Vitamin D intake and mental health-related quality of life in older women: the Iowa Women's Health Study

Objective

Vitamin D deficiency and mood disorders are both prevalent among the elderly. We evaluated the association between vitamin D intake and mental health-related quality of life (QOL) among elderly women participating in a large population-based study.

Study design

This study was a cross-sectional analysis of the Iowa Women's Health Study, a prospective study of cancer risk factors among post-menopausal women in Iowa that began in 1986. Additional survey data was collected from the cohort members in 1987, 1989, 1992, 1997, and 2004. Data for this analysis came from the 2004 questionnaire.

Main outcome measure

Mental health-related QOL was assessed using five scales from the Medical Outcomes Study 36-item Short-form Health Survey. QOL scores were analyzed as continuous variables using linear regression, controlling for age, energy intake, BMI, education, smoking, living arrangement, antidepressant usage, comorbidity history, and physical activity.

Results

Low vitamin D intake (<400 IU/day) was associated with poorer QOL scores compared to women with higher intake (≥400 IU/day). Differences in QOL scores by vitamin D intake group were attenuated with multivariable adjustment, but a significant overall association between vitamin D and QOL scores persisted. Further adjustment for physical activity attenuated all differences as well as the overall association between vitamin D and QOL scores.

Conclusions

Women who consumed <400 IU/day of vitamin D had significantly lower mental health-related QOL compared to those who consumed ≥400 IU/day. Meeting dietary vitamin D recommendations is a potential method for improving QOL among the elderly.     

PRIME: impact of previous mental health problems on health-related quality of life in women with childbirth trauma

We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n?=?137) or parenting support (n?=?125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06; 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08; 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.     

Determinants of health-related quality of life in coronary artery disease patients: a prospective study generating a structural equation model

The authors used structural equation modeling to test a conceptual model of HRQL in coronary artery disease. The model, which included biomedical factors and individual and environmental characteristics, was tested in a multicenter group of 465 patients at three timepoints (baseline evaluation of chest pain and 1- and 3-month follow-ups). A satisfactory fit was obtained for the model over time. Depression and anxiety symptoms exerted the most significant influence on HRQL. HRQL and the mediating factors were found to be distinct phenomena. The authors concluded that mediating factors, especially depression and anxiety symptoms, should be taken into consideration in clinical routine if HRQL is regarded as a clinical outcome.     

Mental health and health-related quality of life in Croatian island population

Aim

To explore differences in self-perceived health as an indicator of health status and mortality, in six isolated populations from Croatian islands and to compare the results with control from general Croatian population obtained through the National Health Survey.

Method

Health-related quality of life was measured using the Short Form Health Status Questionnaire (SF-36). The questionnaire was administered to 600 participants, inhabitants of 6 villages: Rab, Barbat, Lopar, and Supetarska Draga on island Rab, and Komiža and Vis, on island Vis, and to control group of 600 participants from the general Croatian population matched by age and gender to islanders.

Results

The islanders scored higher than controls on 3 out of 8 health dimensions, physical functioning (80.1 ± 22.4 vs 73.2 ± 24.8, P<0.001), vitality (61.0±20.3 vs 55.7 ± 19.9, P<0.001), and pain (70.1 ± 28.0 vs 65.9 ± 26.5, P = 0.008). Social functioning of islanders was significantly lower than in control group (73.4 ± 18.6 vs 77.6 ± 23.4, P = 0.001). There was also a significant variation in health status among the islanders according to the isolation level, with the largest differences in general health perception and mental health. High isolation group reported the lowest score of all groups on mental health (P = 0.018), physical functioning (P = 0.045), general health (P = 0.001), and vitality dimension (P = 0.027).

