were similar to the normal BMI quartiles. Only in the 4th quartile, that of children with severe obesity, were scores significantly lower. In contrast, in both physical and social domains scores decreased progressively with increased BMI Z-scores. In the obese group, parents' scores were lower than the children's in all domains. HRQOL scores of obese children assessed in the hospital clinic were similar to that of obese children assessed in the community. Moderately obese children had similar emotional and school HRQOL scores as normal weight children, whereas in the physical domain, a significant difference was documented even in moderate obesity. Parents of obese children perceived their child's HRQOL lower than the children themselves. We believe that intervention programs aimed at improving HRQOL should be directed to both parents and children. Understanding the resilience of moderately obese children in school and emotional domains may assist us in the management of childhood obesity.

The two-year impact of first generation protease inhibitor based antiretroviral therapy (PI-ART) on health-related quality of life

BackgroundProtease inhibitor based antiretroviral therapy (PI-ART) was introduced in 1996 and has greatly reduced the incidence of HIV-related morbidity and mortality in the industrialised world. PI-ART would thus be expected to have a positive effect on health-related quality of life (HRQL). On the other hand, HRQL might be negatively affected by strict adherence requirements as well as by short and long-term adverse effects. The aim of this study was to assess the influence of two years of first generation PI-ART on HRQL in patients with a relatively advanced state of HIV-infection. Furthermore, we wanted to investigate the relation between developments in HRQL and viral response, self-reported adherence and subjective experience of adverse effects in patients with PI-ART.MethodsHRQL was measured by the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL). Sixty-three items from the SWED-QUAL forms two single-item and 11 multi-item dimension scales. For this study, two summary SWED-QUAL scores (physical HRQL composite score and emotional HRQL composite score) were created through a data reduction procedure. At the 2-year follow-up measurement (see below), items were added to measure adherence and subjective experience of adverse effects. Demographic and medical data were obtained from specific items in the questionnaires and from the medical files. Seventy-two patients who were among the first to receive PI-ART (indinavir or ritonavir based) responded to the questionnaire before the start of PI-ART. Of these, 54 responded to the same instrument after two years of treatment (13 had died, four had changed clinic and one did not receive the questionnaire).ResultsThe main findings were that the emotional HRQL deteriorated during two years of PI-ART, while the physical HRQL remained stable. Multiple linear regression analyses showed that experience of adverse effects contributed most to the deterioration of emotional HRQL.ConclusionIn this sample of patients with relatively advanced state of HIV-infection, our data suggested that a negative development of physical HRQL had been interrupted by the treatment and that the emotional dimension of HRQL deteriorated during two years after start of PI-ART. Subjective experience of adverse effects made a major contribution to the decrease in emotional HRQL. The results underline the importance of including HRQL measures in the evaluation of new life prolonging therapies.

Health-related quality of life and its relationship to cognitive and emotional functioning in multiple sclerosis patients.

The existing knowledge about the health-related quality of life (HRQoL) and its relationship to cognitive and/or emotional functioning in multiple sclerosis (MS) is scarce. We assessed differences between subgroups of MS outpatients (n = 209) on one HRQoL instrument: a version of the Functional Assessment of Multiple Sclerosis quality of life instrument; on two cognitive functioning tests: the Mini-Mental State Examination and the clock drawing test; and on two emotional functioning tests: the Hamilton Rating Scale for Depression and the Hamilton Rating Scale for Anxiety. Three disease-related characteristics were assessed: physical disability, duration of the illness, and clinical course. The results showed that each of these has an effect on at least one dimension of HRQoL and on one mental functioning test. Thus, the more severe, the more progressive, and the longer the illness duration, the lower the HRQoL. Likewise, cognitive mean scores decreased and emotional mean scores increased with greater illness severity and progressive the MS. Furthermore, we also found significant correlations between cognitive and emotional functioning tests and HRQoL dimensions. Thus, the worse cognitive functioning and the higher depressive and anxiety symptoms score the lower the HRQoL.

Can parents rate their child's health-related quality of life? Results of a systematic review.

A systematic review was conducted to determine the relationship between ratings of children's health-related quality of life (HRQoL) made by parents and children. This was investigated in relation to four questions: is agreement greater for some domains (e.g. physical HRQoL) than others?; do parents perceive illness to have a greater impact than their child?; how is agreement affected by child age, gender and illness status?; and is the relationship between proxy ratings affected by the method of data collection? Fourteen studies were identified. Consistent with previous research, there was greater agreement for observable functioning (e.g. physical HRQoL), and less for non-observable functioning (e.g. emotional or social HRQoL). Three studies assessed whether parents perceive the illness to have a greater impact than their child, but no clear conclusions could be drawn given differences in measures used. Agreement is better between parents and chronically sick children compared with parents and their healthy children, but no effects were found for age or gender. All of these results may be dependent on the specific measure of HRQoL employed. There remain strong arguments for obtaining information from both parents and children whenever possible.