Health-Related Quality of Life of Asylum Seekers and Refugees in Germany: a Cross-Sectional Study with Data from the German Socio-Economic Panel

The purpose of this study was to estimate the health-related quality of life (HrQoL) of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017. The analysis was based on the 2016 and 2017 refugee samples of the German Socio-Economic Panel (n = 6821). HrQoL was measured using a modified version of the SF-12v2 questionnaire and presented as physical (PCS) and mental (MCS) component summary scores. PCS and MCS scores for the total sample, males and females were calculated by sociodemographic characteristics. Associations between PCS and MCS scores and sociodemographic variables were examined by a linear regression with bootstrapped standard errors. The mean PCS and MCS scores of the sample were 53.4 and 47.9, respectively. Female sex was statistically significantly associated with lower PCS and MCS scores. The SF-12 subscale general health was valued highest with a score of 55.4, whereas the subscale role emotional was valued lowest with a score of 46.9. Employment was statistically significantly associated with higher PCS and MCS scores. Persons from Afghanistan had statistically significantly lower MCS scores than persons from Syria, whereas MCS scores were statistically significantly higher for persons from Eritrea. Physical and mental HrQoL of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017 was higher and lower than the German norm, respectively. Female sex, older age, unemployment and being separated, divorced or widowed were negatively associated with HrQoL. The three largest ethnical groups of asylum seekers and refugees, Syrians, Afghans and Eritreans, differ inherently in their HrQoL.

     

Inequality and Social Heterogeneity in Self-Reported Health Status in the Tunisian Population: An Analysis Using the MIMIC Model

Using a MIMIC model with structural equations and two synthetic health scores, this study attempts to explore the impact of the measurement of health status on socioeconomic inequalities in health. The results showed satisfactory internal consistency for both summary measures that are the Physical Component Summary (PCS) and the Mental Component Summary (MCS). A Physical Component Summary and Mental Component Summary calculated from the Short Form health survey (SF-12) items showed the same magnitude of health state and degree of change overtime; Cronbach’s α for PCS-12 and MCS-12 was .93 and .86, respectively. Known subgroups comparison showed that the SF-12 discriminated well between men and women and those who differed in age and educational status. In addition, results suggest the existence of reporting heterogeneity biases for a given latent health state, women and old people are more likely to report physical activity limitations; Mental health problems are over-reported by women and divorced people and under-reported by the oldest people; Clerks, farmers and retired as well as employees and homemakers in the top of the social hierarchy more often report physical activity limitations. Finally, highly educated and socially advantaged people more often report social activities limitations due to the problems of physical and mental health.     

The validity of personal disturbance scale (DSSI/sAD) in people with diabetes mellitus,using longitudinal data

Despite being used since 1976, Delusions-Symptoms-States-Inventory/states of Anxiety and Depression (DSSI/sAD) has not yet been validated for use among people with diabetes. The aim of this study was to examine the validity of the personal disturbance scale (DSSI/sAD) among women with diabetes using Mater-University of Queensland Study of Pregnancy (MUSP) cohort data. The DSSI subscales were compared against DSM-IV disorders, the Mental Component Score of the Short Form 36 (SF-36 MCS), and Center for Epidemiologic Studies Depression Scale (CES-D). Factor analyses, odds ratios, receiver operating characteristic (ROC) analyses and diagnostic efficiency tests were used to report findings. Exploratory factor analysis and fit indices confirmed the hypothesized two-factor model of DSSI/sAD. We found significant variations in the DSSI/sAD domain scores that could be explained by CES-D (DSSI-Anxiety: 55%, DSSI-Depression: 46%) and SF-36 MCS (DSSI-Anxiety: 66%, DSSI-Depression: 56%). The DSSI subscales predicted DSM-IV diagnosed depression and anxiety disorders. The ROC analyses show that although the DSSI symptoms and DSM-IV disorders were measured concurrently the estimates of concordance remained only moderate. The findings demonstrate that the DSSI/sAD items have similar relationships to one another in both the diabetes and non-diabetes data sets which therefore suggest that they have similar interpretations.     

