Internal structure and psychometric properties of Diabetes Distress Scale for Type 1 Diabetes

Diabetes-related distress (DD) refers to the worries and concerns about the nature and complications of Type 1 diabetes (T1D) and the frustration with the burdens of its management. Research suggests that sources of DD among people with T1D differ from those among Type 2. Many adults with T1D experience difficulties that are often unrecognised, unaddressed and mismanaged. The Diabetes Distress Scale for Type 1 diabetes (T1-DDS), is a newly developed instrument that is used to identify the specific sources of DD, exclusively for adults with T1D. The aim of the study was to examine the factorial structure of T1-DDS in Greek population and to evaluate its psychometric properties for use in research and clinical practice. A sample of 102 adults with type 1 diabetes, aged 38.85 (±10.08) years, females 63%, BMI 21.45 (±5.84) kg/m2, diabetes duration 21.35 (±13.73) years, HbA1c 7.5% (±1.2;58 mmol/mol) completed the translated T1-DDS. Exploratory factor analysis (EFA) and confirmatory (CFA) factor analysis were used to investigate the factor structure of the scale. Reliability was explored by internal consistency. Convergent validity was assessed through correlations with measures of psychological distress and diabetes status variables. Differential validity was assessed on the basis of known-group comparisons, with expected differences in distress for gender and age. Confirmatory factor analysis provided a low fit for the 7-factor model. Exploratory factor analysis supported a conceptually justifiable 5-factor model in the Greek sample. Internal consistencies of all five factors ranged from α=0.76 to 0.89. As expected, all factors were correlated with psychological distress [(r=0.510, p<0.01) for the total scale]. Management distress was positively correlated with HbA1c (r=0.397, p<0.01) and BMI (r=0.296, p<0.01), and Family/Friends distress was negatively correlated with duration of diabetes (r=-0.298, p<0.01). Further analyses showed that men exhibited higher score in relations to the social context of diabetes management (t=2.164, p<0.05 for Negative Social Perceptions), (t=2.572, p<0.05 for Family/Friends distress), and younger participants reported significantly higher distress in relation to reactions from friends and family (t=2.106, p<0.05). The Greek version of T1-DDS is a valid and reliable measure of diabetes-related distress that can be used in clinical practice to address personal needs and direct targeted interventions.

Anxiety, Depression and Health Beliefs in End Stage Renal Disease (ESRD) Patients

Health locus of control (HLOC) constitutes an important psychological domain of interest to the manifestation and course of disease. Research has shown that health locus of control beliefs can be predictive of anxiety and depression and could therefore act as a good determinant of psychological adjustment for patients with chronic conditions. The aim of this study was to explore the relationship between locus of control health beliefs with depression and anxiety in end stage renal disease patients. Also, to explore whether these beliefs can indeed predict patients’ psychological adjustment. 144 adult patients undergoing haemodialysis or peritoneal dialysis participated in this cross-sectional prospective study. Sociodemographic and medical characteristics were recorded and the following structured questionnaires were administered: the Multidimensional Health Locus of Control (MHLC) (Wallston et al, 1994), the Centre of Epidemiological Studies Depression Scale (CES-D) (Fountoulakis et al, 2001), the State-Trait Anxiety Inventory 2 (STAI 2) and the General Health Questionnaire (GHQ) (Garyfallos et al, 1991). ANOVA analysis was performed to examine whether patients’ MHLC scores correlated with CES-D, STAI 2 and GHQ scores and regression analysis was performed to determine the degree to which health locus of control beliefs can predict depression and anxiety. Results revealed significant relationships between health locus of control beliefs and anxiety, depression thus demonstrating the role health beliefs can play in patients’ psychological adjustment with important implications for clinical practice.