Conclusion

Inhabitants of Croatian islands in general showed better health-related functioning on the most of the health dimensions than general population. Islanders scored lower than controls only on social functioning which can be explained by their geographical isolation and small population. Low mental health score of islanders in the high isolation group should be taken in account in planning health services for islands.Research dealing with environmental and cultural issues has mainly been focused on urban life. Little attention has so far been paid to the quality of life parameters on remote or geographically isolated areas such as islands, where lifestyle is affected mostly by geographical conditions.There are two important characteristics of the lifestyle in remote islands or geographically isolated communities: a) medical health care is usually insufficient and b) there are few opportunities for personal growth of inhabitants due to limited interaction with new stimuli (1). Geographical environment and social and health needs of the island population require a specific type of health care, the implementation of which demands investment of considerably larger financial resources. On the other hand, islands and isolated areas are places with many positive lifestyle aspects, such as clean and healthy environment (no smoke or noise, proximity to the sea or the mountains), and less hassle and stress in life (easier transportation, more free time, less competition, well known social environment). The inhabitants of Dalmatian islands represent an exceptional example of rare, genetically isolated groups residing in the contemporary Europe (2). The geographical specificity induced development of a number of isolated groups, each exhibiting specific social and health-related phenomenon. As a direct result of isolation, several genetic disorders have emerged (3-7). Isolate island populations provide a valuable resource for health research. They not only allow investigations that improve our understanding of unique and rare genetic disorders, but can also contribute to a better understanding of common diseases that are important contributors to the burden of disease globally. An example is the research in the population of Sardinia, which showed that 12% of the inhabitants carry beta thalassemia-predisposing mutations in the beta globin gene; it was subsequently shown that beta thalassemia carriers have 25% lower plasma low density lipoprotein (LDL) than the non-carriers (8). In contrast to various anthropological and genetic analyses, there have been little or no investigations of the health-related quality of life in such populations (9).Health-related quality of life refers to the personal sense of physical and mental health and the ability to react to factors in the physical and social environments. It is more subjective than life expectancy and therefore is more difficult to measure. A self-administered health status questionnaire gives us subjective assessments of health for both individual persons and entire communities. These measures capture individuals’ subjective assessment of their health through examining various health domains, such as physical, psychological and role function. In both clinical and public health settings, subjective perceptions of health have often greater saliency for functioning and survival than do physiologic and clinical assessments. Global assessments, in which a person rates his or her health as “poor,” “fair,” “good,” “very good,” or “excellent,” can serve as reliable indicators of one’s perceived health (10). Subjective measures of health status have been advocated as a useful proxy for objective measures. In some studies the question about global self rated health has been found to be a powerful predictor of the mortality within a targeted population group (11). Since self-perceived health represents an important indicator of health status and morbidity, the aim of this study was to explore differences in self-perceived health in 6 isolated communities on Croatian islands. The results were compared with Croatian data from National Health Survey 2003 (12). According to the characteristics of Croatian island population, it is to be expected that the specificity of isolated populations will be reflected in the self-perceived physical and mental health as well in the indicators of social functioning of individuals.     

Determinants of quality of life in Greek middle-age women: a population survey

Objectives

The aim of the present study was to evaluate how sociodemographic parameters, lifestyle indicators and intensity of climacteric symptoms affect the quality of life (QOL) of Greek community dwelling middle-aged women.

Study design

This population survey included 1140 middle-aged women aged 45–65 who represented 1% of the whole female population of this age group in Greece, stratified by residential area.

Main outcome measures

Participants were asked to complete a questionnaire concerning sociodemographic and anthropometric parameters, medical history, the Utian quality of life (QOL) scale and the Greene climacteric scale rating menopausal symptoms.

Results

In the univariate analysis, normal body mass index, married status, higher education, employment, good financial status, physical exercise and a high calcium diet were associated with higher total QOL scores (p-value < 0.001). Multivariate regression analysis showed that higher total QOL scores were predicted by being married (separated/divorced/widowed: beta = −3.17, p-value = 0.008), by physical exercise (beta = 4.84 and beta = 4.57 for 1–3 h and >3 h per week respectively, p-value < 0.001) and by a good financial status (beta = 7.05, p-value < 0.001), while a higher score in the Greene scale resulted in lower total QOL scores (beta = −0.77, p-value < 0.001). Women with a better QOL were more health conscious and more probable to have utilized the public health preventive resources.

Conclusions

Menopause as a life event has no effect on the QOL of Greek middle-aged women. On the contrary, the presence and intensity of climacteric symptoms have a negative impact on all aspects of QOL. Marital and financial status, as well as physical exercise, are also significant predictors of QOL.     

The Huntington's Disease health-related Quality of Life questionnaire (HDQoL): a disease-specific measure of health-related quality of life

Huntington's disease (HD) is a genetic neurodegenerative disorder characterized by motor, cognitive and psychiatric disturbances, and yet there is no disease-specific patient-reported health-related quality of life outcome measure for patients. Our aim was to develop and validate such an instrument, i.e. the Huntington's Disease health-related Quality of Life questionnaire (HDQoL), to capture the true impact of living with this disease. Semi-structured interviews were conducted with the full spectrum of people living with HD, to form a pool of items, which were then examined in a larger sample prior to data-driven item reduction. We provide the statistical basis for the extraction of three different sets of scales from the HDQoL, and present validation and psychometric data on these scales using a sample of 152 participants living with HD. These new patient-derived scales provide promising patient-reported outcome measures for HD.     

