Psychological Well-Being and Health Related Quality of Life among a Group of Low-Income Women Living with HIV/AIDS in South Africa

This study documented the relationships among biomedical factors, psychosocial factors, health related quality of life (HRQOL) and suicidality in respect of HIV positive women in KwaZulu-Natal. One hundred and thirty three (133) women over the age of 18 years (mean age 32.96 yrs; SD = 7.28) participated in the study. Participants completed a Suicidality Measure (SM: Sheebhan, Janavs, Amorim, Janavs, Weiller, Hergueta, Baker & Dunbar, 1998), Multidimensional Scale of Perceived Social Support (MPSS: Zimet, Dahlem, Zimet & Farley, 1988) and the Health Related Quality of Life Survey—SF-36 (Ware, Kosinski & Dewey, 2002). Information on social/contextual variables including income, marital status, employment status, number of children was obtained. Participants completed two biomedical measures, CD4 count and time since diagnosis information. The findings revealed a compromised level of HRQOL in the participants. After controlling for biomedical factors, psychosocial measures did not explain differences in quality of life. Perceived social support was inversely related to suicidality. Newly diagnosed patients were less likely to think of suicide as an option.     

Measurement issues in health-related quality of life: Challenges for health psychology

Abstract

Quality of life assessment is a central element of clinical trials and related forms of evaluative research. Early efforts to establish appropriate methods of measuring quality of life drew on psychometric principles and emphasised the need for validated measures. However, it is increasingly clear that, whilst still a central requirement of quality of life measures, validity needs to be emphasised alongside a number of other essential properties that have become clearer as the field has developed. Moreover formal psychometric methodology has to be adapted to take account of the specific needs of evaluative research. Research is beginning to develop more appropriate methods of outcome assessment in this area. Further lines of research are suggested to examine psychometric with other approaches to measurement of health-related quality of life.     

Positive factors associated with quality of life among Chinese patients with renal carcinoma: a cross-sectional study

Quality of life and positive psychological variables has become a focus of concern in patients with renal carcinoma. However, the integrative effects of positive psychological variables on the illness have seldom been reported. The aims of this study were to evaluate the quality of life and the integrative effects of hope, resilience and optimism on the quality of life among Chinese renal carcinoma patients. A cross-sectional study was conducted at the First Hospital of China Medical University. 284 participants completed questionnaires consisting of demographic and clinical characteristics, EORTC QLQ-C30, Adult Hope Scale, Resilience Scale-14 and Life Orientation Scale-Revised from July 2013 to July 2014. Pearson’s correlation and hierarchical regression analyses were performed to explore the effects of related factors. Hope, resilience and optimism were significantly associated with quality of life. Hierarchical regression analyses indicated that hope, resilience and optimism as a whole accounted for 9.8, 24.4 and 21.9% of the variance in the global health status, functioning status and symptom status, respectively. The low level of quality of life for Chinese renal carcinoma patients should receive more attention from Chinese medical institutions. Psychological interventions to increase hope, resilience and optimism may be essential to enhancing the quality of life of Chinese cancer patients.     

A Comparison of Effectiveness of Dohsa‐hou and the Alexander Technique on Happiness,Social Adjustment,Hope, Mental Health,and Quality of Life in Patients with Parkinson's Disease

The purpose of this study was to compare the effectiveness of Dohsa‐hou and the Alexander Technique on happiness, social adjustment, hope, mental health, and quality of life in patients with Parkinson's disease. The statistical population of this study included all of the patients with Parkinson's disease who were clients of neural therapeutic centers in Isfahan City in 2015. Among this population, 28 patients were selected through convenience sampling as the sample of the study. The Oxford Happiness Questionnaire, the Social Adjustment Scale, the Adult Hope Scale, the General Health Questionnaire, and the Word Health Quality of Life Questionnaire were used as the instruments of the study. Data were analyzed by analyses of variance with repeated measures. The results showed that both interventions of this study can improve happiness, hope, and quality of life in patients with Parkinson's disease, but Dohsa‐hou is more effective than the Alexander Technique in the improvement of happiness and hope. Probable explanations have been discussed.     

Self-rated emotional health in adults with and without HIV

Affect is an important indicator of quality of life; unfortunately, many people with Human Immunodeficiency Virus (HIV) disease are vulnerable to depression and negative affect. In a secondary data analysis, 50 HIV-positive and 50 HIV-negative adults between 30 and 65 years old completed several affective measures and rated their emotional health. The HIV-positive adults reported more negative affect than the HIV-negative adults. Older age, loneliness, and HIV stigma were associated with such negative affect.     

