Mental Health Component Scores Research Articles

Association between diabetes-specific health literacy and health-related quality of life among elderly individuals with pre-diabetes in rural Hunan Province, China: a cross-sectional study

ObjectivesTo examine the association between diabetes-specific health literacy (DSHL) and health-related quality of life (HRQoL) among elderly individuals with pre-diabetes in rural China.Design, setting and participantsThis cross-sectional study included 434...

MON-LB042 Health-Related Quality of Life in Women with Polycystic Ovary Syndrome/Anovulatory Androgen Excess versus Local Population-Based Control Women (from the British Columbia Canadian Multicentre Osteoporosis Study [BC CaMos

Polycystic Ovary Syndrome (PCOS) affects 5-20% of reproductive-aged women and is associated with lower Health-Related Quality of Life (HRQoL)1,2,3. HRQoL in PCOS, however, is often determined in small or clinical samples with no or convenience sample controls. Our aim was to cross-sectionally compare generic SF-36 HRQoL results in community dwelling, physician-diagnosed women with PCOS to randomly selected age-similar local women. Women with PCOS/AAE had enrolled in two local studies (n = 93)4, and were eligible if they were non-menopausal and had PCOS based on Androgen Excess/PCOS Society criteria. Eligibility in both groups required age ≤53 years and, for controls, menstruation in the last year. Control women were from both Adult and Youth BC CaMos cohorts (n = 56). All completed the interviewer-administered CaMos questionnaire5. Statistical analysis used descriptive, T-test and multiple regression to explore relationships among HRQoL domains/component scores versus demographic, anthropomorphic and comorbid condition variables, particularly body mass index (BMI), physical activity patterns and combined hormonal contraceptive (CHC) usage. We compared SF-36 data in pre/perimenopausal women mean aged 34.5±10.0 (SD) years, BMI 27.5±7.5. After controlling for BMI, education, comorbidities and past use of CHC, all HRQoL domain and component scores were significantly lower in women with PCOS then in controls. Domain score differences of 5 are clinically important; PCOS women scored -5.8 to -19.9 points lower (mean -11.6) with the greatest difference for Emotional Role. The Physical Component summary score was -2.2 and the Mental Component summary -7.2 lower in women with PCOS compared with population-based controls; score differences of 2-3 are considered clinically important. In both groups, participation in regular exercise was the strongest predictor of higher overall HRQoL. In both cohorts, comorbidity negatively predicted the physical component score (PCS) of HRQoL; PCOS status negatively predicted the mental component score of HRQoL. PCS group differences became less significant as BMI increased, but MCS remained significantly different. This first comparison of the validated, generic SF-36 in pre/perimenopausal population-based versus women with PCOS documented highly significantly lower scores in women with PCOS on all domains and both components. These data confirm evidence that participation in regular exercise is related to better overall HRQoL in PCOS. Also, obesity in women with PCOS, in contrast to controls, was not associated with the overall HRQoL. We also found that CHC was associated with general health, mental health and mental component scores in women with PCOS. Ref.1Prior JCEM 2014; 2Alvarez-Blasco Clin Endo 2010; 3Azziz Fertil Steril 2009; 4Kalyan Sci Reports 2017; 5Kreiger Can J. Aging 1999. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population

