SF-36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers

OBJECTIVE: Despite many studies, the impact of chronic insomnia on daytime functioning is not well understood. The aim of our study was to detect this impact by evaluating quality of life (QoL) using a validated instrument, the 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36), in three matched groups of severe insomniacs, mild insomniacs, and good sleepers selected from the general population. METHODS: Three matched groups of 240 severe insomniacs, 422 mild insomniacs, and 391 good sleepers were recruited from the general French population after eliminating those with DSM-IV criteria for anxiety or depression. All subjects were asked to complete the SF-36. Scores for each QoL dimension were calculated and compared statistically among the three groups. RESULTS: Severe insomniacs had lower QoL scores in eight dimensions of the SF-36 than mild insomniacs and good sleepers. Mild insomniacs had lower scores in the same eight dimensions when compared with good sleepers. No dimension was significantly more altered than the other. CONCLUSIONS: The mental health status and role of emotional QoL dimensions were worse in severe and mild insomniacs than in good sleepers. This result held even though we screened for psychiatric diseases, which shows a clear interrelation between insomnia and emotional state. General health status was also worse in severe and mild insomniacs than in good sleepers. However, we could conclude only that insomnia was related to a worse health status and not whether it was a cause or consequence of this worse health status. Finally, the degradation of QoL scores was correlated with the severity of insomnia.     

Gender differences in health-related quality of life in patients with bipolar disorder

Health-related quality of life (HRQOL) is a widely accepted measure of illness state that is related to morbidity and mortality. Findings from various populations show that women report lower HRQOL than men. We analyzed baseline HRQOL data for gender differences from a multisite, randomized controlled study for adults with bipolar disorder. HRQOL was assessed using the 12-item Short Form (SF-12) physical component summary (PCS) and mental component summary (MCS) health scales. Multivariate linear and bivariate regression models examined differences in self-reported data on demographics, depressive symptoms (nine-item Patient Health Questionnaire), bipolar disorder symptoms (Internal State Scale), and medical comorbidities. Out of 384 enrolled (mean age?=?42 years), 256 were women (66.7 %). After controlling for sociodemographic characteristics and clinical factors, women had lower SF-12 PCS scores than men [β?=??1.78, standard error (SE)?=?0.87, p?<?0.05], indicating worse physical health, but there were no gender differences in MCS scores. After controlling for patient factors including medical and behavioral comorbidities, the association between gender and PCS score was no longer significant. Of the medical comorbidities, pain was associated with lower PCS scores (β?=??4.90, SE?=?0.86, p?<?0.0001). Worse physical HRQOL experienced by women with bipolar disorder may be explained by medical comorbidity, particularly pain, suggesting the importance of gender-tailored interventions addressing physical health conditions.     

Somatoform pain disorder in the general population

BACKGROUND: Chronic pain disorder is assumed to represent a frequent and disabling condition. However, data on the prevalence of somatoform pain symptoms and somatoform pain disorder in the community are limited to date. METHODS: German versions of the Composite International Diagnostic Interview were administered to a representative national sample of 4,075 people. Somatoform pain disorder was diagnosed by standardized diagnostic algorithm based on the DSM-III-R criteria (absence of adequate physical findings). One subgroup was identified as also meeting the DSM-IV criterion B for 'significant distress or psychosocial impairment due to the somatoform pain'. RESULTS: A lifetime prevalence rate of somatoform pain disorder according to DSM-III-R of 33.7% and a 6-month rate of 17.3% was found. When applying the DSM-IV B criterion, the prevalence rate dropped to 12.3 and 5.4%, respectively. In both groups more than 95% of the probands had contacted their doctor because of the pain. In 25% of the probands the pain was positively assigned to psychological factors. A female:male ratio of 2:1 was found. CONCLUSIONS: Somatoform pain disorder (DSM-III-R) is a frequent condition. However, only about one third of these subjects is severely distressed or impaired by the pain. A clear operationalized concept of the DSM-IV criterion C 'psychological factors are judged to have an important role in the onset, severity, exacerbation or maintenance of the pain' should be provided in the further development of the diagnosis 'pain disorder' in order to make this diagnosis suitable for general population surveys.     