Depression,Positive and Negative Affect,Optimism and Health-Related Quality of Life in Recently Diagnosed Multiple Sclerosis Patients: The Role of Identity,Sense of Coherence,and Self-efficacy

The study aimed to describe the levels of depression, positive and negative affect, optimism and health-related quality of life (HRQOL) in a group of recently diagnosed multiple sclerosis (MS) patients (up to 3 years since the diagnosis), taking into account gender, age, and disease duration differences, and to investigate the possible role of identity, sense of coherence (SOC), and self-efficacy in MS (SEMS) on patients’ depression, positive and negative affect, optimism, and HRQOL. The cross-sectional study involved 90 MS patients (61% women; age: M = 37, SD = 12) with an Expanded Disability Status Scale score between 1 and 4 (mild to moderate disability). Patients completed measures of depression (CESD-10), positive and negative affect (PANAS), optimism (LOT-R), HRQOL (SF-12), identity motives, SOC, and SEMS. Depression scores were near the cut-off level for clinically significant depressive symptoms, and negative affect was higher and HRQOL was lower than those in the general population. Women and younger patients reported better adjustment as time passes since the diagnosis. Results of multiple regressions indicated that higher SOC was related to higher mental health, lower negative affect and lower depression. Higher SEMS was predictive of greater positive affect and lower negative affect, whereas higher identity satisfaction was predictive of higher positive affect and optimism and lower depression. The results suggest the usefulness of addressing identity redefinition, SOC and self-efficacy in psychological interventions aimed at promoting patients’ adjustment to MS.     

Transactional Relationships among Cognitive Vulnerabilities, Stressors, and Depressive Symptoms in Adolescence

The transactional cognitive vulnerability to stress model Hankin & Abramson (Psychological Bulletin, 127:773–796, 2001) extends the traditional diathesis-stress model by proposing that the relationships among cognitions, depressive symptoms, and stressors are dynamic and bidirectional. In this study three different pathways among these variables were assessed simultaneously: (1) cognitive vulnerabilities and stressors as predictors of depressive symptoms (vulnerability model), (2) depressive symptoms and cognitive vulnerabilities as predictors of stressors (stress generation model), and (3) depressive symptoms and stressors as predictors of cognitive vulnerabilities (consequence model). A fully cross-lagged design panel was employed with 1,187 adolescents (545 girls and 642 boys, Mean Age?=?13.42 years) who were assessed at two time points separated by 6 months. They completed measures of cognitive vulnerabilities (maladaptive schema domains and negative inferential style), stressors, and depressive symptoms. Inferential style and schemas of the disconnection and rejection domain predicted prospective increases in depressive symptoms. Initial levels of depressive symptoms and most cognitive vulnerabilities predicted greater stress generation. Initial levels of stressors and depressive symptoms predicted an increase in negative inferential style and maladaptive schema domains over time. These bidirectional relationships were mostly similar for boys and girls, although there were a few gender differences. The findings support a transactional model with reciprocal relationships among stress, depressive symptoms, and cognitive vulnerabilities. Transactional implications for depression interventions among adolescents are discussed.     

Quality of Life (QoL) in a Brazilian Sample of Older Adults: The Role of Sociodemographic Variables and Depression Symptoms

The aim of the present study was to identify relevant variables associated with Quality of Life (QoL) in older adults. Older adults, up to 60 years old, were interviewed. Subjects were recruited through convenience sampling. 339 paticipants, who were stratified by gender, age, and subjective perception of health and illness, answered questions on sociodemographic issues, QoL (WHOQOL-100) and depressive symptomathology (Beck Depression Inventory—BDI). The multiple linear regression analysis showed associations of overall perception of QoL with depression levels, subjective perception of health status and gender. The individual analysis of each domain concluded that depression levels are correlated to all QoL domains, while health status was associated with physical, psychological, independence level and social relationship domains. Other variables were also assessed. The assessment of older adults concerning their QoL perceptions is associated with gender, age, marital status, social class, literacy rate, perception of health, and more substantially associated with depressive symptoms levels. Nevertheless, some limitations of this study and further ones are suggested.     

Understanding depressed mood in the context of a family-oriented culture

This study examined the contribution of individual and family variables to depressive symptoms among youths in a family-centered culture. Participants were 262 Mexican adolescents (mean age = 15.9 years). At the individual level, gender (being female) and higher levels of perceived stressfulness of life events and ruminative coping style were correlated with higher frequency of depressive symptoms. At the family level, higher levels of perceived parental warmth and acceptance and parental monitoring were correlated with lower levels of depressed mood, whereas higher levels of parent-adolescent conflict were associated with greater frequency of depressive symptoms. Regression analyses confirmed our prediction that both individual factors (gender, ruminative coping) and family factors (parental warmth and parental monitoring) would make unique contributions to depressive symptoms. The model comprised of individual and family variables accounted for 50% of the variance in depressed mood. Moreover, parental warmth and acceptance attenuated the impact of ruminative coping style on adolescents' depressive symptomatology. Findings are discussed in relation to previous research on adolescents in another family-centered culture (China), and directions for future research are proposed.     

Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.     

Depressive‐symptom onset during toddlerhood in a sample of depressed preschoolers: Implications for future investigations of major depressive disorder in toddlers

This study investigated the occurrence of depressive symptoms prior to age 36 months as retrospectively reported by parents of preschoolers with clinical depression. The study provides some of the first empirical data on the manifestations of depressive symptoms during the toddler period, advancing existing theoretical and case‐report literature. A sample of 301 (depressed, disruptive, and healthy) children between the ages of 3.0 and 6.0 years were screened and oversampled for depressive symptoms from community sites. Primary caregivers (parents) were interviewed about their child's symptoms of depression (as well as other symptoms of mental disorders and developmental parameters), and age of first onset of depressive symptoms was ascertained. Findings suggest that clinical‐level symptoms of depression may arise as early as age 24 months. The domain of negative self‐concept during the toddler period evidenced by self‐deprecation and difficulty making choices emerged as the two strongest variables predictive of preschool depression. Our results suggest that prospective empirical studies of depressive symptoms in children younger than 3 years of age should now be undertaken.     

Night Eating and Loss of Control over Eating in Bariatric Surgery Candidates

The goal was to examine the relationship between loss of control over eating (LOC_E) and other variables, including eating pathology, in bariatric candidates. Two hundred and twenty-six participants completed measures of depressive symptoms, eating pathology, health-related quality of life (HRQOL), and alcohol use. Participants were divided into those who did (n = 123) and did not (n = 103) report subjective LOC_E. Participants with LOC_E had significantly higher levels of night eating, depressive symptoms, and eating disorder psychopathology and lower mental HRQOL. There were no observed differences in alcohol use, dietary restraint, or physical HRQOL. This study highlights eating and mental health-related correlates of LOC_E, providing evidence that it is associated with increased psychological burden in bariatric candidates. This is one of the first studies to report the relationship between LOC_E and night eating in this group and future research could elaborate on these variables to determine their importance in long-term weight loss.     

Effects of Patients' Age,Gender, and Depression on Medical Students' Beliefs,Attitudes, Intentions,and Behavior1

This study examines the effects of patient age, gender, and depression on 88 advanced medical students' beliefs, attitudes, intentions, and behavior. Each subject heard an audiotaped patient portrayal. Patient age (32 or 67 years), gender, and depressive symptoms varied in a 2 × 2 × 2 between-subjects factorial design. All of the patients reported the same symptoms except that half of them also presented symptoms of depression. Questionnaires assessed beliefs about the patient's condition, attitudes toward the patient, treatment intentions, and recall of patient information. Expectations of an age bias were not substantiated. Females were rated less seriously ill, less likely to require laboratory tests, and more likely to receive medication than males. Among depressed patients, counseling and reassurance were more likely for females, and a nonpsychiatric consult was more likely for males. Recall of the symptoms presented was better for depressed patients. The implications for medical practice are discussed.     

Reciprocal Associations Between Depressive Symptoms and Disordered Eating Among Adolescent Girls and Boys: A Multiwave,Prospective Study

Symptoms of depression and eating disorders increase during adolescence, particularly among girls, and they tend to co-occur. Despite this evidence, there is meager research on whether depression increases the risk of future eating pathology, or vice versa, and we do not know whether these processes are different for adolescent girls and boys. Accordingly, this study explored the prospective reciprocal associations between depressive symptoms and disordered eating at different time points from preadolescence to mid-adolescence and tested the moderator effect of gender on these associations. A community-based sample of Spanish youth (N?=?942, 49 % female) was assessed at ages of approximately 10-11 (T1), 12-13 (T2), 14-15 (T3), and 16-17 (T4) years. The bidirectional relationships between depressive symptoms and disordered eating were estimated in an autoregressive cross-lagged model with latent variables. A unidirectional, age-specific association between depressive symptoms at T1 and disordered eating at T2 was found. No other significant cross-lagged effect emerged, but the stability of the constructs was considerable. Gender did not moderate any of the links examined. Regardless of gender, the transition from childhood to adolescence appears to be a key period when depressive symptoms foster the development of disordered eating. These findings suggest that early prevention and treatment of depression targeting both girls and boys may result in lower levels of depressive symptoms and disordered eating in adolescence.     

