Physical Health Quality Of Life Research Articles

The impact of neighborhood disadvantage on health-related quality of life among African American and White cancer survivors

Following improvements in cancer survival rates quality of life (QOL) has become a key health outcome among cancer survivors. Neighborhood disadvantage has been shown to have a detrimental effect on health outcomes. To date, little is known regarding the influence of neighborhood disadvantage on the health-related QOL of cancer survivors. This study aimed to examine the associations between neighborhood disadvantage and health-related QOL among African American and White cancer survivors. Data were obtained from a retrospective survey study of African American (n=248) and White (n=244) cancer survivors. Physical (PHQOL) and mental health (MHQOL) QOL was measured by the Rand 36-Item Short Form. The neighborhood disadvantage index was created based four components, including prevalence of poverty, mother-only households, home ownership and the prevalence of college educated individuals living in the area. Covariates included demographic characteristics and clinical factors. To adjust the nesting effects of participants living in neighborhoods, a mixed effect linear regression model was conducted to test the association between neighborhood disadvantage and PHQOL and MHQOL after controlling for covariates. Regression results showed that patients living in more disadvantaged neighborhoods reported lower PHQOL than those in more advantaged places (β =−1.21, P=0.020). However, this relationship was not observed for MHQOL outcomes (β =−0.06, P=0.49). Race did not exert an independent influence on observed relationships. Study results contribute to a growing body of research documenting the detrimental effects of neighborhood disadvantage on cancer related outcomes.

Guided Digital Cognitive Behavioral Program for Anxiety in Primary Care: Propensity-Matched Controlled Trial.

BackgroundCognitive behavioral therapy (CBT) is the gold standard treatment for adult anxiety disorders but is often not readily available in a scalable manner in many clinical settings.ObjectiveThis study examines the feasibility, acceptability, and effectiveness of a coach-facilitated digital cognitive behavioral program for anxious adults in primary care.MethodsIn an open trial, patients who screened positive for anxiety (General Anxiety Disorder-7 [GAD7] score ≥5) were offered the digital cognitive behavioral program (active group, n=593). Primary outcomes included anxiety, quality of life (QoL), and ambulatory medical use over 6 months. Intent-to-treat (ITT) and modified intent-to-treat (mITT) analyses were completed. Subsequently, we compared the outcomes of participants with those of a matched control group receiving primary care as usual (CAU; n=316).ResultsMore than half of the patients downloaded the cognitive behavioral mobile app program and about 60% of these were considered engaged, which was defined as completion of ≥3 techniques. The active group demonstrated medium size effects on reducing anxiety symptoms (effect size d=0.44; P<.001) and improving mental health QoL (d=0.49; P<.001) and showed significantly improved physical health QoL (d=0.39; P=.002) and a decreased likelihood of high utilization of outpatient medical care (odds ratio=0.49; P<.001). The active group did not significantly outperform the CAU group in anxiety reduction or QoL improvement (d=0.20; P=.07). However, intent-to-treat analysis showed that the active group had a significantly lower likelihood of high utilization of outpatient medical care than the enhanced CAU group (P<.0001; odds ratio=0.09).ConclusionsA coach-facilitated digital cognitive behavioral program prescribed in primary care is feasible and acceptable. Primary care patients prescribed a digital cognitive behavioral program for anxiety experienced significant improvements in anxiety symptoms, QoL, and reduced medical utilization. This effect was observed even among patients with chronic medical conditions and behavioral health comorbidities. Although the primary outcomes in the active group did not improve significantly more than the CAU group, health care utilization declined, and some secondary outcomes improved in participants who engaged in the program compared to the CAU group.Trial RegistrationClinicalTrials.gov NCT03186872; https://clinicaltrials.gov/ct2/show/NCT03186872

The impact of brief lifestyle self-management education for the control of seizures.

