The Impact of Demographic Characteristics on Health-related Quality of Life Profile of Malaysian Epilepsy Population

The possibilities of adverse drug reactions and disease-related psychosocial implications have led to the current emphasis on health-related quality of life (HRQoL) assessment in epilepsy. The main objective of this study was to determine the impact of various demographic characteristics i.e. gender, age, marital status, ethnic origin, religion, and employment status on HRQoL profiles in Malaysian epilepsy patients. Patients with epilepsy were recruited from ten public hospitals in Sabah, Malaysia. Upon written consents, they completed the Malay Quality of Life In Epilepsy-30 (QOLIE-30) instrument which assesses Seizure Worry, Overall QoL, Emotional Well-Being, Energy/Fatigue, Cognitive Functioning, Medication Effects and Social Functioning. An Overall Score was generated to represent a summarised HRQoL score. Univariate and multiple linear regression analyses were both carried out using SPSS 14 for (1) all patients and (2) patients possessing Poor QoL (Overall Score < median) and Good QoL (Overall Score ≥ median). One-hundred-and-thirteen patients participated in the study. The respondents ranged from 18–76 years with a mean age of 31 years. Majority were Kadazandusuns (n = 46; 40.7%) and many were unmarried (n = 68; 60.2%), Muslims (n = 50; 44.2%) and unemployed (n = 54; 47.8%). Age was the most significant factor across all patients (B = −0.372, t = −2.238, p = 0.027), regardless of Poor or Good QoL level. Older patients (>56 years) fared the worst in many HRQoL areas. Those with Poor QoL were mostly affected by marital status (widowed/divorced) and ethnic origin (Kadazandusun/Chinese). Religion (Buddhism/Hinduism) emerged as the most prominent HRQoL predictor for patients experiencing Good QoL and being Chinese too played a role. These outcomes indicate that specific demographic characteristics are influential in determining the HRQoL of epilepsy patients. Consequently, healthcare professionals could utilise such information in planning the best treatment and care by considering both the medical and psychosocial impacts towards patients. This paper was part of a research project and majority of its components had been presented at the 7th Conference On International Society For Quality Of Life Studies (ISQoLS) 2006, Rhodes University, Grahamstown, South Africa, 17–20 July 2006.     

Test of a Factor Mixture-Based Taxonic-Dimensional Model of Anxiety Sensitivity and Panic Attack Vulnerability among University and Clinical Samples in Mexico City

The aim of the present study was to evaluate a factor mixture-based taxonic-dimensional model of anxiety sensitivity (AS) (Bernstein et al. Behavior Therapy 41:515-521, 2010), as measured by the ASI-3 (Taylor et al. Psychological Assessment 19:176-188, 2007), in regard to panic attacks, anxiety symptoms, and behavioral impairment among a university sample (N = 150, n _females  = 107, M _age = 21.3 years, SD = 4.3) and a clinical sample (N = 150, n _females  = 102, M _age = 39.0 years, SD = 12.0) from Mexico City, Mexico. Findings demonstrated cross-national support for the conceptual and operational utility of the AS taxonic-dimensional hypothesis (Bernstein et al. Journal of Anxiety Disorders 20:1-22, 2007b). Specifically, (1) the FMM-based AS taxon class base rate was significantly greater among the clinical relative to the university sample; (2) risk for panic attacks was significantly greater among the AS taxon class relative to the AS normative class; and (3) continuous individual differences in AS physical and psychological concerns, within the AS taxon class, were associated with level of risk for panic attacks, as well as panic attack severity and anxiety symptom levels. Similar AS taxonic-dimensional effects were observed in relation to degree of behavioral impairment across domains of functioning. The study results are discussed with respect to their implications for better understanding the nature of AS-related cognitive vulnerability for panic and related anxiety psychopathology.     