Insight, quality of life and cognitive functioning in euthymic patients with bipolar disorder

INTRODUCTION: The relationship between insight, quality of life and cognition in bipolar disorder has not been clearly established. METHOD: A neuropsychological battery assessing attention, mental control, perceptual-motor skills, executive functions, verbal fluency, abstraction and visuo-spatial attention was administered to 70 remitted bipolar patients and 50 healthy controls. Insight was assessed using the Scale to Assess Unawareness of Mental Disorder; Quality of Life was assessed using the Portuguese version of the WHO Quality of Life Assessment--Abbreviated version (WHOQOL-BREF-PT). RESULTS: No differences in QoL and cognitive performance were observed between bipolar patients with 'impaired' and 'preserved' insight. Insight was found to be correlated with poorer psychological and environmental QoL. A multiple regression model showed that depressive symptoms were significant predictors of physical, psychological and environmental QoL. CONCLUSION: The present study adds to the notion that depressive symptoms, even of low intensity, are strong predictors of QoL. The present study suggests that the impact of insight on self-reported QoL may be subtle during remission and may be more substantially affected in the presence of manic symptoms.     

应用SF-36量表评估中轴型SpA患者非甾体抗炎药治疗后生活质量变化

目的：应用36条简明健康状况调查量表（SF-36量表）评估中轴型脊柱关节炎（中轴型SpA）患者应用非甾体抗炎药（NSAIDs）治疗后生活质量的变化情况。方法：选择2014年10月~2015年9月在郑州大学第一附属医院确诊为中轴型SpA的患者120例。均同意使用指定药物及指定量表评估,并签署知情同意书。采用随机、双盲、平行对照的方法,通过单纯随机分组,将120人分为艾瑞昔布组和塞来昔布组,均为每次200 mg,每天2次,治疗3个月。采用中文版SF 36量表评估中轴型SpA患者NSAIDs治疗前后的生活质量变化情况。分析生活质量和血沉（ESR）、C反应蛋白（CRP）、Bath AS疾病活动指数(BASDAI)、Bath强直性脊柱炎功能指数(BASFI)、加拿大脊柱关节炎研究协会评分(SPARCC)之间的相关性。结果：中轴型SpA患者116人完成最终评估,4人失访。应用SF36量表评估中轴型SpA患者NSAIDs治疗3个月前后生活质量变化,两种药物治疗效果的对比差异无统计学意义(P>0.05)。总体患者NSAIDs治疗3个月后,生理功能、生理职能、躯体疼痛、总体健康、社会功能、情感职能与治疗前差异有统计学意义（P<0.05）;活力、精神健康,差异无统计学意义(P>0.05)。BASDAI与PF、RP、BP、GH、VT、SF、RE呈正相关（P<0.05）;BASDAI与MH无明显相关性（P>0.05）;BASFI与PF、RP、BP、GH、SF、RE、MH呈正相关（P<0.05）;BASFI与VT无明显相关性（P>0.05）。ESR只与SF、RE呈正相关（P<0.05）;CRP只与SF、MH呈正相关（P<0.05）;SPARCC只与PF呈正相关(P<0.05）。BASDAI、BASFI是影响PF的重要影响因素（P<0.05）; BASDAI是影响BP、GH、VT、RE的重要影响因素（P<0.05）;BASFI是影响RP、SF、MH的重要影响因素（P<0.05）。 结论：非甾体抗炎药能改善中轴型SpA患者的生活质量,艾瑞昔布和塞来昔布疗效相当;SF 36量表适用于评估中轴型SpA患者的生活质量。     