this study examined a brief lifestyle self-management intervention, based on self-determination theory, to manage seizure frequency, and its effects on health-related quality of life and resilience in people with epilepsy aged over 18 years. most people with epilepsy can identify factors that may trigger seizures and may try to avoid these; however, education from clinicians on this varies. a cohort study with control design. sixty participants were purposively sampled and allocated to an intervention or a control group. moderate correlations were found, particularly between: resilience and satisfaction with life; medication adherence and psychological quality of life; and psychological quality of life and satisfaction with life. The mean seizure occurrences between the control and intervention groups were 12.71 (SD 24.55) and 6.76 (SD 13.40) respectively after the intervention. While the study was not powered to assess this, the intervention may be most effective regarding medication adherence and physical health quality of life. the relationship between self-efficacy and seizure management appeared to be strengthened by the programme. This study is the first known to measure resilience in relation to lifestyle self-management for seizure control in people with epilepsy. Relevance to practice: nurses are well placed to work with patients' strengths towards self-efficacy and potentially resilient coping.

Evaluation of the Effects of Clobazam on Seizure Control and Quality of Life in Children With Lennox-Gastaut Syndrome: A Pilot Study.

This is a prospective study of children with Lennox-Gastaut syndrome receiving clobazam as adjunctive therapy. This pilot study aims to examine medication effectiveness as it relates to seizure reduction, as well as improvement in parent-reported behavior and quality of life (QOL). Ten patients with Lennox-Gastaut syndrome aged 3-11 years were enrolled in this 6-week, 4 phase study. Seizure frequency, QOL, and Aberrant Behavior Checklist questionnaires were evaluated at 0, 2, 6, and 10 weeks during the study. Patients showed improvement on indices of QOL, including physical activities (62.5%), well-being (37.5%), cognition (87.5%), social activities (37.5%), behavior (87.5%), general health (50%), and overall QOL (87.5%). The Quality of Life in Childhood Epilepsy (QOLCE) questionnaire revealed significant improvement in cognition (P = .008), social activities (P = .049), behavior (P = .038), and overall QOL (P = .018). The Aberrant Behavior Checklist exhibited a trend toward improvement in hyperactivity. There was improvement in all patients with documented baseline seizures (8/10), with 5 showing significant improvement (95%-100% reduction) and 3 showing minor improvement (7%-23% reduction). Statistically significant improvement in areas of cognition, social activities, behavior, and overall QOL were seen. An overall trend toward a positive well-being was seen in our patients with clobazam, as adjunct therapy for Lennox-Gastaut syndrome in children.

(189) Intersectional Health-Related Stigma and Poor Quality of Life in People Living with HIV and Chronic Pain

Intersectional health-related stigma (IHRS) refers to stigma that arises at the convergence of multiple health conditions. People living with HIV (PLWH) and chronic pain have two highly stigmatized health conditions, and thus may be at especially high risk for internalizing these stigmas and consequently experiencing reduced health-related quality of life (QOL). This study examined the intersectionality of internalized HIV and chronic pain stigma in relation to mental QOL and physical QOL in a sample of PLWH and chronic pain. Participants (N = 66) were recruited from an HIV clinic in the Southeastern United States. Chronic pain was defined as pain that has been present for at least three consecutive months, and that has been an ongoing problem for at least half the days in the past six months. All participants completed the HIV Stigma Mechanisms Scale, Internalized Chronic Pain Stigma Scale, and the Short Form 36 Health Survey (SF-36). An intersectional HIV and chronic pain stigma composite variable was created and participants were categorized as either high (29%), moderate (35%), or low (36%). Results from two unadjusted ANOVAs revealed that intersectional HIV and chronic pain stigma was significantly associated with poor mental QOL (F2,65 = 3.09, p = .05) and poor physical health QOL (F2,65 = 8.74, p

Understanding the roles of patient symptoms and subjective appraisals in well-being among breast cancer patients.

