Associations between illness perceptions and health-related quality of life in adults with cystic fibrosis

Objective

The objective of this work was to examine the relationship between illness perception, health status, and health-related quality of life (HRQOL) in a cohort of adults with cystic fibrosis (CF).

Methods

In the Project on Adult Care in Cystic Fibrosis, we administered five subscales (Illness Consequences, Illness Coherence, Illness Timeline—Cyclical, Personal Control, and Treatment Control) of the Illness Perception Questionnaire—Revised (IPQ-R). Multivariable linear regression analyses explored the associations between illness perception, health status, symptom burden, and physical and psychosocial HRQOL, as measured by various domains of the Cystic Fibrosis Questionnaire—Revised (CFQ-R).

Results

Among the 199 respondents (63% female; mean age, 36.8±10.2 years), IPQ-R scores did not differ on age, gender, or lung function. In multivariable regression models, neither clinical characteristics nor physical or psychological symptom burden scores were associated with CFQ-R physical domains. In contrast, higher scores on Illness Consequences were associated with lower psychosocial CFQ-R scores. Higher scores on the Illness Coherence and Personal Control scales were associated with higher psychosocial CFQ-R scores.

Conclusion

Adults with CF report a high understanding of their disease, feel that CF has significant consequences, and endorse both personal and treatment control over their outcomes. Illness perceptions did not vary with increased age or worsening disease severity, suggesting that illness perceptions may develop during adolescence. Illness perceptions were associated with psychosocial, but not physical, aspects of HRQOL. Efforts to modify illness perceptions as part of routine clinical care and counseling may lead to improved quality of life for adults with CF.     

Illness perceptions, mood and health-related quality of life in patients with amyotrophic lateral sclerosis

Objectives

To divide amyotrophic lateral sclerosis (ALS) patients in two clusters according to their illness representation, and to identify, between the two clusters, the differences in functional state, mood, and quality of life.

Methods

Seventy-four patients with ALS were recruited at our ALS Centre from different Italian regions, having been for multidisciplinary consultations. The patients' functional impairment was evaluated by the ALS Functional Rating Scale as well as the Bulbar Score and Forced Vital Capacity. Psychological Characteristics and quality of life of ALS patients were evaluated by Profile of Mood State, Illness Perception Questionnaire, and 36-item Short Form Health Survey.

Results

Only few of the ALS patients studied showed critical mood ratings. On the whole, the perceived quality of life, mood state, and the dimensions relating to their illness representation seem to be correlated to the functional state and respiratory capacity. The clustering of patients according to their illness representations allowed to highlight that ALS patients can be divided into two groups: adaptors and nonadaptors. The patients of the two groups, adaptors and nonadaptors, differed in respiratory capacity as well as in their mood and health-related quality of life.

Conclusions

This study supports the Common Sense Model (CSM) of illness representation when considering ALS patients. Their psychological reactions to illness and quality of life depend not only on the severity of the illness but also on the way the illness is represented. Therefore, CSM could become the theoretical framework for psychological interventions in ALS patients.     

米氮平对2型糖尿病患者合并抑郁症的疗效观察

目的 探讨果氮平对2型糖尿病患者合并抑郁症的疗效.方法 将120例合并抑郁症的2型糖尿病患者,随机分为研究组和对照组,每组60例.对照组仅用降糖药治疗,研究组在常规降糖药治疗基础上联用米氮平( 15～45mg/d)治疗,治疗8周.在治疗前和治疗8周末均进行汉密尔顿抑郁量表(HAMD)评定和空腹血糖、餐后2h血糖、糖化血...     

抑郁、焦虑对腔隙性梗死患者健康相关生存质量的影响

目的分析腔隙性梗死患者健康相关生存质量和情绪健康状况。方法使用世界卫生组织（WHO）生存质量表中文版简表（QOL-BREF）、抑郁自评量表（SDS）、焦虑自评量表（SAS）进行生存质量和心理健康状况调查。结果腔隙性梗死组在QOL-BREF的生理、心理领域得分（分别为12.5±1.7、12.2±1.8）比常模下降（15.1±2.3、13.9±1.9,t=11.72,8.610,P〈0.05）,有抑郁情绪者占55.1%,有焦虑情绪者占39.9%。结论合并抑郁、焦虑情绪障碍是腔隙性梗死患者生存质量下降的重要因素。     

Comorbid depression and health-related quality of life in patients with coronary artery disease

