Utility of the PedsQL™ family impact module: assessing the psychometric properties in a community sample

Purpose

Research on families coping with pediatric chronic illnesses has established that children and parents are affected by the illness. Therefore, optimal assessment of parent and family functioning is clinically important. The PedsQL? family impact module (FIM) assesses parents’ health-related quality of life (HRQOL) and family functioning. While the FIM has been shown to be reliable and valid in multiple chronic illness groups, there is little data on its use in non-clinical groups. The study’s objective was to assess the reliability, validity, and factor structure of the FIM in a community sample.

Methods

Nine hundred and twenty-nine community parents of children 2–17 years old completed an anonymous online survey. The mean age of the participants was 37.6 years (SD = 8.6), and the majority were mothers (63.6 %), white (82.9 %), and married (74.8 %). The mean age of the children being reported on was 8.8 years (SD = 3.9), and the majority were female (52.3 %) and 41.2 % were reported as having at least one chronic condition.

Results

All of the FIM’s scales demonstrated excellent internal consistency reliability. Confirmatory factor analysis of the measure supported the current structure. The measure correlated in the expected direction with validated measures of anxiety, depression, child HRQOL, and number of chronic conditions endorsed. Independent t tests indicated that the measure has discriminant validity between parents who reported having a child with a chronic condition to those who did not.

Conclusion

The results of this study suggest the FIM is a reliable and valid measure of parent HRQOL and family functioning within a community sample, and facilitate its use in comparative studies.     

Health-related quality of life of infants from ethnic minority groups: the Generation R Study

Purpose

To assess whether the health-related quality of life of infants from ethnic minority groups differs from the health-related quality of life of native Dutch infants and to evaluate whether infant health and family characteristics explain the potential differences.

Methods

We included 4,506 infants participating in the Generation R Study, a longitudinal birth cohort. When the child was 12 months, parents completed the Infant Toddler Quality of Life Questionnaire (ITQOL); ITQOL scale scores in each ethnic subgroup were compared with scores in the Dutch reference population. Influence of infant health and family characteristics on ITQOL scale scores were evaluated using multivariate regression models.

Results

Infants from ethnic minority groups presented significantly lower ITQOL scale scores compared to the Dutch subgroup (e.g., Temperament and Moods scale: median score of Turkish subgroup, 70.8 (IQR, 15.3); median score of Dutch subgroup, 80.6 (IQR, 13.9; P < 0.001)). Infant health and family characteristics mediated an important part of the association between the ethnic minority status and infant health-related quality of life. However, these factors could not fully explain all the differences in the ITQOL scale scores.

Conclusions

Parent-reported health-related quality of life is lower in infants from ethnic minority groups compared to native Dutch infants, which could partly be explained by infant health and by family characteristics.     

Demographic and clinical characteristics associated with quality of life in patients with chronic obstructive pulmonary disease

Purpose

Despite an increasing interest in the relationships among multiple symptoms and quality of life (QOL), little known about the association between anxiety, depression, and pain and both disease-specific and generic QOL in patients with chronic obstructive pulmonary disease (COPD).

Methods

In a cross-sectional study of 100 COPD patients, disease-specific QOL was measured by St. George’s Respiratory Questionnaire and generic QOL by the QOL scale. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and pain was assessed with a numeric rating scale.

Results

Of the 100 patients, 31 % reported clinically meaningful anxiety, 13 % depression, and 45 % reported the presence of pain. Younger patients (p = 0.02) and those with higher anxiety scores (p = 0.02) reported worse disease-specific QOL. Patients with lower physical function (p = 0.04) and those with higher depression scores (p < 0.001) reported worse generic QOL. Age, comorbidity, physical function, anxiety, depression, and pain explained 19.2 and 49.6 % of the variance in disease-specific and generic QOL scores, respectively.

