Mental HRQoL Research Articles

The self-care practices of family caregivers of persons with poor prognosis cancer: differences by varying levels of caregiver well-being and preparedness.

Little is known about the impact of family caregiving for adults with poor prognosis cancer on caregivers' own individual self-care practices. We explored differences in caregivers' discrete self-care practices associated with varying levels of caregiver well-being, preparedness, and decision-making self-efficacy. Cross-sectional survey within eight community-based southeastern U.S. cancer centers was conducted. Family caregivers of Medicare beneficiaries ≥65years with pancreatic, lung, brain, ovarian, head and neck, hematologic, or stage IV cancer completed measures of individual self-care practices (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and sleep), well-being (anxiety, depression, and health-related quality of life [HRQoL]), preparedness, and decision-making self-efficacy. Caregivers (n=294) averaged 66years, were mostly female (72.8%), white (91.2%), Protestant (76.2%), retired (54.4%), and patients' spouse/partner (60.2%). Approximately, half were rural-dwellers (46.9%) with incomes <$50,000 (53.8%). Most provided support 6-7days/week (71%) for >1year (68%). Nearly a quarter (23%) reported high depression and 34% reported borderline or high anxiety. Low engagement in all self-care practices was associated with worse caregiver anxiety, depression, and mental HRQoL (all p values<.05). Caregivers with lower health responsibility, spiritual growth, interpersonal relation, and stress management scores had lower preparedness and decision-making self-efficacy. A significant proportion of caregivers simultaneously report low engagement in all forms of self-care practices, high depression and anxiety, and low HRQoL mental health scores. Caregiver well-being, preparedness, and decision-making self-efficacy might be optimized through interventions targeted at enhancing health responsibility, stress management, interpersonal relationships, and spiritual growth self-care practices.

Predictors of quality of life among adolescents and young adults with a bleeding disorder

BackgroundHealth-related quality of life (HRQoL) in adolescents and young adults with bleeding disorders is under-researched. We aimed to describe factors related to HRQoL in adolescents and young adults with hemophilia A or B or von Willebrand disease.MethodsA convenience sample of volunteers aged 13 to 25 years with hemophilia or von Willebrand disease completed a cross-sectional survey that assessed Physical (PCS) and Mental (MCS) Component Summary scores on the SF-36 questionnaire. Quantile regression models were used to assess factors associated with HRQoL.ResultsOf 108 respondents, 79, 7, and 14% had hemophilia A, hemophilia B, and von Willebrand disease, respectively. Most had severe disease (71%), had never developed an inhibitor (65%), and were treated prophylactically (68%). Half of patients were aged 13 to 17 years and most were white (80%) and non-Hispanic (89%). Chronic pain was reported as moderate to severe by 31% of respondents. Median PCS and MCS were 81.3 and 75.5, respectively. Quantile regression showed that the median PCS for women (61% with von Willebrand disease) was 13.1 (95% CI: 2.4, 23.8; p = 0.02) points lower than men. Ever developing an inhibitor (vs never) was associated with a 13.1-point (95% CI: 4.7, 21.5; p < 0.01) PCS reduction. MCS was 10.0 points (95% CI: 0.7, 19.3; p = 0.04) higher for prophylactic infusers versus those using on-demand treatment. Compared with patients with no to mild chronic pain, those with moderate to severe chronic pain had 25.5-point (95% CI: 17.2, 33.8; p < 0.001) and 10.0-point (95% CI: 0.8, 19.2; p = 0.03) reductions in median PCS and MCS, respectively.ConclusionsEfforts should be made to prevent and manage chronic pain, which was strongly related to physical and mental HRQoL, in adolescents and young adults with hemophilia and von Willebrand disease. Previous research suggests that better clotting factor adherence may be associated with less chronic pain.