OBJECTIVE: This article reviews recent studies relating to the impact of depression and its treatment on the health-related quality of life (HRQOL) of patients with coronary artery disease (CAD). METHODS: Articles for the primary review were identified via MEDLINE and PsycINFO (1995-2006). RESULTS: Evidence suggests that depression has an aversive impact on the HRQOL of patients with stable CAD as well as on patients hospitalized for acute myocardial infarction and coronary artery bypass graft surgery. Unfortunately, there are few depression treatment studies in patients with CAD that make use of standardized HRQOL measures, but the limited evidence suggests that successful treatment has positive implications for HRQOL in these patients. The mechanisms through which depression impacts on HRQOL require further study but are likely to be behavioral. CONCLUSIONS: Depressive symptoms significantly undermine HRQOL in patients with CAD despite successful medical and surgical management. Although successful treatment of depression has not been shown to reduce mortality rates in patients with CAD, further study may find that the HRQOL benefits of such treatment are equally valuable.     

脑梗死患者的生活质量与其焦虑、抑郁情绪的相关性研究

目的 探讨脑梗死患者的生活质量与其焦虑、抑郁情绪的关系。方法 采用Zung焦虑自评量表（SAS）、Zung抑郁自评量表（SDS）及生活质量综合评定问卷（GQOLI）对80例脑梗死患者（脑梗死组）及80名健康人（对照组）进行问卷调查,并对生活质量与其焦虑、抑郁情绪作相关分析。结果 脑梗死患者的生活质量总分及躯体功能、心理功能、社会功能3个维度评分均明显低于对照组（P〈0．01）,而SAS及SDS评分均明显高于对照组（P〈0．01）。脑梗死患者的生活质量总分及躯体功能、心理功能、社会功能3个维度评分均与SAS及SDS评分呈显著性负相关。结论 脑梗死患者的生活质量较差,焦虑、抑郁情绪明显;其生活质量与焦虑、抑郁情绪密切相关。     

The effect of depression on quality of life of patients with type II diabetes mellitus

Diabetes mellitus (DM) is a frequently encountered metabolic disease with chronic features and involves numerous complications throughout its course, which causes severe restriction and disability in an individual's life. It has been reported that the incidence of depression is higher in diabetic patients and that diabetes is one of the risk factors in the development of depression. It has also been reported that co-morbid psychiatric disorders cause further deterioration in the quality of life in diabetic patients. The aim of this study was to investigate the effects of depression on the quality of life in type II DM patients. Sixty patients (30 females and 30 males) with current major depressive episode diagnosed according to DSM-IV criteria, and 48 type II DM patients (30 females and 18 males) without a major depressive episode (non-depressed group) were included in the study. All patients were evaluated with a semi-structured interview form to assess the clinical features of DM, Hamilton Rating Scale for Anxiety (HRSA), Hamilton Rating Scale for Depression (HRSD), and the Turkish version of The World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF). The HRSD and HRSA scores in the depressed group were 24.87+/-4.83 and 21.07+/-5.44, respectively, whereas those in the non-depressed group were 7.83+/-3.92 and 6.88+/-3.43, respectively. The physical health, psychological health, social relationship, environmental and social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores were found significantly lower in the depressed group than the non-depressed group. There were significant negative correlations between HRSD and HRSA scores and physical health, psychological health, social relationship, environmental and social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores. Furthermore, there were significant negative correlations between the HbA1c level and physical health, social relationship, environmental domain, social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores. However, there was a significant positive correlation between the level of education and physical health, psychological health, social relationship, environmental social pressure domain, overall quality of life, and WHOQOL-BREF total scores. There were significant negative correlations between social relationship domain score, and age and duration of illness. Our study demonstrates that the presence of depression in type II DM further deteriorates the quality of life of the patients. Since treating depression would have a beneficial effect on the quality of life, clinicians should carefully assess for depression associated with type II DM.     

抑郁、焦虑对癫(癎)患者健康相关生存质量的影响

目的 调查癫(癎)患者健康相关生存质量和情绪健康状况,探讨各种因素对患者生存质量的影响.方法 使用世界卫生组织(WHO)生存质量量表中文版简表(QOL-BREF)附加癫(癎)生存质量量表(QOLIE)-31(中文版)、抑郁自评量表(SD5)、焦虑自评量表(SAS)进行生存质量和心境健康状况调查.多元逐步回归分析各种因素对生存质量的影响.结果 癫(癎)患者(n=141)在WHOQOL-BREF的生理、心理领域得分(分别为12.7±1.8、12.4 4-1.9)比常模下降(15.1±2.3、13.9±1.9,t=11.75、8.625,P<0.05);有抑郁情绪者占57.4 % ,有焦虑情绪者占39.7 % .合并抑郁、焦虑情绪的癫(癎)患者在除外QOLIE-31药物的影响领域的生存质量各个领域得分均减低;多元逐步回归结果显示,影响QOLIE总分的3个因素按影响作用大小依次是焦虑、抑郁和病程.结论 合并抑郁、焦虑情绪障碍,病程长是癫(癎)患者生存质量下降的重要因素.     

