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.     

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.     

Depression,Panic-Fear,and Quality of Life in Near-Fatal Asthma Patients

The aim of this study was to assess the relationships between depressive symptoms and symptom-centered panic-fear (P-F), and reports of health-related quality of life (HRQOL), in persons with near-fatal asthma (NFA), controlling for age, gender, and pulmonary function. Forty persons with NFA were interviewed. Sociodemographic and clinical asthma-related information were collected. HRQOL was assessed by the SF-36 Health Questionnaire, depressive symptoms were assessed by the Beck Depression Inventory, and P-F was assessed by the P-F scale of the Asthma Symptom Checklist. Multiple regression analyses were carried out with the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of the SF-36 as a dependent variable, and depressive symptoms, P-F, age, gender, and pulmonary function as independent variables. Results showed that P-F and age were associated with PCS, whereas depressive symptoms accounted for a marked percentage of the variance explained in MCS. Neither gender nor pulmonary function were related to HRQOL. In conclusion, depressive symptoms and P-F play an important role in how persons with NFA assess their HRQOL. These patient-centered variables are potentially modifiable and may offer new ways to intervene in order to improve HRQOL in persons with NFA.     

The Coronary Health Improvement Project (CHIP) for lowering weight and improving psychosocial health

This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF-36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.     

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.     

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.     

Health-related quality of life of preterm children and their caregivers

As advances in medical science have extended the limit of viability downward to 23 or 24 weeks gestation, interest has turned from long-term health outcomes to quality of life for survivors. During the last decade, the first studies of the health-related quality of life (HRQOL) of children and young adults who were born extremely preterm were published. Taken from the fields of anthropology, economics, sociology, and psychology, the foundation of HRQOL is formed by theories of functionalism, positive well-being, and utility. HRQOL can be defined as the physical, psychological, and social domains of health, which can be influenced by an individual's experiences and perception. HRQOL instruments are generally composed of multiple domains and measure physical functioning, mental health, and social role functioning in some form. Utilities, or preferences for health outcomes under conditions of uncertainty, are also used. Studies of HRQOL to-date indicate that preterm children have, on average, poorer health than their normal birthweight peers, but the majority do not perceive their quality of life as significantly different than others of their own age. Measures of HRQOL should not replace the traditional measures of morbidity, but should become part of the standard battery of tools used to assess a preterm child's health and well-being. Ultimately, studies of the HRQOL of preterm children should identify aspects of life, physical, psychological, or social, that could be improved with intervention.     

Millon Behavioral Medicine Diagnostic (MBMD) Predicts Health-Related Quality of Life (HrQoL) Over Time Among Men Treated for Localized Prostate Cancer

Prostate cancer treatment presents multiple challenges that can negatively affect health-related quality of life (HrQoL), and that can be further compromised by maladaptive personality styles and psychological adjustment difficulties. This study examined the utility of a comprehensive psychosocial screening tool to identify psychosocial traits that prospectively predict HrQoL status among men treated for localized prostate cancer. The Millon Behavioral Medicine Diagnostic (MBMD) was administered to 66 men (M age = 68 years, 59% White) treated by either radical prostatectomy or radiotherapy along with standard measures of general and prostate-cancer-specific quality of life assessed at a 12-month follow-up. Higher scores on both summary MBMD Management Guides (Adjustment Difficulties and Psych Referral) and higher scores on personality styles characterized by avoidance, dependency, depression, passive aggressiveness, and self-denigration predicted lower HrQoL (β range = –.21 to –.50). Additionally, higher scores on the MBMD Depression, Tension-Anxiety, and Future Pessimism scales predicted lower HrQoL. Finally, higher scores on the MBMD Intervention Fragility and Utilization Excess scale also consistently predicted poorer mental and physical health functioning over time. These results point to the utility of the MBMD to help screen for potential impairments in mental and physical health functioning in men undergoing treatment for prostate cancer.     

Assessing general maladjustment with the MMPI-2

The validities of 7 MMPI-2 (Butcher, Graham, Ben-Porath, Tellegen, & Kaemmer, 2001) measures of general maladjustment were compared using a composite criterion measure based on self-reported symptom severity and clinicians' ratings of symptom severity and level of functioning. Participants were 274 male and 425 female clients at a community mental health center and 105 male and 247 female clients at a university psychological clinic. All MMPI-2 measures were significantly related to the composite criterion measure for both male and female clients in both settings. The mean score on 8 clinical scales (M8) consistently was the best indicator of maladjustment. Although other MMPI-2 measures sometimes added significantly to the variance accounted for in the criterion measure, increments were small and probably not clinically meaningful. However, M8 added significantly and meaningfully to each of the other MMPI-2 measures in predicting maladjustment. Implications for using the MMPI-2 to assess general maladjustment in outpatient mental health settings are discussed.     