Influence of the mental health status on a new measure of objective functional impairment in lumbar degenerative disc disease

Background ContextThe Timed Up and Go (TUG) test has recently been proposed as a simple and standardized measure for objective functional impairment (OFI) in patients with lumbar degenerative disc disease (DDD). PurposeThe study aimed to explore the relationship between a patient's mental health status and both patient-reported outcome measures (PROMs) and TUG test results. Study Design/SettingThis is a prospective institutional review board-approved two-center study. Patient SampleThe sample was composed of 375 consecutive patients scheduled for lumbar spine surgery and a healthy cohort of 110 control subjects. Outcome MeasuresPatients and control subjects were assessed with the TUG test and a comprehensive panel of subjective PROMs of pain intensity (visual analog scale [VAS]), functional impairment (Roland-Morris Disability Index [RMDI]), Oswestry Disability Index [ODI]), as well as health-related quality of life (hrQoL; Euro-Qol [EQ]-5D). MethodsStandardized age- and sex-adjusted TUG test T-scores were calculated. The dependent variable was the short-form (SF)-12 mental component summary (MCS) quartiles, and the independent variables were the TUG T-scores and PROMs. Direct and adjusted analyses of covariance were performed to estimate the interaction between the SF-12 MCS quartiles and the independent variables. ResultsIn patients, there was a significant decrease in the subjective PROMs, notably the VAS back pain (p=.001) and VAS leg pain (p=.035), as well as significant increase in the RMDI (p<.001), ODI (p<.001), and the EQ-5D index (p<.001) with every increase in the quartile of the SF-12 MCS. There were no significant group differences of OFI as measured by the TUG T-scores across the SF-12 MCS quartiles (p=.462). In the healthy control group, a significant decrease in VAS leg pain (p=.028), RMDI (p=.013), and ODI (p<.001), as well as a significant increase in the EQ-5D index (p<.001), was seen across the SF-12 MCS quartiles, whereas TUG T-scores remained stable (p=.897). ConclusionsThere are significant influences of mental hrQoL on subjective measures of pain, functional impairment, and hrQoL that might lead to bias when evaluating patients with lumbar DDD who suffer from reduced mental hrQoL. The TUG test appears to be a stable instrument and especially helpful in the evaluation of patients with lumbar DDD and mental health problems.

Pre-diagnosis health-related quality of life, surgery, and survival in women with advanced epithelial ovarian cancer: A SEER-MHOS study

ObjectiveHealth-related quality of life (HRQOL) has been found to be associated with overall survival in women with ovarian cancer. However, previous studies assessed HRQOL after surgery within clinical trial populations only. The study goal was to determine the association of pre-cancer diagnosis HRQOL with the likelihood of receiving surgery and with overall survival in a national, population-based cohort of older women with advanced ovarian cancer. MethodsThe Surveillance, Epidemiology, and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database was queried to identify 374 women aged 65years and older with advanced stage epithelial ovarian cancer from 1998 to 2011. Responses to the Short Form 36 (SF-36) and Veterans-RAND-12 (VR-12), two single-item global health questions, and Activities of Daily Living (ADLs) were abstracted. Multivariable models were used to quantify associations of HRQOL and ADL assessments with surgery and overall survival, adjusted for demographic and clinical characteristics. ResultsOf 374 women with a HRQOL assessment prior to diagnosis, 199 (53%) underwent surgery. Increases in physical and mental HRQOL domains were significantly associated with receipt of surgery. The relationship between HRQOL domains and overall survival were not statistically significant. For ADLs, only difficulty in toilet use was significantly associated with survival. ConclusionIn this population-based sample of older women with advanced epithelial ovarian cancer, pre-diagnosis HRQOL was predictive of receiving surgery, but not of overall survival.

Telephone-Delivered Stepped Collaborative Care for Treating Anxiety in Primary Care: A Randomized Controlled Trial.