An interpersonal perspective on depression: the role of marital adjustment, conflict communication, attributions, and attachment within a clinical sample

Previous studies have focused on the difficulties in psychosocial functioning in depressed persons, underscoring the distress experienced by both spouses. We selected conflict communication, attribution, and attachment as important domains of depression in the context of marital adjustment, and we analyzed two hypotheses in one single study. First, we analyzed whether a clinical sample of couples with a depressed patient would differ significantly from a control group on these variables. Second, we explored to what degree these variables mediate/moderate the relationship between depressive symptoms and marital adjustment. The perspectives of both spouses were taken into account, as well as gender differences. In total, 69 clinical and 69 control couples were recruited, and a series of multivariate analyses of variance and regression analyses were conducted to test both hypotheses. Results indicated that both patients and their partners reported less marital adjustment associated with more negative perceptions on conflict communication, causal attributions, and insecure attachment. In addition, conflict communication and causal attributions were significant mediators of the association between depressive symptoms and marital adjustment for both depressed men and women, and causal attributions also moderated this link. Ambivalent attachment was a significant mediator only for the female identified patients. Several sex differences and clinical implications are discussed.     

Sociodemographic and Lifestyle Correlates of Health-Related Quality of Life in Croatian University Students

The purpose of this study was to assess the health-related quality of life (HRQoL) in a sample of Croatian university students and to determine its association with sociodemographic and lifestyle characteristics. The study was conducted on a random sample of 1750 students in Zagreb, Croatia. We used the 12-item Short-Form Health Survey (SF-12v2) and separate questions on sex, age, body mass index (BMI), settlement size, disposable income, cigarette consumption, alcohol consumption, and exercise frequency. The HRQoL scale on which Croatian students scored the highest was Physical Functioning. High mean scores were also found for other physical health measures, while the scores in mental health scales were somewhat lower. Male students scored significantly higher than females on all SF-12 scales (p?<?0.05). The regression analysis showed that Physical Component Summary score (PCS) is negatively related to BMI (partial r?=??0.09) and cigarette consumption (partial r?=??0.06), and positively related to alcohol consumption and exercise frequency (partial r?=?0.08, for both), while Mental Component Summary score (MSC) is positively related to BMI (partial r?=?0.07) and exercise frequency (partial r?=?0.10). Although HRQoL-scores for the Croatian students were higher than in the general population of Croatia and student populations in several other countries, there is still room for improvement, especially in the mental health aspect. In general, HRQoL was found to be significantly lower among females and smokers, but positively related with exercise frequency. In order to improve students’ HRQoL, university authorities should consider initiating health-promotion programs with emphasis on females, smokers and non-exercisers.     

Anxiety,depression, and health-related quality of life in aging people living with HIV compared to diabetes patients and patients with minor health conditions: a longitudinal study

HIV infection has evolved from a fatal to a treatable condition, leading to an increase in the rate of elderly People Living with HIV (PLWH). However, little is known about the psychosocial burden of elderly PLWH. Thus, the aim of this longitudinal multi-center cohort study was to investigate whether elderly PLWH experience more anxiety and depression and reduced health related quality of life (HRQOL) compared to elderly patients with other chronic conditions. PLWH were compared to diabetes patients (DM) and patients with minor health conditions (MHC), e.g. patients with hypertension or allergic conditions. All patients were over 50 years old. Anxiety and depression (HADS) as well as HRQOL (SF-36) were assessed at baseline and after 12 months. 218 PLWH, 249 DM and 254 MHC were included. At baseline, the study groups did not differ in anxiety, depression, and physical HRQOL. However, PLWH indicated lower mental HRQOL than DM and MHC patients (p = 0.001). We did not obtain any moderating effects showing a differential effect of patient characteristics on anxiety, depression, and HRQOL in the three patient groups. At follow-up, the level of anxiety, depression, and HRQOL did not change significantly. The prevalence of anxiety ranged between 27 and 35%, and that of depression between 17 and 28%. Thus, the results of our investigation tentatively suggest that the psychosocial adaptation to HIV among elderly PLWH resembles those of other chronic diseases. There may be some subtle impairments, though, as PLWH experienced lower mental HRQOL.     