Using the ASEBA to Screen for Callous Unemotional Traits in Early Childhood: Factor Structure,Temporal Stability,and Utility

This study evaluated a five-item screening measure of Callous Unemotional (CU) traits using items drawn from the Preschool Form of the Achenbach System of Empirically Based Assessment (ASEBA). Using data from the Durham Child Health and Development study (N = 178), confirmatory factor analyses demonstrated that CU items could be distinguished from Attention Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant (ODD) items. The two-year stability (N = 137) of CU (ϕ = .84) was comparable to that of ADHD (ϕ = .79) and ODD (ϕ = .69). Three groups of children were selected based on parent-rated ODD and CU behaviors at the 36-month assessment (N = 37; ODD+CU, N = 7; ODD-only, N = 12; non-ODD, N = 18). Multiple measures of infant temperament predicted group membership with 84% accuracy. Consistent with Frick and Morris’ (Journal of Clinical Child and Adolescent Psychology 33(1):54–68, 2004) hypotheses, ODD+CU and ODD-only children exhibited temperamental profiles in infancy that were consistent with low fear and emotionally dysregulated pathways into conduct problems, respectively.     

Psychological Factors Associated with a Better Quality of Life Following Head-Up Tilt Testing

Quality of life (QoL) is reduced in patients with recurrent vasovagal (VVS) or unexplained syncope (US). Little is known concerning the natural evolution of QoL following diagnosis. Psychological factors contributing to QoL improvement, such as psychological distress and self-efficacy remain to be explored. The objective of this study is to examine whether QoL changes 2 months and 6 months following head-up tilt (HUT) testing as well as to determine whether psychological factors are predictive of changes in QoL. Seventy-three patients undergoing HUT for recurrent syncope were interviewed 1 month before as well as 2 months and 6 months following HUT, using semi-structured interviews and questionnaires. Pre-HUT QoL was significantly worse than at the 2-month (p = 0.000) and 6-month follow-ups (p = 0.000). Psychological distress at baseline was associated with worse QoL 2 months post-HUT (Beta = .280; p = .024), independently of socio-demographic and clinical factors. Improved self-efficacy at follow-up predicted improvements in QoL (Beta = −.186; p = .023). Two and 6 months post-HUT, QoL is mproved in patients with recurrent syncope. Better QoL is predicted by low psychological distress and a heightened sense of self-efficacy following HUT. Strategies for enhancing self-efficacy and reducing psychological distress could be an efficient way to promote QoL in patients suffering from recurrent syncope.     

Quality of Life in Patients with Recurrent Vasovagal or Unexplained Syncope: Influence of Sex, Syncope Type and Illness Representations

Health-related quality of life (QoL) is reduced in patients with recurrent vasovagal (VVS) or unexplained (US) syncope. Little is known regarding these patients’ QoL as pertains to their capacity to attain their life goals. Factors influencing QoL, such as sex, syncope type and illness representations have not been studied. Our objective is to examine the relationship between illness representations and QoL, as well as possible sex and syncope type differences. One hundred and four patients undergoing tilt-table testing (TTT) for recurrent syncope were interviewed one month before TTT, using questionnaires. Data were analysed using ANCOVAs, a-priori Helmert contrasts for illness representations, and regressions. Patients with US had a poor QoL compared to those with VVS [F(1, 91) = 10.46; p < 0.01], particularly in men (p < 0.01). Patients with higher perceived syncope severity showed an impoverished QoL relative to those with less severe perceptions [F(1, 91) = 5.47; p < 0.05]. A hierarchical regression revealed that illness representations mediate the impact of lifetime number of syncope on QoL. In conclusion, QoL is reduced in these patients, and is influenced by illness representations. Helping patients change their perceptions about their syncope may be an efficient way to promote QoL.     

Health Related Quality of Life After Gastric Bypass Surgery

The majority of studies which have evaluated health related quality of life are limited in the duration of follow up. The objective of this study was to prospectively conduct an evaluation using a repeated cross sectional analysis of separate patient cohorts who were up to four years after gastric bypass surgery. Adult Roux-en-Y gastric bypass patients were recruited to the study. All patients were requested to complete a general health status questionnaire, the Short Form-36 (SF-36), before surgery or at their post operative out patient follow up visits. Patient weight was documented at each follow up visit. A cross sectional analysis was performed to evaluate SF-36 scores in each annual cohort. Data are reported as mean +/− S.D. Three-hundred-eight patients completed at least one SF-36 assessment [Initial assessment at the time of surgery, time 1, n = 245, 1y n = 149, 2y n = 70, 3y n = 59, 4y n = 61]. The SF-36 scores were greater (p < 0.05) in each of the separate post surgery cohorts for physical functioning, role limitations due to physical health, social functioning, pain, vitality, general health and the physical component summary (PCS) scores. While not comparing changes in scores within individuals over time, these data suggest early improvement especially in the physical dimension of health related quality of life. In this analysis, this finding was also observed in each of the separate cohorts up to 4 years after gastric bypass surgery.     

