Psychometric Evaluation of the Japanese Version of the Elder Life Adjustment Interview Schedule for Depression

The Elder Life Adjustment Interview Schedule (ELAIS) was developed as an age- and culture-sensitive assessment device for depression and 9 environmental, behavioral, and health correlates (Schlatter et al., 1993, J. MARC Res. 1: 27–42). The psychometric adequacy of the ELAIS has been demonstrated with samples of elder Americans of Asian, Caucasian, and Native Hawaiian ancestry (Dubanoski et al., 1996, J. Clin. Gerospsychol. 2: 247–262). This study reports on the reliability and construct validity of a translated Japanese version. Participants were 55 community-dwelling elders living in the areas surrounding Maebashi, Japan. The ELAIS contains 14 scales of which 9 represent theoretical predictors of depression. The 2 Environmental Condition scales measure life events and social support. The 4 Behavioral Competency scales measure recreational activity, assertiveness, self-reinforcement, and perceived control. The 3 Health Factor scales measure perceived health, functional ability, and objective health. The 5 Other scales measure demographics, depression, life satisfaction, cognitive functioning, and response style. Results yielded acceptable internal consistency and stability reliability coefficients for all but 1 of the subscales on the ELAIS (informational social support). Construct validity support was found for the Depression scale and 6 theoretical predictors, including life events, recreational activity, assertiveness, self-reinforcement, functional ability, and objective health. Treatment and prevention implications for the cross-ethnic multivariate assessment of depression among elders are discussed.     

Perceived stress,life events,dysfunctional attitudes,and depression in adolescent psychiatric inpatients

Hewitt, Flett, and Mosher (1992) examined the factor structure of the Perceived Stress Scale (PSS) and its relation to depression in adult psychiatric patients. This study sought to replicate and extend their findings, using a sample of 203 adolescent psychiatric inpatients. All patients admitted to the adolescent unit in a psychiatric hospital over a 3-year period were administered the PSS, as well as measures of depression, life events, dysfunctional attitudes, and intellectual abilities. Consistent with Hewittet al., two factors were found in the PSS, reflecting perceived distress and perceived coping ability. Regression analyses indicated that, for males, both factors account for independent variance in depression, whereas for females, only the distress factor is related to depression. In addition, for both male and female, dysfunctional attitudes account for significant variance in depression in addition to PSS, but negative life events do not. None of the variables were related to intellectual abilities. Implications for clinical assessment and intervention are discussed.     

Perceptions of the roles of behaviour and genetics in disease risk: Are they associated with behaviour change attempts

Objective: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions.

Design: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention.

Measures: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress.

Results: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge.

Conclusion: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.     

Cognitive and Behavioral Contributions to Depression Severity,Quality of Life,and Functioning Among People Living With HIV in South Africa

Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates.Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale—Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population.Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment.The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population.     

Social problem‐solving,perceived stress,depression and life‐satisfaction in patients suffering from tension type and migraine headaches

This study aimed at investigating social problem solving, perceived stress, depression, and life‐satisfaction in patients with tension type and migraine headaches. Forty‐nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self‐report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T‐tests, chi‐square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life‐satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life‐satisfaction in patients suffering from primary headache.     

Postsurgical physical activity and fatigue-related daily interference in women with non-metastatic breast cancer

Purpose: Women undergoing surgery for breast cancer experience side effects, such as fatigue, reduced quality of life (QOL) and depression. Physical activity (PA) is associated with improved psychological adjustment during treatment and survivorship, yet little is known about how PA relates to fatigue, depression and QOL in the period following surgery for breast cancer. The purpose of the study was to examine the relationships between these constructs in women who recently underwent surgery for breast cancer.

Methods: At 2–10 weeks post-surgery, 240 women with non-metastatic breast cancer reported intensity and duration of moderate and vigorous PA (MVPA), fatigue (intensity and interference), depressed mood, clinician-rated depression and functional QOL.

Results: In the path analysis models tested, women that reported greater weekly MVPA reported less fatigue interference, greater functional QOL, less depressed mood, and lower clinician-rated depression. Tests of indirect effects suggested that fatigue interference may be an intermediate pathway by which MVPA relates to functional QOL, clinician-rated depression and depressed mood.

Conclusion: Women who are more physically active in the months after breast cancer surgery show greater psychological adaptation in the initial phases of their treatment.     