Conclusions

Findings from this study suggest that the relationships between patient characteristics and common symptoms and QOL differ when disease-specific and generic measures of QOL are evaluated. Additional research is warranted to confirm these findings in COPD patients. Clinicians need to evaluate these common symptoms when planning and implementing symptoms management interventions to improve COPD patients’ QOL.     

Cross-cultural adaptation, reliability, and validity of the Turkish version of PedsQL 3.0 Arthritis Module: a quality-of-life measure for patients with juvenile idiopathic arthritis in Turkey

Purpose

The aim of this study was to describe the cultural adaptation, validity, and reliability of a Turkish version of the pediatric quality-of-life inventory (PedsQL) 3.0 Arthritis Module in a population with juvenile idiopathic arthritis (JIA).

Methods

A total of 169 patients with JIA and their parents were enrolled in the study. The Turkish version of the childhood health assessment questionnaire (CHAQ) was used to evaluate the validity of related domains in the PedsQL 3.0 Arthritis Module. Both the PedsQL 3.0 Arthritis Module and CHAQ were filled out by children over 8 years of age and by the parents of children 2–7 years of age.

Results

Internal reliability was poor to excellent (Cronbach’s alpha coefficients 0.56–0.84 for self-reporting and 0.63–0.82 for parent reporting), and interobserver reliability varied from good to excellent (intraclass correlation coefficient (ICC) 0.79–0.91 for self-reporting and 0.80–0.88 for parent reporting) for the total scores of the PedsQL 3.0 Arthritis Module. Parent–child concordance for all scores was moderate to excellent (ICC 0.42–0.92). The PedsQL 3.0 Arthritis Module and CHAQ were highly positively correlated, with coefficients from 0.21 to 0.76, indicating concurrent validity.

Conclusions

We demonstrated the reliability and validity of quality-of-life measurement using the Turkish version of the PedsQL 3.0 Arthritis Module in our sociocultural context. The PedsQL 3.0 Arthritis Module can be utilized as a tool for the evaluation of quality of life in patients with JIA aged 2–18 years.     

To what extent do single symptoms from a depression rating scale predict risk of long-term sickness absence among employees who are free of clinical depression?

Purpose

Depression rating scales have predicted long-term sickness absence (LTSA) in previous studies. With this study, we investigated to what extent single symptoms from a depression rating scale predicted LTSA among employees who were free of clinical depression.

Methods

We studied 6,670 female employees in the Danish eldercare sector. Frequency of 12 depressive symptoms over the last 2 weeks was assessed with the Major Depression Inventory. A symptom was considered as elevated if it was present at least “slightly more than half of the time.” Data were linked to a national register on LTSA (≥3 weeks). We calculated hazard ratios (HR) from Cox’s proportional hazard models to analyze whether a symptom predicted time to onset of LTSA during a 1-year follow-up. Analyses were adjusted for age, family status, health behaviors, occupational group, and previous LTSA.

Results

Of the 12 symptoms, three predicted LTSA after adjustment for covariates: “felt low in spirits and sad” (HR = 1.41, 95 % CI = 1.05–1.89), “felt lacking in energy and strength” (HR = 1.33, 95 % CI = 1.08–1.64), and “had trouble sleeping at night” (HR = 1.38, 95 % CI = 1.09–1.74).

Conclusion

Among female eldercare workers free of clinical depression, feelings of low spirits and sadness, feelings of lack of energy and strength, and sleep disturbances predict risk of LTSA. Interventions that decrease the prevalence of these symptoms might contribute to a reduction in LTSA in this population.     

Impaired parent-reported health-related quality of life of underweight and obese children at elementary school entry

Purpose

Examine the health-related quality of life of 5–6-year-old underweight, overweight and obese children.

Methods

Our cross-sectional study included 3,227 parent–child dyads from the “Be active, eat right” study. Parents completed questionnaires regarding child and parental characteristics. Health-related quality of life of the child was measured using the Child Health Questionnaire Parent Form 28. Children were classified normal weight, overweight, obese, severely obese, and underweight according to the international age and gender BMI cutoff points. Bootstrap analyses were performed for general linear models corrected for potential confounding variables.