Race and health-related quality of life in midlife women in Baltimore,Maryland

Objective

Only a few studies have examined the association between race/ethnicity and health-related quality of life (HRQOL) during midlife. Thus, the purpose of this study was to examine this association in the context of a population-based study of Caucasian and African-American women aged 45–54 years.

Methods

Data from 626 pre- and peri-menopausal African-American and Caucasian women aged 45–54 years were analyzed. HRQOL was measured using Cantril's Self-Anchoring Ladder of Life, a validated measure of overall life satisfaction. Body mass index was determined using measured height and weight. Information on race and other variables such as education was based on self-report. Logistic regression models were constructed to examine the unadjusted and adjusted associations between race and low present HRQOL (≤6 on Cantril's Ladder of Life).

Results

In both the unadjusted and adjusted analyses, race was not significantly associated with low present HRQOL (unadjusted OR 1.57; 95% CI 0.93, 2.65; adjusted OR 0.82; 95% CI 0.42, 1.61). In the fully adjusted model, only the number of menopausal symptoms and self-rated health were significantly associated with present HRQOL.

Conclusions

Findings from this population-based study suggest that race is not a statistically significant determinant of present HRQOL among midlife women.     

Health information needs and health-related quality of life in a diverse population of long-term cancer survivors

Objective

To investigate health information needs and their association with health-related quality of life (HRQOL) in a diverse, population-based sample of long-term cancer survivors.

Methods

We analyzed health information needs from 1197 cancer survivors 4–14 years post-diagnosis drawn from two cancer registries in California. Multivariable regression models were used to identify factors associated with endorsement of total number and different categories of needs. The relationship between number of needs and HRQOL and effect modification by confidence for obtaining information was examined.

Results

Survivors reported a high prevalence of unmet information needs in the following categories: side effects & symptoms: 75.8%; tests & treatment: 71.5%; health promotion: 64.5%; interpersonal & emotional: 60.2%; insurance: 39.0%; and sexual functioning & fertility: 34.6%. Survivors who were younger, non-White, and did not receive but wanted a written treatment summary reported a higher number of needs. Number of information needs was inversely related to mental well-being, particularly for those with low confidence for obtaining information (P < 0.05).

Conclusion

These patterns suggest disparities in access to important health information in long-term survivors and that affect HRQOL.

Practice Implications

Findings suggest a need for tailored interventions to equip survivors with comprehensive health information and to bolster skills for obtaining information.     

Association between social capital,health-related quality of life,and mental health: a structural-equation modeling approach