Brooding and Reflection as Subtypes of Rumination: Evidence from Confirmatory Factor Analysis in Nonclinical Samples using the Dutch Ruminative Response Scale

Previous research has shown that depressive rumination is an important vulnerability factor for experiencing depressive symptoms. The most widely used measure to assess depressive rumination is the Ruminative Response Scale (RRS). According to Treynor et al. (Cognitive Therapy and Research 27:247–259, 2003), the RRS contains two subscales, reflecting two different rumination subcomponents: brooding and reflection. The present study examined the psychometric properties of the RRS in two samples (N = 432 and N = 407). Based on a confirmatory factor analysis (CFA), results confirmed that a two-dimensional model with brooding and reflection factors provided an adequate fit to the data. Reliability, convergent and discriminant validity of the rumination subcomponents were appropriate. Furthermore, brooding but not reflection predicted depressive symptoms prospectively, even when accounting for concurrent depressive feelings. The results provide the first confirmatory factor-analytical support for the widely assumed two-factor model of the RRS and add to the accumulating body of evidence supporting the multidimensional nature of depressive rumination.     

Physical Activity, Life Satisfaction, and Self-Rated Health of Middle School Students

Little research has examined the association between life satisfaction, self-rated health (SRH), and physical activity concurrently for middle school students. A convenience sample of 245 students in grades 7 and 8 was surveyed about physical activity, life satisfaction, and SRH using the U.S. Centers for Disease Control and Prevention (CDC) 2005 Middle School Youth Risk Behavior Survey. ANOVA analyses revealed significantly reduced life satisfaction for females who reported not engaging in vigorous physical activity during the past 7 days [p < .01, effect size (ES) = .75]. Significantly reduced life satisfaction was detected for both males (p < .001, ES = .66) and females (p < .0001, ES = .80) who reported not playing on sports teams. Additionally, logistic regression analyses showed the odds of reporting fair/poor SRH increased 5.4 times for males (CI = 1.30–22.39, p < .05) and 30.9 times for females (CI = 3.74–255.43, p < .001) who reported not playing on sports teams. Preliminary findings suggest physical activity and sports participation is associated with improved life satisfaction and SRH for middle school students. In addition, although some gender differences were observed, consistent findings for sports participation suggest sports participation may carry multiple social, mental, and physical benefits for youth.     

Coronary Intervention Improves Disease Specific Health-Related Quality of Life but Not Individualised Quality of Life: A Potential Response Shift Effect?

To explore potential response shift effects with different quality of life (QoL) instruments in cardiac patients undergoing coronary intervention. Study Design and Setting: Recalibration was assessed with the disease specific health-related quality of life (HRQL) instrument MacNew in combination with a then-test approach. Reconceptualisation and reprioritisation were assessed with the individualised QoL instrument SEIQoL-DW. Significant treatment effects were seen on the MacNew (global Δ: 0.6 ± 1.1, p = 0.004) but not on the SEIQoL-DW (Δ: 3.3 ± 16, p = 0.37) 6 months after coronary intervention. No recalibration effect was found on the MacNew then-test, while with the SEIQOL-DW potential response shift effects of reconceptualisation and reprioritisation were seen. For the first time response shift effects were explored in cardiac patients undergoing coronary intervention. This study confirmed that there is a clinically significant improvement in disease specific HRQL over time following successful coronary interventions. However, no treatment effect was seen for individualised QoL with the SEIQoL-DW. This might be due to reconceptualisation and reprioritisation response effects. Future studies need to focus on exploring response shift effects, and the interrelationship between its different components, captured by different patient reported outcome instruments in larger patient groups undergoing coronary interventions.     