Collaborative care for depression is more effective in improving treatment outcomes than primary care physicians' (PCPs) usual care (UC). However, few trials of collaborative care have targeted anxiety. To examine the impact and 12-month durability of a centralized, telephone-delivered, stepped collaborative care intervention (CC) for treating anxiety disorders across a network of primary care practices. Randomized controlled trial with blinded outcome assessments. A total of 329 patients aged 18-64 referred by their PCPs in response to an electronic medical record (EMR) prompt. They include 250 highly anxious patients randomized to either CC or to UC, and 79 moderately anxious patients who were triaged to a watchful waiting (WW) cohort and later randomized if their conditions clinically deteriorated. Twelve months of telephone-delivered CC involving non-mental health professionals who provided patients with basic psycho-education, assessed preferences for guideline-based pharmacotherapy, monitored treatment responses, and informed PCPs of their patients' care preferences and progress via the EMR. Mental health-related quality of life ([HRQoL]; SF-36 MCS); secondary outcomes: anxiety (Hamilton Anxiety Rating Scale [SIGH-A], Panic Disorder Severity Scale) and mood (PHQ-9). At 12-month follow-up, highly anxious patients randomized to CC reported improved mental HRQoL (effect size [ES]: 0.38 [95% CI: 0.13-0.63]; P = 0.003), anxiety (SIGH-A ES: 0.30 [0.05-0.55]; P = 0.02), and mood (ES: 0.45 [0.19-0.71] P = 0.001) versus UC. These improvements were sustained for 12months among African-Americans (ES: 0.70-1.14) and men (ES: 0.43-0.93). Of the 79 WW patients, 29% met severity criteria for randomization, and regardless of treatment assignment, WW patients reported fewer anxiety and mood symptoms and better mental HRQoL over the full 24-month follow-up period than highly anxious patients who were randomized at baseline. Telephone-delivered, centralized, stepped CC improves mental HRQoL, anxiety and mood symptoms. These improvements were durable and particularly evident among those most anxious at baseline, and among African-Americans and men.

The MELFO-Study: Prospective, Randomized, Clinical Trial for the Evaluation of a Stage-adjusted Reduced Follow-up Schedule in Cutaneous Melanoma Patients-Results after 1 Year.

Background Guidelines for evidence-based follow-up in melanoma patients are not available. This study examined whether a reduced follow-up schedule affects: patient-reported outcome measures, detection of recurrences, and follow-up costs.Methods This multicenter trial included 180 patients treated for AJCC stage IB-II cutaneous melanoma, who were randomized in a conventional follow-up schedule group (CSG, 4 visits first year, n = 93) or experimental follow-up schedule group (ESG, 1–3 visits first year, n = 87). Patients completed the State-Trait Anxiety Inventory, cancer worry scale, impact of events scale, and a health-related quality of life questionnaire (HRQoL, RAND-36). Physicians registered clinicopathologic features and the number of outpatient clinic visits.ResultsSociodemographic and illness-related characteristics were equal in both groups. After 1-year follow-up, the ESG reported significantly less cancer-related stress response symptoms than the CSG (p = 0.01), and comparable anxiety, mental HRQoL, and cancer-related worry. Mean cancer-related worry and stress response symptoms decreased over time (p < 0.001), whereas mental HRQoL increased over time (p < 0.001) in all melanoma patients. Recurrence rate was 9 % in both groups, mostly patient-detected and not physician-detected (CSG 63 %, ESG 43 %, p = 0.45). Hospital costs of 1-year follow-up were reduced by 45 % in the ESG compared to the CSG.Conclusions This study shows that the stage-adjusted, reduced follow-up schedule did not negatively affect melanoma patients’ mental well-being and the detection of recurrences compared with conventional follow-up as dictated by the Dutch guideline, at 1 year after diagnosis. Additionally, reduced follow-up was associated with significant hospital cost reduction.Electronic supplementary materialThe online version of this article (doi:10.1245/s10434-016-5263-7) contains supplementary material, which is available to authorized users.

