A comparison of the EQ-5D and the SF-6D across seven patient groups

As the number of preference-based instruments grows, it becomes increasingly important to compare different preference-based measures of health in order to inform an important debate on the choice of instrument. This paper presents a comparison of two of them, the EQ-5D and the SF-6D (recently developed from the SF-36) across seven patient/population groups (chronic obstructive airways disease, osteoarthritis, irritable bowel syndrome, lower back pain, leg ulcers, post menopausal women and elderly). The mean SF-6D index value was found to exceed the EQ-5D by 0.045 and the intraclass correlation coefficient between them was 0.51. Whilst this convergence lends some support for the validity of these measures, the modest difference at the aggregate level masks more significant differences in agreement across the patient groups and over severity of illness, with the SF-6D having a smaller range and lower variance in values. There is evidence for floor effects in the SF-6D and ceiling effects in the EQ-5D. These discrepancies arise from differences in their health state classifications and the methods used to value them. Further research is required to fully understand the respective roles of the descriptive systems and the valuation methods and to examine the implications for estimates of the impact of health care interventions

A comparison of the EuroQol and the Health Utilities Index in patients treated for congenital anomalies

It seems generally believed that the HUI3 is a more responsive utility measure than the EQ-5D because of the crude level structure of the EQ-5D compared to the HUI3. As empirical evidence to support this hypothesis is lacking, we undertook a study to compare the construct validity of the utility indices of the EQ-5Dindex and the HUI3index in 135 patients treated for congenital anorectal malformation and 57 patients treated for congenital diaphragmatic hernia. Discriminant validity was tested by the ability of the HUI3index and EQ-5Dindex to distinguish clinically relevant subgroups in the patient populations. Convergent validity was tested using Pearson correlations of the HUI3index and the EQ-5Dindex with the symptom scores. In general the index scores were in line with expectations: the higher the level of symptomaticity, the lower the indices. The HUI3 classified patients in more health states than the EQ-5D and classified a smaller percentage in the best health state. Nevertheless, the EQ-5Dindex distinguished more clinically relevant subgroups than the HUI3index. The two indices were correlated weakly to moderately with the symptom scores, which was expected given the relatively good quality of life of the patients. Despite the higher number of health states of the HUI, the EQ-5Dindex discriminated more clinically relevant subgroups than the HUI3index. This means that discriminative power of the utility indices is not determined merely by the number of health states of the underlying classification system. Differences in the description of the health states might explain this finding.</p

Prevention and Intervention Programs Targeting Sexual Abuse in Individuals with Mild Intellectual Disability:A Systematic Review

Introduction: Compared to their non-disabled peers, individuals with mild intellectual disability (MID) are at higher risk of becoming a victim of sexual abuse and more vulnerable to its disruptive effects. This review provides an overview of content and effectiveness of prevention and intervention programs targeting sexual abuse in individuals with MID. Methods: PRISMA guidelines were followed and quality and effectiveness of the programs were evaluated taking into account the rating of the Quality Assessment Tool for Quantitative Studies (QATQS). Results: Twelve studies were included. In prevention programs role-play prevailed, whereas the content of intervention programs varied. All studies received a "weak" QATQS rating. By consequence, effectiveness of the program was downgraded to "unclear" in ten, and "ineffective" in two studies. Conclusion: Further development of programs and higher quality of research is needed to investigate whether they are effective in preventing sexual abuse or reducing its consequences in individuals with MID

Identifying social participation subgroups of individuals with severe mental illnesses:a latent class analysis

Purpose To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). Methods A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. Results Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. Conclusions Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning

The Body Experience Questionnaire for adults with mild intellectual disability or borderline intellectual functioning (BEQ-mb):Development and initial evaluation

Background: Body experience is an important facet of psychosocial functioning and health. However, to date no test exists to measure body experience in adults with mild intellectual disability and borderline intellectual functioning (MID-BIF). We therefore adapted the Body Experience Questionnaire (BEQ) to this group, resulting in the BEQ-mb, and evaluated its usability, comprehensibility, and reliability. Method: The BEQ-mb was developed in five stages: concept development, focus group, verbal reports, pilot testing, and evaluation. Results: The BEQ-mb is applicable in, and comprehensible by, adults with MID-BIF. Internal consistency is good for the total scale and the body awareness and body satisfaction subscales, but low for the body attitude subscale. Test-retest reliability is excellent for the total scale and the subscales. Conclusion: The BEQ-mb unlocks new opportunities for clinical examination and research on body experience. Future research is needed to investigate its structural validity

Strategies for parenting by mothers and fathers with a mental illness

WHAT IS KNOWN ON THE SUBJECT?: The combination of coping with their mental health problems and caring for children makes parents vulnerable. Family-centred practice can help to maintain and strengthen important family relationships, and to identify and enhance the strengths of a parent with a mental illness, all contributing to the recovery of the person with the mental illness. WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE?: Taking the strength and the opportunities formulated by parents themselves as a starting point is fairly new. Parents with severe mental illness find strength for parenting in several ways. They feel responsible, and this helps them to stay alert while parenting, whereas parenthood also offers a basis for social participation through school contacts and the child's friendships. Dedication to the parent role provides a focus; parents develop strengths and skills as they find a balance between attending to their own lives and caring for their children; and parenting prompts them to find adequate sources of social support. In this study these strategies were found to be the fundamentals of recovery related to parenting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can support and coach patients who are identified as parents, and self-chosen parenting related goals are set and addressed. A family-focused approach by nurses can be used to prevent problems for children and their families, identify their strengths as well as vulnerabilities, and address the challenges to build resilience. ABSTRACT: Introduction Understanding of the problems of parents with mental illness is growing. Gaining insight into strategies for parenting, while taking the opportunities formulated by these parents themselves as a starting point is fairly new. Question What are the strategies of parents with a mental illness to be successful? Method Experiences of 19 mothers and eight fathers with a mental illness were explored with in-depth interviews. Data were content analysed, using qualitative methods. Results Next to feelings of inadequacy, interviewees also describe how children enrich and structure their lives and are not only a burden but serve as distraction from problems. Developing activities that interest both child and parent provides avenues for emerging strength. Mental illness constrains fathers, but also gives opportunities to develop a meaningful relation with their children. Discussion Strategies like being fully dedicated to the parental role, finding a balance between attention for one's own life and parenting and finding adequate sources of support are found to be fundamental for recovery in the parent role. Implications for practice Peer groups can be of valuable help and mental health workers can support parents to set self-chosen parenting related goals

Professionals’ opinions on support for people with chronic illness in their roles as parents in mental or in general health care

Chronic illness affects a person’s wellbeing and affects the ability to perform the social roles of spouse or parent. When working with people with long-lasting mental or somatic illnesses, social workers and nurses are confronted with needs for support, especially for parents. Although programs are in place for the children of parents with chronic illnesses, specific services for the parents themselves are scarce, as are parenting support courses for professionals. In an explorative study we investigated the similarities and differences between mental health organizations and general hospitals in providing support to parents. Using a cross-sectional design, information on supported parenting was collected through an internet questionnaire. Twice as many professionals in general hospitals can provide support to parents than did those in mental health organizations that were not trained in supported parenting. Professionals in mental health institutions generally reported that the attention paid to the parental role is insufficient. However, professionals in mental health organizations who were trained in supported parenting considered paying attention to the parental role more as a part of their job than the participants from organizations without such training. Further research should expand this first pilot study on the attitude of professionals towards supported parenting