BackgroundMental health problems have an adverse effect on the course of cardiac disease. The integration of their diagnosis and treatment into cardiology care is generally poor. It is particularly challenging in cultural environments where mental health problems are stigmatized. The objective of the current study was to investigate the proportion of cardiac patients with depression and anxiety as well as factors associated with the presence of these symptoms in a Palestinian population.MethodsThis cross-sectional hospital-based study was conducted on patients consecutively admitted with a new or existing cardiac diagnosis to one of the four main hospitals in Nablus, Palestine over an eight-month period. Data was obtained from hospital medical charts and an in-person interview, using a structured questionnaire with a sequence of validated instruments. All subjects were screened for depression and anxiety using the Cardiac Depression Scale (CDS) and the Depression Anxiety Stress Scale (DASS-42). Multivariate ordered logistic regression analyses were performed to identify factors among four categories (socio-demographic, clinical, psychosocial, lifestyle) independently associated with depression and anxiety.ResultsIn total, 1053 patients with a confirmed cardiac diagnosis were included in the study with a participation rate of 96%. Based on the CDS and DASS-42, 54% met the criteria for severe depression (CDS > 100) and 19.2% for severe-to-very severe anxiety (DASS-anxiety > 15), respectively. Symptoms of depression and anxiety were more prevalent among females and less educated patients. Factors independently associated with both depressive and anxiety symptoms were post-traumatic stress disorder symptoms, low level of self-esteem, high somatic symptoms, low physical and mental health component scores, active smoking, physical inactivity, and longer disease duration. Patients with depressive and anxiety symptoms also reported poor social support and lower resilience.ConclusionThere was a high level of depression and anxiety in this sample of cardiac patients. The results point to characteristics of patients in particular need for mental health screening and suggest possible targets for intervention such as strengthening of social support and of physical activity. The integration of mental health services into cardiac rehabilitation in Palestine and comparable cultural settings is warranted from the time of first diagnosis and onward.

The effect of forensic events on health status and housing stability among homeless and vulnerably housed individuals: A cohort study.

We sought to characterize the association between a forensic event (arrest or incarceration) with housing vulnerability and mental and physical health status over a four-year follow-up among a cohort of homeless and vulnerably housed individuals in Vancouver, Toronto and Ottawa. Data were obtained from the Health and Housing in Transition Study, a prospective cohort study of homeless and vulnerably housed individuals between 2009 and 2012. Participants were interviewed in-person at baseline (N = 1190) and at four annual follow-up time points. We used generalized estimating equations to characterize the independent associations between a forensic event and the number of residential moves and SF-12 physical and mental health component scores over the four-year follow-up period. We analyzed data from 1173 homeless and vulnerably housed participants. Forensic events were reported by 446 participants at baseline. In multivariate analyses, a history of forensic event in the preceding twelve months was independently associated with an increased number of residential moves over the four-year follow-up period (ARR 1.24; 95% CI 1.19–1.3). It was not, however, independently associated with a change in physical or mental health status (respective ß-estimates; 95% CI: -0.34; -1.02, 0.34, and -0.69; -1.5, 0.2). Female gender and a history of problematic substance use were significantly associated with all three primary outcomes. This suggests arrest or incarceration is associated with increased housing vulnerability. The results underline the importance of supporting individuals experiencing arrest or incarceration with post-release planning in order to obtain stable housing after discharge.

Gender differences and burden of chronic conditions: impact on quality of life among the elderly in Taiwan.

Multiple chronic conditions affect people's health-related quality of life (QoL) and the distributions of the conditions may differ between genders. Our goal was to examine gender differences in chronic conditions and QoL among community-living elderly in Taiwan and to examine whether differences in QoL between genders, if present, were attributable to the distribution of chronic conditions. We used data from the Nutrition and Health Survey in Taiwan (NAHSIT, 2005-2008), which interviewed a representative sample of the Taiwanese population. The survey questions included the SF-36 questionnaire to assess participants' QoL and items for participants' medical history. We used multiple linear regressions to examine the difference in QoL between genders. We included 1179 elders for our analysis; men accounted for 52% (612/1179). The mean age was 73; women were slightly younger. The mean (standard deviation) of SF-36 physical and mental health component score (PCS and MCS) was 44.5 (11.1) and 55.6 (9.0), respectively, and women reported a significantly lower PCS than men (difference - 4.85, p < 0.001). Urinary incontinence, arthritis, stroke, and kidney disease were associated with a clinically meaningful decrease in PCS (≤ - 6.5 points). The difference in PCS between genders was not attenuated after we accounted for chronic conditions in regression analysis. Our findings suggest that women tend to report that their physical health-related QoL is poorer than that of men, and such a difference does not seem to be attributable to the distribution of chronic conditions. Elderly men and women may perceive health-related QoL differently.

