The conceptual relationship between health indicators and quality of life: results from the cross-cultural analysis of the EUROHIS field study

An internet-based cognitive behavioural intervention for adults with depression in Arabic-speaking countries: A randomized controlled trial

Internet-based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet-based cognitive behavioural writing intervention for Arabic-speaking participants with depression living in the MENA region. A total of 259 participants (167 female, age in years: M = 25.58, SD = 6.39) with depressive symptoms indicative of clinical relevance were randomly allocated to a treatment group (TG; nTG = 128) or a waitlist control group (WG; nWG = 131). The TG received an internet-based intervention over a 6-week period. The primary outcome was depressive symptoms, and secondary outcomes were anxiety and quality of life (QoL). T-tests with change scores from pre- to post-treatment were used for data analyses. Intention-to-treat (ITT) as well as completer analyses were calculated. The ITT analysis revealed significant differences between the TG and WG in depression (T257 = -4.89, p < 0.001, d = 0.70) and QoL (T257 = 3.39, p < 0.001, d = 0.47). Significant differences regarding anxiety symptoms (T257 = 3.25, p < 0.05, d = 0.53) were identified for the completer sample. The general dropout rate was 39.9%. The results indicate the feasibility and efficacy of an internet-based cognitive behavioural writing intervention in adults from Arabic-speaking countries. The development and implementation of such interventions can be used to improve access to psychological help and adequate treatment.

Quality of life and mental health in emerging adults with cerebral palsy compared to the general population

Background

While evidence concerning Quality of Life (QoL) in youth with cerebral palsy (CP) in comparison to the general population has been accumulating, there is a lack of studies exploring differences on a wider range of positive and negative mental health outcomes in emerging adults.

Methods

This binational case control study is part of the SPARCLE cohort study on QoL and participation of youth with CP. QoL (WHOQOL-BREF), depression (PHQ-9), anxiety (GAD-7) and self-efficacy (GSE) were assessed in 198 emerging adults with CP and 593 emerging adults from the general population, matched for country of residence, age and gender. ANCOVAs with impairment and pain as covariates were run.

Results

Similar levels of QoL were found in both samples, except for the environmental domain, with better QoL for emerging adults with CP compared to the general population. There were significant descriptive differences regarding depression with worse levels in the CP sample, however, also worse levels of self-efficacy. Pain as a covariate had a significant negative impact on all measures, leading to poorer self-efficacy while worsening depression and anxiety; impairment had a significant worsening impact on physical QoL and self-efficacy only.

Conclusion

Similar expressions of mental health outcomes in emerging adults with CP and the general population indicate the high adaptive capability of emerging adults with CP.

The relationship between clinical recovery and personal recovery among people living with schizophrenia: A serial mediation model and the role of disability and quality of life

OBJECTIVE

We examine the relationship between two perspectives on recovery from schizophrenia: clinical recovery and personal recovery. Clinical recovery emphasizes an individual's psychiatric symptoms and functioning, whereas personal recovery emphasizes adaptation to one's illness that includes taking responsibility for one's recovery, establishing an identity apart from the illness, and finding meaning, purpose, and hope in life.

METHODS

Using serial mediation analysis, we examine the relationship between clinical and personal recovery in the context of two potential mediators, disability and quality of life. Study participants were 356 people with a diagnosis of schizophrenia and living with family in Changsha City of Hunan Province, China.

RESULTS

Although clinical recovery was modestly associated with personal recovery (r = 0.27, p < 0.001), subsequent serial mediation analysis showed that clinical recovery is not directly related to personal recovery when accounting for disability and quality of life. Clinical recovery was a significant predictor of disability, which predicted quality of life and personal recovery. Among the three mediation paths, quality of life accounted for most of the mediation effect (54%), followed by disability (24%), and disability and quality of life serially (22%). We discuss the implications of these findings for theory development, intervention, and future research.

Profiles of subjective health among people living alone: a latent class analysis

Background

Living alone has increased globally and especially in Finland where 45% of all households are single occupancy. Epidemiological research has found that living alone a risk factor for a wide range of adversities related to quality of life but the rapidly-changing demographics of people living alone calls for a more detailed investigation of their subjective health status.