Results

Severely obese children (β, ?2.60; 95 % CI, ?4.80 to ?0.57, p < 0.01) and underweight children (β, ?1.11; 95 % CI, ?1.85 to ?0.39, p < 0.01) had lower parent-reported scores on the physical summary scale. On the physical functioning profile scale parents of overweight and severely obese children also reported statistically significant lower scores (p < 0.05 and p < 0.01, respectively).There were no significant differences regarding the psychosocial summary scale scores between the different weight categories.

Conclusion

Underweight and overweight children experience impaired health-related quality of life on the physical functioning domain. Physicians, teachers and parents should be aware of the possible negative impact on health-related quality of life in underweight and overweight 5–6-year-old children.     

Development of the PROMIS® pediatric global health (PGH-7) measure

Purpose

To develop a practical, efficient, and reliable pediatric global health (PGH) measure that would be useful for clinical, quality improvement, and research applications.

Methods

Using the Patient Reported Outcome Measurement Information System (PROMIS) mixed-methods approach for item bank development, we identified an item pool that was well understood by children as young as age 8 years and tested its psychometric properties in an internet panel sample of 3,635 children 8–17 years old and 1,807 parents of children 5–17 years old.

Results

The final version of the PGH measure included 7 items assessing general, physical, mental, and social health. Four of these items had the same wording as the PROMIS adult global health measure. Internal consistency was 0.88 for the child-report form and 0.84 for the parent form; both had excellent test–retest reliability. The measures showed factor invariance across age categories. There was no differential item functioning by age, gender, race, or ethnicity. Because the measure includes the general health rating question, it is possible to estimate the PGH scale using this widely used single item.

Conclusions

The PROMIS PGH-7 measure is a brief and reliable 7-item measure of a child’s global health.     

Depression and anxiety symptoms in bronchiectasis: associations with health-related quality of life

Background and purpose

Bronchiectasis causes pulmonary infections and loss of lung function, resulting in chronic respiratory symptoms and worsening health-related quality of life. The aims of this study were to measure symptoms of depression and anxiety in a sample of patients with bronchiectasis and evaluate their relationship to health outcomes and health-related quality of life.

Methods

This cross-sectional study included adolescents and adults with bronchiectasis. Patients completed the hospital anxiety and depression scale and the St. George respiratory questionnaire. Health outcome data, including clinical, radiological and spirometric values, were recorded from medical charts.

Results

Ninety-three participants with bronchiectasis of any aetiology were recruited: 20 % had elevated depression-related scores and 38 % had elevated anxiety-related scores. Increased symptoms of depression and anxiety were significantly associated with age; anxiety was associated with more frequent exacerbations. Regression analyses indicated that after controlling for demographic (gender and age) and clinical variables (exacerbations frequency, daily sputum, aetiology and spirometry), both depression and anxiety symptoms predicted significantly worse health-related quality of life. In comparison with other predictors, psychological symptoms explained the largest amount of variance in health-related quality of life.

Conclusions

Symptoms of depression and anxiety were significant predictors of health-related quality of life in patients with bronchiectasis, independently of respiratory involvement, gender, age or other variables.     

Cancer-specific health-related quality of life in children with brain tumors

Purpose

To understand the influence of disease and treatment on the health-related quality of life (HRQOL) of children with brain tumors, compared to the HRQOL of children with other cancers, from the viewpoints of children and parents.

Methods

A total of 133 children aged 5–18 years and 165 parents of children aged 2–18 completed questionnaires of the Pediatric Quality of Life Inventory Cancer Module (Pain and Hurt, Nausea, Procedural Anxiety, Treatment Anxiety, Worry, Cognitive Problems, Perceived Physical Appearance, and Communication scales); higher scores indicate a better HRQOL. The Cancer Module scores, weighted by age and treatment status, were compared to those obtained in a previous study of children with other cancers (mostly leukemia).