Relative health-related quality of life after treatment of unruptured intracranial aneurysms: long-term outcomes and influencing factors.

Health-related quality of life (HRQOL) is an important clinical outcome parameter. Its analysis is particularly meaningful to patients with minor functional impairment. The main goal of this study was to assess long-term data of HRQOL and their variables for patients undergoing treatment for unruptured intracranial aneurysms (UIAs). Therefore, a cross-sectional study of HRQOL (SF-36 questionnaire) was conducted in patients treated for UIA using a telephone survey assessing numerous medical and sociodemographic variables. A total of 96 patients with a follow up longer than 36 months post-treatment were included. HRQOL results were compared with the German reference population. Uni- and multivariate analyses were performed to detect variables with an impact on outcome. After a mean follow up of 57.75 ± 13.56 months, patients with treated UIAs showed a significant decrease in the mental health domains ‘role emotional’ and ‘social functioning’ and the ‘mental health component score’ (MHCS) compared with the age- and sex-matched reference population. Overall, 47% of the patients showed a clinically and psychosocially relevant decrease compared with the mean MHCS of the reference population. Multivariate analysis suggests that mainly the treatment modality (coiling versus clipping) and additional remaining untreated UIAs negatively impacted mental HRQOL. In conclusion, the partly significant losses in HRQOL identify the necessity for less-wearing treatment strategies and a better prediction of risk of UIA rupture. Our results indicate that certain factors in the guidance and management of patients undergoing endovascular treatment may negatively affect their mental HRQOL. The relevance of additional UIAs remaining untreated on HRQOL is a new finding that should be considered in the counseling of patients with multiple UIAs.

The impact of preexisting disease on outcomes of simple orthopaedic trauma: A prospective cohort study

BackgroundThis article describes a prospective cohort study trial which aims to determine what risk factors might be associated with increased levels of pain, disability and psychological distress following simple orthopaedic trauma. MethodsPatients were recruited from two large tertiary referral hospitals. Outcome measures were return to work, measurement of the visual analogue scale for pain and the SF 12 physical component score (PCS) and mental health component score. ResultsFifty-five participants were recruited. Overall, participants had significant improvement in their levels of pain, and all who were working before the injury returned to work. Those with a preexisting disease had a significantly lower (p = 0.007) initial PCS with no significant changes in either mental health component score or PCS. ConclusionsDifferences in outcomes were observed in patients with and without preexisting disease.

Improvements in Health-Related Quality of Life With Electroconvulsive Therapy: A Meta-analysis.

Although the antidepressant efficacy of ECT is well documented, patient-reported outcomes after this treatment are less well characterized. The aims of the current meta-analysis are to quantify the impact of an acute course of ECT on health-related quality of life (HRQoL) and to identify related moderators, specifically post-ECT depressive symptom remission and patient age. We searched PubMed, PsycINFO, and Web of Science databases for randomized and nonrandomized studies that report on changes in HRQoL measures after an acute course of ECT. Only studies that used the Medical Outcomes Study Short Form 36 (SF-36) instrument were included. A random effects model using the Hedges' g effect size was used in calculating the pre-post ECT outcomes on all 8 SF-36 subscales and the SF-36 total scores including the physical and mental composite scores. Subgroup analyses were conducted using remission status and age as moderators. Four studies contributed to this analysis. Significant improvements across all subscales of the SF-36 were observed. Large and very large effect sizes were present for both the SF-36 physical component score (PCS) and mental health component score (MCS), with the change in MCS being statistically superior to the PCS (MCS, Hedges' g = 1.28; 95% confidence interval, 1.15-1.42; PCS, Hedges' g = 0.97; 95% confidence interval, 0.86-1.07). Medium, large, and very large effect sizes were observed for SF-36 subscales scores. Post-ECT depression remission status was related to HRQoL improvement, with statistically significant differences present between remitters and nonremitters for PCS, MCS, and most SF-36 subscale scores. No significant differences were observed in improvement in HRQoL with ECT based on patient age. An acute course of ECT for depressive symptoms produces medium to very large effect size improvements in HRQoL across multiple components and subscales measured by the SF-36. The magnitude of the effects reported by ECT patients is greater than those that have been reported in other open-label studies of brain stimulation techniques. This study confirms that ECT plays a vital role in the treatment of the most severely ill patients with depressive disorders.