Methods

Using a cross-sectional survey sent for a random sample of Finnish residents in single-person households (n = 884), we explored with latent class analysis whether the respondents form different health profiles based on the three health dimensions defined by the World Health Organization: physical, social, and mental well-being. The identified groups were then compared in terms of demographic characteristics with the χ² test and quality of life using linear regression models. Sensitivity analyses were run using more refined, manual 3-step BCH method.

Results

Four distinct health profiles were found: Languishing (4%), Managing (35%), Healthy (30%), and Flourishing (31%). The groups differed in most socio-demographic aspects such as marital and employment status, but not in terms of geographic location or gender (apart from group Languishing that contained more men). Controlling for these socio-demographic differences, all groups showed different average levels of perceived quality of life to the expected direction.

Conclusions

Our findings suggest that people living alone are indeed a very heterogeneous group in terms of subjective health. Instead of seeing living alone as a mere risk for low quality of life, concept of living alone should be understood more broadly both in public discussion and scientific research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11396-2.

Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in Mutual Support Groups Coordinated by SMART Recovery Australia: Protocol for a Pilot Study

BACKGROUND

Despite the importance and popularity of mutual support groups, there have been no systematic attempts to implement and evaluate routine outcome monitoring (ROM) in these settings. Unlike other mutual support groups for addiction, trained facilitators lead all Self-Management and Recovery Training (SMART Recovery) groups, thereby providing an opportunity to implement ROM as a routine component of SMART Recovery groups.

OBJECTIVE

This study protocol aims to describe a stage 1 pilot study designed to explore the feasibility and acceptability of a novel, purpose-built mobile health (mHealth) ROM and feedback app (Smart Track) in SMART Recovery groups coordinated by SMART Recovery Australia (SRAU) The secondary objectives are to describe Smart Track usage patterns, explore psychometric properties of the ROM items (ie, internal reliability and convergent and divergent validity), and provide preliminary evidence for participant reported outcomes (such as alcohol and other drug use, self-reported recovery, and mental health).

METHODS

Participants (n=100) from the SMART Recovery groups across New South Wales, Australia, will be recruited to a nonrandomized, prospective, single-arm trial of the Smart Track app. There are 4 modes of data collection: (1) ROM data collected from group participants via the Smart Track app, (2) data analytics summarizing user interactions with Smart Track, (3) quantitative interview and survey data of group participants (baseline, 2-week follow-up, and 2-month follow-up), and (4) qualitative interviews with group participants (n=20) and facilitators (n=10). Feasibility and acceptability (primary objectives) will be analyzed using descriptive statistics, a cost analysis, and a qualitative evaluation.

RESULTS

At the time of submission, 13 sites (25 groups per week) had agreed to be involved. Funding was awarded on August 14, 2017, and ethics approval was granted on April 26, 2018 (HREC/18/WGONG/34; 2018/099). Enrollment is due to commence in July 2019. Data collection is due to be finalized in October 2019.

CONCLUSIONS

To the best of our knowledge, this study is the first to use ROM and tailored feedback within a mutual support group setting for addictive behaviors. Our study design will provide an opportunity to identify the acceptability of a novel mHealth ROM and feedback app within this setting and provide detailed information on what factors promote or hinder ROM usage within this context. This project aims to offer a new tool, should Smart Track prove feasible and acceptable, that service providers, policy makers, and researchers could use in the future to understand the impact of SMART Recovery groups.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/15113.

Quality of life after stroke rehabilitation discharge: a 12-month longitudinal study

PURPOSE

To analyse trends in quality of life (QoL) development among older stroke patients within the first year after rehabilitation discharge, and to investigate the impact of including proxy interviews in research and practice.

METHODS

A prospective cohort study with follow-up at 3, 6, and 12 months with 411 patients and proxy respondents was conducted. The EUROHIS-QOL 8-item index was used to assess QoL. By performing descriptive analyses, QoL development over time was compared among subgroups. Linear mixed models were calculated to estimate mean changes from baseline to 12-month follow-up. The effects of patient characteristics and time on QoL were investigated using comprehensive mixed models.

RESULTS

One year after rehabilitation discharge, the majority of patients had neither maintained nor regained their initial QoL. Proxy respondents reported significantly lower QoL (22.6-29.5 points, p < 0.001). Characteristics associated with lower QoL were stroke severity, depression, and pain. Having a small social network was negatively associated with QoL (-1.66 points, 95%CI: -2.84/-0.48, p = 0.006).