Results

The weighted mean scores for Pain and Hurt (effect size d = 0.26) and Nausea (d = 0.23) from child reports and the scores for Nausea (d = 0.28) from parent reports were higher for children with brain tumors than scores for children with other cancers. The scores for Procedural Anxiety (d = ?0.22) and Treatment Anxiety (d = ?0.32) from parent reports were lower for parents of children with brain tumors than the scores for parents of children with other cancers. The child-reported Pain and Hurt score of the Cancer Module was higher (d = 0.29) and in less agreement (intraclass correlation coefficient = 0.43) with scores from the Brain Tumor Module, indicating that assessments completed with the Cancer Module misesteem pain and hurt problems in children with brain tumors.

Conclusions

The profiles of cancer-specific HRQOL in children with brain tumors differ from those of children with other cancers; we therefore suggest that these children receive specific psychological support.     

Health-related quality of life in young adults in education,employment, or training: development of the Japanese version of Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales Young Adult Version

Purpose

The purpose of the study is to develop a Japanese version of the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales Young Adult Version (PedsQL-YA-J) and determine the feasibility, reliability, and validity of the scales.

Methods

Translation equivalence and content validity were verified using back-translation and cognitive debriefing tests. A total of 428 young adults recruited from one university, two vocational schools, or five companies completed questionnaires. We determined questionnaire feasibility, internal consistency, and test–retest reliability; checked concurrent validity against the Center for Epidemiologic Studies Depression Scale (CES-D); determined convergent and discriminant validity with the Medical Outcome Study 36-item Short Form Health Survey (SF-36); described known-groups validity with regard to subjective symptoms, illness or injury requiring regular medical visits, and depression; and verified factorial validity.

Results

All scales were internally consistent (Cronbach’s coefficient alpha = 0.77–0.86); test–retest reliability was acceptable (intraclass correlation coefficient = 0.57–0.69); and all scales were concurrently valid with depression (Pearson’s correlation coefficient = 0.43–0.57). The scales convergent and discriminant validity with the SF-36 and CES-D were acceptable. Evaluation of known-groups validity confirmed that the Physical Functioning scale was sensitive for subjective symptoms, the Emotional Functioning scale for depression, and the Work/School Functioning scale for illness or injury requiring regular medical visits. Exploratory factor analysis found a six-factor structure consistent with the assumed structure (cumulative proportion = 57.0 %).

Conclusions

The PedsQL-YA-J is suitable for assessing health-related quality of life in young adults in education, employment, or training, and for clinical trials and epidemiological research.     

Development of the Healthy Pathways Child-Report Scales

Purpose

The Child Health and Illness Profile (CHIP) has separate child (6–11 years) and adolescent (12–21 years) editions that measure youth’s self-assessed health, illness, and well-being. The purpose of this study was to revise the CHIP by combining the two editions to create the Healthy Pathways Child-Report Scales.

Methods

We modified the original CHIP domains of Comfort, Risk Avoidance, Satisfaction, and Resilience to reflect advances in child health conceptualization. Classical test and item response theory psychometric analyses were conducted using data collected from 2,095 children (49% boys, 80% White, 17% African-American, 3% Hispanic, Age: M = 10.6, SD = 1.0) in grades 4–6 at 34 schools.

Results

After minor revisions, 16 of the 17 scales were found to measure unidimensional self-assessed health, illness, and well-being constructs comprehensively, but with a minimal number of items. Scales were unbiased by age, gender, survey modality, and geographic location. Construct validity was demonstrated by the instrument’s capacity to differentiate among children with and without chronic illnesses and to detect expected age and gender differences.

Conclusions

The Healthy Pathways Child-Report Scales may be used to reliably and accurately assess unidimensional aspects of health, illness, and well-being in clinical and population-based research studies involving youth in transition from childhood to adolescence.     

