World Health Organization Quality Of Life Scale Research Articles

Subjective positive well-being

Among the seven models of positive mental health so clearly described by George Vaillant in this issue of World Psychiatry, the model of subjective well-being, reflecting the positive tone of the World Health Organization (WHO) definition of health, has cross-cultural validity. Actually, Vaillant himself refers to the single-item question “How do you feel about your life as a whole?” as a simple candidate for such a cross-culturally valid measure. In the WHO Quality of Life Scale (WHOQOL), another “global” question is: “How would you rate your quality of life?”. This item is measured on a “bipolar” scale with such answer categories as “poor”, “neither poor nor good”, and “good” 1. The WHOQOL has been found useful in many cross-cultural studies 1. In the late 1970s, the Index Medicus accepted self-reported quality of life scales as outcomes in clinical studies. The most frequently used quality of life scales in the 1980s and 1990s were the Psychological General Well-Being Scale 2 and the Short-Form 36 item health survey (SF-36) 3. Psychometric analyses of these scales identified the factors of physical versus mental health. The WHO (Five) Well-being Index (WHO-5) was then developed for the purpose of measuring positive mental health 4. The WHO-5 includes the following five items: a) feeling cheerful and in good spirits, b) feeling calm and relaxed, c) feeling active and vigorous, d) feeling fresh and rested when waking up, and e) feeling interested in day-to-day activities. The Likert answer categories, which take the past two weeks into account, range from “all of the time” to “at no time”. As in the SF-36, the total score on the WHO-5 ranges from 0 to 100, where high scores signify better well-being. Decreased positive well-being as measured on WHO-5 is a sensitive indicator of mental health problems 5, and in clinical trials the goal of treatment is to move the scores up to the mean scores in the general population, i.e. approximately 70 6. Subjective psychological well-being or health-related quality of life is often considered to be a rather individualistic, personal or idiographic issue, implying that a cross-cultural definition is very difficult to obtain. As discussed elsewhere 7, subjective well-being might in the first place be considered as a self-reflective, private language in which the person is communicating with herself or himself from the moment when she or he wakes up, perceiving and planning the day, having emotional appetite for starting her or his day. However, studies all over the world have indicated that the WHO-5 items seem to cover basic life perceptions of well-being, allowing this private language to be translated into a simple language of communication 6,7. In Table 1 of his paper, Vaillant demonstrates that subjective well-being indeed predicted objective mental health with the highest coefficient of correlation when compared to the other models of positive health over a time span of 15 years. The predictive validity of the WHO-5 in a 6-year survival analysis of cardiology patients was also found to be high 8. Vaillant states that “chemicals can alleviate mental illness but do not improve healthy brain function”. The pharmacopsychometric triangle has recently been introduced in trials of antidepressants 6,7,9. The outcomes of pharmacotherapeutic chemicals are hereby triangularized. Antidepressants are not intended to directly treat decreased quality of life, but to treat depressive illness (A) with as few side effects as possible (B). When the balance between (A) and (B) is evaluated by the patients themselves on subjective well-being scales such as the WHO-5 (C), where the goal is to move the scores up into the area of the general population mean scores 6, antidepressants do not, as concluded by Vaillant, enhance mental health beyond this level. Forty years ago, the great American psychopharmacologist L. Hollister 6 taught me that, when treating a 35-year old man for a major depressive episode with an antidepressant, we can move his depression scores down to remission over 6 weeks and then, hopefully, in the relapse prevention continuation therapy, bring him out of the depressive episode. On the other hand, we are not able to then turn the patient into a great violinist if he never had held a violin in his hands prior to treatment. Within the field of clinical medicine we as psychiatrists do our best to restore the brain functions of our patients suffering from mental disorders, using subjective well-being as an essential goal of treatment within the pharmacopsychometric triangle.