CONCLUSIONS

Quality of life scores reported at the time of rehabilitation discharge are often not lasting. Including severely impaired patients via proxies reduces the risk of overestimating QoL outcomes. Outpatient's characteristics should be taken into account when planning therapy strategies to maintain previously achieved health goals. Regular re-assessments are required.Implications for rehabilitationThere should be an awareness that improvements in quality of life (QoL) achieved during rehabilitation are not sustainable.Regularly re-assessing pain status, psychological burden, and social network size could help clinicians to determine treatment strategies for maintaining and improving rehabilitation achievements.Conducting proxy interviews is required to assess disease burden of patients with severe stroke (e.g., non-linguistic patients).

Impaired parent-reported quality of life in treatment-seeking children with obesity is mediated by high levels of psychopathology

PURPOSE

The purpose of the current study was to explore psychopathology as a mediator of quality of life (QOL) in children and adolescents with obesity. The notion that psychopathology and QOL are two distinct constructs was also tested.

METHODS

A sample of treatment-seeking children and adolescents with obesity (n = 185, average age = 11.5, mean BMI SDS = 3.03) was matched to a community sample of children (n = 799, average age = 11.5). Both self- and parent-reported measures of QOL (KINDL-R) and psychopathology (CBCL/YSR) was completed.

RESULTS

Parent-reported QOL was impaired, and both self-reported and parent-reported psychopathology was elevated in children and adolescents with obesity. Psychopathology accounted for all the variance of the effect of obesity on parent-reported QOL. The distinction between QOL and psychopathology was supported through confirmatory factor analysis.

CONCLUSION

Impaired parent-reported QOL in children and adolescents with obesity was attributable to their elevated levels of psychopathology.

Teststatistische Prüfung und Normierung der deutschen Versionen des EUROHIS-QOL Lebensqualität-Index und des WHO-5 Wohlbefindens-Index

Zusammenfassung. Der Beitrag berichtet über die teststatistische Prüfung und Normierung der deutschen Versionen des EUROHIS-QOL 8 Item Index (EUROHIS-QOL) zur Erfassung der generischen Lebensqualität und des Wohlbefindens-Index der WHO (WHO-5) zur Erfassung der Wohlbefindens aus Sicht der Befragten. Datengrundlage bildet eine repräsentative Stichprobe der bundesdeutschen Bevölkerung aus dem Jahr 2004. Die teststatistische Prüfung verweist auf gute psychometrische Eigenschaften des EUROHIS-QOL Index. Obgleich Modifikationsmöglichkeiten bestehen, wird die Selektion von Items ausgeschlossen, weil dies den komzeptuellen Vorgaben der Indexkonstruktion widersprechen würde. Die Ergebnisse der teststatistischen Prüfung des WHO-5 sind hinsichtlich der psychometrischen Eigenschaften als ausgezeichnet einzuschätzen. Erstmals werden geschlechts- und altersgruppenspezifische Normwerte für die deutschsprachigen Versionen der beiden Instrumente vorgelegt.

The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study

BACKGROUND

Survey research including multiple health indicators requires brief indices for use in cross-cultural studies, which have, however, rarely been tested in terms of their psychometric quality. Recently, the EUROHIS-QOL 8-item index was developed as an adaptation of the WHOQOL-100 and the WHOQOL-BREF. The aim of the current study was to test the psychometric properties of the EUROHIS-QOL 8-item index.

METHODS

In a survey on 4849 European adults, the EUROHIS-QOL 8-item index was assessed across 10 countries, with equal samples adjusted for selected sociodemographic data. Participants were also investigated with a chronic condition checklist, measures on general health perception, mental health, health-care utilization and social support.

RESULTS

Findings indicated good internal consistencies across a range of countries, showing acceptable convergent validity with physical and mental health measures, and the measure discriminates well between individuals that report having a longstanding condition and healthy individuals across all countries. Differential item functioning was less frequently observed in those countries that were geographically and culturally closer to the UK, but acceptable across all countries. A universal one-factor structure with a good fit in structural equation modelling analyses (SEM) was identified with, however, limitations in model fit for specific countires.

CONCLUSIONS

The short EUROHIS-QOL 8-item index showed good cross-cultural field study performance and a satisfactory convergent and discriminant validity, and can therefore be recommended for use in public health research. In future studies the measure should also be tested in multinational clinical studies, particularly in order to test its sensitivity.