The impact of influenza-like illness in young children on their parents: a quality of life survey

Background

Influenza-like illness can cause excess paediatric morbidity and burden on parents.

Objectives

We determined the quality of life (QoL) impact of children’s influenza-like illness (ILI) on their parents.

Methods

We conducted a prospective cohort study in childcare centres and a general practice in Sydney, Australia. Using PAR-ENT-QoL, we measured QoL of parents of children aged 6 months–3 years before the 2010 influenza season, then again for parents of children with ILI (ILI group) using SF-12v2 Acute Form and PAR-ENT-QoL, and contemporaneously for parents of aged-matched children without ILI (non-ILI group).

Results

Of 381 children enrolled from 90 childcare centres, 105 developed ILI. PAR-ENT-QoL scores of the ILI group were significantly lower in the post-ILI follow-up interviews than at baseline (60.99 vs. 79.77, p < 0.001), and those of non-ILI group at follow-up interviews (60.99 vs. 84.05, p < 0.001). SF-12v2 scores of the ILI group were also significantly lower than those of non-ILI group: physical component summary (50.66 vs. 53.16, p = 0.011) and mental component summary (45.67 vs. 53.66, p < 0.001). Two factors were significantly associated with parental QoL: total time spent caring child during ILI and whether the child had severe ILI or not. Correlations between PAR-ENT-QoL and SF-12v2 scores were satisfactory.

Conclusions

Parents had significantly lower QoL while their child had ILI, compared with before ILI and with parents of children without ILI. The public health impact of ILI in children on the QoL in families is far from negligible. QoL measurement can complement economic evaluation of ILI disease burden and provide a more complete picture of impact.     

Development of the Italian version of the 42-item Chronic Pain Coping Inventory, CPCI-I: cross-cultural adaptation, factor analysis, reliability and validity

Purpose

The aim of this study was to translate and adapt the Italian version of the Chronic Pain Coping Inventory (CPCI) and validate the translation in subjects with chronic non-specific pain of the locomotor system.

Methods

The questionnaire was developed following international recommendations. The psychometric analyses included factor analysis, reliability by internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass coefficient correlation, ICC), and construct validity by calculating the correlations between the subscales of the CPCI with measures of pain (numerical rating scale, NRS), disability (SIP-Roland Scale) and depression (CES-D) (Pearson’s correlation).

Results

The CPCI was satisfactorily administered to 270 subjects with chronic non-specific pain. Results of confirmatory factor analyses revealed that, of the CPCI-I 8 subscales, 6 demonstrated good data-model fit (CFI and NFI ≥0.90, RMSEA ≤0.08). Cronbach’s alpha was satisfactory in all of the subscales (0.71–0.80); the ICCs were good/excellent in all of the subscales (0.80–0.91). The correlations with the NRS, SIP-Roland and CES-D were poor in most cases as only the CPCI-Guarding subscale moderately correlated with disability (r = 0.31).

Conclusion

The CPCI was successfully translated into Italian and proved to have a good factorial structure and psychometric properties similar to the original and adapted versions. The use of the Italian version of the CPCI is recommended for clinical and research purposes.     

Promoting School Readiness in the Context of Socio-Economic Adversity: Associations with Parental Demoralization and Support for Learning

Background

Existing research suggests that parenting stress and demoralization, as well as provision of learning activities at home, significantly affect child school readiness. However, the degree to which these dimensions of parenting uniquely influence child school readiness remains unclear.

Objective

This study tested the hypothesis that parent demoralization and support for learning are distinct constructs that independently influence child school readiness. Direct and indirect (mediated) models of association were examined.

Methods

117 kindergarten children with low literacy and language skills and their parents were recruited from three Northeastern school districts serving primarily low-income families. Parents reported on their own depressive symptoms, parenting difficulties, attitudes and behaviors related to learning activities, and the frequency of parent–child conversation at home. Teachers rated child school readiness, as indicated by classroom behaviors, approaches to learning, and emergent language and literacy skills.