HIV infection and mental health: suicidal behaviour--systematic review

Suicide has long been associated with serious illness generally and HIV specifically. New treatments have affected prognosis in HIV positively, but it is unclear how they impact on suicidal burden (thoughts, self-harm and completions). This review examines all published suicide and HIV data for a definitive account of (1) prevalence of HIV-related suicidality, (2) measurement within studies and (3) effectiveness of interventions. Standard systematic research methods were used to gather quality published papers on HIV and suicide, searching published databases according to quality inclusion criteria. From the search, 332 papers were generated and hand searched resulting in 66 studies for analysis. Of these, 75% were American/European, but there was representation from developing countries. The breakdown of papers provided 12, which measured completed suicides (death records), five reporting suicide as a cause of attrition. Deliberate self-harm was measured in 21, using 22 instruments; 16 studies measured suicidal ideation using 14 instruments, suicidal thoughts were measured in 17, using 15 instruments. Navigating the diverse range of studies clearly points to a high-suicidal burden among people with HIV. The overview shows that autopsy studies reveal 9.4% of deceased HIV+?individuals had committed suicide; 2.4% HIV+?study participants commit suicide; approximately 20% of HIV+?people studied had deliberately harmed themselves; 26.9% reported suicidal ideation, 28.5% during the past week and 6.5% reported ideation as a side effect to medication; 22.2% had a suicide plan; 19.7% were generally "suicidal" (11.7% of people with AIDS, 15.3% at other stages of HIV); 23.1% reported thoughts of ending their own life; and 14.4% expressed a desire for death. Only three studies recruited over 70% female participants (39 studies recruited over 70% men), and six focussed on injecting drug users. Only three studies looked at interventions - predominantly indirect. Our detailed data suggest that all aspects of suicide are elevated and urgently require routine monitoring and tracking as a standard component of clinical care. There is scant evidence of direct interventions to reduce any aspect of suicidality, which needs urgent redress.     

HIV and depression--a systematic review of interventions

HIV-positive individuals are more likely to be diagnosed with major depressive disorder than HIV-negative individuals. Depression can precede diagnosis and be associated with risk factors for infection. The experience of illness can also exacerbate depressive episodes and depression can be a side effect to treatment. A systematic understanding of which interventions have been tested in and are effective with HIV-seropositive individuals is needed. This review aims to provide a comprehensive understanding of evaluated interventions related to HIV and depression and provide some insight on questions of prevalence and measurement. Standard systematic research methods were used to gather quality published papers on HIV and depression. From the search, 1015 articles were generated and hand searched resulting in 90 studies meeting adequacy inclusion criteria for analysis. Of these, 67 (74.4%) were implemented in North America (the US and Canada) and 14 (15.5%) in Europe, with little representation from Africa, Asia and South America. Sixty-five (65.5%) studies recruited only men or mostly men, of which 31 (35%) recruited gay or bisexual men. Prevalence rates of depression ranged from 0 to 80%; measures were diverse and rarely adopted the same cut-off points. Twenty-one standardized instruments were used to measure depression. Ninety-nine interventions were investigated. The interventions were diverse and could broadly be categorized into psychological, psychotropic, psychosocial, physical, HIV-specific health psychology interventions and HIV treatment-related interventions. Psychological interventions were particularly effective and in particular interventions that incorporated a cognitive-behavioural component. Psychotropic and HIV-specific health psychology interventions were generally effective. Evidence is not clear-cut regarding the effectiveness of physical therapies and psychosocial interventions were generally ineffective. Interventions that investigated the effects of treatments for HIV and HIV-associated conditions on depression generally found that these treatments did not increase but often decreased depression. Interventions are both effective and available, although further research into enhancing efficacy would be valuable. Depression needs to be routinely logged in those with HIV infection during the course of their disease. Specific data on women, young people, heterosexual men, drug users and those indiverse geographic areas are needed. Measurement of depression needs to be harmonized and management into care protocols incorporated.     

Stress management interventions for HIV+ adults: a meta-analysis of randomized controlled trials, 1989 to 2006.

OBJECTIVE: Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults. DESIGN: This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077). MAIN OUTCOME MEASURES: Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). RESULTS: Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. CONCLUSION: Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.     