To examine the roles of both patient symptoms, and subjective appraisals of stress (self-efficacy, symptom barriers, symptom distress), in understanding well-being (anxiety, depression, cancer-specific quality of life, mental health quality of life, and physical health quality of life) in breast cancer patients. We examined data from 104 female breast cancer patients. Using a stress process model, we hypothesized that while high levels of patient symptoms would be associated with poorer patient well-being, these effects would be mediated by subjective appraisals, including patient self-efficacy, perceived symptom barriers, and symptom distress. As expected, higher levels of patient symptoms were associated with poorer well-being on all five indicators. Subjective appraisals of stress added significantly to predictors of well-being, and were mediators of this relationship across all five outcomes. While patient symptoms are important predictors of patient well-being, subjective appraisals of the stressfulness of symptoms, and of patients' self-efficacy in managing symptoms, are also key factors. The findings suggest the utility of a stress process model in understanding well-being in breast cancer patients, and point to the potential value of targeting patient appraisals as well as symptoms to improve psychological well-being and quality of life.

Abstract P257: Acute Type A Aortic Dissection: Post-Repair Quality of Life and Its Association With Post-Traumatic Stress Disorder, Exercise and Sexual Activity

Introduction: Aortic dissection (AD) classically presents with abrupt onset of symptoms immediately followed by major emergency surgery. This can be physically and mentally traumatic. Little is known about the post-repair Quality of Life (QOL) of patients and its association with exercise, post-traumatic stress disorder (PTSD), and sexual activity. Our objective was to describe these associations. Methods: There were 295 identified patients who survived acute type A aortic dissection repair. All were surveyed and 132 responded. Included was the Veterans RAND 12-item Health Survey (VR-12). Also included was a validated screening tool to identify PTSD (PC-PTSD) and questions about exercise and sexual activity. The VR-12 produces physical and mental health QOL summary scores (PCS and MCS) that are standardized using a T-score metric with mean of 50±10. Wilcoxon signed rank tests were used to test if median PCS and MCS scores were equal to 50. Kruskal-Wallis tests were used to test for associations between QOL and PTSD, post-AD exercise status, and limited sexual activity. Hodges-Lehmann (HL) estimates of the location shifts between the two groups and their 95% CIs are also provided as (HL [lower CI, upper CI]). Skewed distributions are presented as median [15 th , 85 th ] percentiles. Results: Median PCS (40.1 [25.9, 51.2]) was significantly lower than 50 (P&lt;.0001). There was no statistical difference between median MCS (54.6 [33.9, 61.4]) and 50 (P=0.2454). The median PCS QOL score was significantly lower in AD patients who screened positive for PTSD than those who did not (HL: -9.3 [-14.0,-4.1], p=0.0008). The same was true for the median MCS score (HL: -17.0 [-23.1,-10.0], p&lt;.0001). The median PCS QOL score was significantly higher in AD patients who were exercisers than those who were not (HL: 6.8 [2.4, 11.1], p=.0015). The same was true for the median MCS score (HL: 4.2 [1.0, 7.8], p=.0095). The median PCS QOL score was significantly lower in AD patients experiencing limited sexual activity after their dissection than those who did not (HL: -8.0 [-12.6, -4.3], p=.0002). The same was true for the median MCS score (HL: -5.5 [-10.5,-1.8], p=.0026). Conclusions: The traumatic and debilitating nature of AD and its emergency repair results in lower physical, but not mental, QOL scores than the general population. Lower physical and mental scores are also associated with PTSD, non-exercisers and limited sexual activity in this population. To promote physical and mental QOL in these patients, physicians should investigate and treat PTSD, encourage exercise, and promote resumption of sexual activity when safe.