Illness perceptions,mood and quality of life: A systematic review of coronary heart disease patients

Objective

To examine published literature investigating the relationship between illness perceptions, mood and quality of life (QoL) in coronary heart disease (CHD) populations.

Methods

Key databases were systematically searched (CINAHL, Medline, PsycINFO, Scopus and Web of Science) for studies matching the inclusion criteria between November 2011 and February 2012. References of included studies were examined and key authors contacted. Studies were subject to a quality control check.

Results

21 studies met the inclusion criteria. A synthesis of the results found that illness perceptions were correlated to and predicted QoL and mood across CHD diagnoses. Specific illness perceptions (control, coherence and timeline) were found to be important for patients that had experienced an unexpected medical event, such as myocardial infarction.

Conclusion

The results of this study provide support that illness perceptions are related to outcomes across CHD populations and disease progression, however the results do not selectively support one particular model. Recommendations are consistent with cardiac rehabilitation guidelines. Further research should focus on the systemic impact of illness perceptions.     

The relative impact of anxiety, depression, and clinical seizure features on health-related quality of life in epilepsy

PURPOSE: To determine the independent effects of depression and anxiety on health-related quality of life (HRQOL) in epilepsy as well as the relative explanatory power of psychiatric comorbidity compared with demographic and clinical epilepsy variables (e.g., seizure frequency, severity, and chronicity). METHODS: Subjects (n = 87) with temporal lobe epilepsy completed self-report measures of depression, anxiety, HRQOL, and seizure severity. Information was derived regarding subjects' seizure frequency, duration, and treatment. HRQOL status (QOLIE-89) was examined in relation to self-reported symptoms of anxiety and depression, clinical seizure features, and demographic characteristics. RESULTS: Depression and anxiety were independently associated with reduced HRQOL. Psychiatric comorbidity explained more variance in HRQOL than did combined groups of clinical seizure or demographic variables. Although weaker in explanatory power than psychiatric comorbidity, several epilepsy factors were nonetheless significantly related to HRQOL, including seizure frequency, severity, and chronicity. CONCLUSIONS: Interictal anxiety and depression exert independent adverse effects on HRQOL. In addition, frequent, severe, and chronic seizures reduce HRQOL, but appear less powerful predictors of HRQOL than interictal psychiatric symptoms. Recognition and treatment of comorbid depression and anxiety is an important consideration in improving quality of life in epilepsy.     

Illness perceptions mediate the relationship between depression and quality of life in patients with epilepsy

The current study examined whether negative illness perceptions help explain the link between depression and quality of life. Seventy patients with epilepsy completed standardized self‐report questionnaires measuring depression, illness perception, and quality of life (QOL). Illness perception statistically mediated the relationship between depression and QOL (Indirect effect (CI; confidence interval) = ?.72, lower limit = ?1.7, upper limit = ?.22, p < .05). Results held with and without adjusting for potential confounding variables (age, sex, ethnicity, income, and seizure frequency) and when operationalizing depression as a continuous variable that indexed severity of symptoms or as a dichotomous variable that indexed criteria consistent with a diagnosis of major depressive disorder. This study is the first to suggest that illness perceptions may be a useful target in screening and intervention approaches in order to improve QOL among low‐income, racially/ethnically diverse patients with epilepsy.     

The impact of depression and anxiety disorder symptoms on the health-related quality of life of children and adolescents with epilepsy

This study evaluated the effects of depression and anxiety disorder symptoms on the health-related quality of life (HRQOL) of children and adolescents with epilepsy. Sixty children and adolescents and their parents participated in the study. Symptoms of anxiety disorders were identified by the Screen for Child Anxiety Related Emotional Disorders questionnaire (SCARED) and symptoms of depression by the Mood and Feeling Questionnaire (MFQ). The Pediatric Quality of Life Inventory (PedsQL) was used for HRQOL assessments. A series of simple and partial correlations revealed that the levels of HRQOL significantly decrease as symptoms of depression or anxiety disorders increase and vice versa. Stepwise regression method of children's ratings resulted in a final model of school achievement and symptoms of generalized anxiety and separation anxiety disorder as predictors that explain 50.9% of the variation in HRQOL (F = 11.21, p < 0.000). For parents' ratings, the final model included symptoms of depression and separation anxiety disorder as predictors that explain 38.4% of the variation in HRQOL (F = 10.82, p < 0.000). In summary, symptoms of depression and generalized and separation anxiety disorders have the most significant impact on HRQOL.     