Quality of Life in Gulf War Veterans: the Influence of Recency and Persistence of Psychiatric Morbidity

Important contributors to quality of life (QOL), such as psychosocial factors, have received limited exploration in veteran populations, in contrast to a significant amount of research focused on health-related quality of life (HRQL). This study investigated QOL and HRQL amongst Gulf War veterans compared with an era-military comparison group 20 years after the 1990/91 Gulf War, and whether psychiatric status over time and psychiatric comorbidities predicted QOL and HRQL. We then investigated which of a range of psychological health, physical health and social factors contribute greatest to QOL. Psychological interviews and postal questionnaires were administered to a cohort of Gulf War veterans and a military-era comparison group in 2000–02 and 2011–12. Gulf War veterans had poorer QOL and HRQL compared with a military comparison group, but the pattern of factors that influenced QOL was the same for both groups. Poorer QOL and HRQL were significantly associated with more recent and persistent psychiatric morbidity over time. Further analyses showed that affective disorders, followed by anxiety disorders had the largest impact on QOL and HRQL, and that QOL and HRQL were negatively affected by each additional psychiatric diagnosis. The importance of these findings was highlighted in a structural equation model that revealed psychological health contributed most to QOL, social support contributed a moderate amount, but physical health contributed only a very small amount. QOL in veterans is an important issue even many years after deployment and psychological health plays a predominant role in QOL.

     

Positive and problematic support,stress and quality of life in patients with systemic lupus erythematosus

Background and Objectives: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Previous studies showed that perceived social support has an important role in enhancing patient's quality of life (QOL). However, the precise mechanisms through which social support exerts such an effect are not completely understood. The aim of this paper is to test two alternative models explaining the relationship between social support (positive and problematic) and two dimensions of QOL: Health-Related (HR-QOL) and Non-Health-Related (NHR-QOL). Design: Model A (mediation) hypothesized that positive support would reduce stress while problematic support would increase stress), and that this in turn would reduce QOL. Model B (moderation) hypothesized that the effect of support on QOL would be moderated by the experience of stress in that more stressed individuals would show stronger effects. Methods: Three hundred and forty-four Italian patients with SLE completed an online questionnaire. Results: Stress partially mediated the relationship between support and QOL dimensions (either HR-QOL and NHR-QOL) thus supporting Model B. As hypothesized, positive support reduced stress, while problematic support increased stress. Conclusions: These findings help to explain the complex relationship between social support, stress and QOL in patients with SLE.     

Effect of treatments for depression on quality of life: a meta-analysis*

Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are the two first-line treatments for depression, but little is known about their effects on quality of life (QOL). A meta-analysis was conducted to examine changes in QOL in adults with major depressive disorder who received CBT (24 studies examining 1969 patients) or SSRI treatment (13 studies examining 4286 patients) for their depression. Moderate improvements in QOL from pre to post-treatment were observed in both CBT (Hedges’ g = .63) and SSRI (Hedges’ g = .79) treatments. The effect size remained stable over the course of the follow-up period for CBT. No data were available to examine follow-ups in the SSRI group. QOL effect sizes decreased linearly with publication year, and greater improvements in depression were significantly associated with greater improvements in QOL for CBT, but not for SSRIs. CBT and SSRIs for depression were both associated with moderate improvements in QOL, but are possibly caused by different mechanisms.     

Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure

Abstract

Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms.

Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5?±?11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant.

Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.     

An Investigation of the Relationships Between Spirituality, Health Status and Quality of Life in Adolescents

This study examines the relationships between six spirituality-related attributes and quality of life (QOL) in adolescents, and the extent to which these relationships are mediated by perceived physical and mental health status and five important life domains (family, friends, living environment, school experiences, and perception of self). The data were obtained via a cross-sectional health survey of 8,225 adolescents in British Columbia, Canada. Structural equation modeling was used to test the hypothesized relationships. All spiritual attributes are significantly associated with three or more of the life domains, and four of the attributes significantly explain global QOL after controlling for the other variables in the multivariate model. The attributes indicative of adolescents’ feelings about their future and other existential matters were found to be relatively most explanatory with respect to global QOL. The predominant mediators include adolescents’ satisfaction with their family, their perceived self, and their perceived mental health status. Spirituality is important with respect to adolescents’ QOL. The multivariate model provides preliminary insights into the relevance of several attributes of spirituality and the possible mechanisms by which these attributes may contribute to adolescents’ QOL.     