Correlation between Lumbopelvic and Sagittal Parameters and Health Related Quality of Life in Adults with Lumbosacral Spondylolisthesis

Introduction The impact of sagittal plane imbalance has been demonstrated for adult deformity and pediatric spondylolisthesis. The association between lumbopelvic parameters, global sagittal balance, and health status has not been well-defined in adults with lumbosacral spondylolisthesis. The role for deformity reduction in lumbosacral spondylolisthesis in the adult has not been well-defined. The purpose of this study is to evaluate the impact of sagittal alignment and lumbosacral parameters on health status in adults with L5-S1 spondylolisthesis. Methods Secondary analysis of data from a multicenter, prospective study. Health status measures included SF-12 and SRS-30. Radiographic predictor variables included: C7 sagittal vertical axis deviation (SVA), T1 and T9 spinopelvic inclinations, pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), slip angle, Meyerding slip grade, and Labele classification. Pearson's correlations were calculated between each radiographic parameter and health status measure. Results Forty-five patients were included (male 15, female 30; average age 40.5 ± 18.7) as summarized in Table 1 . For low-grade slips, SVA had strong negative correlations with SF12-MCS, SRS-30 appearance, mental, and satisfaction domains (−0.57, −0.60, −0.58, −0.53, respectively; p &lt; 0.05). PI had strong negative correlations with SRS-30 total, mental, and subscore domains (−0.57, −0.53, −0.57, respectively; p≤0.05). SS also had a strong negative correlation with SF12-MCS (−0.61; p = 0.02), while thoracic kyphosis had a strong positive correlation with SRS-activity (0.62; p = 0.02). For high-grade slips, slip angle had a moderate negative correlation with SF12-MCS (−0.36; p = 0.05). SVA had strong negative correlations with SF12-PCS, SRS-30 appearance, activity domains (−0.48, −0.48, 0.45; p &lt; 0.05) and a moderate negative correlation with SRS-30 subscore (−0.37; p &lt; 0.05). T1PI had a moderate negative correlation with SF12-PCS and SRS-22 appearance (−0.37, −0.36; p≤0.05). Conclusion Lumbosacral spondylolisthesis in adults negatively impacts mental and physical HRQoL. While HRQoL are similar between patients with low- and high-grade slips, multiple global and local radiographic sagittal parameters negatively impact HRQoLs for both groups. Improvement of global sagittal balance and lumbopelvic parameters in adults with lumbosacral spondylolisthesis may be useful in improving health status in adults. [Table: see text]

The Effect of Preoperative Type 2 Diabetes and Physical Fitness on Mental Health and Health-Related Quality of Life after Roux-en-Y Gastric Bypass.

Objective. To investigate the predictive value of type 2 diabetes and lack of physical activity for mental health and health-related quality of life after Roux-en-Y gastric bypass. Method. Forty severely obese patients undergoing Roux-en-Y gastric bypass were included in the GASMITO study. Information about physiological and psychological factors was prospectively assessed at four time points, two times prior to surgery and two times after surgery. Measures included oral and intravenous glucose tolerance tests, VO2max test, Symptoms Checklist (SCL-90), Short Form Health Survey 36 (SF-36), Body Image Questionnaire, and a questionnaire assessing sociodemographic factors and medical status. Results. Mean % excess weight loss was 65% (±12) at 18-month follow-up and 50% of the participants with diabetes experienced total remission. Also, significant improvements were observed with regard to physical fitness, mental distress, health-related quality of life, and weight-related body image (p < 0.05). The interaction between follow-up time and type 2 diabetes at baseline significantly predicted six of the thirteen psychological subscales (p < 0.05) and, across the follow-ups, physical fitness level made modest contributions to variations in mental symptoms and HRQOL but not weight-related body image. Conclusion. The results suggest that baseline difference in mental symptoms and physical HRQOL between diabetic and nondiabetic patients declines across follow-ups and resolves around the time of surgery.

Perceived injustice after traumatic injury: Associations with pain, psychological distress, and quality of life outcomes 12 months after injury.