心理干预对恶性肿瘤患者焦虑、抑郁状态及生活质量的影响

目的 探讨心理干预对恶性肿瘤患者焦虑抑郁状态及生活质量的影响.方法 将205例恶性肿瘤患者随机分为对照组和心理干预组,对照组采用常规放疗、化疗及最佳支持治疗,心理干预组在常规治疗基础上对患者进行心理干预,治疗前后采用焦虑自评量表(SAS),抑郁自评量表(SDS)和EORTC-QLQ-C30量表对患者进行焦虑抑郁状态及生活质量的测定.结果 两组患者入院时SDS及SAS评分比较无统计学差异(P＞0.05),心理干预组第6周SDS及SAS评分均明显低于对照组,差异有统计学意义(P＜0.05),心理干预后可改善癌症患者生活质量,较干预前差异有统计学意义(P＜0.05).结论 心理干预能够改善恶性肿瘤患者焦虑抑郁情绪,提高生活质量,有利于患者的康复.     

社区老年2型糖尿病患者共病抑郁的现况调查及相关危险因素分析

目的 了解社区老年2型糖尿病人群伴发抑郁的现状及相关危险因素.方法 选取2015年1月~2016年12月在上海市梅陇社区卫生服务中心就诊的550例老年2型糖尿病(T2DM)患者进行病人健康问卷抑郁量表(PHQ-9)评定及相关问卷调查,根据PHQ-9评分情况将患者分为共病抑郁组和非抑郁组,对两组患者人口学资料进行比较,采用多因素Logistic回归分析探讨糖尿病共病抑郁的相关危险因素.结果 所调查老年2型糖尿病人群抑郁的发生率为45.27%;糖尿病病程、合并躯体疾病数、空腹血糖、HbA1C为社区老年T2DM患者共病抑郁的独立危险因素(P<0.05).结论 老年T2DM患者中抑郁的发病率高,在对社区老年T2DM患者进行指导、治疗时,除了需要积极控制血糖、HbA1C外,还需要积极关注其可能存在的抑郁症状,做到前期预防、早期发现并及时治疗.     

Dysfunctional illness perception and illness behaviour associated with high somatic symptom severity and low quality of life in general hospital outpatients in China

Objective

In primary care populations in Western countries, high somatic symptom severity (SSS) and low quality of life (QoL) are associated with adverse psychobehavioural characteristics. This study assessed the relationship between SSS, QoL and psychobehavioural characteristics in Chinese general hospital outpatients.

Methods

This multicentre cross-sectional study enrolled 404 patients from 10 outpatient departments, including Neurology, Gastroenterology, Traditional Chinese Medicine [TCM] and Psychosomatic Medicine departments, in Beijing, Shanghai, Chengdu and Kunming. A structured interview was used to assess the cognitive, affective and behavioural features associated with somatic complaints, independent of their origin. Several standard instruments were used to assess SSS, emotional distress and health-related QoL. Patients who reported low SSS (PHQ-15 < 10, n = 203,  SOM−) were compared to patients who reported high SSS (PHQ-15 ≥ 10, n = 201, SOM +).

Results

As compared to SOM − patients, SOM + patients showed significantly more frequently adverse psychobehavioural characteristics in all questions of the interview. In hierarchical linear regression analyses adjusted for anxiety, depression, gender and medical conditions (SSS additionally for doctor visits), high SSS was significantly associated with “catastrophising” and “illness vulnerability”; low physical QoL was associated with “avoidance of physical activities” and “disuse of body parts”; low mental QoL was associated with “need for immediate medical help.”

Conclusion

In accordance with the results from Western countries, high SSS was associated with negative illness and self-perception, low physical QoL with avoidance behaviour, and low mental QoL with reassurance seeking in Chinese general hospital outpatients.     

Cognitive function,depression, anxiety and quality of life in Chinese patients with untreated unruptured intracranial aneurysms

Detected unruptured intracranial aneurysms (UIA) are becoming more common with the increased utilization of CT angiography, MR angiography and digital subtraction angiography. A proportion of patients with UIA remain untreated. We investigated to assess cognitive function, depression, anxiety and quality of life (QoL) in Chinese patients with untreated UIA. Thirty one Chinese patients with untreated UIA and 25 healthy controls were identified and matched for variables including age, sex, and living area. Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA). Depression, anxiety and QoL were screened with the Self-Rating Depression Scale, Self-Rating Anxiety Scale, and Short Form-36, respectively. Non-parametric tests were used for comparisons between groups. No patient had cognitive dysfunction at 1 month or 1 year after detection of UIA. However, a significant decrease of overall MoCA subscores was found in 30 (97%) of 31 patients 5 years after UIA discovery, suggestive of mild cognitive impairment. A significant decrease in depression and anxiety was found in patients over time. QoL in patients was reduced most prominently in psychosocial function and social activities 1 year after detection of UIA, but these improved to within normal limits at the end of the follow-up period. For Chinese patients with untreated UIA, depression, anxiety and reduced QoL may be short-term complications. Mild cognitive impairment may be a long-term complication.     