Predictors of Appraisal and Psychological Well-Being in Alzheimer's Disease Family Caregivers

The objective of this study was to test a model of stress, appraisal, and adaptation in 114 family caregivers of patients diagnosed with dementia of the Alzheimer's type (white non-Hispanic, N = 64; Hispanic-American, N = 50). Results of structural equation analysis show that appraised caregiver burden played a central role in determining the psychological well-being of family caregivers. The findings indicate that this mediating variable, negative caregiver appraisal, was predicted by increased functional limitations and behavioral disturbances in the patient, poorer perceived physical health, and lower levels of perceived emotional support. Contrary to a priori hypotheses, functional limitations in the patient also exhibited a direct association with caregiver depression. Further, patient cognitive impairment and caregiver ethnicity were not related to caregiver appraisal. Overall, these results support the role of appraised burden in mediating the relationships between caregiving factors and the adaptational outcome of depression. The implications of these findings, limitations of the study, and future directions are discussed.     

Perceived stress and everyday memory complaints among older adult women

Abstract

Memory complaints among older adults are often influenced by depression and anxiety, but the association of stress to memory complaints has received little attention. We examined the associations of perceived stress, life events, and activity level to everyday memory complaints among healthy older women, while controlling for the influence of depression and anxiety. Participants (N=54) completed self-report questionnaires on memory complaints, perceived stress, recent life events, activity level, depression, and anxiety. Partial correlation analyses indicated that higher levels of perceived stress were associated with higher levels of memory complaints when controlling for the influence of depression and anxiety, but that life events and activity level were not related to memory complaints. This study highlights that perceived stress, like depression and anxiety, is a psychological factor that influences the appraisal of cognitive ability; however, larger and more heterogeneous samples will be needed to better understand the multifactorial nature of memory complaints in older adulthood.     

Assessment of shared decision-making in community mental health care: Validation of the CollaboRATE

Background/ObjectiveCollaboRATE is a 3-item self-report measure of the patient experience of shared decision-making (SDM) process. The objective of this study is to assess the psychometric properties of CollaboRATE in community mental health care.MethodA cross-sectional study was conducted at a Community Mental Health Center of the Canary Islands Health Service. Two hundred and fifty consecutive psychiatric outpatients were invited to participate. Of those, 191 accepted (76.40% of response rate) and completed the CollaboRATE, the Control Preferences Scale (CPS), and a form with sociodemographic and clinical variables.ResultsExploratory factor analysis ratified the unidimensionality of the measure. High internal consistency was found (α Cronbach = .95, Guttman's λ = .93, and ω = .95). Strong positive correlations (p < .0001) were found between the CollaboRATE and the CPS. Only 39.80% of respondents gave the best possible score on CollaboRATE.ConclusionsThis study provides evidence for the reliability and validity of the Spanish version of the CollaboRATE as a measure of SDM. The measure is quick to complete and feasible for use in outpatient mental health care. At present, a significative number of psychiatric outpatients are not involved in SDM. The use of this measure in psychiatric routine care can be a key tool in assessing and implementing SDM.     

Impacts des conditions de vie durant le confinement sur les personnes souffrant de maladies psychiatriques

IntroductionIndividuals with psychiatric disorders have been the focus of vigilance during the COVID-19 pandemic. The goal of this retrospective study was to estimate the influence of the living conditions of these people, on the evolution of their mood during the first lockdown in spring 2020 in France.MethodA questionnaire was proposed to 86 patients with psychiatric illnesses followed in ambulatory care, in order to evaluate their living conditions, their psychological resources and their perception of the health crisis. Patients responded to scales designed to assess perceived changes in anxiety and depressive symptoms during confinement. Analyses of variance and comparison of means were performed in order to study the variables that were significantly explanatory on the evolution of the disorders.ResultsA majority of patients reported stability of anxiety and depression symptoms during confinement. Alterations in lifestyle, such as an increase in sleep disturbance and smoking, had an effect on anxiety or depression. Occupational activities such as self-care, sports or outings influenced symptomatology. The ability to build on past experiences or to project positively into the future had an effect on symptomatology.DiscussionThese data highlight the specificities of the constraints encountered in lockdown by individuals previously suffering from psychiatric illnesses. Our results point out resources to be considered in adjusting the care modalities of these patients.     