Quality of life and depression in chronic sexually transmitted infections in UK and Greece: The use of WHOQOL-HIV/STI BREF

This is a comparative study aiming to investigate quality of life (QoL) and depression in individuals diagnosed either with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), or genital warts (GW) and genital herpes (GH), in two healthcare settings, in the United Kingdom (UK) or in Greece (Gr). Using a matched-pairs design, two equalized patient samples with sexually transmitted infections (STI) were recruited: from UK (n=43) and from Greece (n=43). QoL was assessed with WHOQOL-HIV BREF for HIV patients and WHOQOL-STI BREF -a newly adapted instrument- for genital warts and genital herpes patients. Depressive symptomatology was measured by the Centre for Epidemiological Studies- Depression Scale (CES-D) along with sociodemographic data. Results indicate that in both country- healthcare settings, a high percentage of individuals diagnosed with any type of STI, reported considerable depressive symptomatology: 35.7% for UK and 41.5% for Greek participants respectively. Regarding QoL, participants in the Greek healthcare settings reported significantly lower scores in the environment domain, and even lower scores were reported by the GW/GH group, in comparison to HIV. Specifically, these groups indicated significantly lower values in the following WHOQOL-BREF environment facets: (i) physical safety and security, (ii) participation in and opportunities for recreation/leisure activities, (iii) home environment, (iv) accessibility and quality in health and social care, and (v) transport facilities. Regarding correlation of QoL and depression, regression analysis provided significant evidence for depression having a differential effect on WHOQOL-BREF QoL domains. Evidence of increased depressive symptomatology in both STI patient- cohorts may shed light into unmet healthcare needs that should be addressed by healthcare providers in UK and Greece respectively. Furthermore, all types of Greek STI participants reported lower QoL, particularly the GW/GH group, indicating important unmet QoL needs in the environment domain, such as health and social care accessibility and quality, or environmental and social resources, all lowering everyday QoL. The present findings may provide guidelines for tailored mental health interventions alleviating depressive symptomatology in STI patients. Provision of targeted-interventions at healthcare and social-environmental levels will contribute to QoL/ health improvement in STI patients.

Comparing immigrant children with native Greek in self-reported-Quality of Life

Research on an international and national context regarding immigrant children and adolescents' quality of life (QoL) is rather scarce. Few international studies have been conducted investigating the presence of psychopathology and providing evidence of behavioural and psychological problems in immigrant adolescents. Regarding immigrant quality of life, thus far investigation was directed mainly to adult immigrant individuals and not to their children. The aim of the present study was to investigate the quality of life (QoL) of immigrant children and young adolescents who live in the greater Athens area, and to compare them with their native Greek peers living in the same communities and attending the same schools.

METHOD

Sixty three immigrant children, from Albanian and Eastern European origin (mean age 11.9 years) and 489 native children (mean age 11.33 years) were administered a QoL instrument specifically developed for children and adolescents: the Kid-KINDL® Questionnaire for 8-12 years old and the Kiddo-KINDL® Questionnaire for 13-16 years old. The dimensions examined in the KINDL® questionnaire refer to: physical wellbeing, emotional well-being, self- esteem, friends, family life and everyday life (school life). The Greek version is reported to show satisfactory values of validity and reliability. Administration of questionnaires was conducted at school after parent consent. Analysis included student's t-test, chi-square test, and multivariate linear regression analysis, as to investigate the relationship between KINDL® QoL dimensions' scores and nationality status, after controlling for gender and age. The results indicated that self-reported QoL scores of immigrant children were significantly poorer in comparison to native children in the domains of self-esteem and family life, as well as in the total QoL scores. In the rest of the QoL domains, similar scores were reported in both immigrant and their native classmates, that is in the dimensions of physical well-being, emotional well-being, friends and school. Investigating the effect of gender in KINDL® QoL parameters, after controlling for nationality and age, no evidence was found for differences between male and female children. Regarding the effect of age, older compared to younger in age children scored significantly lower in emotional well-being, self-esteem, and friends, school and total QoL. The results provide evidence of QoL deficits in self-esteem and family life in immigrant children. QoL deficits seem to increase in more areas as immigrant children grow older. Dimensions regarding self-perception and family may be interrelated, mutually influencing one another. It may be suggested that immigrant children seem to experience reduced self-esteem and distressful feelings within family interpersonal relations. As they grow older, distress seems to become more evident in emotional and social areas of QoL. Mental health interventions should take into account the multilevel impact of family interpersonal experiences on child's psychosocial development, as to design and deliver appropriate interventions supporting parenting for immigrant groups of individuals. Also, specialized mental health promotion programs need to be provided for adolescent immigrant individuals.