Correlates and predictors of positive mental health for school going children

The relationship between positive mental health and well-being was examined in 604 North Indian high school and secondary high school going children aged 11–18 years. The study employed various scales such as Mental Health Continuum-Short Form (MHC-SF; Keyes, 2005), Scale of Positive and Negative Experiences (SPANE) and Flourishing Scale (FS; Diener et al., 2010), World Health Organization Quality of Life-BREF (WHOQOL-BREF, 1996) and Personal Well-being Index Scale-School Going Children (PWI-SC; Cummins & Lau, 2005). The MHC-SF predicted the positive mental health and the various predictors used in this study were SPANE, FS, WHOQOL-BREF and PWI-SC. Positive mental health was found positively correlated with SPANE P, life satisfaction, personal well-being, flourishing and all four domains of quality of life (physical health, psychological well-being, social relationships and environmental health) and negatively correlated with SPANE N. Well-being measures of flourishing, SPANE P, SPANE-N, all four domains of quality of life (physical health, psychological well-being, social relationships and environmental health) significantly predicted children’s positive mental health (49% of variance) and its dimensions like emotional well-being (41% of variance), social well-being (24% of variance) and psychological well-being (47% of variance).     

Quality of life is a process not an outcome

Quality improvement mechanisms increasingly use outcome measures to evaluate health care providers. This move toward outcome measures is a radical departure from the traditional focus on process measures. More radical still is the proposal to shift from relatively simple and proximal measures of outcome, such as mortality, to complex outcomes, such as quality of life. While the practical, scientific, and ethical issues associated with the use of outcomes such as mortality and morbidity to compare health care providers have been well rehearsed, the specific concerns associated with the use of quality of life measures in quality of care research have received little attention. As with much research on quality of life there is a tendency to assume that the disadvantages are outweighed by the general virtue of ??listening?? to patients. In this paper we disagree with this assumption and argue that quality of life is a process, not an outcome.     

Effects of Spirituality on Health‐Related Quality of Life in Men With HIV/AIDS: Implications for Counseling

This study examined the association of spirituality and health‐related quality of life among 226 HIV‐positive men. Two measures of spirituality were used: the Spiritual Growth subscale from the Health‐Promoting Lifestyle Profile II (S. N. Walker, K. R. Sechrist, & N. J. Pender, 1987) and the Spirituality subscale of the HIV Coping Instrument (L. Moneyham, A. Demi, Y. Mizuno, R. Sowell, & J. Guillory, 1998). Health‐related quality of life was measured with the HIV Cost and Services Utilization Study (R. D. Hays et al., 1998). Spiritual coping (i.e., relying on religion‐based coping techniques) was not associated with health‐related quality of life at baseline or 12‐month follow‐up. Spiritual growth (i.e., existential feelings of connection with a force greater than oneself) improved some aspects of mental and emotional well‐being but did not affect physical functioning or pain management.     

Principles and Problems in the Assessment of Quality of Life in Health Care

A remarkable surge in efforts to assess the quality of life of patients has occurred in recent years in medical research. Philosophical discussions of these developments have focused, on the one hand, on epistemological reservations about the plausibility of measuring quality of life and, on the other hand, on moral and ethical qualms about the meaning of life conveyed in such assessments. Whilst providing an important note of caution, such critiques fail to recognise two basic principles of quality of life in medical research. Firstly it is intended to provide understanding about groups and categories of patients rather than individuals. Secondly the purpose of such research is to produce generalisations about the relative costs and benefits of specific health care interventions rather than absolute judgements regarding the quality of life of patients per se. Selecting a good quality of life measure for a clinical trial requires balancing criteria such as validity with practical feasibility. Such measures will play an increasingly central role in providing research evidence to improve health care.     

Stress,coping, HIV status,psychosocial resources,and depressive mood in African American gay,bisexual, and heterosexual men

The associations between stress, physical health, psychosocial resources, coping, and depressive mood were examined in a community sample of African American gay, bisexual, and heterosexual men (N=139). Data were collected from physical exams and in-person interviews. In our theoretical framework, depressive mood scores were regressed first on stressors, next on psychosocial resources, and finally on coping strategy variables. Results revealed that psychosocial resources mediate the effects of stressors, including health symptoms, hassles, and life events, on depressive mood. There were no significant differences in depressive mood associated with HIV status or sexual orientation. Results are discussed in terms of community interventions needed to provide social support as a buffer between stress and psychological distress in African American men. The research was completed at the Center for AIDS Prevention Studies, University of California at San Francisco and was supported in part by National Institute of Mental Health Grants MH44045 and MH42459. The authors express their appreciation to the participants in this study.     