Quality of life (QOL) and depression in HTLV-1 carriers

Material and methods A cross-sectional study was carried out from March to November, 2009 in Salvador, Brazil. The instruments used were a questionnaire for the collection of clinical and epidemiological data, the Mini International Neuropsychiatric Interview, Brazilian Version 5.0.0 (M.I.N.I.) to estimate the rate of depression and the short version of the WHO quality of life scale (WHOQOL-BREF).

The impact of yoga upon female patients suffering from hypothyroidism

Objective To study the effect of yoga on the quality of life of female hypothyroid patients. Design The WHO Quality of Life Scale 22 was used to assess the quality of life of 20 female hypothyroid patients. Subjects attended one hour yoga sessions daily for a period of one month. A pretest–post-test research design was used for data analysis. Results Patients’ quality of life scores following the yoga program were greater than scores obtained prior to undertaking yoga ( p < 0.01). Patients also reported significant improvement in their perception of the overall quality of life and of their health post yoga intervention. Conclusions It can be concluded that yoga is valuable in helping the hypothyroid patients to manage their disease-related symptoms. Yoga may be considered as supportive or complementary therapy in conjunction with medical therapy for the treatment of hypothyroid disorder.

Investigation of the quality of life of hospitalized AIDS patients

Objective To understand the quality of life of hospitalized AIDS patients and analysis the influential factors, to provide basis for making related clinical nursing measures. Methods To combine qualitative and quantitative research and use cluster sampling method, 40 hospitalized AIDS patients were investigated by the general information questionnaire and the World Health Organization Quality of Life Scale ( WHOQOL), 10 cases of them were interviewed deeply. To analyze the results statistically. Results All areas of quality of life of 40 hospitalized patients were lower than the normal crowd. The differences were statistically significant. Patients had various levels of problems in the area of physiological, psychological and social relationship. Conclusions The quality of life of hospitalized AIDS patients is related to patients' physiological,psychological social relationship and understanding level of related knowledge. Nurse should take appropriate measures to promote hospitalized AIDS patient' quality of life. Key words: Hospitalized patients; AIDS; Quality of life

Correlation analysis between quality of life in hospitalized AIDS patients and their nursing needs

Objective To evaluate the quality of life and care needs of hospitalized AIDS patients and analyze the relationship between them to provide basis for clinic nurses' helping patients to improve the quality of life. Methods We adopted the general information questionnaire, patient care needs assessment questionnaire, as well as the World Health Organization Quality of life Scale (WHOQOL)and used cluster sampling method to make face to face interviews with 36 hospitalized AIDS patients. Results The care needs of the 36 AIDS patients were at a high level,all areas of quality of life were lower than the norm. The quality of life of hospitalized AIDS patients was negatively correlated with the care needs. Conclusions Clinic nursing staffs should understand and assess the care needs of patients initiatively and take appropriate measures to improve quality of life of hospitalized AIDS patients. Key words: AIDS; Hospitalized; Quality of life; Care need

Proxy and patients ratings on quality of life in patients with schizophrenia and bipolar disorder in Korea

This study aimed to assess the agreement between patient and proxy ratings of Quality of life (QoL) in patients with psychotic mental illnesses. The abbreviated version of the WHO quality of life scale (WHOQOL-BREF) and 36-item short-form health survey (SF-36) were administered to patient-family proxy pairs of 81 schizophrenia patients with mild symptoms and 50 euthymic bipolar disorder patients. Paired t-tests and the intraclass correlation coefficient (ICC) were used to evaluate the level of agreement between patient and proxy ratings of QoL. At the group level, small standardized differences (0.0-0.3 for schizophrenia, 0.0-0.5 for bipolar disorder) between patient and proxy mean scores were found for most domains in both QoL measures. At the individual level, moderate to good agreement (ICC) was found (schizophrenia: ICC 0.4-0.7 on WHOQOL-BREF; 0.4-0.7 on SF-36; bipolar disorder: ICC 0.4-0.7 on WHOQOL-BREF; 0.6-0.7 on SF-36). The reported agreement was higher than that reported for similar measures in the psychiatric population. These results may be due to the fact that our subjects had mild clinical symptoms and frequent family interaction. These findings suggest that family proxy rating of patients' QoL can be used as a reasonable estimate of the patients' QoL for stable schizophrenia and bipolar patients in Korea.