以健康测量量表评价癫癎及哮喘患儿生活质量的对照研究

目的以健康测量量表（SF-36）评估癫癎及哮喘患儿的生活质量。方法采用SF-36量表对2007年6至12月在复旦大学附属儿科医院神经专科、呼吸专科及儿童保健门诊就诊的癫癎患儿、哮喘患儿和健康儿童进行生活质量评定。结果研究期间85例癫癎患儿（癫癎组）、81例哮喘患儿（哮喘组）和87名健康儿童（正常对照组）进入分析。3组儿童的年龄、性别和受教育程度相匹配。①疾病及治疗情况：癫癎组和哮喘组服用1种药物者分别为70／85例和59／81例,癫癎组63／85例和哮喘组56／81例患病后规则服药,两组在服药种类和依从性上差异无统计学意义（P均〉0．05）;癫癎组36／85例至本次调查前至少有1年癫癎未发作;哮喘组29／81例最大呼气峰流速监测持续保持个人最佳值的80％以上。②生活质量评价：癫癎组的生活质量总分和8个分项的终得分与正常对照组差异均有统计学意义（P〈0．01）;哮喘组的生活质量总分及生理功能、身体疼痛、总体健康和活力4个分项的终得分与正常对照组差异均有统计学意义（P〈0．01）;无论疾病控制与否,癫癎组生活质量均较哮喘组差;癫癎组情感功能及精神健康状况明显差于哮喘组,其心理障碍不随疾病控制而明显改善。结论①癫癎和哮喘患儿生活质量较健康儿童明显下降;②癫癎患儿较哮喘患儿生活质量损害更为明显;③SF-36量表可作为评价疾病控制程度的手段,辅助评价疾病治疗的疗效;④癫癎患儿的心理障碍应引起临床高度关注。     

Health-related quality of life in patients with spinal cord injury: review of the short form 36-health questionnaire survey

Advances in medical and rehabilitative care have increased interest in studying how different factors may affect the health-related quality of life (HRQOL) of individuals with spinal cord injury (SCI). There has been a large increase in the number of studies assessing HRQOL among persons with SCI. However, despite these advances, numerous issues remain unanswered because these studies have used a variety of methodologic approaches and assessment tools to examine how different factors have a role in predicting HRQOL in SCI populations. Therefore, standardized instruments should be used as part of this process. The Medical Outcomes Study Short Form (SF-36) was developed in order to survey health status of the general population. However, the available data on the HRQOL of individuals with SCI are currently limited. In addition, there is little information currently available on the factors that are associated with HRQOL in the SCI population and this issue remains controversial. The findings from several individual studies that used the SF-36 to assess the HRQOL of patients suffering from SCI were reviewed, and the results were interpreted with disability in mind. This review article aims to summarize the data regarding the HRQOL of individuals with SCI by using the SF-36.     

Health-related quality of life using the EuroQol 5D questionnaire in Korean patients with type 2 diabetes

We aimed; 1) to determine the validity of the EuroQol 5D (EQ-5D) for the health-related quality of life (HRQOL) of Korean patients with type 2 diabetes, and 2) to identify associated factors of the HRQOL of these patients. Follow-up surveys were conducted for consecutive patients with type 2 diabetes. HRQOL was assessed using the EQ-5D and the Short Form-36 (SF-36). The validity of EQ-5D was assessed with the perspectives of known group, convergent and discriminant validity. Additionally, a linear mixed model using a backward elimination was used for identify associated factors. Of the 1,072 patients included in the first survey, 858 (80.0%) completed the questionnaires in the follow-up. In the known group validity, the problem rates in each EQ-5D dimension were highest among women, elderly people, and less-educated subjects. The Spearman's ρ between the EQ-5D and the SF-36 scales were larger in the comparable dimensions than those in the less comparable dimensions. In the final model, we found that sex, age, education, body mass index, atrial fibrillation, stroke, and retinopathy were statistically significant. Our data suggest that the EQ-5D is a valid tool for Korean patients with type 2 diabetes and that various factors could affect their HRQOL.     

Quality of life in patients with atopic dermatitis: using the Japanese version of the SF-36 health status questionnaire]

Atopic dermatitis is a common skin disorder with an age onset mainly from infancy to adolescence. Patients with this disorder usually have a long history of repeated relief and relapse. The aim of the present studies is to quantify the relationship between the QOL score of patients and symptomatic characteristics (including severity measured by SF-36). From November 2000 to February 2001, the study recruited 281 patients with atopic dermatitis who had been treated at the Nagano dermatology and allergology clinic. The results of this study demonstrated that the symptoms severity and pruritus grade had strong influences on QOL score, and the location of pruritic lesion on the neck had the strongest influence on their self-perceived health status. The patients group with moderate atopic dermatitis who showed pruritus lesion in face, neck, and or knee, and female had consistently lower scores than male on all of the subscales. In conclusion, it is critically important to control of pruritus, and to develop an appropriate management.     