Assessing Dimensions of Parental Discipline

This study examines the advisability to distinguish dimensions of discipline, by evaluating the Dimensions of Discipline Inventory (DDI, Straus and Fauchier 2007) in a sample of Belgian undergraduate students (N = 371) who retrospectively reported on their mothers’ and fathers’ discipline behaviors aimed at correcting child misbehavior at age 10. First, confirmatory factor analyses showed that a model with nine factors fitted the data best, but also a model with four second-order factors was acceptable. Second, a multigroup confirmatory factor analysis with a Belgian and a U.S. sample (N = 633) provided additional evidence for the nine-factor structure. Correlations between DDI scales and other parenting related variables demonstrated meaningful relations. Additionally, some DDI subscales were associated with measures of current problem behavior. To conclude, the present study illustrated that it is both useful and possible to differentiate between discipline constructs.     

An Evaluation of the Relation Between Distress Tolerance and Posttraumatic Stress within a Trauma-Exposed Sample

The present investigation examined the incremental associations between distress tolerance, or the perceived capacity to tolerate emotional distress, and global posttraumatic stress symptom severity as well as symptom cluster severity, beyond the variance accounted for by number of trauma exposure types and negative affectivity. The sample consisted of 140 adults (72 women; M _age = 25.9, SD = 11.1) who endorsed exposure to traumatic life events, as defined by posttraumatic stress disorder diagnostic criterion A (American Psychiatric Association 2000). Participants did not meet diagnostic criteria for current axis I psychopathology. Distress tolerance demonstrated significant incremental associations with global posttraumatic stress symptom severity (p < .01) as well as re-experiencing (p < .05), avoidance (p = .05), and hyperarousal (p < .001) symptom cluster severity. Given the cross-sectional study design, causation cannot be inferred. Theoretical implications and future directions for better understanding associations between distress tolerance and posttraumatic stress are discussed.     

Mindfulness in Iran and the United States: Cross-Cultural Structural Complexity and Parallel Relationships with Psychological Adjustment

In theory, mindfulness has a role to play in resolving intercultural conflicts. This suggestion rests upon the relatively untested presumption that mindfulness operates similarly across cultures. In a test of this presumption, university students from two countries that are often in conflict at the governmental level, Iran (N = 723) and the United States (N = 900), responded to the Mindful Attention Awareness Scale (Brown and Ryan Journal of Personality and Social Psychology 84(4):822–848, 2003), along with an array of other psychological measures. This Mindfulness Scale displayed structural complexities in both societies, but a measurement invariant subscale was nevertheless identified. Similar cross-cultural evidence of concurrent validity was obtained in relationships with wide-ranging measures of adjustment. Nonsignificant linkages with Public Self-Consciousness and Self-Monitoring demonstrated discriminant validity in both societies. These data identified mindfulness as a cross-culturally similar psychological process that could plausibly have a role in resolving intercultural conflicts.     

Equivalency for Father and Mother Ratings of the ADHD Symptoms

The study used multiple-group confirmatory factor analysis (CFA) and multiple indicators multiple causes (MIMIC) procedures to examine the measurement and construct equivalencies for father and mother ratings of ADHD symptoms, recoded as binary scores. Fathers (N = 387) and mothers (N = 411) rated their primary school-aged children on the Disruptive Behavior Rating Scale (Barkley & Murphy, 1998). For the multiple-group CFA analyses, the results involving differences in practical fit indices supported full measurement and construct equivalencies, whereas the chi-square difference test showed lack of equivalency in five symptoms for factor loadings, four symptoms for error variance, and the variance and mean scores for the hyperactivity-impulsivity factor. For the MIMIC analyses, six symptoms lacked equivalency for thresholds. These findings extend existing data in this area. The theoretical, psychometric and clinical implications of the findings are discussed.     