An Australian survey on health and injuries in adult competitive surfing.

There is limited research that explores health and injuries of surfers. The aim of this study is to describe the health and injury profile of adult Australian competitive surfers. In this cross-sectional study, all registered participants at the 2014 Australian Surfing Titles were invited to complete an online survey comprising: 1) demographic and surfing information; 2) health-related quality of life using the SF-12 questionnaire; and 3) surfing injury history. Descriptive statistics were used to describe the survey responses. The sample consisted of 227 (77% male) surfers with mean age of 35.0±13.2 years. They spent on average, 10.0±6.5 hours per week surfing. The mean SF-12 physical and mental health component scores were significantly higher than the population norm at 53.3±5.4 and 55.6±6.2, respectively. A total of 175 (81%) respondents reported incurring at least one surfing-related injury in their lifetimes, while 90 (58%) respondents reported incurring at least one surfing-related injury in the current season. The most commonly injured body regions were the lower back, foot, knee, and ankle, while the most frequent types of injury were abrasion and laceration. Although adult Australian competitive surfers report greater physical and mental health-related quality of life compared to the general population, surfing-related injuries are relatively common. The present study reveals a higher burden of lower back injuries compared to previous reports as well as differences in injury profiles amongst the surfing disciplines.

Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data.

ObjectivesRacism is an important health determinant that contributes to ethnic health inequities. This study sought to describe New Zealand adults’ reported recent experiences of racism over a 10 year period. It also sought to examine the association between recent experience of racism and a range of negative health and wellbeing measures.MethodsThe study utilised previously collected data from multiple cross-sectional national surveys (New Zealand Health Surveys 2002/03, 2006/07, 2011/12; and General Social Surveys 2008, 2010, 2012) to provide prevalence estimates of reported experience of racism (in the last 12 months) by major ethnic groupings in New Zealand. Meta-analytical techniques were used to provide improved estimates of the association between recent experience of racism and negative health from multivariable models, for the total cohorts and stratified by ethnicity.ResultsReported recent experience of racism was highest among Asian participants followed by Māori and Pacific peoples, with Europeans reporting the lowest experience of racism. Among Asian participants, reported experience of racism was higher for those born overseas compared to those born in New Zealand. Recent experience of racism appeared to be declining for most groups over the time period examined. Experience of racism in the last 12 months was consistently associated with negative measures of health and wellbeing (SF-12 physical and mental health component scores, self-rated health, overall life satisfaction). While exposure to racism was more common in the non-European ethnic groups, the impact of recent exposure to racism on health was similar across ethnic groups, with the exception of SF-12 physical health.ConclusionsThe higher experience of racism among non-European groups remains an issue in New Zealand and its potential effects on health may contribute to ethnic health inequities. Ongoing focus and monitoring of racism as a determinant of health is required to inform and improve interventions.

Changes in biopsychosocial outcomes for a mixed cohort of ICU survivors.