Results

In a factor analysis, parent demoralization and support for learning emerged as distinct constructs. Structural equation models revealed that parent demoralization was negatively associated with child school readiness, whereas parent support for learning was positively associated with child school readiness. Neither parenting construct mediated the effect of the other.

Conclusions

Among low-income families with children at high risk for school difficulties, parental demoralization and support of learning opportunities at home appear to independently influence child school readiness. Thus, parent-based interventions targeting child school readiness would likely benefit from enhancing both parental self-efficacy and provision of learning activities.     

Close relations to parents and emotional symptoms among adolescents: beyond socio-economic impact?

Objectives

This study examined the relationship between trustful communication with parents and frequency of emotional symptoms in schoolchildren and whether this relationship was modified by the family’s socio-economic position.

Methods

Pooled data (n = 15,646) from the Danish Health Behaviour in School-aged Children surveys 2002, 2006 and 2010 were analysed by multilevel multivariable logistic regression.

Results

8 % of all schoolchildren reported emotional symptoms almost daily. Odds ratio for daily symptoms was 2.1 (1.8–2.4) for children without trustful communication with parents compared to children with trustful communication. This association appears unaffected by family occupational class. A substantial socio-economic gradient in emotional symptoms persisted, independent of parent–child communication.

Conclusions

Trustful communication with parents might have a fundamental importance, regardless of socio-economic position.     

Health state utilities for non small cell lung cancer

Background

The Pediatric Quality of Life Inventory? (PedsQL?) is a child self-report and parent proxy-report instrument designed to assess health-related quality of life (HRQOL) in healthy and ill children and adolescents. It has been translated into over 70 international languages and proposed as a valid and reliable pediatric HRQOL measure. This study aimed to assess the psychometric properties of the Korean translation of the PedsQL? 4.0 Generic Core Scales.

Methods

Following the guidelines for linguistic validation, the original US English scales were translated into Korean and cognitive interviews were administered. The field testing responses of 1425 school children and adolescents and 1431 parents to the Korean version of PedsQL? 4.0 Generic Core Scales were analyzed utilizing confirmatory factor analysis and the Rasch model.

Results

Consistent with studies using the US English instrument and other translation studies, score distributions were skewed toward higher HRQOL in a predominantly healthy population. Confirmatory factor analysis supported a four-factor and a second order-factor model. The analysis using the Rasch model showed that person reliabilities are low, item reliabilities are high, and the majority of items fit the model's expectation. The Rasch rating scale diagnostics showed that PedsQL? 4.0 Generic Core Scales in general have the optimal number of response categories, but category 4 (almost always a problem) is somewhat problematic for the healthy school sample. The agreements between child self-report and parent proxy-report were moderate.

Conclusion

The results demonstrate the feasibility, validity, item reliability, item fit, and agreement between child self-report and parent proxy-report of the Korean version of PedsQL? 4.0 Generic Core Scales for school population health research in Korea. However, the utilization of the Korean version of the PedsQL? 4.0 Generic Core Scales for healthy school populations needs to consider low person reliability, ceiling effects and cultural differences, and further validation studies on Korean clinical samples are required.     

Predictors of self-reported health-related quality of life according to the EQ-5D-Y in chronically ill children and adolescents with asthma,diabetes, and juvenile arthritis: longitudinal results

Purpose

Health-related quality of life (HRQoL) is an important patient-reported outcome in clinical and health research. The EQ-5D-Y assesses child and adolescent HRQoL by five items on mobility, self-care, usual activities, pain/discomfort, and anxiety/depression as well as a visual analogue scale (VAS) on the current health state. This study investigates predictors of self-reported HRQoL according to the EQ-5D-Y in chronically ill children and adolescents using longitudinal data.