Hypothalamic Pituitary Adrenal Axis Functioning in Reactive and Proactive Aggression in Children

The purpose of this study was to examine the association between hypothalamic-pituitary-adrenal axis (HPA-axis) reactivity and proactive and reactive aggression in pre-pubertal children. After a 30-min controlled base line period, 73 7-year-old children (40 males and 33 females) were randomly assigned to one of two experimental tasks designed to elicit fear (N = 33) or frustration (N = 32), or a validity check condition (N = 8). This was followed by a 60-min controlled regulation phase. A total of 17 saliva samples for cortisol analysis were collected including 12 post-stress samples at 5-min intervals. Reactive and proactive aggression levels were assessed via the teacher-completed Aggression Behavior Teacher Checklist (Dodge and Coie, J Pers Soc Psychol, 53(6), 1146–1158, 1987). Reactive aggression significantly predicted total and peak post-stress cortisol regardless of stress modality. Proactive aggression was not a predictor of any cortisol index. Examination of pure reactive, proactive, combined, or non-aggressive children indicated that reactive aggressive children had higher cortisol reactivity than proactive and non-aggressive children. Our data suggest that while an overactive HPA-axis response to stress is associated with reactive aggression, stress induced HPA-axis variability does not seem to be related to proactive aggression.     

The Effects of Weight Loss Attempts, Exercise Initiation, and Dietary Practices on Health Related Quality of Life

This study (N = 98) randomly placed participants in either a higher protein or American Heart Association diet group with each group initiating an aerobic exercise program. Body composition (BC) was measured using four different methodologies (DEXA, BIA, skinfold, BMI) along with height and weight, while Health-Related Quality of Life (HRQOL) changes were measured using the Medical Outcomes Short Form 36 (SF-36). There were no significant time/diet interactions in HRQOL scores, body fat measures, and weight with the exception of Role-Physical scores (p = .006) with posttest scores higher in participants in Diet 1. Role-Physical scores changed significantly in participants in Diet 1 (p = .0001) and Diet 2 (p = .026) with higher posttest scores in each group. Social functioning had a significant main effect for time in both groups with pretest scores in both diet groups lower than their respective posttest scores (p = .015). HRQOL pretest scores were not significantly different between groups at baseline (p = .56). ANOVA revealed no significant differences in average calories between groups (p = .88). Analysis revealed no differences in exercise in minutes (p = .66) nor statistically significant changes in BC or weight (p = .65). Conclusions: Improvements in HRQOL were demonstrated in two subscales related to physiological and psychological functioning. These novel findings add to literature suggesting that HRQOL, at least concerning social functioning, work and other daily activities (Role-Physical) may improve by initiating an exercise and dietary program even when weight loss or BC improvements have been unsuccessful.     

The Validity of a New,Self-report Measure of Multiple Intelligence

In all, 187 participants completed a new, self-report measure of eight multiple intelligences (Haselbauer 2005), a General Knowledge test (Irwing et al. Personality and Individual Differences 30:857–871, 2001), a measure of Approaches to Learning Styles (Biggs 1987), a measure of the Big Five personality traits (Costa and McCrae 1992), as well as gave their own estimated scores on the Gardner (1999) multiple intelligences. Alpha co-efficients were modest with only three of the eight test-derived, multiple intelligence scores being over .70. ‘Linguistic’ and Mathematical intelligence alone were correlated with General Knowledge. Five of the eight ‘intelligences’ were correlated both with Extraversion and Openness. Regressions indicated that ‘Intrapersonal intelligence’ was closely linked with Stability and Conscientiousness; ‘Interpersonal intelligence’ with Extraversion; ‘Linguistic intelligence’ with Openness; ‘Mathematical intelligence’ with Agreeableness and Conscientiousness. Correlations between self-estimated and test-derived emotional intelligence showed correlations ranging from r = .18 to r = .56 for similar type ‘intelligences’. This study provides modest evidence for the concurrent and construct validity of this measure. It requires more psychometric evidence of validity before it is used.     

Adolescents’ Life Satisfaction During the Transition to Post-Comprehensive Education: Antecedents and Consequences