Quality of life and mental health among women with ovarian cancer: examining the role of emotional and instrumental social support seeking

The purpose of the present study was to examine the role of emotional and instrumental social support seeking in the quality of life (QOL) and mental health of women with ovarian cancer. Participants were recruited through the Pennsylvania Cancer Registry, and one hundred women took part in a mail questionnaire that collected information on their demographics, medical status, social support seeking, QOL and mental health including anxiety, depression and stress. Hierarchical linear regression analyses were conducted to assess the influence of emotional and instrumental social support seeking on QOL and mental health. After controlling for remission status, greater emotional social support seeking was predictive of higher overall QOL, social/family QOL, functional QOL and lower depression scores. Instrumental social support seeking was not significant in the models. The results illustrate that social support seeking as a coping mechanism is an important consideration in the QOL and mental health of women with ovarian cancer. Future studies should examine the psychological and behavioral mediators of the relationship to further understand the QOL and mental health of women with ovarian cancer.     

The Perceived Stress Scale: Factor structure and relation to depression symptoms in a psychiatric sample

The present study sought to examine the factor structure and psychometric properties of the Perceived Stress Scale (PSS) when administered to psychiatric patients. We also examined predictive validity of the PSS by assessing the association between the Perceived Stress Scale and the Beck Depression Inventory. A heterogeneous sample of 96 psychiatric patients (48 men, 48 women) completed the Perceived Stress Scale (PSS) and the Beck Depression Inventory. Factor analysis of the PSS established that the scale consisted of two factors. The first factor was comprised primarily of items reflecting adaptational symptoms. In contrast, the second factor consisted of items reflecting coping ability. Both factors had an adequate degree of internal consistency. Finally, a series of regression analyses predicting depression found that both factors accounted for unique variance in depression scores in women, but only the first factor accounted for unique variance in men. It is concluded that the PSS is a multidimensional and internally consistent measure of perceived stress.This research was supported by Grant 410-91-1690 from the social sciences and Humanities Research Council of Canada as well as by grants from the Research and Program Evaluation Committee Brockville Psychiatric Hospital.     

Quality of life in patients before and after kidney transplantation

Abstract

The aim of the present study was to differentially determine quality of life (QOL) in patients with end-stage renal disease (ESRD) after successful kidney transplantation (RT, Group A) compared with ESRD patients on a waiting list for RT (Group B). and with healthy controls (Group C) because opinions vary as to which treatment modality can best assure ESRD patients a high QOL.

Groups A, B and C each consisted of 149 persons, matched for age and gender. The Munich Quality of Life Dimensions List (MLDL) was used to measure global aspects of QOL. Distinct aspects of QOL were investigated by the Brief Symptom Inventory (BSI) and the Questionnaire for Social Support (K-22).

Groups A and C reported similar QOL. Which was significantly higher than in group B (p < .0001). This was particularly true for the physical and psychological status and daily activities, but not for the social situation. Groups A and B reported similar social support, which was significantly, lower than in group C (p < 006). Both ESRD groups reported higher satisfaction with social support than healthy controls (p < .0001).

Successful RT nor only improved distinct aspects of QOL in patients with ESRD, but even put them on par with healthy controls regarding physical and psychological QOL.

Lower social support and higher satisfaction with social support in both groups of ESRD patients should be evaluated further. From a clinical viewpoint. the improvement of physical and psychological aspects of QOL in RT patients is impressive; but more attention should be paid to constantly low social support in this group of patients. International multi center longitudinal studies to investigate QOL in ESRD patients under different treatments am necessary.     

The role of objective health indicators and neuroticism in perceived health and psychological well-being among patients with chronic heart failure

A total of 119 clinically stable patients with symptomatic congestive heart failure (34 females, 85 males) were recruited from an outpatient hospital practice to explore the role of objective health indicators and neuroticism in subjective health (physical limitations) and psychological well-being. Patients were grouped according to the New York Heart Association functional class criteria (NYHA: indicator of functional status) and proatrial natriuretic factor (proANF), a cardiac hormone that maintains normal fluid balance and vascular resistance. Scores on these two objective indicators of disease severity were generally unrelated to psychological measures, whereas neuroticism scores (EPQ-N) were significantly correlated with indicators of subjective health (perceived disease-related physical limitations) and psychological well-being (depression, general life-satisfaction). Significant interactions between proANF and neuroticism appear due to low physical limitation score among subjects with elevated level of proANF and low scores on neuroticism. High physical limitation was reported by subjects with high level of proANF as well as high scores on neuroticism. Moreover, a marginal significant interaction between NYHA and EPQ-N scores in relation to severity of depression was detected by analyses from two-way ANOVA. Gender differences were due to higher proANF scores in males than females, whereas females scored higher than males on EPQ-N, perceived physical limitation and depression. Results from path analyses supported an indirect effect of neuroticism via perceived physical limitation for males. Possible mechanisms involved in these relations are discussed.