Performance of the WHOQOL-BREF among Norwegian substance use disorder patients

BackgroundQuality of life (QoL) is an established outcome measure of substance use disorder treatment. The WHOQOL-BREF is the gold standard tool, but its appropriateness for particularly vulnerable patient populations must be further explored. This article examines the scaling qualities of the WHOQOL-BREF in a Norwegian substance use disorder population, and explores relationships with social and health variables.Methods107 participants in a larger national treatment study provided data during structured interviews. Item responses, responsiveness, and domain scaling qualities are reported. General linear models identified correlates of impaired QoL.ResultsThree out of four domains exhibited acceptable scaling qualities, while the social relationships domain had low internal validity. 59% of the variance in physical health QoL was explained in our model by the negative main or interaction effects of depression, unemployment, social isolation, smoking, residential treatment, and weight dissatisfaction. 52% of the variance in psychological health QoL was explained by depression and being single. Depression also had significant main effects in social relationships QoL (R2 = .27) and environment QoL (R2 = .39), and social isolation and exercise had further interaction effects in environment QoL.ConclusionsAfter one year in treatment, the impact of low social contact in reducing QoL, rather than specific substance use patterns, was striking. The social relationships domain is the shortest in the WHOQOL-BREF, yet social variables were important in other areas of QoL. Social support could benefit from more attention in treatment, as a lack of social support seems to be a strong risk factor for poor QoL in various domains. The WHOQOL-BREF exhibits otherwise satisfactory measurement characteristics and is an appropriate tool among this population.

Anxiety and Fear of Exercise in Cardiopulmonary Rehabilitation: PATIENT AND PRACTITIONER PERSPECTIVES.

One unexplored mechanism for poor outcomes in cardiovascular and pulmonary rehabilitation (CVPR) is fear about aerobic exercise. Patients in CVPR may tend to avoid aerobic exercise because of the fear of physical sensations associated with exertion. This study examined fear about exercise in patients enrolled in outpatient CVPR and practitioner beliefs and behaviors related to fear associated with exercise. Survey data were collected from patients (n = 117) enrolled in cardiac rehabilitation (n = 69) and pulmonary rehabilitation (n = 48) and practitioners (n = 16) who were exercise physiologists and nurses working in CVPR. Fears about exercise and avoidance behaviors were common among patients. In pulmonary rehabilitation, fears and avoidance of exercise were correlated with higher levels of anxiety and depression (r values = 0.27-0.54), lower forced expiratory volume in the first second of expiration/forced vital capacity (r values = -0.13 to -0.39), lower health-related quality of life (r values = -0.13 to -0.62), and stronger beliefs about utility of anxiety treatment (r values = 0.21-0.36). In cardiac rehabilitation, fears about exercise were correlated with higher levels of anxiety (r values = 0.19-0.38), lower mental health quality of life (r values = -0.25 to -0.27), and stronger beliefs about utility of anxiety treatment (r values = 0.30-0.40), and avoidance of exercise was correlated with lower exercise tolerance and poorer physical health quality of life (r values = -0.22 to -0.24). Practitioners estimated that an average of 47 ± 20% of patients experience fear associated with exercise and reported low feelings of preparedness to address patient anxiety and fear. It may be beneficial to provide practitioners with skills to recognize and address anxiety and fear in their patients as it relates to exercise.

Stress-mediated quality of life outcomes in parents of disabled children: A case–control study

The purpose of the present study was to resolve whether caregiving for a child with disability influences the physical and mental health of the caregivers and whether stress is related to the quality of life of the caregivers. The Parental Stress Scale questionnaire for the assessment of parental stress and the Short Form-12 version 2 questionnaire for the assessment of physical and mental health quality of life were distributed among 69 parents of developmentally disabled children and 137 parents of healthy children (control group). Various sociodemographic factors were also included. A significant difference was seen between the two groups in terms of employment, presence of disabled sibling, smoking, and physical activity. Parents of developmentally disabled children had significantly higher stress levels and worse mental health-related quality of life. Overall physical health quality of life was similar between cases and controls. Stress had a negative correlation with both mental and physical health quality of life of the parents. Stress related to raising a child with disability negatively influences the parental quality of life. Stress management aiming at its prevention and reduction might be significant aspects of intervention for the improvement of the quality of life of the caregivers.