Methods

Data from the German Kids-CAT study on children and adolescents with asthma, diabetes, and juvenile arthritis gathered over a period of six months were analyzed (n?=?310; 7–17 years old; 48% female). Self-, parent-, and pediatrician-reported data were collected from June 2013 to October 2014. Generalized linear mixed models and linear mixed models served to examine effects of socio-demographic as well as disease- and health-specific predictors on the items as well as on the VAS of the EQ-5D-Y.

Results

Ceiling effects for the EQ-5D-Y indicated low burden of disease in the analyzed sample. Longitudinal analyses revealed associations between less health complaints and better HRQoL for all investigated HRQoL domains. Further, age- and gender-specific effects, and associations of better disease control, longer duration of the disease and less mental health problems with better HRQoL were found.

Conclusions

Subjective health complaints and mental health problems should be considered in the care of children and adolescents with asthma, diabetes, and juvenile arthritis. Future research should suggest administering the items of the EQ-5D-Y with five instead of three response options, and investigate HRQoL over a longer period.

     

Assessment of health-related quality of life 6 years after childhood cochlear implantation

Purpose

To examine the impact of cochlear implant (CI) intervention on health-related quality of life (HRQOL) assessed by both self- and parent-reported measures.

Methods

In this national study of children implanted between ages 6 months and 5 years, HRQOL of 129 children 6-year post-CI was compared to 62 internal study (NH1) and 185 external (NH2) samples of hearing children frequency-matched to the CI group on sociodemographic variables. HRQOL ratings of children and their parents in each group, measured using the Child Health and Illness Profile-Child Edition, were compared, and their associations with the Family Stress Scale were investigated.

Results

CI children reported overall and domain-specific HRQOL that was comparable to both NH1 and NH2 peers. CI parents reported worse child scores than NH1 parents in Achievement, Resilience, and Global score (p’s < 0.01) but similar or better scores than socioeconomically comparable NH2 parents. Higher family stress was negatively associated with all parent-reported HRQOL outcomes (p’s < 0.01). Parent–child correlations in HRQOL global scores trended higher in CI recipients (r = 0.50) than NH1 (r = 0.42) and NH2 (r = 0.35) controls.

Conclusions

CI recipients report HRQOL comparable to NH peers. These results, from both child and parent perspective, lend support to the effectiveness of CI intervention in mitigating the impact of early childhood deafness. Family stress was associated with worse HRQOL, underscoring a potential therapeutic target. Parent–child agreement in HRQOL scores was higher for CI families than NH families, which may reflect higher caregiver insight and involvement related to the CI intervention.     

Emotional demands and the risks of depression among homecare workers in the USA

Purpose

Homecare workers’ diversity of emotional demands and their relation to mental health problems have not yet been fully explored. The purpose of this study is to investigate the types of emotional demands on homecare workers and the association of these demands with depression.

Method

Data were collected from two surveys of a random sample of 1,599 homecare workers (June 2003–September 2003 and December 2003–February 2004). Depression was assessed using a 20-item RCES-D screening scale.

Results

Homecare workers appeared to have a variety of emotional demands: unfair treatment, client’s family abuse, unmet care needs, client health, and emotional suppression. In general, homecare workers were more likely to be exposed to their client health and emotional suppression (mean scores = 1.46–3.07) than to be exposed to unmet care needs, unfair treatment, and client’s family abuse (mean scores = 1.02–1.38). After adjusting for potential confounders, four emotional-demand factors (excluding the client health factor) were significantly associated with a high risk of subthreshold depression at Wave 1. In particular, the factor “unmet care needs” was an essential predictor of 6-month subthreshold depression at Wave 2.

Conclusion

This study illustrated the diversity of emotional demands among homecare workers and their association with depression. Our mixed findings regarding the cross-sectional and longitudinal analyses suggested that further research should refine the measurement of emotional demands and their relationship with mental health among homecare workers.