The present four-wave longitudinal study, conducted in Finland, investigated the extent to which life satisfaction changed among adolescents during the transition from comprehensive school to an academic or a vocational track. The participants were 15-year-old adolescents (Time 1: N = 687, Time 2: N = 642, Time 3: N = 818, Time 4: N = 749) who filled in the Diener et al. (J Pers Assess 49: 71–75, 1985). Satisfaction With Life Scale twice during their final term of comprehensive school and twice after the transition either to upper secondary or vocational education. At comprehensive school they reported their academic achievement, expected educational track, educational aspirations, self-esteem, and background information, while at the last measurement point they reported their school engagement and attained educational track. Latent Growth Modeling showed, first, that life satisfaction increased during the educational transition. Second, the higher the adolescents’ academic achievement and self-esteem, the higher the level of their life satisfaction during the transition. Third, among girls, the lower their self-esteem, the more their life satisfaction increased during the educational transition. Fourth, among both boys and girls, a high level of life satisfaction during the transition predicted academic track and school engagement at the last measurement point. Finally, among girls, an increase in life satisfaction during the transition predicted school engagement and an academic track. The results support the stage-environment fit theory according to which the nature of the educational environment is more important than the transition per se for changes in adolescents’ life satisfaction (see Eccles and Midgley in Research on motivation in education. Academic Press, New York, pp. 139–186, 1989).     

Construct Validity of ADHD-IN,ADHD-HI,ODD toward Adults,Academic and Social Competence Dimensions with Teacher Ratings of Thai Adolescents: Additional Validity for the Child and Adolescent Disruptive Behavior Inventory

Confirmatory factor analysis was used to test the construct validity of an attention-deficit/hyperactivity disorder-inattention, attention-deficit/hyperactivity disorder-hyperactivity/impulsivity, oppositional defiant disorder toward adults, academic and social competence factor model with teacher ratings of Thai adolescents (n = 872) with the Child and Adolescent Disruptive Behavior Inventory. The five-factor model resulted in an adequate fit in an absolute sense (i.e., CFI = .960; TLI = .985; RMSEA = .065; and WRMR = .883). All the items had significant and substantial loadings on their respective factors (i.e., > .78) with the five-factors showing discriminant validity. The five-factor model also resulted in similar results for boys and girls separately as well as younger and older adolescents. The current findings with the teacher version of the measure in conjunction with earlier research with mothers’ and fathers’ ratings of Brazilian, Thai, and American children (Burns et al., Psychological Assessment, 20, 121-130, 2008) and Thai adolescents (Burns et al., Psychological Assessment, 21, 635-641, 2009) provide increasing support for the construct validity of Child and Adolescent Disruptive Behavior Inventory within multiple cultures. Procedures are also outlined to improve the content validity as well as test the construct validity of forthcoming parent and teacher DSM-V ADHD/ODD rating scales.     

Happiness as Stable Extraversion: Internal Consistency Reliability and Construct Validity of the Oxford Happiness Questionnaire Among Undergraduate Students

The Oxford Happiness Questionnaire (OHQ) was developed by Hills and Argyle (2002) to provide a more accessible equivalent measure of the Oxford Happiness Inventory (OHI). The aim of the present study was to examine the internal consistency reliability, and construct validity of this new instrument alongside the Eysenckian dimensional model of personality. The Oxford Happiness Questionnaire was completed by a sample of 131 undergraduate students together with the abbreviated form of the Revised Eysenck Personality Questionnaire. The data demonstrated good internal consistency reliability (alpha = .92) and good construct validity in terms of positive association with extraversion (r = .38 p < .001) and negative association with neuroticism (r = −.57 p < .001). The kind of happiness measured by the OHQ is clearly associated with stable extraversion.     

The UCLA Body Project II: Breast and Body Dissatisfaction among African, Asian, European, and Hispanic American College Women

Breast and global body dissatisfaction were examined in Asian (n = 237), European (n = 196), Hispanic (n = 109), and African (n = 58) American college women. Asian American women reported the lowest body satisfaction on the Appearance Evaluation Scale (Cash, T. F. The multidimensional body-self relations questionnaire users’ manual: 3rd revision, 2000) and greatest breast dissatisfaction on one of two breast dissatisfaction measures. Ethnic differences in breast dissatisfaction, but not in body dissatisfaction, disappeared when body size (BMI) was statistically controlled. Results were consistent with research showing that (1) ethnic differences in body dissatisfaction are small, (2) studies of ethnic differences must include appropriate controls for total or specific body size, and (3) Asian college women report lower global body satisfaction than women of African, European, or Hispanic heritage. For additional papers and information, please contact David Frederick at enderflies1@aol.com, visit his website at or contact Gordon B. Forbes at gforbes@millikin.edu.