Validity of the SF-12 in a Canadian Old Order Mennonite Community

To assess the validity of the Physical and Mental Component Summary scores (PCS-12 and MCS-12) of the SF-12 Health Survey (SF-12) in an Old Order Mennonite (OOM) community in Ontario, Canada. Most SF-12 validation studies have focused on general populations or clinical groups. This paper adds to the SF-12 literature by validating the instrument in a minority population. Sixty percent of the adult OOM population (n?=?1,171) completed a survey which had the SF-12 embedded within it. The survey also included questions on health determinants and the prevalence of chronic conditions. Factor analysis was used to confirm the two-factor structure of the SF-12. Item-scale correlations were calculated to assess convergent and discriminant validity. PCS-12 and MCS-12 variability by known subgroups were also explored. Factor analysis confirmed the two-factor structure and hypothesized loadings on the latent physical and mental health factors. Item-scale correlations demonstrated satisfactory convergent and discriminant validity. SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents for gender, age, income adequacy, marital status, self-reported health measures, and other health determinants such as coping, trust, social interaction, and spirituality. PCS-12 and MCS-12 scores were lower in those with various chronic conditions compared to those without.The SF-12 appears to be a valid instrument for measuring health status in this minority population. Future SF-12 studies in OOMs and other populations may benefit from using Version 2 of the SF-12, where the dichotomous questions have been replaced by questions offering respondents more choice.     

Type D personality,illness perception,social support and quality of life in continuous ambulatory peritoneal dialysis patients

The previous studies reported Type D was associated with poor quality of life (QoL), increased psychological distress, and impaired health status in cardiac patients. The aim of this study is to assess the relationships among Type D personality, illness perception, social support, and investigate the impact of Type D personality on QoL in continuous ambulatory peritoneal dialysis (CAPD) patients. Type D personality was assessed by the Chinese 14-item Type D Personality Scale (DS14). Illness perceptions were assessed using the Chinese version of the Brief Illness Perception Questionnaire (B-IPQ). Social support status was assessed by the well-validated social support rating scale (SSRS). Patients’ QoL was assessed by using Medical Outcomes Short Form 36 (SF-36), respectively. The Type Ds had significantly lower objective support score (8.18 ± 2.56 vs. 9.67 ± 3.28, p = 0.0001), subjective support score (6.71 ± 2.0 vs. 7.62 ± 1.93, p = 0.0001) and utilization of social support score (6.76 ± 2.0 vs. 7.61 ± 1.94, p = 0.0001) than that of the non-type Ds. Type Ds believed their illness had much more serious consequences (7.67 ± 2.64 vs. 6.27 ± 3.45, p < 0.001), and experience much more symptoms that they attributed to their illness (6.65 ± 2.54 vs. 7.31 ± 2.36, p = 0.023). Significant differences were found between Type Ds and non-Type Ds in PCS (40.53 ± 6.42 vs. 48.54 ± 6.21 p < 0.001) and MCS (41.7 1 ± 10.20 vs. 46.35 ± 9.31, p = 0.012). The correlation analysis demonstrated that Type D was negatively associated with physical component score (PCS) (r = –0.29, p < 0.01), mental component score (MCS) (r = –0.31, p < 0.01), and social support (r = –0.24, p < 0.001). Using multiple linear regression analysis, we found that Type D personality was independently associated with PCS (β = –0.32, p < 0.001) and MCS (β = –0.24, p < 0.001). Type D personality was a predictor of poor QoL in CAPD patients. The current study is the first to identify a strong association among Type D, illness perceptions, social support and QoL in CAPD patients. The worse illness perceptions and lower social support level therefore represent possible mechanisms to explain the link between Type D and poor QoL in CAPD patients.     

Protective Effects of Maternal and Peer Support on Depressive Symptoms during Adolescence

The current study examined the contributions of maternal and peer support to depressive symptoms in early to mid-adolescence and variation in these contributions across age, gender, and race. Five waves of data on maternal support, peer support, and depressive symptoms were collected on rural youth (N = 3,444) at 6 month intervals. Multilevel modeling was used to evaluate within and between-person effects of maternal and peer support on depressive symptoms. Within-person effects of peer support did not vary by age, gender, or race. At the between-person level, peer support predicted levels of depressive symptoms at age 12, but this effect became nonsignificant after controlling for maternal support. Within-person effects of maternal support did not vary with age but were qualified by gender and race. Between-person effects of maternal support on depressive symptom levels at age 12 and slopes varied across race and gender, respectively. Findings highlight the robustness of the protective effects of maternal and peer support during adolescence among girls and white youth.