The role of neuropsychology in UK pediatric HIV care: Relevance to clinical practice and research

There has been a dramatic improvement in the survival of children with perinatally-acquired HIV (PHIV) following the introduction of effective treatment in 1990s. The care for children living with PHIV is now focused on more accurately understanding the effects of both HIV and HIV treatment on the developing body and brain. An evaluation of current HIV neuroimaging, and neurocognitive research, when combined with clinical experience in the area of HIV, could help to inform United Kingdom (UK) PHIV service provision. This paper argues that an understanding from a neuropsychological perspective will help these young people to optimize their health, quality of life, and future functioning. The aim of the paper is to bring together research and clinical understanding of HIV and its treatment effects on the developing brain, together with an understanding of other potential neurological risk factors. It is argued here that there is a need for targeted neuropsychology assessment and preventative interventions, supported by clinical and preliminary research on the neurocognitive effects of HIV and its treatments.     

Exploring Associations Between Self-Compassion,Self-Criticism,Mental Health,and Quality of Life in Adults with Cystic Fibrosis: Informing Future Interventions

Self-compassion is increasingly recognised as an important and beneficial factor in quality of life and mental health-related research, but research within the adult cystic fibrosis (CF) population is scarce. In a cross-sectional study, 114 (56 female, 58 male) adults with CF completed and returned a series of validated questionnaires that assessed CF-related quality of life, negative emotional states (depression, anxiety and stress), self-compassion, and self-criticism. Quality of life and self-compassion were positively correlated, and each in turn were inversely correlated with negative emotional states and self-criticism. Negative emotional states correlated positively to self-criticism. Self-compassion and/or self-criticism moderated ten relationships between various sub-domains of quality of life and negative emotions. Psychological interventions that increase self-compassion may be beneficial for enhancing mental health and quality of life for adults with CF.

     

Validation of the Personal Wellbeing Index for People with End Stage Kidney Disease

The quality of life of people with end stage kidney disease (ESKD) has traditionally been measured using instruments that emphasise objective health status. The present study validates an alternative measure, the Personal Wellbeing Index (PWI), which measures subjective wellbeing. An Australian ESKD sample (N?=?172, Mean age?=?64.04, SD?=?14.82) completed the PWI as well as health-specific quality of life measures. The PWI was subject to confirmatory factor analysis, and a series of regressions and between-group comparisons were performed to reveal that it is a psychometrically appropriate measure for this sample. The PWI and health-specific measures each yield different and complementary results. Thus, the PWI is proposed as a complement to existing health-related quality of life tools, in order to broaden understanding of the patient’s subjective experience. The resulting profile is argued to better inform targeted interventions to improve the quality of life of people with ESKD.     

The indirect effect of contextual factors on the emotional distress of infertile couples

Few studies were dedicated to study the role of contextual factors, such as the socioeconomic status and urban or rural residence in emotional distress of infertile couples. This study aimed to explore the impact of contextual factors on emotional distress, either directly or by affecting the importance of parenthood in one's life, which in turn affects emotional distress. In this cross-sectional study, 70 couples recruited during hormonal stimulation phase prior to in vitro fertilisation completed clinical and sociodemographic forms and self-report questionnaires assessing representations about the importance of parenthood and emotional distress. Path analysis using structural equation modelling was used to examine direct and indirect effects among variables. Results indicated that socioeconomic status and place of residence had an impact in emotional distress by affecting the representations about the importance of parenthood in one's life. Gender differences were found regarding model paths, suggesting that the social context may have a stronger influence on women's emotional distress than on their partners’ distress. When delineating psychological interventions, health care providers should consider that cultural values about children and parenthood contribute to shape the infertility experience.     

Neurobehavioral outcomes in diseases of childhood. Individual change models for pediatric human immunodeficiency viruses.

The growing incidence of human immunodeficiency virus-1 (HIV-1) and acquired immunodeficiency syndrome (AIDS) in children is a major public health problem. Current research emphasizes treatments for ameliorating deleterious effects on the child's neurological and behavioral development. This article outlines approaches to the assessment of individual change that may provide alternatives to more traditional approaches to the assessment of neurobehavioral outcomes in children with chronic diseases. These approaches provide more precise conceptualizations of changes that lead directly to statistical designs and measurement strategies for assessing effects of HIV-1 and AIDS on development. Such assessments can be superimposed on current clinical trial methodologies to evaluate the efficacy of pharmacological and behavioral interventions designed to improve quality of life in HIV-1 infected children.