A study to assess the relationship among sleep, physical health, psychological health, and quality of life among undergraduate students

Context: The sleep is an important biological function, and the students are especially vulnerable to sleep-related problems which may have an impact on their health and well-being. Aims: The aim of this study was to assess the quality of sleep (QoS) and to study the relationship among QoS, physical health, psychological health, and quality of life (QoL) in undergraduate (UG) students. Settings and Design: In a cross-sectional study, 625 UG students filled out a semi-structured questionnaire. Subjects and Methods: The participants were administered the Pittsburgh Sleep Quality Index, WHO-5 Well-Being Index (WHO-5), and Rotterdam Symptom Checklist. Statistical Analysis Used: The data were compared using percentages and proportions. Results: A higher number of participants were with poor QoS in the categories of poor physical health (P = 0.003) and poor QoL (P = 0.001). The psychological distress in the group with poor QoS was found to be greater than the psychological distress in the group with good QoS (P = 0.001). Conclusions: In UG students, QoS was found to be positively associated with physical health, psychological health, and QoL. There is a need for longitudinal studies in this field to establish the causality.

Transition of Children with Perinatally Acquired HIV-Infection into Adulthood: Social Outcome and Quality of Life.

In India, access to free anti-retroviral therapy has improved the survival of perinatally human immunodeficiency virus (HIV) infected children resulting in the transition of many such children to adulthood. This study aims to understand the social-outcomes and quality of life (QOL) among these adults. This cross-sectional study was conducted in two tertiary HIV care centers in south India. Perinatally HIV-infected adults aged >18 y were enrolled after obtaining consent. Data were collected by questionnaire based interviews for social outcomes and WHO Quality of Life-BREF (WHOQOL-BREF) for QOL. The social-outcome indicators monitored pertained to family support, educational qualification and occupational, economic, and marital status. The mean age of 107 participants was 18·9 ± 1·1y. The school drop-out rate was 58%. Sixty-two percent were double orphans. Forty-three-percent of the participants were employed with mean per-capita monthly income of Rs.4105 ± 2979 ($65·2 ± 47·3). Fourteen-percent of the participants were married, or in a relationship, and a majority of them, 93%, were females. For QOL, the mean raw score was highest for social relationship (15·79). Relative to studying subjects, a higher proportion of school dropouts scored poorly in social relationship (42% vs.14·8%; Chi-square = 5·28; p = 0·02) and environmental QOL (46% vs.19·6%;Chi-square = 8·09; p = 0·004). The proportion of subjects with a poor physical health QOL was higher among those with a per-capita monthly income above the national average than those with below the national average (69% vs.33·3%; Chi-square = 5·27; p = 0·02). Though clinico-immunological disease was stable in these perinatally HIV-infected young adults, their social-outcomes pertaining to education, occupation, income, and family support were poor. Factors like education, parental care, and income of the subjects were associated with poor QOL.

Patient-Reported and Neurocognitive Outcomes in Patients Treated with Axicabtagene Ciloleucel