BackgroundProlonged inflammation and infection associated with being critically ill and the ensuing physical inactivity has proven negative effects on the recovery of physical function, psychological health and reintegration into society for intensive care unit (ICU) survivors. Limited evidence is available on changes in biopsychosocial outcomes for South Africans recovering from an episode of critical illness.ObjectivesTo determine changes in biopsychosocial outcomes for a mixed cohort of ICU survivors in hospital and at 1 month and 6 months after discharge.MethodA prospective, observational, longitudinal study was conducted. Severity of illness, mechanical ventilation (MV) duration and ICU and hospital length of stay (LOS) were recorded. Physical function in ICU test-scored (PFIT-s) was performed at discharge from ICU and hospital. At 1 month and 6 months, peripheral muscle strength, exercise endurance, health-related quality of life (HRQOL), depression status and return to work were assessed. Descriptive and inferential statistics were used.ResultsParticipants (n = 24) had a median age of 51.5 years, majority were male (n = 19; 79%) and most were employed before admission (n = 20; 83%). At 6 months, 11 participants (n = 11) were part of the final sample. Median PFIT-s changed significantly (0.3 points; p = 0.02) between ICU and hospital discharge. Peripheral muscle strength improved significantly for upper and lower limbs over 6 months (p = 0.00–0.03) but change in median 6-minute walk test distance (65m) was not significantly different. Significant improvements occurred in mean Medical Outcomes Short Form-36 (SF-36) physical health component scores (8.8 ± 7.6; p = 0.00). Mean SF-36 mental health component scores had a strong negative relationship with MV duration (r = −0.7; p = 0.01), LOS (r = −0.56; p = 0.04) and Patient Health Questionnaire 9 scores (r = −0.72; p = 0.01). Six participants (55%) returned to employment.ConclusionClinically important improvements in biopsychosocial outcomes related to physical function and social factors were observed. Limitations in mental aspects of HRQOL were present at 6 months and some reported mild depressive symptoms.Clinical implicationsIntensive care unit survivors with a history of prolonged MV duration and hospital LOS who exhibit limitations in mental HRQOL, and signs of depressive symptoms should be referred to a psychologist for evaluation.

Effects of depression and anxiety on quality of life in five common neurological disorders.

It is unclear whether anxiety and depression impact health-related quality of life (HRQoL) equally across neurological diseases. This study examines the association between anxiety or depression and HRQoL in select neurological disorders. HRQoL was measured using the Short Form Health Survey (SF-12) in neurological patients: epilepsy (n = 279), migraine (n = 268), multiple sclerosis (MS) (n = 222), stroke (n = 204), and Parkinson's disease (PD) (n = 224). Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and Hospital Anxiety and Depression Scale (HADS-A), respectively. Multiple linear regression was used to evaluate variables associated with the SF-12 mental health component (MCS) and physical health component scores (PCS). Pratt index was used to estimate the relative importance of anxiety and depression on HRQoL. Anxiety and depression had the largest contribution to PCS in stroke and to MCS in epilepsy. Overall, anxiety and depression had a larger contribution to MCS as compared to PCS, except in stroke patients. Different patterns were seen across neurological diseases, with mental health variables strongly affecting MCS in all conditions, with also a sizable contribution to PCS in migraine, MS, and stroke. Anxiety and depression have varying impacts on HRQoL across neurological diseases. It is important for clinicians to be aware of how these patterns differ in each condition.

Health-Related Quality of Life among Chronic Opioid Users, Nonchronic Opioid Users, and Nonopioid Users with Chronic Noncancer Pain.

Evaluate the association between opioid therapy and health-related quality of life (HRQoL) in participants with chronic, noncancer pain (CNCP). Medical Expenditure PanelSurvey Longitudinal, Medical Conditions, and Prescription Files. Using a retrospective cohort study design, the Mental Health Component (MCS12) and Physical Health Component (PCS12) scores of the Short Form-12 Version 2 were assessed to measure mental and physical HRQoL. Chronic, noncancer pain participants were classified as chronic, nonchronic, and nonopioid users. One-to-one propensity score matching was employed to match chronic opioid users to nonchronic opioid users plus nonchronic opioid users and chronic opioid users to nonopioid users. A total of 5,876 participants were identified. After matching, PCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff=-0.98, 95% CI: -2.07, 0.10), chronic versus nonopioid users (LSM Diff=-2.24, 95% CI: -4.58, 0.10), or chronic versus nonchronic opioid users (LSM Diff=-2.23, 95% CI: -4.53, 0.05). Similarly, MCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff=0.76, 95% CI: -0.46, 1.98), chronic versus nonopioid users (LSM Diff=1.08, 95% CI: -1.26, 3.42), or chronic versus nonchronic opioid users (LSM Diff=-0.57, 95% CI: -2.90, 1.77). Clinicians should evaluate opioid use in participants with CNCP as opioid use is not correlated with better HRQoL.