Impact of Psoriasis on Quality of Life: Relationship between Clinical Response to Therapy and Change in Health-related Quality of Life

Psoriasis exerts significant, negative, impact on patients' quality of life (QOL). Recently, the relationship between QOL and skin lesion improvement has been emphasized in the treatment of psoriasis patients. The purpose of study was to compare the QOL in psoriasis and other skin diseases, and to evaluate the generic QOL, skin specific QOL, stress, depression and anxiety before and after treatment in patients. A total of 138 patients with psoriasis were recruited in this study and 83 patients complete the questionnaire at week 16. Questionnaires were comprised of generic WHO QOL scale, dermatology specific questionnaires (Skindex-29), psoriasis life stress inventory (PLSI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). Clinical response was assessed by the PASI. After treatment, health-related QOL was improved and PASI improvement showed smaller correlation with Skindex-29, compared with the correlations between self-reported severity score (SRSS) improvement and Skindex-29. Regression analysis revealed that duration, SRSS, stress, and depression were factors affecting baseline HRQOL in patients, and age, duration, and SRSS were predictors associated with HTQOL score changes. Treatment improved HRQOL, BAI, BDI, and PLSI scores. Psoriasis may become more burdensome in groups of patients who suffer long disease duration, high SRSS, depression, and stressful environments.

Cognitive Behavior Therapy for Stuttering: A Case Series

The present investigation was aimed at studying the efficacy of cognitive behavior therapy (CBT) in reducing the symptoms of stuttering and dysfunctional cognitions and in enhancing assertiveness and quality of life in clients with stuttering. Five clients with stuttering who met the inclusion criteria (male clients with diagnosis of stuttering) and exclusion criteria (clients with brian damage), substance abuse or mental retardation were enrolled for the study. A single-case design was adopted. The pre-, mid- and post-assessment were carried out using Stuttering Severity Scale (SSI), Perception of Stuttering Inventory (PSI), Beck's Anxiety Inventory (BAI), Dysfunctional Attitude (DAS), Fear of Negative Evaluation (FNE), Assertiveness Scale (AS), Rosenberg's Self-Esteem Scale (RSES), and World Health Organization - Quality of Life Scale (WHO-QOL). Five clients received cognitive behavioral intervention comprising of psycho-education, relaxation, deep breathing, humming, prolongation, cognitive restructuring, problem-solving strategies and assertiveness. At post-treatment assessment, there was improvement. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research.

The reliability and validity of the short version of the WHO Quality of Life Instrument in an Arab general population

BACKGROUND AND OBJECTIVES:There is rising interest in quality of life (QOL) research in Arabian countries. The aim of this study was to assess in a nationwide sample of Kuwaiti subjects the reliability and validity of the World Health Organization Quality of Life (WHOQOL-BREF), a shorter version of the widely used QOL assessment instrument that comprises 26 items in the domains of physical health, psychological health, social relationships, and the environment.METHODS:A one-in-three systematic random proportionate sample of consenting Kuwaiti nationals attending large cooperative stores and municipal government offices in the six governorates completed the Arabic translation of the questionnaire. The indices assessed included test-retest reliability, internal consistency, item internal consistency (IIC), item discriminant validity (IDV), known-groups and construct validity.RESULTS:There were 3303 participants (44.8% males, 55.2% females, mean age 35.4 years, range 16 to 87 years). The intra-class correlation for the test-retest statistic and the internal consistency values for the full questionnaire and the domains had a Cronbach's alpha≥0.7. Of the 24 items that constitute the domains, 21 met the IIC requirement of correlation ≥0.4 with the corresponding domain, while 16 met the IDV criterion of having a higher correlation with their corresponding domain than other domains. Domain scores discriminated significantly between well and sick groups. In the factor analysis, four strong factors emerged with the same construct as in the WHO report.CONCLUSION:The Arabic translation of the WHOQOL-BREF has impressive reliability and validity indices. The poor IDV findings are due to the multidimensional nature of the questionnaire. The highly significant validity indices should reassure researchers that the questionnaire represents the same constructs across cultures. Negatively worded items possibly need refinement.

