Do we know what global ratings of health-related quality of life measure?

Information is lacking about the public's perception of the term health-related quality of life (HRQL). Specifically, what are the relations between the domains included in the operational definition of HRQL tools and global health ratings. The purpose of this analysis was to identify factors associated with global rating of HRQL. We conducted a survey of a representative sample of 2,030 Israeli adults, aged 45–75 years. Multiple linear regression analysis was used to identify associations between the dependent variable, the global rating, and socio-economic details, presence of disease states, and each of the domains of the SF-36. The results demonstrate that the model explains only 52% of the variance of the global rating score. The general health domain of the SF-36 explains the vast majority of the variance, 38.5% . Another important explanatory variable was physical functioning domain, which explains 7.0% of the variance and to a lesser extent vitality. The other domains of the SF-36, socio-economic details and presence of disease states contribute only small percentages to the total explained variance of the global ratings of HRQL. It seems that there is a considerable difference between the operational definition of the research community of HRQL and the public perception of this term.     

Is the Evaluation of the Global Quality of Life Determined by Emotional Status?

The present study investigated relationships between global QOL perceptions and well-being dimensions. Especially our goal was to evaluate the impact of generally recognised four broad dimensions of QOL (physical, functional, social and emotional well-being) on global QOL perceptions, additionally person's satisfaction with life achievements and economical situation were measured as well as social demographic variables. The subjects were a representative sample of Finns (n = 4613, from 25 to 65 years) of the FINRISK-97 study. Correlation coefficients and models of hierarchical regression indicated that physical, functional and social well-being as well as sociodemographic factors and satisfaction with life achievements are important factors of global QOL perceptions both among males and females. However percentages of variances explained with these measures were only moderately high, ranging from 1 to 10%. After measures of emotional well-being were entered into the models of hierarchical analyses of regression, variances explained grew dramatically over 20%. The results of the study indicated that global QOL judgements are likely to be based on current emotional state.     

Competent kids: children and adolescents with a chronic illness

The social and personal competence of children and adolescents with a seizure disorder or an orthopaedic condition was assessed by parents and teachers. The contributions to these assessments of characteristics of the child, the intensity of the illness, and the child's temperament were explored using a hierarchical regression model. Parents and teachers rated all children as functioning fairly well. Children with a seizure disorder were perceived as significantly less competent than were their healthy peers (P less than 0.05). Across health status groups, children received higher competence scores from their parents than they did from their teachers (P less than 0.05). Competence scores did not differ according to the age of the child. The patterns of variables that predicted ratings of competence differed according to illness type and rater. Indicators of illness intensity explained a larger share of the variance in competence ratings for children with a seizure disorder (25%) than for children with an orthopaedic condition (5%). For children in this latter group, temperament explained a much larger proportion of the variance in both parents' (29%) and teachers' (42%) ratings of competence than did the illness intensity variables.     

The impact of mental illness on quality of life: A comparison of severe mental illness,common mental disorder and healthy population samples

Patient-centred outcomes such as quality of life (QOL) are valued and used extensively in mental healthcare evaluations, but concerns remain about their practical application due to perceived measurement issues, including responsiveness and relationships with objective indicators and depression. Evidence from general population studies challenge some assumptions, suggesting that measurement difficulties might relate to the characteristics of mental health samples, rather than measurement itself. This paper assesses the impact of mental illness on QOL and its measurement, examining whether the life-conditions, opportunities and QOL of different mental health-status groups vary, and if explanatory models of domain-specific and global QOL differ. Objective life-conditions, access to life-opportunities and subjective QOL were assessed over 2 years, using the same methodology in severe mental illness (SMI; n = 149 (baseline)/n = 126 (follow-up)), common mental disorder (CMD; n = 794/354) and no disorder (n = 1119/583) groups. Objective life-conditions were worse in the SMI group than in mentally healthy population and CMD groups, but the opportunities available to the SMI group were no more restricted than the CMD group. Subjective QOL ratings reflected this; SMI group scores were lower than the healthy population and in some life-domains the CMD group. Models of QOL suggested that life-quality was explained differently in the three groups. QOL studies combining mental health samples should control for health-status group, and domain-specific and global indicators of lifestyle and opportunity.     

How important are mens lower urinary tract symptoms (LUTS) and their impact on the quality of life (QOL)?

Purpose: To investigate the extent to which symptom severity and related factors contribute to the explained variance of the quality of life (QOL) of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH).Methods: Data from 480 men awaiting urological assessment were collected by questionnaires shortly after referral by their general practitioners in 1997–2000. The World Health Organization’s QOL questionnaire (WHOQOL-bref), International Prostate Symptom Score (I-PSS), Symptom Problem Index (SPI), International Continence Society Benign Prostatic Hyperplasia questionnaire (ICS-BPH), the Sandvik Incontinence Severity Index, and BPH Specific Impact on Activity (BSIA) were used.Results: Regression analyses with WHOQOL-bref scores as dependent variables (physical, psychological, social relations, environmental domains, as well as overall QOL and general health) showed that symptom severity predicted only physical health. The severity of urinary incontinence was predictive of all domains except general health. Sexual function was predictive of all domains. Regression coefficients were close to zero. The explained variance of WHOQOL-bref scores was low (5–17%).Conclusions: The WHOQOL-bref might be too comprehensive to identify associations between specific symptom-related factors. Alternatively, our results indicate that LUTS suggestive of BPH and LUTS-associated factors are not very important determinants of QOL.     