Background: Axicabtagene ciloleucel (axi-cel) is a CD19 targeted chimeric antigen receptor (CAR) T-cell therapy that may induce durable responses in relapsed/refractory lymphoma patients whose survival prospects are otherwise poor. Recent FDA approval of axi-cel and other CAR T-cell therapies is expected to lead to a growing population of cancer survivors treated with these therapies. Little is known about patient-reported outcomes (PROs) such as symptomatology and quality of life (QOL) in these patients. The goal of the current observational study was to examine PROs and neurocognitive functioning in adult patients in the first 90 days after treatment with axi-cel.Methods: Patients who were scheduled to undergo axi-cel therapy as part of a clinical trial or standard of care at Moffitt Cancer Center were recruited prior to conditioning chemotherapy. Patients completed items from the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) at enrollment and 14, 30, 60, and 90 days post-CART. A total of 20 symptoms were selected for inclusion based on clinician-rated toxicity of CART reported on clinical trials as well as symptoms likely to be of concern to cancer patients (e.g., fatigue, insomnia, diarrhea, constipation, nausea, decreased appetite). Patients also completed the Medical Outcomes Study Short Form 36 (SF-36) QOL measure at baseline and 90 days. Neurocognitive assessments were completed at baseline and 30 days using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Means, SDs, frequencies, and Wilcoxon signed rank tests were used to characterize outcomes and change over time.Results: Participants were 29 patients (28% female; mean age=58, SD=13; 52% treated on an interventional trial). Participants were diagnosed with diffuse large B-cell lymphoma (76%), follicular lymphoma or transformed follicular lymphoma (10%), mediastinal large b cell lymphoma (3%), or other indications (11%). Of these, 11 completed neurocognitive testing at baseline and 30 days. Patient-reported symptoms spiked at 14 days post-CAR-T before returning to levels similar to baseline. The most common symptoms at 14 days post-CAR-T were decreased appetite (95% any severity, 48% moderate to severe), fatigue (95% any severity, 43% moderate to severe), and dry mouth (85% any severity, 38% moderate to severe). By 90 days post-CAR-T, the most common symptoms were fatigue (82% any severity), insomnia (55% any severity), and joint pain (45% any severity); no patients reported moderate to severe symptoms at this time. Non-significant improvements were observed in physical health QOL (mean increase=1.43; p=0.37) and mental health QOL (mean increase=2.66, p=0.07) from baseline to 90 days. Patients demonstrated non-significant declines in total RBANS percentile score from baseline to day 30 (mean decrease=-8.18, p=0.32). Updated results will be presented at the meeting.Conclusions: This study is the first to our knowledge to report on both PROs and neurocognitive outcomes in patients treated with CAR T-cell therapy. Results indicate that moderate-to-severe patient-reported symptoms were transient following axi-cel, although a majority of patients reported ongoing, low-grade symptoms at 90 days post-treatment. Quality of life and neurocognition did not significantly change over time. These preliminary findings warrant larger future studies with longer follow-up to better understand changes in PROs and neurocognition in cancer survivors treated with CAR-T. DisclosuresJim:Janssen: Consultancy; RedHill Biopharma: Consultancy. Locke:Kite Pharma: Other: Scientific Advisor; Novartis Pharmaceuticals: Other: Scientific Advisor; Cellular BioMedicine Group Inc.: Consultancy.

INSOMNIA TREATMENT IN ADULTS OVER AGE 50 WITH OSTEOARTHRITIS PAIN: EFFECTS ON PHYSICAL FUNCTION AND QUALITY OF LIFE

Insomnia is prevalent among adults with osteoarthritis (OA), a common degenerative disorder for which age is a primary risk factor. Research suggests that cognitive-behavioral therapy for insomnia (CBTi) in older adults with comorbid chronic pain can improve sleep, with weaker effects on reported pain. In the current pilot study, we tested whether CBTi improved OA-related physical limitations and quality of life, as well as insomnia, as these factors are important contributors to well-being in aging. Thirty three adults, ages 51 to 74 years (Mean (SD) age=60.8(6.8)), with OA-related knee pain and insomnia were randomized to 6-session CBTi (n=16) or a weekly phone contact control group (n=17). The Insomnia Severity Index, WOMAC Osteoarthritis Index scales (pain, stiffness, and physical limitations), and WHO Quality of Life domain scales (physical health, psychological, social, environment) were assessed prior to randomization and 8-weeks later. General linear models indicated that participants in the CBTi group relative to the control group showed significantly larger declines over time in insomnia severity (p<.001), and larger improvements in OA-related symptoms based on total score on the WOMAC (p=.03), which was due to reductions in physical limitations (p=.01), but not pain (p=.47). WHO Quality of Life physical health (p=.001) and environment (p=.04) domain scores showed significantly larger improvements in the CBTi group compared to the control group. Age did not play a significant role in outcomes. CBTi is a promising approach to improve well-being and promote healthy aging among adults with comorbid osteoarthritis pain and insomnia.

Quality of Life and its Relationship with Perceived Stigma among Opioid Use Disorder Patients: An Exploratory Study.