Antioxidant Effect of Tianwang Buxin Pills A Traditional Chinese Medicine Formula: Double-Blind, Randomized Controlled Trial

Reactive oxygen species (ROS) and their derivatives play important roles in the development of diseases such as, cardiovascular disease, ischemic disease, and aging. Much effort has been devoted to finding both an effective and non-toxic antioxidant traditional Chinese medicine (TCM) herbal formula. Tianwang Buxin Pills (TBPs) have been used in TCM to treat mild cognitive impairment and palpitations. Recently, research has revealed that TBPs are effective against oxidative stress and psychological stress in experimental studies. However, randomized controlled trials (RCT) are rare. This study was conducted to assess the antioxidative and anti-stress effects of TBPs by analyzing (determination) reactive oxygen metabolites (d-ROMs test) of the blood, the stress response inventory (SRI), and the Korean version of the WHO Quality of Life Scale Abbreviated Version (WHOQOL-BREF) in 39 healthy volunteers (Placebo group = 20, TBPs group = 19) before and after oral administration of TBPs for 4 weeks. However, d-ROMs test, SRI, and WHOQOL-BREF values did not differ significantly between the two groups. These results indicate that TBPs do not effectively restrain ROS or their derivatives.

Relationship between Depression and Quality of Life in Persons with Hiv Infection in Nigeria

Despite the fact that two-thirds of all the people with HIV live in sub-Saharan Africa, little is known about the emotional state and quality of life (QOL) of subjects with HIV in this region. The objective of this study was to evaluate the association between clinical depression and quality of life in a group of HIV sero-positive subjects in Nigeria. Subjects with HIV infection (n = 87) completed a questionnaire detailing sociodemographic and HIV related variables. The subjects were assessed for the diagnosis of depression using the Mini International Neuropsychiatric Interview (MINI) and their subjective health related quality of life (QOL) was assessed using the short version of the WHO quality of life scale (WHOQOL-BREF). There were 25 (28.7%) subjects with diagnosis of depression. Lower educational level correlated with poorer QOL in all the domains of WHOQOL-BREF except the "social relationship" domain. Also, poor social support correlated with poorer QOL scores on domains of "physical health" and "social relationship" and presence of medical problems was significantly associated with poorer scores on domains of "physical health" and "psychological health." Diagnosis of depression was significantly correlated with poorer QOL in all domains except the "social relationship" domain. Poorer health related QOL in Nigerian subjects with HIV was associated with depression, lower educational and socioeconomic levels, and poor social support. Early identification and referral of patients with depression needs to be incorporated into intervention programs designed for HIV infected individuals in this region.

Effects of 8 weeks administration of Korean Panax ginseng extract on the mood and cognitive performance of healthy individuals

Background: Previous research has suggested that single doses of a standardised Panax ginseng extract can decrease fasted blood-glucose levels and modulate cognitive performance in healthy young volunteers. The latter has generally been seen in terms of improved secondary memory performance. However, both the cognitive effects of chronic administration of ginseng and the potential modulation of working memory have received comparatively little research attention. Aims: The current double-blind, placebo-controlled, balanced cross-over study investigated the effects of 8-weeks administration of Korean ginseng extract (200 mg) on cognitive performance, gluco-regulatory parameters and ratings of subjective mood and 'quality of life'. Methods: 'Eighteen healthy young participants were assessed pre-dose and 3 hours post-dose on the mornings of Day 1, Day 29 and Day 57 of 8 week treatment regimens of both placebo and ginseng. A four-week placebo wash-out separated the treatment phases. Each assessment included the Cognitive Drug Research battery, computerised working memory tasks, and Bond-Lader mood scales. The WHO Quality of Life scale (WHOQOL-BREF) was completed once per visit. Gluco-regulatory parameters were assessed with assays of blood glucose, insulin and HbA1c. Results: Data from the 16 participants that completed the study showed that there were no significant, acute treatment related differences on Day 1 of treatment, or in gluco-regulatory parameters throughout the study. However, time related performance improvements were evident following chronic administration of ginseng on the '3-Back' and 'Corsi-block' computerised working memory tasks. Ginseng was also associated with an improved score on the 'social relations' subscale of the WHOQOL-100, and a significant shift on the 'calm' factor of the Bond-Lader mood scales (from calm/relaxed towards excited/tense). Conclusion: The results of the current study suggest that Korean ginseng extract can modulate working memory performance and subjective ratings of 'quality of life' and mood. Replication with a larger sample size may further elucidate the actions of this product.