帕罗西汀对2型糖尿病伴发抑郁患者疗效观察

目的评价帕罗西汀对2型糖尿病伴发抑郁患者抑郁、焦虑症状的疗效及安全性。方法对45例2型糖尿病伴发抑郁患者给予帕罗西汀治疗12周,采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、MOS健康状况调查问卷(SF-36)评定疗效,采用副反应量表(TESS)和相关实验室检查评定安全性。结果帕罗西汀能明显改善2型糖尿病伴发抑郁患者抑郁、焦虑症状,治疗后患者生活质量明显提高；无明显副反应。结论帕罗西汀对2型糖尿病伴发抑郁患者的治疗安全有效。     

抑郁症患者生活质量及其相关因素分析

目的 分析抑郁症患者生活质量及其相关因素,为制定提高患者生活质量的对策提供参考。方法 于2018年11月19日-2019年9月7日在湛江中心人民医院、广东医科大学附属医院、广东三九脑科医院选取符合《国际疾病分类（第10版）》（ICD-10）抑郁症诊断标准的住院患者117例。通过查阅病历,收集患者血常规、尿常规、血生化检查、血气分析等临床客观指标,采用抑郁症患者生活质量测定量表QLICD-DE(V2.0)评定患者生活质量。采用简单相关分析探讨QLICD-DE(V2.0)评分与各临床客观指标的相关性,并使用多重线性回归分析进一步筛选与抑郁症患者生活质量相关的因素。结果 简单相关分析显示,抑郁症患者QLICD-DE(V2.0)总评分与血清总蛋白和血小板分布宽度均呈正相关（r=0.198、0.281,P<0.05或0.01）,与红细胞压积呈负相关（r=-0.300,P<0.01）。多重线性回归分析结果显示,血清白/球蛋白比值和治疗依从性（B=-19.836、-3.711,P<0.05或0.01）是躯体功能的影响因素;血小板分布宽度（B=2.706,P<0.01）是心理功...     

正念干预对炎症性肠病患者抑郁、焦虑及生活质量影响的Meta分析

目的评价正念干预对炎症性肠病(IBD)患者抑郁、焦虑及生活质量的影响,为IBD患者正念干预的临床应用提供循证参考。方法对PubMed、Embase、PsycINFO、Cochrane Library、中国知网、万方数据库、中国生物医学文献数据库进行检索,收集关于正念疗法干预IBD患者的随机对照研究的相关数据,采用RevMan 5. 3进行Meta分析。结果共纳入5项随机对照研究,包括319例IBD患者,其中干预组163例,对照组156例。Meta分析结果显示,干预结束时,与对照组相比,正念干预组抑郁水平更低,差异有统计学意义(SMD=-0. 56,95%CI:-0. 87～-0. 26,P0. 05),正念干预对IBD患者焦虑水平(SMD=-0. 15,95%CI:-0. 59～0. 30,P=0. 52)、生活质量(SMD=0. 13,95%CI:-0. 20～0. 47,P=0. 44)的改善无统计学意义;长期随访,与对照组相比,正念干预对IBD患者抑郁、焦虑及生活质量的改善差异无统计学意义(P0. 05)。结论正念干预可能有助于降低IBD患者抑郁水平,但长期效应尚不明确。     

舍曲林对2型糖尿病患者抑郁症状的疗效观察

目的探讨舍曲林对2型糖尿病患者合并抑郁症的疗效。方法将60例合并抑郁症的2型糖尿病患者,随机分为研究组（服用舍曲林组,30例）和对照组（未服用舍曲林组,30例）,治疗8周。以汉密尔顿抑郁量表（HAMD）评定疗效,用糖化血红蛋白（HbAlc）水平监测血糖控制情况。结果治疗8周后,研究组抑郁症状的改善明显优于对照组（P〈0．01）,痊愈率（43．3％）和有效率（66．7％）均明显高于对照组（分别为16．7％和36．7％）（P〈0．01）;研究组HbAlC水平较治疗前显著下降,且明显低于对照组（P〈0．01）。结论舍曲林能明显改善2型糖尿病患者的抑郁症状,更有利于患者血糖的控制。