There is growing recognition that individuals who experience traumatic injuries perceive themselves as victims of injustice and that elevated levels of perceived injustice are associated with problematic physical and psychological outcomes. To date, research regarding injustice perception and injury outcomes has been restricted to a small number of musculoskeletal pain conditions. No research to date has examined the potential impact of perceived injustice among individuals admitted for trauma care. As part of this cross-sectional study, individuals (n = 155) admitted to a Level-1 trauma center completed measures of perceived injustice, pain, depression, posttraumatic stress, and health related (physical and mental/emotional) quality of life (HRQoL) outcomes 12 months after trauma admission. Bivariate analyses revealed significant associations between perceived injustice and demographic variables (education, income, race, and age) as well as injury-related variables (type of injury and length of hospital stay). Perceived injustice was correlated with greater pain intensity, depression, and PTSD symptoms, as well as poorer physical and mental HRQoL. Controlling for relevant demographic and injury-related variables, perceived injustice accounted for unique variance in pain intensity, depression severity, the presence and intensity of PTSD symptoms, mental HRQoL, and was marginally significant for physical HRQoL. This is the first study to examine perceived injustice in a trauma sample. Results support the presence of injustice perception in this group and its associations with pain and quality of life outcomes. Additional research is suggested to explore the impact of perceived injustice on recovery outcomes among individuals who have sustained traumatic injury.

Cancer and quality of life in spousal dyads: spillover in couples with and without cancer-related health problems.

Poor health of one spouse can adversely influence the partner's health outcomes ("spillover"). This study aimed to estimate quality of life spillover among spouses and to determine how presence of cancer influenced these effects. We examined data on husband-wife dyads with cancer-related health problems, medical events, or disabilities (n = 910) and matched comparison dyads from the 2004-2012 Medical Expenditures Panel Survey, a population-based survey of the USA. Mental and physical health-related quality of life and depressed mood were reported at two time points (T1 and T2, 11 months apart on average). Dyadic multilevel models evaluated the cross-lagged impact of HRQoL and depressed mood at T1 on spouses' HRQoL at T2, controlling for sociodemographics and health conditions. Small but statistically significant spillover was observed for mental and physical HRQoL among couples with cancer. Spillover occurred from both the spouse to the survivor and from survivor to spouse. Depressed mood, in particular, showed stronger spillover effects from the spouse to the survivor than the inverse. Similar effects were not observed in dyads without cancer. Screening for and treating poor HRQoL and depressed mood concurrently in both cancer survivors, and their spouses may positively influence HRQoL outcomes. Future research is needed to further elucidate these findings and determine whether a concurrent approach to psychosocial care in survivors and their spouses may improve long-term outcomes.

Mind and body: Mental health and health related quality of life in SCI caregivers from Neiva, Colombia.

Despite the body of research on caregivers of individuals with various types of disabilities, SCI caregivers have received comparably less attention, especially in regions like Latin America. The purpose of this study was to examine the association between HRQOL and mental health in SCI caregivers from Colombia. A cross sectional study assessed SCI caregivers (n = 40) in Neiva, Colombia. Participants completed a measure of their HRQOL (SF-36 Health Questionnaire) and four measures of mental health (Satisfaction With Life Scale, Zarit Burden Interview, Patient Health Questionnaire-9, and State-Trait Anxiety Inventory). A canonical correlation between variables revealed that 64% of the variance was shared between mental health and HRQOL. The domains that loaded highest within the canonical correlation were social functioning, general health, and anxiety, indicating that SCI caregivers with higher anxiety experienced lower social functioning and lower general health. Furthermore, 15 of the 24 bivariate correlations between mental health and HRQOL were statistically significant, suggesting a strong connection between these two sets of variables. Rehabilitation professionals in Latin America should consider the development of caregiver interventions focusing on both physical and mental health, as the two constructs are closely connected through social functioning, general health, and anxiety.

Associations of sense of coherence with psychological distress and quality of life in inflammatory bowel disease.