Appraisal of a specific scale for quality of life (AlQoL-9) in Greek alcohol dependent individuals attending: A confirmatory factor analysis

Αlcohol abuse/dependence seriously affects quality of life (QoL). The AlQoL-9 scale, derived from the generic instrument SF-36, is the only instrument in the international literature which is specific as a measure of QoL for alcohol-dependent patients. It can provide health carers with valuable information regarding the needs of alcoholic individuals and the effects of therapeutic interventions. The aim of this study was to assess the psychometric properties of the Greek version of AlQoL-9 taking as a basis the research on the original French and English versions. A sample of 170 participants (118 males, 52 females) aged 24-74 years (mean age=48.2 years, SD=9.6) recruited from inpatient and outpatient detoxification units in different regions of Greece completed the AlQoL-9 questionnaire and the World Health Organization Quality of Life Assessment - short version (WHOQOL-BREF). The internal structure of the AlQoL-9 questionnaire was examined using confirmatory factor analysis (CFA). The associations of AlQoL-9 with sociodemographic and clinical variables were examined. The correlation coefficients between AlQoL-9 and scores on the domains of the WHOQOL-BREF questionnaire were computed as an indication of convergent validity. The average inter-item correlation between the AlQoL-9 items was 0.403. CFA supported a single factor underlying the AlQoL-9 items. Cronbach's alpha for the Greek version of the scale showed high internal consistency, 0.837, and could not be improved by omitting any item. The AlQoL-9 score showed significant associations with gender (mean 29.2, SD=6.2 for males; mean 26.1, SD=7.2 for females: p=0.004) and with comorbidity (mean 25.7, SD=7.8 with comorbidity, mean 29.5, SD=5.8 without: p=0.001). The AlQoL-9 score was significantly correlated (p<0.001) with all scores of the WHOQOL-BREF, most strongly with the WHOQOL domains of physical health (Pearson's r=0.720) and psychological health (r=0.693) and less so with social relationships (0.481), environment (0.411), and the single-item measures of overall health (0.554) and overall quality of life (0.522). The present study demonstrated that the Greek version of the AlQoL-9 constitutes a valid and reliable single-factor research instrument for evaluating quality of life among alcohol-dependent individuals. It is recommended to be used in combination with a generic QoL instrument e.g. the WHOQOL-BREF. It is suitable for clinical everyday practice to monitor possible patient QoL changes, as well as in large scale studies investigating QoL in the relevant population.

Quality of life in newly diagnosed children with specific learning disabilities (SpLD) and differences from typically developing children: a study of child and parent reports

INTRODUCTION

Research on quality of life (QoL) of school children with specific learning disabilities (SpLD) and their parents is scarce. The present study explores QoL deficits in newly diagnosed children with SpLD and their parents, in comparison to a similar age group of typically developing children. Possible associations between parental and child QoL were statistically explored in both groups of children.

METHODS

70 newly diagnosed children with SpLD [International Classification of Diseases-10 (ICD-10) criteria] (38 boys, 32 girls, mean age 10.1 years) and a control group of 69 typically developing children of the same age (40 boys, 29 girls, mean age 10.6 years) were recruited. Children were of normal intelligence quotient, attending mainstream schools. Their parents were also recruited so a child's scores could be associated with corresponding parental scores (mother or father). Children's QoL was assessed by the German questionnaire for measuring quality of life in children and adolescents (KINDL(R) ) questionnaire and parental QoL by World Health Organization Quality of Life brief questionnaire (WHOQOL-BREF) of the World Health Organization.

RESULTS

Children with SpLD in comparison to typically developing children reported according to the KINDL(R) measurement poorer emotional well-being, lower self-esteem and satisfaction in their relationships with family and friends. Surprisingly, school functioning was not reported by these children as an area of concern. Parents of children with SpLD indicated experiencing lower satisfaction in the WHOQOL-BREF domains of social relationships and environment. Correlational and regression analysis with parental-child QoL scores provided evidence that in the SpLD group, parental scores on WHOQOL-BREF social relationships and psychological health domains could be predictors of the child's emotional well-being, satisfaction with family, friends and school functioning. Stepwise regression analysis verified the effect of parents' WHOQOL-BREF social relationships domain on several dimensions of children's KINDL(R) QoL.