The SF-36 Among Cambodian and Vietnamese Refugees: An Examination of Psychometric Properties

Among traumatized Cambodian (N=90) and Vietnamese (N=94) refugees attending a psychiatric clinic, the study examined the validity and psychometric properties of the Short Form-36 Health Survey (SF-36), a measure of self-perceived mental and physical health. In both patient samples, all eight SF-36 scales displayed excellent internal consistency (item-scale correlations and Cronbach's α). But, similar to other studies of Asian samples, (a) the Vitality (VT) scale did not separate from the Mental Health (MH) and General Health (GH) scales, as evidenced by item-scale and interscale correlations, and (b) the VT scale loaded as strongly (Vietnamese sample) or more strongly (Cambodian sample) than the MH scale on the so-called Mental Factor in a two-factor solution of the eight scales (with the GH scale also loading heavily on the same factor).     

Parental Problem-Solving Abilities and the Association of Sickle Cell Disease Complications with Health-Related Quality of Life for School-Age Children

Children with sickle cell disease (SCD) are at risk for poor health-related quality of life (HRQOL). The current analysis sought to explore parent problem-solving abilities/skills as a moderator between SCD complications and HRQOL to evaluate applicability to pediatric SCD. At baseline, 83 children ages 6–12 years and their primary caregiver completed measures of child HRQOL. Primary caregivers also completed a measure of social problem-solving. A SCD complications score was computed from medical record review. Parent problem-solving abilities significantly moderated the association of SCD complications with child self-report psychosocial HRQOL (p = .006). SCD complications had a direct effect on parent proxy physical and psychosocial child HRQOL. Enhancing parent problem-solving abilities may be one approach to improve HRQOL for children with high SCD complications; however, modification of parent perceptions of HRQOL may require direct intervention to improve knowledge and skills involved in disease management.     

语词分析下结构式写作在应对负性生活事件中的作用

对以结构式写作处理负性生活事件的90份写作文本进行语词分析,以语词分析类别中心理历程四个维度的语词数为自变量,以被试写作后SF-36量表总分、社会功能、躯体功能和情感职能得分为因变量进行的回归分析表明,对写作文本的认知历程对被试总体身心健康、社会功能和躯体功能状况均有正向作用,社会历程对躯体功能状况呈负向作用．感知历程中的特征因素对被试情绪职能呈负向作用。研究证实了书面叙述对负性生活事件的积极处理效应,并对认知与社会互动因素的作用机制进行了初步探索。     

Threats to the Internal Validity of Spinal Surgery Outcome Assessment: Recalibration Response Shift or Implicit Theories of Change?

A recalibration response shift will cause the patient to think about a self-report measure’s response options differently after a health state change. Commonly assessed using the retrospective-pretest design (“then-test”), recent guidelines suggest adjusting then-test estimates for competing explanations. This prospective longitudinal study investigated recalibration response shift after adjusting for implicit theories of change in patients undergoing spinal surgery. The Oswestry Disability Index (ODI) and Short Form-36 (SF-36) were collected before surgery and at 6 weeks and 3 months after spinal decompression surgery. Then-tests of the measures were also collected at all post-tests. Recalibration response shift was operationalized as the then-minus-pre difference score on the evaluative SF-36. Implicit theories of change were operationalized as the then-minus-pre difference score on the perception-based ODI. Improved vs. No-Effect patient groups were compared using the Minimally Important Difference (±15 points) as a cut-off on the Visual Analogue Scale (VAS) items for back and leg pain. Logistic regression analyses investigated whether recalibration response shift had an independent effect distinguishing patient groups, after adjusting for implicit theories of change. The sample (baseline n?=?169, mean age 52, 39 % female) was well-educated, and 1/3 were working. All then-minus-pre difference scores were non-zero at each time point and were stable over time. In the adjusted models distinguishing Improved versus No Effect groups, then-minus-pre ODI difference scores were significant in the majority of the adjusted models at all timepoints, but only one then-minus-pre SF-36 difference score—for physical functioning recalibration—was significant and only at 6-weeks post-surgery. This suggests that implicit theories of change bias the estimation of post-surgical outcomes, but that recalibration response shift biased only the estimation of physical functioning and only at 6 weeks post-surgery. Recalibration response shift and implicit theories of change can both be sources of bias in patient-reported outcome assessment. Our findings suggest that implicit theories of change are a greater threat to validity in this patient sample. Future research using the then-test should control for implicit theories of change to minimize misspecification of effects.     