The Effects of Exercise on Physical and Psychological Outcomes in Cancer Caregivers: Results From the RECHARGE Randomized Controlled Trial.

Family caregivers to cancer patients are at risk for physical and psychological morbidity as a direct result of being in the caregiver role. Exercise as an intervention to support caregiver health and well-being has been tested in other caregiver populations; however, no randomized controlled trials testing the effects of an aerobic and resistance training program have been conducted where cancer caregivers only have participated. To examine the effects of a 12-week exercise program on quality of life (Short Form 36 v2), psychological outcomes, physical activity levels, and physical fitness in caregivers to cancer patients. Seventy-seven caregivers were randomized to either an exercise intervention or wait-list control. Two participants in the exercise arm dropped out immediately after their baseline assessment. Outcome data for n = 77 participants were analyzed using intention-to-treat analysis with linear mixed models. Significant group by time interaction effects were detected for exercise on the mental health component score of quality of life, self-reported weekly exercise levels, and the six-minute walk test. Small to medium effect sizes were detected on several outcomes including physical health component of quality of life (d = 0.36), mental health component of quality of life (d = 0.74), depression (d = 0.41), anxiety (d = 0.35), physical activity levels (d = 0.80), and the six-minute walk test (d = 0.21). The findings suggest that exercise may improve health and well-being and could be considered as an additional type of support offered to cancer caregivers. NCT02580461.

Long-Term Functional Outcomes after Traumatic Thoracic and Lumbar Spine Fractures

The incidence of thoracolumbar spine fractures in blunt trauma is 4 to 5 per cent. These fractures may lead to neurologic injury, chronic back pain, and disability. Most studies from United States trauma centers focus on neurologic sequelae and/or compare treatment modalities. However, most patients with spine fractures do not have a neurologic deficit. Our primary objective was to determine the long-term outcome of traumatic thoracolumbar spine fractures, specifically addressing quality of life, chronic pain, and employment using a validated patient outcome survey. A chart review of 138 adult blunt trauma patients who sustained a thoracolumbar spine fracture and were admitted to our Level I trauma center from 2008 to 2013 was performed. A phone interview based on the Short-Form 12®, a general health survey, was then conducted. Of the 134 patients who met the inclusion criteria, 46 (34%) completed the survey. The average Short-Form 12® scores were 51.0 for the physical health component score and 52.9 for the mental health component score. These did not differ significantly from the national norm. Furthermore, 83 per cent (38) of the survey respondents returned to work full-time at the same level as before their injury. Majority of the patients (76%) said they did not have pain two to seven years after injury. Despite a commonly held belief that back injury leads to chronic pain and disability, after sustaining a thoracic or lumbar fracture, patients are generally able to return to work and have a comparable quality of life to the general population. This knowledge may be useful in counseling patients regarding expectations for recovery from trauma.

Satisfaction Rates and Quality of Life Changes Following Total Knee Arthroplasty in Age-Differentiated Cohorts