To investigate the relationship between sense of coherence, psychological distress and health related quality of life in inflammatory bowel disease (IBD). This cross-sectional study enrolled a consecutive sample of 147 IBD (aged 45.1 ± 14.1 years; 57.1% female) patients recruited from a tertiary gastroenterology service. Sixty-four participants met diagnostic criteria for Crohn's disease, while eighty-three patients had ulcerative colitis. Socio-demographic data (education, age, race, gender, gross monthly income and marital status), disease-related variables (illness activity, relapse rate in past 2 years, history of surgery and time since diagnosis), sense of coherence (Antonovsky's SOC scale), psychological distress symptoms (Hospital Anxiety and Depression Scale) and health-related quality of life (HRQoL; WHOQOL-Bref) were assessed. Hierarchical multiple regression analyses were performed to identify factors that are independently associated with psychological distress and HRQoL in patients with IBD and to provide indications for possible moderating or mediating effects. In addition, formal moderation and mediation analyses (Sobel tests) were performed to confirm potential moderators/mediators of the relationship between SOC, psychological distress symptoms and HRQoL. Lower SOC scores (std beta= -0.504; P < 0.001), female gender (std beta = 0.176; P = 0.021) and White race (std beta = 0.164; P = 0.033) were independently associated with higher levels of depressive symptoms, while lower levels of SOC (std beta = -0.438; P < 0.001) and higher relapse rate (std beta = 0.161; P = 0.033) were independently associated with more severe anxiety symptoms. A significant interaction between time since diagnosis and SOC was found with regard to the severity of depressive or anxiety symptoms, as the interaction term (time since diagnosis X SOC) had beta coefficients of -0.191 (P = 0.009) and -0.172 (P = 0.026), respectively. Lower levels of anxiety symptoms (std beta = -0.369; P < 0.001), higher levels of SOC (std beta = 0.231; P = 0.016) and non-White race (std beta = -0.229; P = 0.006), i.e., mixed-race, which represented the reference category, were independently associated with higher levels of overall HRQoL. Anxiety symptoms were the most potent independent correlate of most aspects of HRQoL. In addition, anxiety mediated the association between SOC and satisfaction with health, as well as its relationship with physical, mental, and social relations HRQoL. Depressive symptoms also mediated the association between SOC and mental HRQoL. Our data indicated that SOC is an important construct, as it influences psychological distress and has significant albeit indirect effects on several HRQoL domains in IBD.

A Triple Aim Framework For The Performance Assessment Of Disease Management Programs

Objectives: A structured and comprehensive assessment of disease management implementations is not straightforward due to the broadness of the interventions and the various evaluation possibilities. The aim of this study was to develop a comprehensive framework for outcome measurement of disease management programs based on the triple aim framework of the Institute for Healthcare Improvement to facilitate future performance assessment using multi-criteria decision analysis (MCDA). Methods: Based on literature review and our expertise in performing economic evaluations in disease management we identified domains of outcomes for each aim of the triple aim framework. For each domain we identified indicators to assess the performance of disease management programs. Results: The first aim of the framework, population health improvement, was subdivided into the domains health-adjusted life years, mortality, wellbeing, health-related quality of life (HrQol), complications, symptoms, clinical outcomes, healthy behaviour, knowledge, and self-management skills. The second aim, improvement of patient experience, was subdivided into patient involvement, patient centeredness, continuity of care, coordination, communication, information systems, safety and access. The third aim of cost reductions distinguished program, medical and nonmedical costs. Potential Indicators of the identified sub-criteria include the ASCOT (Adult Social Care Outcomes Toolkit) for measuring wellbeing, smoking rates and BMI (Body Mass Index) to measure healthy behaviour, the EuroQol-5D and Short Form-36 for measuring physical, mental and social HrQol, different dimensions of the PACIC (Patient Assessment of Chronic Illness Care) and CAHPS (Consumer Assessment of Healthcare Providers and Systems) for measuring patient experience and several measurement tools for measuring friction costs and costs of informal care. Conclusions: In designing a structured outcome-based framework for the performance evaluation of disease management programs we paved the way for future work including a comprehensive evaluation of disease management using MCDA. MCDA not only requires measurement of indicators but also weighting of their relative importance.