Impact of anxiety disorder comorbidity on quality of life in euthymic bipolar disorder patients: differences between bipolar I and II subtypes

BACKGROUND: Few studies investigated the impact of anxiety disorder comorbidity on health-related quality of life (HRQoL) of bipolar patients and none examined bipolar subtypes differences. The aim of the study was 1) to determine comorbidity rates for anxiety disorders in euthymic bipolar subjects, comparing bipolar type I and II disorders (BDI and BDII), and 2) to compare within each group HRQoL measures in subjects with and without anxiety comorbidity. METHODS: Comorbidity was evaluated through the SCID-I; HRQoL was assessed using the 36-Item Short-Form Health Survey (SF-36). All subjects were euthymic since at least 2 months, as confirmed by a HAM-D <8 and a YMRS <6. A comparison was made for SF-36 scores between subjects (all bipolars, BDI and BDII) with and without anxiety disorders. RESULTS: 105 patients were enrolled: 44 with BDI and 61 with BDII. Current and lifetime anxiety disorders comorbidities were 32.4% and 41.0% for all bipolars, 31.8% and 40.9% for BDI and 32.8% and 41.0% for BDII. BDI patients differed in several SF-36 domains from BDII subjects, which reported a poorer HRQoL. A current and lifetime comorbid anxiety disorder was associated with a poorer HRQoL considering all bipolars; when examining separately BDI and II subjects, however, the deleterious effect was restricted to BDI patients. LIMITATIONS: The cross-sectional assessment of HRQoL, the generic instrument used (SF-36) and the small sample size. CONCLUSIONS: Our study confirms the high comorbidity rates for anxiety disorders in bipolar subjects and provides evidence that anxiety comorbidity impacts HRQoL in subjects with BDI and not BDII.     

Psychological correlates of pain behavior in patients with chronic low back pain

Pain behaviors that are excessive for the degree of known physical disease are common in patients with chronic low back pain and are frequently assumed to arise from a comorbid depressive illness. Although some studies have confirmed an association between depression and excessive pain behavior, methodologic problems (such as the use of depression ratings that also recorded symptoms attributable to physical disease) make interpretation of this finding difficult. We recruited 54 consecutive patients with chronic (>6 months) low back pain from a hospital clinic. Subjects completed self-rated assessments of anxiety and depression (Hospital Anxiety and Depression Scale) designed to be minimally affected by physical symptoms, along with assessments of disability (ODQ), pain (visual analogue scale), pain behavior (Waddell checklist), and physical impairment. Seventeen subjects (31%) exhibited excessive pain behavior. Overall, they were no more depressed or anxious than the remainder, although men with excessive pain behavior showed a trend toward being more depressed. Patients with excessive pain behavior were more disabled (self-rated and observer-rated), reported greater pain, and were more likely to be female and to have pain of shorter duration. Pain behavior did not correlate with anxiety or depression, but correlated with measures of disability and pain intensity. Factor analysis revealed that physical disability, pain intensity, and pain behavior loaded heavily on the first factor. Anxiety and depression loaded together on a separate factor. We conclude that pain behaviors were not related to anxiety or depression in our group, although gender differences between groups could have contributed to our negative findings. Pain behaviors may influence other physical measures. Further studies are required to investigate the relation between depression and pain behavior while controlling for gender differences.     