Relationship between depression and quality of life in Nigerian outpatients with heart failure

Objective Our objective was to evaluate the relationship between depression and health-related quality of life (QoL) in Nigerian outpatients with heart failure (HF). Methods We used a cross-sectional study in which outpatients with HF ( n=100) completed the WHO Quality of Life Scale—Brief Version to assess their subjective QoL. The patients were also assessed for the diagnosis of major depressive disorder (MDD) in accordance with the Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition. Results The factors independently associated with poor QoL include disability due to illness, presence of MDD, younger age, and longer duration of illness. Patients with MDD had worse QoL than patients without MDD on dimensions of physical health, psychological health, and environment. Conclusion Depression adversely affects the QoL of patients with HF. Programs designed to improve the QoL of patients with HF need to incorporate the early identification and treatment of depression. Future studies are warranted to investigate the impact of improved depression management on QoL in patients with HF.

Comparative study on quality of life and its influencing factors in hysteria patients

目的 探讨癔症患者生活质量及其影响因素.方法 采用自制一般情况调查表、生活质量问卷、症状自评量表和社会支持量表对78例癔症患者和58例正常人进行测试.结果 (1)症状自评量表(SCL-90)中,所有的因子得分均高于正常对照组,2组比较均差异有显著性;(2)社会支持量表,以主观支持[(22.79±5.08)分]明显低于对照组(P＜0.01);(3)生活质量总体[(12.40±3.43)分]低于正常对照组,具体因子是疼痛不适[(16.73±2.58)分]、睡眠[(8.25±1.94)分]、负性情感[(16.11±3.11)分]、医疗依赖[(16.52±3.29)分]、工作能力[(13.63±3.27)分]、性生活[(10.17±2.85)分]、生活安全感[(11.23±2.97)分](P＜0.05～0.01);7个因子得分差异有显著性;6个维度中在生理领域、心理领域、独立领域、环境领域四个纬度有统计学意义.多元逐步回归分析发现:影响癔症生活质量的因素是抑郁、主观支持、恐怖.结论 癔症患者生活质量较健康人低;情绪低落、药物依赖、社会功能下降、主观情感上获得的支持缺少,是造成生活质量下降的关键原因。

Outcome assessment in low back pain: how low can you go?