A Disproportionate Burden of Care: Gender Differences in Mental Health, Health-Related Quality of Life, and Social Support in Mexican Multiple Sclerosis Caregivers

Background. Multiple sclerosis (MS) rates in Latin America are increasing, and caregivers there experience reduced mental and physical health. Based on rigid gender roles in Latin America, women more often assume caregiving duties, yet the differential impact on women of these duties is unknown. Methods. This study examined gender differences in mental health (Patient Health Questionnaire-9, Satisfaction with Life Scale, Rosenberg Self-Esteem Scale, State-Trait Anxiety Inventory, and Zarit Burden Inventory), health-related quality of life (HRQOL; Short Form-36), and social support (Interpersonal Support Evaluation List-12) in 81 (66.7% women) Mexican MS caregivers. Results. As compared to men caregivers, women had lower mental health (p = 0.006), HRQOL (p < 0.001), and social support (p < 0.001). This was partially explained by women caregivers providing care for nearly twice as many hours/week as men (79.28 versus 48.48, p = 0.018) and for nearly three times as many months (66.31 versus 24.30, p = 0.002). Conclusions. Because gender roles in Latin America influence women to assume more substantial caregiving duties, MS caregiver interventions in Latin America—particularly for women caregivers—should address the influence of gender-role conformity on care and psychosocial functioning.

Anxiety and depression mediate the health-related quality of life differently in patients with cardiovascular disease and stroke-preliminary report of the Yilan study: a population-based community health survey.

BackgroundCardiovascular disease and stroke have emerged as substantial and growing health challenges to populations around the world. Besides for the survival and medical prognosis, how to improve the health-related quality of life (HRQoL) might also become one of the goals of treatment programs. There are multiple factors that influence HRQol, including comorbidity, mental function and lifestyle. However, substantial research and investigation have still not clarified these underlying pathways, which merit further attention. The purpose of this study was to determine how psychological factors affect the link between cardiovascular disease and stroke with HRQoL.Methods and ResultA total of 1,285 elder subjects at least 65 years of age (47.2% male) were enrolled. The mental function and HRQol of each patient was then measured using the Hospital Anxiety and Depression Scale and Short Form-12. After multiple regression analysis, anxiety, depression, cardiovascular disease, stroke, education level and age were shown to be associated with both mental component score (MCS) and physical component score (PCS). In the mediation analysis using the SPSS macro provided by Preacher and Hayes, cardiovascular disease and stroke affected HRQoL via anxiety and depression, respectively.ConclusionsThese results suggest that cardiovascular disease and stroke have negative impacts on patient MCS and PCS through different underlying pathways. Cardiovascular disease influences the HRQoL both directly and indirectly with the mediation of anxiety, and stroke influences the HRQoL by way of depression. These findings support the proposition that different combinations of both physical and psychological support are necessary to best manage these diseases.

Health-Related Quality of Life 3 Months After Kidney Transplantation as a Predictor of Survival Over 10 Years

This study explores the association between kidney function, side effects of immunosuppressive treatment, coping self-efficacy, and physical and mental HRQoL at 3 months (baseline) after kidney transplantation (KT) and their impact on patient and graft survival for up to 10 years (follow-up). A group of 151 patients provided at baseline their socioeconomic and medical (CKD-EPI) data and completed the End-Stage Renal Disease Symptom Checklist (perceived side effects), the coping self-efficacy scale, and the SF-36. At follow-up, patients' health status was noted. Univariate GLM exploring the main effects of the independent variables on physical and mental HRQoL was performed; furthermore, Cox regression analyses were performed to determine whether the early posttransplantation factors predicted patient and graft survival. Less severe side effects of immunosuppressive treatment and higher efficacy in stopping unpleasant emotions were associated with both higher physical and mental HRQoL at baseline. Younger age was associated with higher physical HRQoL and older age, and lower efficacy in getting support from family and friend were associated with higher mental HRQoL. Patients reporting higher physical and mental HRQoL at 3 months and with higher age and better kidney function had higher odds of surviving with a functioning graft. Older age, higher kidney function, and higher physical and mental HRQoL at baseline significantly improved the odds of graft and patient survival over 10 years. These results show the importance of close monitoring of early posttransplantation HRQoL along with kidney function and reported side effects because of their effect on long-term patient outcomes.

