Lower Mental Health-related Quality Research Articles

Lower mental health related quality of life precedes dementia diagnosis: findings from the EPIC-Norfolk prospective population-based study

Lower Health Related Quality of Life (HRQoL) precedes dementia in older adults in the USA. We explore prospective associations between HRQoL and dementia in British adults in mid and late-life, when interventions to optimise cognitive ageing may provide benefit. 7,452 community-dwelling participants (57% women; mean age 69.3 ± 8.3 years) attended the European Prospective Investigation of Cancer-Norfolk study’s third health check (3HC) and reported their HRQoL using Short-Form 36 (SF-36). Cox Proportional Hazard regression models explored associations between standard deviation differences in baseline Physical Component (PCS) and Mental Component Summary (MCS) scores, as well as eight SF-36 sub-scales (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health), and incident dementia over ten years. Logistic regression models explored cross-sectional relationships at the 3HC between HRQoL and objective global cognitive function (n = 4435; poor cognition = lowest performance decile). The cohort was examined as a whole and by age-group (50–69, ≥ 70), considering socio-demographics and co-morbidity. Higher MCS scores were associated with lower chance of incident dementia (Hazard Ratio [HR] = 0.74, 95% CI 0.68–0.81) and lower odds of poor cognition (Odds Ratio [OR] = 0.82, 0.76–0.89), with findings similar by age-group. Higher PCS scores were not associated with dementia in the whole cohort (HR = 0.93, 0.84–1.04) or considering age-groups; and were only associated with poor cognition in younger participants (OR = 0.81, 0.72–0.92). Similarly, associations between higher scores on subscales pertaining to mental, but not physical, HRQoL and lower dementia incidence were observed. Lower mental HRQoL precedes dementia diagnosis in middle-aged and older British adults.

Survivors’ knowledge of their diagnosis, treatment and possible late adverse effects after autologous stem cell transplantation for lymphoma

Purpose: Lymphoma survivors after high dose therapy with autologous stem cell therapy (HD-ASCT) are at high risk for late adverse effects (AEs). Information patients receive and collect throughout their cancer trajectory about diagnosis, treatment schedule and risks of AEs may influence attitudes and health-related behavior in the years after treatment. The purpose of this study was to explore level of knowledge in lymphoma survivors after HD-ASCT at a median of 12 years after primary diagnosis.Material and methods: From a national study on the effects of HD-ASCT for lymphomas, 269 survivors met for an outpatient examination, including a structured interview addressing knowledge about diagnosis and treatment. Survivors were also asked whether they knew and/or had experienced certain common late AEs. Numbers of recognized and experienced late AEs were presented as sum scores. Factors associated with the level of knowledge of late AEs were analyzed by linear regression analysis.Results: Eighty-one percent of the survivors knew their diagnosis, 99% knew the components of HD-ASCT and 97% correctly recalled having had radiotherapy. Ninety percent reported awareness of late AEs, but the level of knowledge and personal experience with specified AEs varied. Thirty-five percent of survivors stated to have received follow-up for late AEs. In multivariable analysis younger age at diagnosis, having received mediastinal radiotherapy, higher mental health related quality of life, a higher number of self-experienced late AEs and having received follow-up care for late AEs were significantly associated with a higher level of knowledge of AEs.Conclusion: The majority of lymphoma survivors treated with HD-ASCT correctly recalled diagnosis and treatment, while knowledge of late AEs varied. Our findings point to information deficits in survivors at older age and with lower mental health related quality of life. They indicate benefit of follow-up to enhance education on late AEs in lymphoma survivors.

Depressive symptoms, mental health-related quality of life, and survival among older patients with multiple myeloma.

e18232 Background: Few studies have evaluated the impacts of depressive symptoms and mental health on patients diagnosed with multiple myeloma (MM). The aim of this study was to examine associations between depressive symptoms and poor mental health-related quality of life in relation to survival in a cohort of older MM patients. Methods: We conducted an analysis using a prospective cohort from the Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) of patients aged 65 years and older diagnosed with first primary MM between 1998 and 2014. Subjects were required to have completed at least 1 pre-diagnosis survey and depressive symptoms were determined based on positive responses to at least 1 of 3 depression screening questions. Veterans-RAND-12 mental component scores (MCS) were also analyzed to evaluate mental health-related quality of life. We used multivariable Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between pre-diagnosis depressive symptoms and risks of all-cause and cancer-specific mortality. Secondary analyses examined mortality risks in relation to pre-diagnosis MCS. Results: Of 522 multiple myeloma patients, the mean (SD) age at diagnosis was 76.9 (6.1) years and 158 (30%) self-reported positive depressive symptoms. Patients with depressive symptoms had a higher number of comorbid conditions and nearly all (84%) scored below the median MCS. Pre-diagnosis depressive symptoms were not associated with all-cause (HR 1.01, 95% CI: 0.79-1.29) or cancer-specific mortality (HR 0.94, 95% CI: 0.69-1.28). Myeloma patients scoring in the second MCS tertile (versus the highest tertile) had a modestly increased risk of all-cause (HR 1.19, 95% CI 0.91-1.55) and cancer-specific mortality (HR 1.17, 95% CI 0.86-1.60), but these estimates were not statistically significant. Conclusions: Pre-diagnosis depressive symptoms and lower mental health-related quality of life are not associated with survival for MM. Nevertheless, the considerably high prevalence of depressive symptoms and poor mental health status among older patients with multiple myeloma deserves clinical attention.