BackgroundComparisons of satisfaction rates following total knee arthroplasty (TKA) among large, age-differentiated, rigorously matched cohorts are lacking. Therefore, we compared satisfaction rates following TKA in large, age-differentiated, propensity score-matched cohorts. MethodsWe identified primary TKAs performed for non-inflammatory arthritis in patients of ages 18-55 or 65-75, yielding 529 younger and 2001 older patients. Patient-reported outcomes were recorded pre-operatively and 2 years post-operatively. 1:1 propensity score matching between groups yielded 529 patient pairs. Matching was based on gender, body mass index, American Society of Anesthesiologists grade, Charlson Comorbidity Index, and Short Form 12 Mental Health Component score. Outcomes were compared between matched groups using t-test and Wilcoxon rank-sum test. ResultsSatisfaction with knee surgery was 86% among younger patients and 91% among older patients. Distribution of satisfaction responses was shifted toward greater satisfaction in older patients (P < .001). Overall quality of life (QOL) improvement was 91% among younger patients and 96% among older patients. Pre-operative and post-operative knee-related QOL was better among older patients (P < .0001). Post-operative global health-related QOL was equivalent between groups based on Short Form 12 Physical Component Score and Mental Health Component score (P = .6646 and P = .5705, respectively) and QOL improvement questionnaires (P = .181). Younger patients reported greater knee-related dysfunction and higher activity levels pre-operatively and post-operatively (P ≤ .0002). ConclusionSatisfaction with knee surgery was over 85% regardless of age. Younger patients perceived more knee-related dysfunction and dissatisfaction after surgery despite higher levels of self-reported activity pre-operatively and post-operatively.

The Onset of ADL Difficulties and Changes in Health-Related Quality of Life

BackgroundThe effect of the onset of difficulties with activities of daily living (ADLs) on the health-related quality of life (HRQoL) of older adults is not well understood. We identified strong longitudinal associations between ADL onset and HRQoL changes for older adults in Medicare Advantage Organizations (MAOs).MethodsWe analyzed 473,282 age-eligible MAO beneficiaries in the 2008-2013 Medicare Health Outcomes Surveys (M-HOS) who reported no ADL difficulties at baseline and completed their two-year follow-ups in 2010-2015. The four HRQoL measures were the physical and mental health component scores (PCS and MCS) from the SF-12V, and the CDC’s counts of physically unhealthy and mentally unhealthy days (PUD and MUD) in the past month. Ordinary least squares (OLS) and zero-inflated negative binomial regressions were used.ResultsThe onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet significantly reduced PCS scores by 10.84, 11.29, 9.18, 8.98, 9.49 and 10.67 points, and MCS scores by 7.93, 8.72, 10.13, 5.34, 4.37 and 9.00 points, respectively. The onset of difficulty/inability in bathing, dressing, eating, getting in/out of chairs, walking, and using the toilet increased PUD days by 6.24, 6.83, 6.34, 4.93, 4.96 and 6.72 days, and MUD days by 3.00, 3.19, 3.54, 2.26, 2.07 and 3.27 days, respectively.ConclusionsThere is robust evidence that the onset of ADL difficulties/inabilities significantly and substantially reduced age-eligible MAO beneficiaries’ HRQoL. Prevention strategies focused on ADLs would benefit the performance of MAOs.

Health impacts of UK Lone Parent Obligations: a natural experiment study using data from the UK household panel survey, Understanding Society