降钙素增强双膦酸盐对绝经后骨质疏松患者慢性腰背痛缓解及生活质量改善的作用

BACKGROUND: Salmon calcitonin or elcatonin has been reported to alleviate acute and severe back pain caused by osteoportic fracture. OBJECTIVE: To evaluate the effects of the combined use of elcatonin and risedronate in the treatment of chronic back pain and the improvement of quality of life in postmenopausal women with osteoporosis. METHODS: Forty-five postmenopausal women with osteoporosis accompanied by chronic back pain persisting for more than 3 months, after excluding women with fresh vertebral fractures within the last 6 months, were randomly assigned to a risedronate group (administration of risedronate alone, n=22) and a combined drug group (combined administration of risedronate and elcatonin, n=23). Pain was evaluated using a visual analogue scale (VAS) and the Roland-Morris questionnaire. Bone mineral density was determined by dual-energy X-ray. Quality of life was assessed using the Medical Outcomes Study 36-Item Short-Form (SF-36) at 6 months after treatment. RESULTS AND CONCLUSION: There were 20 and 19 cases in the risedronate and combined drug groups, respectively included in the final analysis. Significant improvements were found in the combined drug group for VAS and mental health status section scores in the SF-36 at final follow-up compared with baseline and 3-month follow-up, while no change was found in the risedronate group. Bone mineral density was increased significantly in both groups, while no significant difference was found between groups. These findings suggest that the use of elcatonin in addition to risedronate for more than 3 months may reduce chronic back pain in osteoporosis patients. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Quality of life in patients with perennial allergic rhinitis: using the Japanese version of the SF-36 Health Status Questionnaire]

Perennial allergic rhinitis may impair daily activities. However it isn't known how it affects a patient's self-perceived health status. In present study, QOL was measured by MOS Short Form 36 Health Survey (SF-36) for assessment of useful information for individualization of care. 252 patients with perennial allergic rhinitis who visited 14 hospitals and clinics from June to August 1999 were questioned, and 249 patients were engaged in this study as subjects. Each patient's background was investigated, and the factors which influenced HRQOL score were identified. In addition, comparisons with healthy subjects and subjects with seasonal allergic rhinitis were performed. It was shown that age, gender, and the number of comorbid conditions were significant contributions to HRQOL score. It was considered that nasal obstruction had a strong influence on SF-36 score compared to other symptoms of nasal allergy. In general, QOL scores were significantly depressed in the patients with perennial and seasonal allergic rhinitis compared with healthy subjects. The difference of scores between perennial allergic rhinitis were not significant, although the patients with seasonal allergic rhinitis showed low scores compare with perennial allergic rhinitis.     

Predictors of disability in patients with chronic low back pain

IntroductionChronic low back pain (CLBP) is a common and disabling health problem. In this study, we aimed to assess the relationship between pain intensity, the components of catastrophizing, depression and disability in patients with chronic low back pain.Material and methodsSeventy-six patients diagnosed with CLBP (age range 25–77 years; 73.7% female) participated in the study. Participants’ socio-demographic data were collected: age, gender, height, weight, and work status (employed or retired). All participants were asked to complete the Pain Catastrophizing Scale (PCS), the visual analogue scale (VAS), the Oswestry Disability Questionnaire (ODQ), and the Beck Depression Inventory (BDI).ResultsThe mean group scores revealed moderate CLBP complaints (VAS – 4 [3–6]), mild depression (BDI – 10 [5–16]), a moderate level of catastrophizing (PCS total score 20.5 [10–34]) and moderate disability (Oswestry Disability Index [ODI] – 31 [14–38]). Positive significant correlations were found between ODI and age, residence, work status, VAS, PCS-rumination, PCS-magnification, PCS-helplessness and BDI, and also between PCS subscales and VAS. Our multivariate linear regression analysis showed that age, pain intensity, PCS-helplessness and depression can predict disability in patients with CLBP, explaining 84% of the variance of disability (R² = 0.851, adjusted R² = 0.843).ConclusionsA multidisciplinary approach is needed for patients with CLBP and should include physical, mental and social evaluation in order to offer an optimal treatment.     

An assessment of health needs of chronic low back pain patients from general practice

The perceived health needs of 50 chronic low back pain patients were explored within an interview procedure. Patients described symptom and treatment histories, the problems they encountered living with back pain and their severity. Problems as goals for recovery were prioritized. The last two tasks were aided by the use of a Problem Board. Interviews were analysed both quantitatively and qualitatively. Results indicated that the use of this patient-centred procedure could be helpful in outlining individual concerns, translatable into recovery goals for intervention, regardless of concurrent medical treatment. Implications of this approach for individual needs assessment in chronic conditions and for planning service development are discussed.