AimTo explore the association(s) between demographic factors, socioeconomic status (SES), social capital, health-related quality of life (HRQoL), and mental health among residents of Tehran, Iran.MethodsThe pooled data (n = 31 519) were extracted from a population-based survey Urban Health Equity Assessment and Response Tool-2 (Urban HEART-2) conducted in Tehran in 2011. Mental health, social capital, and HRQoL were assessed using the 28-item General Health Questionnaire (GHQ-28), social capital questionnaire, and Short-Form Health Survey (SF-12), respectively. The study used a multistage sampling method. Social capital, HRQoL, and SES were considered as latent variables. The association between these latent variables, demographic factors, and mental health was determined by structural-equation modeling (SEM).ResultsThe mean age and mental health score were 44.48 ± 15.87 years and 23.33 ± 11.10 (range, 0-84), respectively. The prevalence of mental disorders was 41.76% (95% confidence interval 41.21-42.30). The SEM model showed that age was directly associated with social capital (P = 0.016) and mental health (P = 0.001). Sex was indirectly related to mental health through social capital (P = 0.018). SES, HRQoL, and social capital were associated both directly and indirectly with mental health status.ConclusionThis study suggests that changes in social capital and SES can lead to positive changes in mental health status and that individual and contextual determinants influence HRQoL and mental health.Mental health is defined by World Health Organization (WHO) as “a state of well-being in which every individual realizes his/her own potential, can cope with the normal pressures of life, can work productively, and is able to make a contribution to his/her community” (1,2). Mental health and associated disorders have received increasing attention worldwide, largely due to their impact on socio-economic and overall health status of patients (3). Mental health problems remain a global concern, and account for a large fraction of diseases (4,5).The overall prevalence of mental disorders in Iran between 2000 and 2008 ranged from 12.5% to 38.9% and was similar in urban (20.9%) and rural areas (21.3%) (6). Anxiety and depression were more prevalent than somatization and social dysfunction (7). The provinces with the highest prevalence of mental problems were Chaharmahal with 38.3% and Golestan with 37.3% (8).Mental health is usually determined by a complex interaction of sociocultural, psychological, environmental, and demographic factors (9). The prevalence of mental health disorders is significantly associated with age, marital status, educational level, employment, and health-related to quality of life (HRQoL) (10). HRQoL incorporates physical and socio-emotional functioning and is used to measure individual''s perception of health status, welfare, and well-being in a society (11). A frequently used psychometrical tool for the assessment of HRQoL is Short-Form Health Survey (SF-12). Its two main components are physical component summary (PCS) and mental component summary (MCS), both of which are associated with mental health (12). Previous studies have confirmed a bidirectional association between physical health and depression (as one of the main dimensions of mental health) (13). However, it is not clear whether there is a causal relationship between them (13,14).The suggested mechanisms by which depression could lead to physical disability and decreased HRQoL are poor health behaviors, increased risk of physical disease, and characteristics of depression (eg, decreased pain threshold) (15). On the other hand, physical disability can lead to depression and deterioration of mental health due to restriction of social activities and loss of social capital (15). Ultimately, this bilateral association between depression and poor physical health can lead to increasing health risks (14).Mental disorders such as depression and anxiety are also influenced by socioeconomic status (SES) (16). SES is commonly conceptualized as an individual or group’s relative social standing or class (16,17). The main predictors of SES are education level, income, and occupation (15,17,18). The correlations between SES and mental health have been explained by various mechanisms. It has been found that negative impact of low SES on mental health (19) can be reduced by the mediating effect of social capital and physical health (4,18).Social capital has been defined as individual’s social networks and social interactions, shared norms, values, and understandings that facilitate collective action within or among groups. It can act as a protective factor, promoting mental health status by reducing socioeconomic inequalities (4,20) and play an important role in reducing the prevalence of mental disorders (4). Previous studies have found that social ties and support significantly improve mental health (9). Nonetheless, the association between social capital, mental health, quality of life, and SES is not consistently reported (21,22). This population-based study aims to explore the association between demographic factors, SES, social capital, HRQoL, and mental health among Tehran residents using structural-equation modeling (SEM).     

The effect of hormone therapy on the health-related quality of life in elderly women

Objectives

The purpose of this study was to compare the health-related quality of life (HRQoL) of elderly users and non-users of hormone therapy (HT).

Subjects and methods

Subjects were participants in an ongoing intervention study, which is aimed at elucidating the effectiveness of an educational program in the prevention of osteoporosis. A random sample (n = 4200) of the female population in Southern Finland within the age group of 60–70 years was drawn from the population register and invited to take part in the trial; 2181 (52%) accepted the invitation and were randomized either to the educational program or to a control group. In 2002 all 2181 participants were asked by a postal survey about HRQoL (generic15D), education, profession, climacteric symptoms, use of HT, chronic diseases and medication. Of the 1663 respondents (76% of the participants; 40% of the original cohort) 585 (mean age 67.5 years) were HT users and 1078 (mean age 68.9 years) non-users.

Results

After standardizing for age, education, number of continuous medication and ongoing diseases HRQoL of HT users was significantly better on the dimensions of usual activities, vitality and sexual activity. The effect of HT on overall HRQoL on a 0–1 scale was positive, but neither statistically significant nor clinically important. The number of medication and diseases had a statistically significant negative effect, but higher education a positive, but statistically non-significant effect on HRQoL overall.

Conclusions

Among elderly women HT use has a statistically significant positive effect on some dimensions of HRQoL, but not on HRQoL overall. To improve HRQoL is not an indication for elderly postmenopausal women to use HT.     