Background:In view of recent global opioid epidemic and scarcity of literature assessing the quality of life (QoL) and stigma among opioid use disorder (OUD) patients, this study aimed to assess the overall QoL and examine its relationship with perceived stigma among them.Materials and Methods:This cross-sectional study assessed patients with OUD at a tertiary care centre. QoL was assessed using the World Health Organization Quality of Life-brief version, whereas perceived stigma was measured using the Perceived Stigma of Substance Abuse Scale (PSAS).Results:Among 168 patients with OUD, all the four domain-wise scores of physical health (r = 0.79, P < 0.01), psychological health (r = 0.87, P < 0.01), social relationships (r = 0.78, P < 0.01) and environment (r = 0.80, P < 0.01) QoL correlated significantly with average score, with maximum impairment noted in the social domain. The mean PSAS score was 21.19 ± 2.99, with perceived stigma found to be significantly associated with impairments in the physical (β = –0.28, P < 0.01), psychological (β = –0.27, P < 0.01) and environment (β = –0.21, P < 0.01) domains of QoL. Furthermore, being employed was significantly associated with impairment in the social domain of QoL (β = –0.17, P = 0.02).Conclusion:OUD similarly affects all the four domains of QoL, with a higher level of perceived stigma associated with significantly poorer QoL in the physical, psychological and environment domains. However, future studies assessing different forms of stigma and QoL among patients with OUD are needed to confirm and better characterise the findings of this study.

Quality of Life in Riot Police: Links to Anger, Emotion Regulation, Depression, and Anxiety

Police work is accepted as a high-risk and stressful occupation, where affective variables may influence both work performance and perceived quality of life (QoL) in police officers. The current study aimed to investigate the associations between QoL, emotion regulation, anger, and mental health in a sample of 156 Turkish riot police officers. Study design was descriptive and cross-sectional. Data was collected using self-report measures. Hierarchical regression analyses revealed that depression and cognitive reappraisal as an emotion regulation strategy were significant predictors of all domains of QoL. Trait anger was the third significant predictor of physical health and environment QoL, whereas anxiety emerged as the third significant predictor of psychological health QoL. Due to the high rates of depression and anxiety found in riot police, routine screening and early interventions to promote mental health should be conducted in this special population. It is suggested to implement psychological prevention programs which encompass emotion and anger regulation training for the promotion of QoL in riot police.

Quality of Life and Symptom Burden 1 Month After Concussion in Children and Adolescents.

We conducted a prospective study of children and adolescents (n = 176; mean age = 13.0 ±2.7 years; 38% female) assessed acutely post-concussion and again 30 days later. We investigated the association between symptom burden and quality of life (QOL) outcomes, as well as the effect of age on QOL. We assessed QOL using patient-reported Pediatric Quality of Life Inventory 4.0, and symptoms using the Health and Behavior Inventory (HBI). Acute (<2 days post-injury) HBI ratings demonstrated a low correlation ( R2 = 0.08) with physical health QOL and a moderate correlation with psychosocial health QOL ( R2 = 0.21) 30 days post-concussion. HBI ratings 30 days post-concussion demonstrated a moderately high correlation with physical health QOL ( R2 = 0.35) and psychosocial health QOL ( R2 = 0.57). Age was not significantly associated with physical or psychosocial QOL ratings. Impairments in QOL following concussion may identify children and adolescents who need additional referral to address persistent symptoms at this time.