Sa1098 The Association Between Socioeconomic Status and Quality of Life of Diabetic Patients With Constipation

by Los Angeles (LA) classification were evaluated. Results: Seventy patients (48%) were partial responder to PPI therapy. These patients reported significantly lower scores in the mental health component summary of SF-8, PSQI and HADS including anxiety and depression than responder to PPI. Anxious or depressive state patients (HADS total score>11) are 69% in partial responder to PPI, whereas 31% in responder to PPI (P=0.006). PPI daily dose and LA classification were also significant factors that associated with the response to PPI. Conclusion: Partial responder to PPI showed decreased mental HRQoL. Persistent and troublesome reflux symptoms on PPI therapy seemed to be important factors affecting mental HRQoL including anxiety, depression and sleep disturbance in Japanese GERD patients. The scores of each questionnaire

Psychosocial Correlates of the Short-Form-36 Multidimensional Health Survey in University Students

Stress, social support, and coping correlates of the Short-Form 36 Health Survey (SF-36) were examined in 307 undergraduate students. Instruments included the SF-36, the Perceived Stress Scale, the Multidimensional Scale of Perceived Social Support, and the Ways of Coping Inventory-Revised. HRQOL appeared worse and reported stress and use of maladaptive coping strategies were higher than age-appropriate national norms. Stress, social-support, and coping strategies were correlated with SF-36 physical and mental health subscales. In a stepwise multiple regression equation predicting the SF-36 Mental Health Composite Scale, stress, escape-avoidance coping, problem-focused coping, and accepting-responsibility coping emerged as significant predictors. In another stepwise multiple regression equation predicting the SF-36 Physical Composite Scale, self-control coping and family support emerged as significant predictors. Results suggest that psychosocial measures are excellent predictors of mental HRQOL but are not as strong for physical HRQOL. Possible interventions for improving health status among college students are offered.

Prevalence and Correlates of Sleep Disturbance in Postmenopausal Women: The Australian Healthy Aging of Women (HOW) Study

Sleep disturbance in midlife women has been studied extensively, although less is known about sleep after menopause. This study examined the relative impact of sociodemographics, modifiable lifestyle factors, and health status on sleep disturbance in postmenopausal women from Queensland, Australia. The longitudinal Healthy Aging of Women (HOW) Study examines health-related quality of life (HRQOL measured by the 12-item Short Form [SF-12(®)] survey [Medical Outcomes Trust, Hanover, CA]); chronic illness; modifiable lifestyle factors, such as physical activity, alcohol consumption, smoking; and sleep disturbance (General Sleep Disturbance Scale [GSDS] (Lee, San Francisco, CA) ≥43 represents poor sleep) in midlife and older women from low- and high-socioeconomic rural and urban areas of South East Queensland, Australia. This article presents cross-sectional data from the 322 women, aged 60-70 years, participating in the HOW study in 2011. For women in this study, sleep disturbance was relatively common, with 23% (n=83) reporting poor sleeping (GSDS ≥43). Sleep-disturbance scores were strongly correlated with being unemployed or on a disability support pension (β=18.69, p<0.01), sedentary lifestyle (β=23.84, p<0.01), and lower mental (β=-0.60, p<0.01) and physical HRQOL scores (β=-0.32, p=0.01), and these variables explained almost one-third of variance in sleep-disturbance scores (ηρ(2)=29%). Multivariable analysis revealed that sleep disturbance was correlated with physical and mental HRQOL, disability, and sedentary lifestyle but not other lifestyle and sociodemographic characteristics. It may be, however, that modifiable lifestyle factors may indirectly impact sleep by influencing health status.

Health-related quality of life among adolescents with eating disorders

ObjectiveHealth-related quality of life (HRQoL) is an emerging area of research in eating disorders (EDs) that has not been examined in adolescents in detail. The aim of the current study is to investigate HRQoL in an adolescent ED sample, examining the impact of ED symptoms on HRQoL. MethodsSixty-seven treatment-seeking adolescents (57 females) with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) completed self-report measures of HRQoL and ED symptoms. ResultsParticipants reported poorer HRQoL in mental health domains than in physical health domains. Disordered attitudes, binge eating, and compensatory behaviors were associated with poorer mental health HRQoL, and body dissatisfaction was associated with poorer physical health HRQoL. ConclusionThe current study assessed HRQoL among adolescents with EDs, finding several consistencies with the literature on adults with EDs. Future research should compare adolescents and adults with EDs on HRQoL.