Social support group attendance is related to blood pressure, health behaviours, and quality of life in the Multicenter Lifestyle Demonstration Project

Changes in coronary risk factors, health behaviours, and health-related quality of life (HRQOL) were examined by tertiles of social support group attendance in 440 patients (21% females) with coronary artery disease. All patients participated in the Multicenter Lifestyle Demonstration Project (MLDP; eight hospital sites in the USA), an insurance-covered multi-component cardiac prevention program including dietary changes, stress management, exercise and group support for 1 year. Significant improvements in coronary risk factors, health behaviours, and HRQOL were noted at 1 year. Several of these improvements (i.e. systolic blood pressure, health behaviours, HRQOL) were related to social support group attendance, favoring those who attended more sessions. The associations between support group attendance to systolic blood pressure and to four HRQOL subscales (bodily pain, social functioning, mental health, and the mental health summary score) remained significant when controlling for changes in health behaviours, but dropped to a non-significant level for the HRQOL subscales 'physical functioning', 'general health' and 'role-emotional'. These results suggest an independent relationship of social support group attendance to systolic blood pressure while improvements in quality of life may be in part due to improved health behaviours facilitated by increased social support group attendance.     

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.     

Relationships Among Religiousness,Spirituality, and Health for Individuals with Stroke

The current study evaluated the relationships among spiritual beliefs, religious practices, physical health, and mental health for individuals with stroke. A cross-sectional analysis of 63 individuals evaluated in outpatient settings, including 32 individuals with stroke and 31 healthy controls was conducted through administration of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the Medical Outcomes Scale-Short Form 36 (SF-36). For individuals with stroke, the SF-36 General Mental Health scale was significantly correlated with only the BMMRS Religious and Spiritual Coping scale (r = .43; p < .05). No other BMMRS factors were significantly correlated with SF-36 mental or physical health scales. Non-significant trends indicated spiritual factors were primarily related to mental versus physical health. This study suggests spiritual belief that a higher power will assist in coping with illness/disability is associated with better mental health following stroke, but neither religious nor spiritual factors are associated with physical health outcomes. The results are consistent with research that suggests that spiritual beliefs may protect individuals with stroke from experiencing emotional distress.     

Longer term outcome of cognitive-behavioural and psychodynamic psychotherapy in routine mental health care: randomised controlled trial

We investigated the comparative effectiveness of cognitive-behavioural (CBT) and psychodynamic therapy (PDT) under clinically representative conditions as a subtrial of a prior study (Watzke et al., 2010, BJP). A consecutive sample of 147 patients with common mental disorders was randomised to either CBT or PDT in routine mental health care. In a primary per-protocol analysis patients randomised to CBT had a significantly better longer term outcome in the primary outcome symptom severity (General Severity Index of the SCL-14; p=.001; partial η(2)=0.073) as well as in health related quality of life (Mental Component Summary of the SF-8; p=.013; partial η(2)=.041) and concerning interpersonal issues (Inventory of Interpersonal Problems, IIP-C; p=.001; partial η(2)=.070) 6 months after treatment than patients randomised to PDT. These results could be confirmed in intention-to-treat analyses (n=180) suggesting that there was no substantial attrition bias due to drop outs at the follow-up assessment. Thus, the so called equivalence outcome paradox was not replicated in this study.     

Group support interventions for women with breast cancer: who benefits from what?

Research on the benefits of social support groups has been inconclusive. One reason is that individual differences in intervention responses have rarely been examined. The authors determined the extent to which individual difference variables moderated the effects of an information-based educational group and an emotion-focused peer discussion group on the mental and physical functioning of women with breast cancer (n = 230). The authors administered the SF-36 (S.E. Ware, K.K. Snow, M. Kosinski, & B. Gandek, 1993), a multidimensional quality of life instrument, pre- and postintervention. Educational groups showed greater benefits on the physical functioning of women who started the study with more difficulties compared with less difficulties (e.g., lacked support or fewer personal resources). Peer discussion groups were helpful for women who lacked support from their partners or physicians but harmful for women who had high levels of support. Implications of these results for clinical interventions are discussed.     

Relationships among parental reports of child, parent, and family functioning.

Most children with psychosocial problems do not present for treatment in mental health settings. They are managed by primary care physicians. Children with psychosocial problems often have parents and/or families with psychosocial distress. The present study measured associations between parental reports of child, parent, and family functioning in individuals in the general population. Participants were 226 parents of children, aged 2-16 years, who presented for routine primary care. Parents reported on the psychosocial functioning of themselves, their child, and their family. All correlations of measures were significant, ranging from .55 to .23. Similar to data from psychiatric samples, the psychological functioning of children, parents, and families were significantly correlated. Unlike in psychiatric settings, child mental health problems were not as closely related to parent or family distress as parent and family distress were related to each other and to child behavior problems.     

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.