The present study examined the psychometric characteristics of a "core-set" of six individual questions (on pain, function, symptom-specific well-being, work disability, social disability and satisfaction) for use in low back pain (LBP) outcome assessment. A questionnaire booklet was administered to 277 German-speaking LBP patients with a range of common diagnoses, before and 6 months after surgical (N=187) or conservative (N=90) treatment. The core-set items were embedded in the booklet alongside validated 'reference' questionnaires: Likert scales for back/leg pain; Roland and Morris disability scale; WHO Quality of Life scale; Psychological General Well-Being Index. A further 45 patients with chronic LBP completed the booklet twice in 1-2 weeks. The minimal reliability (similar to Cronbach's alpha) for each core item was 0.42-0.78, increasing to 0.84 for a composite index score comprising all items plus an additional question on general well-being ('quality of life'). Floor or ceiling effects of 20-50% were observed for some items before surgery (function, symptom-specific well-being) and some items after it (disability, function). The intraclass correlation coefficient (ICC) ("test-retest reliability") was moderate to excellent (ICC, 0.67-0.95) for the individual core items and excellent (ICC, 0.91) for the composite index score. With the exception of "symptom-specific well-being", the correlations between each core item and its corresponding reference questionnaire ("validity") were between 0.61 and 0.79. Both the composite index and the individual items differentiated (P<0.001) between the severity of the back problem in surgical and conservative patients (validity). The composite index score had an effect size (sensitivity to change) of 0.95, which was larger than most of the reference questionnaires (0.47-1.01); for individual core items, the effect sizes were 0.52-0.87. The core items provide a simple, practical, reliable, valid and sensitive assessment of outcome in LBP patients. We recommend the widespread and consistent use of the core-set items and their composite score index to promote standardisation of outcome measurements in clinical trials, multicentre studies, routine quality management and surgical registry systems.

Quality of Life of Oncology Nurses

The aim of the study was to determine the quality of life (QOL) of nursing staff working in oncology units in Turkey. The study was a descriptive study and included 89 oncology nurses from 12 different cities in Turkey who participated in the course "Basic Chemotherapy Courses for Oncology Nurses" in Izmir. This course was organized by Ege University Faculty of Medicine and the Turkish Ministry of Health. Quality of life was assessed with the Questionnaire for Socioeconomic Status and the World Health Organization QOL Scale (WOQOL-BREF). Data were analyzed using descriptive statistics including Student t tests, analysis of variance, and the Scheffe test for post hoc analysis. Mean scores for QOL were 14.52 for the physical health domain, 14.3 for the psychologic domain, 13.57 for the social relationships domain, and 11.78 for the environment domain. It has been concluded that providing care for patients with cancer has a negative impact on the QOL of oncology nurses.

The effects of patient education in lithium therapy on quality of life and compliance

The purpose of this study was to show the effects of education on medication compliance, symptom level and quality of life of outpatients who were being treated with lithium for bipolar disorder. The study was performed comparing a total of 26 patients (14 study and 12 control) who were a patient group in lithium therapy. In the study one group was given a short education program about the disorder and lithium therapy in three sessions. Data were collected from both groups using a medication knowledge form, Brief Symptom Inventory, and WHO Quality of Life Scale before and after the intervention. At the end of 3 months whereas there was no difference seen in the scores of the control group; the study group had an increase in medication knowledge, a decrease in symptom level, an increase in quality of life, and a beginning of more regular medication use. Findings that were obtained show the importance of education about the disorder and medication in increasing the adaptation to society of patients who have bipolar disorder.

Development of the Korean versions of WHO Quality of Life scale and WHOQOL-BREF.

The purpose of this study was to develop the Korean version of World Health Organization Quality of Life study assessment instrument (WHOQOL) and WHOQOL-BREF, an abbreviated version of WHOQOL and to identify contributing factors in the quality of life of Koreans. The WHOQOL and WHOQOL-BREF were translated into colloquial Korean according to instructions of the WHOQOL study group. Then the Korean questionnaire was applied to 538 subjects, composed of 171 medical patients and 367 healthy subjects who volunteered to rate the scale. Finally, 486 subjects completed the rating. Collected data were analyzed statistically. The Korean version of WHOQOL and WHOQOL-BREF domain scores demonstrated good test-retest reliability, internal consistency, criterion validity, content validity and discriminant validity. The physical, psychological, social and environmental domains made a significant contribution to explaining the variance in the quality of life while the independence and spiritual domains made a lesser contribution. The domain scores produced by the WHOQOL-BREF correlated highly with the WHOQOL. The physical health domain contributed most in overall quality of life, while the social domain made the least contribution. These results suggest that the Korean version of WHOQOL and WHOQOL-BREF are valid and reliable in the assessment of quality of life and that physical domain is contributing most and social and spiritual factors are contributing least to the quality of life in Koreans.