“Placement Budgets” for Supported Employment—Impact on Quality of Life in a Multicenter Randomized Controlled Trial

Background: Employment is an important aspect of psychiatric rehabilitation. The objective of this analysis was to explore how quality of life (QoL) may affect the outcome of supported employment and vice versa.Methods: A total of 116 participants with severe mental disorders were randomly assigned to either 25, 40, or 55 h placement budgets, which comprises job coaches' time resources to support a client in finding a job. The intervention followed the individual placement and support model and lasted up to 36 months. Primary outcome was employment in the first labor market for at least 3 months. QoL was assessed 7 times over the entire 36-months observation period using the WHO QoL Bref, which comprises the dimensions physical health, psychological, social relationships, and environment.Results: The three placement budgets did not differentially relate to QoL, but QoL environment showed a significant increase over time across all three groups. Baseline QoL environment weakly predicted subsequent obtainment of employment (F = 4.08, df = 1, p = 0.046, Cohen's d = 0.39). Controlling for baseline QoL, those participants who obtained a job, as compared to those who did not, showed persistent increases in QoL physical health (b = 0.39, p = 0.002, Cohen's d = 0.50) and QoL psychological (b = 0.40, p < 0.001, Cohen's d = 0.47).Conclusion: Obtaining employment in the first labor market improves patients' QoL. Supported employment is a valuable intervention that may benefit patients with severe mental disorder.

Symptoms, Mobility and Function, and Quality of Life in Adults With Acute Leukemia During Initial Hospitalization.

To examine longitudinal symptoms, mobility and function, and quality of life (QOL) in adults newly diagnosed with acute leukemia. 55 adults undergoing induction chemotherapy at the University of North Carolina Lineberger Comprehensive Cancer Center and the Duke Cancer Institute. A prospective, longitudinal study with measures of mobility and function, global physical and mental health, cancer-related fatigue, anxiety, depression, sleep disturbance, pain intensity, and leukemia-specific QOL was conducted. Data were analyzed using descriptive statistics, linear mixed modeling, and one-way analysis of variance. 49 adults with acute leukemia completed assessments during hospitalizations. Global mental health and pain intensity did not change significantly. Global physical health significantly improved. Fatigue, anxiety, depression, and sleep disturbance decreased significantly. QOL increased significantly. The significant decrease in anxiety and fatigue during hospitalization may be attributable to understanding of the disease process, familiarity with the staff, and ability to communicate concerns.

Victimization and posttraumatic stress disorder in homeless women with mental illness are associated with depression, suicide, and quality of life.

ObjectiveThis study aimed to determine the following: 1) the proportion of women in the homeless population with schizophrenia (SZ) or bipolar disorder (BD), in addition to the trajectory of their homelessness (ie, homelessness history, number of nights spent without home during the 180 past nights) and the characteristics of their illnesses compared to men (ie, illness severity, suicide risk, physical health status, and quality of life [QoL]); 2) whether these women were victimized more frequently than similarly situated men; 3) the impact of victimization on these women in terms of illness severity, suicide risk, physical health status, and QoL; and lastly 4) the differences and overlap of homeless women with SZ and BD.MethodsThis study employed data at baseline from a multicenter randomized controlled trial conducted in the following four large French cities: Lille, Marseille, Paris, and Toulouse. Mobile mental health outreach teams recruited SZ/BD homeless patients in the street, emergency shelters, hospitals, and jails from August 2011 to April 2014. Evaluations were performed during face-to-face interviews by psychiatrists and research assistants in the offices of mobile mental health outreach teams that were located in the downtown area of each city. The quantitative data were analyzed using descriptive analyses, chi-square and Student’s t-tests, generalized estimating equation regression models, and path analysis.ResultsA total of 703 patients were included in this study. The proportion of women in the SZ/BD homeless population was 123/703 (17.5%). In this population, women were more likely than men to declare that they were subjected to physical or sexual assault during the past 6 months, that they had been diagnosed with posttraumatic stress disorder (PTSD), and that they had experienced more severe depressive symptoms. Moreover, these women presented a higher suicide risk, worse physical health status, and lower QoL than similarly situated men. Homeless women with BD were more vulnerable than women with SZ. A path analysis revealed that PTSD and violent victimization might explain the higher levels of depression and suicide risk and the lower levels of physical health status and QoL in homeless women.ConclusionSZ/BD homeless women experience more PTSD and victimization than men, which are both associated with poor clinical outcomes. These results confirm the vulnerability of homeless women in this high need population and should be considered by public health policy.