CONCLUSIONS

  The results may suggest certain significant effects of the SpLD condition on newly diagnosed children's QoL. Emotional and social deficits seem to be experienced by this cohort of children and their parents. Investigation into the possible interrelationships between parental and child QoL seems to indicate that parental social wellbeing may to a certain extend influence some dimensions of the child's QoL. The findings are useful for policy making and specialized interventions for children with SpLD and their families.

Depression, physical activity, energy consumption, and quality of life in OSA patients before and after CPAP treatment

BACKGROUND

A variety of studies have demonstrated improvement in quality of life and depressive symptoms in obstructive sleep apnea (OSA) patients after continuous positive airway pressure (CPAP) treatment. However, very little is known about the effect of OSA treatment on physical activity and energy consumption.

OBJECTIVES

The aim of this study was to evaluate the changes in depression, physical activity, energy expenditure, and quality of life (QoL) in OSA patients before and after CPAP therapy.

METHODS

Forty-one patients with OSA as revealed by polysomnography, were included to the study. They responded to the generic World Health Organization Quality of Life (WHOQoL) questionnaire, to the specific-disease Quebec Sleep Questionnaire, and to Center for Epidemiologic Studies Depression Scale (CES-D) in order to evaluate QoL and the incidence of depression. In addition, all patients wore an accelerometer which measured physical activity and energy expenditure during a week. At least 6 months after initiation of CPAP treatment (mean time, 9 months) we re-examined 24 patients who met the compliance with the treatment criteria.

RESULTS

Patients after CPAP therapy had significantly higher scores in all domains of the Quebec Sleep Questionnaire and in the domains of physical health/level of independence and psychological health/spirituality of the WHOQoL. Depression scores were also better in CES-D after treatment. However, despite the improvement in QoL and psychological status, CPAP therapy had no impact on physical activity and energy expenditure.

CONCLUSIONS

CPAP therapy improves QoL and lessens depressive symptoms in our group of well-treated OSA patients. However, physical activity and energy expenditure did not present statistically significant improvement in the same group of OSA patients.

Psychometric properties of WHOQOL-BREF in clinical and health Greek populations: incorporating new culture-relevant items

Τhe present study examines main psychometric properties of the World Health Organisation (WHO) quality of life (QoL) instrument, the WHOQOL-BREF with the inclusion of four national items. Participants were 425 adult native Greek speaking, grouped into patients with physical disorders, psychiatric disorders and healthy individuals. Participants were administered WHOQOL-BREF and 23 national items, the General Health Questionnaire (GHQ-28) and the Life Satisfaction Index (LSI). Confirmatory factor analysis produced acceptable fit values for the original model of 26 items within the four WHOQOL domains: physical health, psychological health, social relationships and environment. Testing for the fit of national items within this model, the results indicated four new items with the most satisfactory fit indices and were thus included forming a 30-items version. The national items refer to: (a) nutrition, (b) satisfaction with work (both loaded in the physical health domain), (c) home life and (d) social life (both loaded in the social relationships domain). Statistical tests were applied to the 26- and 30-items versions producing satisfactory results, with the 30-items version showing slightly better values. Furthermore, results on the 30-items version included: (a) internal consistency, which was found satisfactory, with alpha values ranging from α=0.67-0.81, while the inclusion of new items produced higher alpha values in physical health and social relationships domains, (b) construct validity with good item-domain correlations, as well as strong correlations between domain scores, (c) convergent validity, which was very satisfactory, showing good correlations with GHQ-28 and LSI, (d) discriminant validity, showing instrument's ability to detect QoL differences between healthy and unhealthy participants, and between physically ill and psychiatric patients, and (e) test-retest reliability, with ICC scores in excess of 0.80 obtaining for all domains. The WHOQOL-BREF Greek version was found to perform well with sick and healthy participants, demonstrating satisfactory psychometric properties. Use of the instrument may be recommended for clinical and general populations, for service or intervention evaluation, as well as for cross-cultural clinical trials.