BackgroundIn the UK, lone mothers receiving income support are required to seek work as a condition of receiving that support once their youngest child reaches a specified age. Since 2008, the lower age limit at which these so-called Lone Parent Obligations (LPO) apply has been reduced in steps. We aimed to assess the health impact of exposing increasing numbers of lone parents to welfare conditionality. MethodsWe carried out a natural experimental study in the UK using data from Understanding Society, a UK household longitudinal panel study (2009–13). The primary outcome was the mental health component of SF-12. The physical health component of SF-12 and self-rated health were secondary outcomes. Lone mothers newly exposed to LPO when the age limit was reduced to 7 years old and then to 5 (two intervention groups) were compared with lone mothers who remained unexposed (control 1) or who were exposed before the change (control 2). A difference-in-difference linear regression analysis was conducted on an intention-to-treat basis, adjusting for maternal age, education, and number of children. FindingsThe total sample size was 2359, 291 in the intervention groups (146 age 7 years, 145 age 5 years) and 1966 in the control groups (711 control 1, 1357 control 2). Mental health of lone mothers declined in intervention groups compared with control groups. The mental health component score for lone mothers newly exposed to LPO with children aged 4–6 years changed by −1·39 (95% CI −4·08 to 1·29) compared with unexposed lone mothers and by −2·29 (−4·57 to 0·00) compared with previously exposed lone mothers. Data for the two intervention groups combined were, respectively, −2·13 (−4·17 to −0·10) and −2·21 (−4·13 to −0·30). No impact on SF-12 physical health component scores or on self-rated health was found. InterpretationIn the UK, welfare conditionality appears to have adversely impacted mental health of lone mothers. The study only investigated short-term effects, but the pattern of findings was consistent over the two age comparison groups. Welfare conditionality is increasingly common in high-income countries; possible adverse impacts should be considered rather than assuming that all impacts will be positive. Further research should ascertain longer-term effects of exposure to LPO and the effects of the further reduction in the age threshold from 5 to 3 years in 2017. FundingNHS Research Scotland senior clinical fellowship (SCAF/15/02), Medical Research Council (MC_UU_12017/13 & MC_UU_12017/15), Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15).

Effects of allergy and trait anxiety on heart rate variability: A naturalistic design study

It is unclear whether anxiety and depression impact health-related quality of life (HRQoL) equally across neurological diseases. This study examines the association between anxiety or depression and HRQoL in select neurological disorders.HRQoL was measured using the Short Form Health Survey (SF-12) in neurological patients: epilepsy (n = 279), migraine (n = 268), multiple sclerosis (MS) (n = 222), stroke (n = 204), and Parkinson's disease (PD) (n = 224). Depression and anxiety symptoms were assessed using the Patient Health Questionnaire (PHQ-9) and Hospital Anxiety and Depression Scale (HADS-A), respectively. Multiple linear regression was used to evaluate variables associated with the SF-12 mental health component (MCS) and physical health component scores (PCS). Pratt index was used to estimate the relative importance of anxiety and depression on HRQoL.Anxiety and depression had the largest contribution to PCS in stroke and to MCS in epilepsy. Overall, anxiety and depression had a larger contribution to MCS as compared to PCS, except in stroke patients. Different patterns were seen across neurological diseases, with mental health variables strongly affecting MCS in all conditions, with also a sizable contribution to PCS in migraine, MS, and stroke.Anxiety and depression have varying impacts on HRQoL across neurological diseases. It is important for clinicians to be aware of how these patterns differ in each condition.

Neuropsychiatric symptoms in systemic lupus erythematosus: impact on quality of life.

ObjectiveAssess quality of life in patients with systemic lupus erythematosus (SLE) presenting with neuropsychiatric symptoms (neuropsychiatric SLE, NPSLE).MethodsQuality of life was assessed using the Short-Form 36 item Health Survey (SF-36) in patients visiting the Leiden NPSLE clinic at baseline and at follow-up. SF-36 subscales and summary scores were calculated and compared with quality of life of the general Dutch population and patients with other chronic diseases.ResultsAt baseline, quality of life was assessed in 248 SLE patients, of whom 98 had NPSLE (39.7%). Follow-up data were available for 104 patients (42%), of whom 64 had NPSLE (61.5%). SLE patients presenting neuropsychiatric symptoms showed a significantly reduced quality of life in all subscales of the SF-36. Quality of life at follow-up showed a significant improvement in physical functioning role (p = 0.001), social functioning (p = 0.007), vitality (p = 0.023), mental health (p = 0.014) and mental component score (p = 0.042) in patients with neuropsychiatric symptoms not attributed to SLE, but no significant improvement was seen in patients with NPSLE.ConclusionQuality of life is significantly reduced in patients with SLE presenting neuropsychiatric symptoms compared with the general population and patients with other chronic diseases. Quality of life remains considerably impaired at follow-up. Our results illustrate the need for biopsychosocial care in patients with SLE and neuropsychiatric symptoms.