Prediction of coronary heart disease preventive behaviors in women: a test of the health belief model

Coronary heart disease (CHD) risk increases with age, and this increase is more dramatic in women than men. The incidence of CHD is lower in premenopausal women compared with men. After menopause, the risk of mortality from CHD increases in women. The purpose of this study was to test predictors of CHD preventive behaviors using an adapted form of the Health Belief Model (HBM) in a sample of 178 women. The predictor variables were perceptions of susceptibility to CHD, perceptions of seriousness of CHD, general health motivation, social support, and knowledge of risk factors of CHD. Regression results revealed that susceptibility to CHD, seriousness of CHD, knowledge of risk factors of CHD, and general health motivation together explained 76% of the variance of CHD behaviors. Implications for future research and for improving education about consistent adoption of CHD preventive behaviors are discussed.     

The role of illness perceptions in labor participation of the chronically ill

OBJECTIVE: We aimed to investigate associations between work disability and illness perceptions, over and above medical assessment and self-reported health. METHODS: A representative sample of people aged 15-64 years with various chronic physical diseases was derived from the Panel of Patients with Chronic Diseases in the Netherlands. In this group, 189 patients were fully work-disabled and 363 were employed. In this cross-sectional study, associations between medical health status stated by the general practitioner, self-reported health, and illness perceptions about the consequences of the illness, the timeline (cyclical vs. chronical), control (treatment and personal), coherence and three causal dimensions (psychological, risk factors and immunity) and work disability were investigated. These associations were investigated in three separate steps using multivariate logistic regression analyses, with the employed patients as a reference group. All models were corrected for age, sex, and level of education. RESULTS: In the second multivariate model containing medical health status and self-perceived health, complete work disability was significantly associated with more fatigue (OR 2.42), more self-perceived functional limitations (OR 11.94), higher age, female sex, and lower education. Medical health status was not significantly associated with work disability. After adding illness perceptions to this model, the percentage of explained variance for work disability increased from 65 to 77%. In this final model, work disability was significantly associated with the patient's perception that the consequences of the disease were more severe (OR 5.34), and also with more self-perceived functional limitations (OR 14.27), lower education, being female, and a higher age. Illness perceptions and self-reported health status were significantly associated with work disability. CONCLUSION: We conclude that illness perceptions are significantly associated with work disability in the chronically ill. Self-reported health is more strongly associated with work disability than the assessment of health status by the physician.     

Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study

BACKGROUND: Psychiatric disorder and psychological distress are increasingly recognized as risk factors for coronary heart disease (CHD). Elucidation of the mechanisms of these associations has implications for prevention. This study aims to confirm the association between psychological distress and CHD and examine if it could be explained by other factors such as health behaviours, social isolation and low control at work. METHODS: A prospective occupational cohort study of London-based civil service employees (Whitehall II Study) with baseline data collected from 1985-1988 with a 5-year follow-up. The participants were male and female middle-aged civil servants working in 20 Government Departments; 73% of eligible employees attended baseline screening. Psychological distress measured by the General Health Questionnaire (GHQ) at baseline was used to predict incidence of self-reported CHD and possible and probable electrocardiographic (ECG) abnormalities during follow-up. RESULTS: In men, baseline psychological distress was associated with an increased incidence of overall self-reported CHD (odds ratios [OR] = 1.83, 95% CI : 1.5-2.3) and ECG abnormalities (OR = 1.51, 95% CI : 1.1-2.1), after adjustment for age, employment grade and length of follow-up. In women, baseline psychological distress was also associated with an increased incidence of CHD (OR = 1.60, 95% CI : 1.2-2.1), but not with ECG abnormalities. Adjustment for health behaviours, marital status, social networks and work characteristics reduced the risks for incident CHD by 12% in men and by 10% in women; for ECG abnormalities these adjustments increased the risk in men by 16% and had little effect in women. CONCLUSIONS: The experience of psychological distress confers increased risk of CHD in men that is not explained by health behaviours, social isolation or work characteristics. The increased risk of CHD associated with psychological distress is not consistently demonstrated in women.     

Quality of Life in Diverse Groups of Midlife Women: Assessing the Influence of Menopause, Health Status and Psychosocial and Demographic Factors

This paper examines whether menopausal status is associated with global quality of life (QOL) among women aged 40-55 and whether this association varies by race/ethnicity. We further examine the contributions of other health-related and psychosocial factors to QOL and whether these associations vary by racial/ethnic group. Analyses are based on 13,874 women who participated in the multi-ethnic, multi-race study of mid-aged women called the Study of Women's Health Across the Nation (SWAN). Study participants completed a 15-min telephone or in-person interview that contained questions on a variety of health-related topics. Items of interest for these analyses include global QOL, menstrual history (to assess menopausal status), sociodemographics, health status, lifestyle, and psychosocial variables. Results showed that in unadjusted analyses, early perimenopausal women reported lower QOL compared with premenopausal women, but menopausal status was no longer associated with QOL when analyses were adjusted for other variables. In multivariable models, being married and having low levels of perceived stress were associated with better QOL across all racial/ethnic groups. While there were many consistencies across racial/ethnic groups, we also found that the nature of the associations between QOL and education, marital status, perceived stress and social support varied across racial/ethnic groups.     

Associations between neighborhood perceptions and mental well-being among older adults

This study examined whether perceived neighborhood factors were associated with positive well-being in older adults using data from the English Longitudinal Study of Ageing. Neighborhood perceptions were assessed at baseline (2006/2007) and three measures of well-being – hedonic, eudaimonic and evaluative – were assessed at baseline and follow-up (2010/2011) for 6134 participants. In cross-sectional and longitudinal analyses, negative neighborhood perceptions were associated with poorer well-being on all three measures. These associations remained significant after adjusting for a range of sociodemographic and health status variables and depressive symptoms.