Relationship between health-related quality of life domains and bone status in postmenopausal Japanese women

OBJECTIVE: To assess the relationship between health-related quality of life domains and bone status, including bone metabolism, in postmenopausal Japanese community women. DESIGN: The study subjects were 88 women who were participants in a screening program for osteoporosis in 2003 without a history of mental disorders, metabolic disorders, smoking, bone fractures, and/or estrogen treatment. The participation rate was 75.9%. The age range was 50 to 68 years (mean, 57), and body mass index (BMI) ranged from 15.7 to 36.6 (mean, 22.4). Health-related quality of life domains were evaluated using the Medical Outcomes Study Short-Form 36 Health Survey, and bone mineral content was measured by quantitative ultrasound of the calcaneus. Serum total osteocalcin and serum N-telopeptide were measured by enzyme-linked immunosorbent assay. Multiple linear regression models were used to study the association of age, BMI, and eight health-related quality of life domains as independent variables in age-corrected bone status and markers of bone turnover as dependent ones. RESULTS: The participants' calcaneal Z scores by quantitative ultrasound ranged from -2.14 to 2.71. The mean Z score was -0.17 (-0.27, -0.07). Multiple regression analysis revealed that BMI (P < 0.05), physical function (P < 0.01), and role-emotional (role limitations caused by emotional problems) (P < 0.01) were factors in increasing bone mineral content. Also, a positive relationship was found between vitality (P < 0.01), social function (P < 0.05), and total osteocalcin. CONCLUSIONS: Although causality is not clear, in addition to low BMI, role limitations due to poor emotional status and low physical function are related to low bone mineral content in postmenopausal Japanese community women. These results imply that when we are concerned about osteoporosis in postmenopausal women, we should pay attention not only to their physical function but also to their psychological state.     

Effect of raloxifene on quality of life: a prospective study using the Utian Quality of Life (UQOL) Scale

OBJECTIVE: The Utian Quality of Life Scale (UQOL) is a new questionnaire used to quantify patient perception of quality of life in postmenopausal women. The current study is the first to use the UQOL in ascertaining treatment effects on quality of life in postmenopausal women. DESIGN: This was a randomized, double-blind, placebo-controlled study of healthy postmenopausal women. Participants were randomized to raloxifene 60 mg/day or placebo. Participants completed the UQOL at baseline, at 3 months, and at the 6-month study endpoint. RESULTS: A total of 74 women (mean age, 55.6 years) were randomized. In the overall population, there were no significant changes from baseline to 6 months within or between treatment groups in any of the domains or total score, although raloxifene was associated with positive changes from baseline in the occupational (P = 0.093) and health (P = 0.055) domains. In women who completed the study, raloxifene was associated with a significant improvement from baseline in the occupational (P = 0.041) and health (P = 0.025) domains and in the total score (P = 0.044), whereas placebo had no effect. There were no statistically significant differences between raloxifene and placebo in any of the domains or total score. CONCLUSION: Although there were no treatment group differences, raloxifene was associated with an improvement from baseline in the occupational and health domains and in the overall score of the UQOL. Larger studies are needed using the UQOL as a primary endpoint to determine whether the positive effects of raloxifene on quality of life observed in this trial are real or a chance finding.     

A prospective study of sleep duration and mortality risk in women

STUDY OBJECTIVES: It is commonly believed that 8 hours of sleep per night is optimal for good health. However, recent studies suggest the risk of death is lower in those sleeping 7 hours. We prospectively examined the association between sleep duration and mortality in women to better understand the effect of sleep duration on health. DESIGN: Prospective observational study. SETTING: Community-based. PARTICIPANTS: Women in the Nurses Health Study who answered a mailed questionnaire asking about sleep duration in 1986. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Vital status was ascertained through questionnaires, contact with next of kin, and the National Death Index. During the 14 years of this study (1986-2000), 5409 deaths occurred in the 82,969 women who responded to the initial questionnaire. Mortality risk was lowest among nurses reporting 7 hours of sleep per night. After adjusting for age, smoking, alcohol, exercise, depression, snoring, obesity, and history of cancer and cardiovascular disease, sleeping less than 6 hours or more than 7 hours remained associated with an increased risk of death. The relative mortality risk for sleeping 5 hours or less was 1.15 (95% confidence interval [CI], 1.02-1.29) for 6 hours, 1.01 (95% CI, 0.94-1.08), for 7 hours, 1.00 (reference group), for 8 hours, 1.12 (95% CI, 1.05-1.20), and for 9 or more hours 1.42 (95% CI, 1.27-1.58). CONCLUSIONS: These results confirm previous findings that mortality risk in women is lowest among those sleeping 6 to 7 hours. Further research is needed to understand the mechanisms by which short and long sleep times can affect health.