Comparison of mental health treatment status and use of antidepressants in men and women with eating disorders

ABSTRACTMental health treatment status and antidepressant use were investigated among men and women with an eating disorder (ED) who were interviewed in a general population survey of 3005 adults (aged ≥15 years). Compared to women, men with an ED were significantly less likely to receive treatment for a mental health problem or to be currently using an antidepressant. On multivariate analyses, female gender, lower mental health-related quality of life, and lower weight/shape overvaluation were significant predictors of receiving treatment and antidepressant use. Treatment was less likely in men and in people with higher ED cognitions.

Do social relations buffer the effect of neighborhood deprivation on health-related quality of life? Results from the LifeLines Cohort Study

We investigated whether social relations buffer the effect of neighborhood deprivation on mental and physical health-related quality of life. Baseline data from the LifeLines Cohort Study (N=68,111) and a neighborhood deprivation index were used to perform mixed effect linear regression analyses. Results showed that fewer personal contacts (b, 95%CI: −0.88(−1.08;−0.67)) and lower social need fulfillment (−4.52(−4.67;−4.36)) are associated with lower mental health-related quality of life. Higher neighborhood deprivation was also associated with lower mental health related quality of life (−0.18(−0.24;−0.11)), but only for those with few personal contacts or low social need fulfillment. Our results suggest that social relations buffer the effect of neighborhood deprivation on mental health-related quality of life.

The Importance of Screening for Mild Depression in Adults with Diabetes

Aim: While the impact of major depression on diabetes has gained increasing attention, the role of minor depression is less well investigated. This observational study compared three groups of adults with Type 1 (T1DM) or Type 2 (T2DM) diabetes mellitus: with me) no depressive symptoms (NODEP), ii) mild depressive symptoms (MILD) and iii) moderate-to-severe symptoms (MOD/SEVERE)-on diabetes distress, psychological distress, anxiety and somatic symptoms, quality of life and HbA1c levels. Methods: 245 outpatients attending two hospital diabetes services (27% with T1DM; 73% with T2DM) completed self-report measures including patient health questionnaire (PHQ), problem areas in diabetes (PAID) scale and short form health survey (SF12). Participants were interviewed by a psychiatrist and HbA1c levels recorded. Results: Half the sample reported depressive symptoms on the PHQ-9 (29% in the MILD group, 21% in MOD/ SEVERE and the remaining 50% in the NODEP group). Compared to the NODEP group, MILD group participants had significantly higher levels of diabetes distress, psychological distress, anxiety and somatic symptoms and significantly lower mental-health related quality of life. Participants in the MOD/SEVERE group had significantly higher levels of diabetes distress, psychological distress, anxiety, and somatic symptoms than either of the other two groups, and significantly lower quality of life. The groups did not differ significantly on HbA1c. Conclusions: Mild symptoms of depression in patients with diabetes are common and are associated with higher levels of diabetes distress, psychological distress, anxiety and somatic symptoms and lower quality of life. Addressing mild depression provides a potential avenue for preventing clinical depression in patients with diabetes.

Symptom-specific course trajectories and their determinants in primary care patients with Major Depressive Disorder: Evidence for two etiologically distinct prototypes

BackgroundThe course-heterogeneity of Major Depressive Disorder (MDD) hampers development of better prognostic models. Although latent class growth analyses (LCGA) have been used to explain course-heterogeneity, such analyses have failed to also account for symptom-heterogeneity of depressive symptoms. Therefore, the aim was to identify more specific data-driven subgroups based on patterns of course-trajectories on different depressive symptom domains. MethodsIn primary care MDD patients (n=205), the presence of the MDD criterion symptoms was determined for each week during a year. Weekly ‘mood/cognition’ (MC) and ‘somatic’ (SOM) scores were computed and parallel processes-LCGA (PP-LCGA) was used to identify subgroups based on the course on these domains. The classes׳ associations with baseline predictors and 2-/3-year outcomes were investigated. ResultsPP-LCGA identified four classes: quick recovery, persisting SOM, persisting MC, and persisting SOM+MC (chronic). Persisting SOM was specifically predicted by higher baseline somatic symptomatology and somatization, and was associated with more somatic depressive symptomatology at long-term follow-up. Persisting MC was specifically predicted by higher depressive severity, thinking insufficiencies, neuroticism, loneliness and lower self-esteem, and was associated with lower mental health related quality of life and more mood/cognitive depressive symptomatology at follow-up. LimitationsThe sample was small and contained only primary care MDD patients. The weekly depression assessments were collected retrospectively at 3-month intervals. ConclusionsThe results indicate that there are two specific prototypes of depression, characterized by either persisting MC or persisting SOM, which have different sets of associated prognostic factors and long-term outcomes, and could have different etiological mechanisms.