Quality of life, mental health and health beliefs in haemodialysis and peritoneal dialysis patients: investigating differences in early and later years of current treatment

BACKGROUND

The study examines differences regarding quality of life (QoL), mental health and illness beliefs between in-centre haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD/PD) patients. Differences are examined between patients who recently commenced treatment compared to patients on long term treatment.

METHODS

144 End-Stage Renal Disease (ESRD) patients were recruited from three treatment units, of which 135 provided full data on the variables studied. Patients consisted of: a) 77 in-centre haemodialysis (HD) and 58 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, all currently being treated by dialysis for varied length of time. Patients were compared for differences after being grouped into those who recently commenced treatment (< 4 years) and those on long term treatment (> 4 years). Next, cases were selected as to form two equivalent groups of HD and CAPD/PD patients in terms of length of treatment and sociodemographic variables. The groups consisted of: a) 41 in-centre haemodialysis (HD) and b) 48 continuous ambulatory peritoneal dialysis (CAPD/PD) patients, fitting the selection criteria of recent commencement of treatment and similar sociodemographic characteristics. Patient-reported assessments included: WHOQOL-BREF, GHQ-28 and the MHLC, which is a health locus of control inventory.

RESULTS

Differences in mean scores were mainly observed in the HD patients with > 4 years of treatment, providing lower mean scores in the QoL domains of physical health, social relationships and environment, as well as in overall mental health. Differences in CAPD/PD groups, between those in early and those in later years of treatment, were not found to be large and significant. Concerning the analysis on equivalent groups derived from selection of cases, HD patients indicated significantly lower mean scores in the QoL domain of environment and higher scores in the GHQ-28 subscales of anxiety/insomnia and severe depression, indicating more symptoms in these areas of mental health. With regards to illness beliefs, HD patients who recently commenced treatment provided higher mean scores in the dimension of internal health locus of control, while CAPD/PD patients on long term treatment indicated higher mean scores in the dimension of chance. Regarding differences in health beliefs between equivalent groups of HD and CAPD/PD patients, HD patients focused more on the dimension of internal health locus of control.

CONCLUSION

The results provide evidence that patients in HD treatment modality, particularly those with many years of treatment, were experiencing a more compromised QoL in comparison to CAPD/PD patients.

Detecting changes in quality of life and psychiatric symptomatology following an in-patient detoxification programme for alcohol-dependent individuals: the use of WHOQOL-100

The present study examines quality of life (QoL) and psychiatric symptomatology prior to and upon completion of a 5-week in-patient detoxification programme with the aim to identify any changes produced following clinical intervention. A group of 46 alcohol-dependent individuals, who were consecutively admitted for detoxification in the Psychiatric Hospital of the University of Athens, were clinically-assessed at admission and just before discharge with DSM-IV, CIDI-WHO and with the Hamilton Depression and Anxiety Scales (HDRS, HARS) and the Global Assessment Scale (GAS) for depression, anxiety and overall functioning, respectively. In addition, the patients were invited to complete the World Health Organization Quality of Life WHOQOL-100 instrument. Differences between admission and discharge scores were examined using related sample t-tests. Correlations between the WHOQOL-100 scores and clinically-assessed symptomatology measures were performed. Regression analysis was conducted to investigate the correlation of clinical and socio-demographic variables with patient overall QoL. The results indicate that QoL scores increased at discharge in 16 out of the 24 WHOQOL-100 facets. In addition, patient-assessed status of health was significantly improved. Improvement was also observed in the symptomatology scales rated by the clinician, providing evidence for lower levels of depression, anxiety and a higher level of functioning. Moderate correlations were found between WHOQOL-100 domains and psychiatric symptomatology scales. Significant WHOQOL-100 gains at discharge and clinically-assessed improvement in the HDRS, HARS and GAS, provide evidence of the WHOQOL-100 instrument's sensitivity to changes in clinical condition. The WHOQOL-100 measurement may be suitable for detecting QoL deficits or therapeutic gains in alcohol-dependent patients and may prove useful to mental health professionals for treatment planning.