Functional health state description and valuation by people aged 65 and over:a pilot study

Abstract Background Assessing quality of life among the elderly is a complex and multifaceted issue. Elderly people might find valuing and describing their personal experience of quality of life (QoL) demanding and cumbersome. This study therefore sought to determine the feasibility of administering two questionnaires in two samples of elderly people. Methods A preference-based instrument (EQ-5D + C) and a currently achieved functioning questionnaire (CAF) were utilized. Two pilot studies were performed. The first was performed in South Africa (n = 30), designed to test whether elderly respondents could complete and understand the two questionnaires and also to indicate which valuation method, visual analogue scale or time trade off they preferred. A second pilot study was performed in the Netherlands (n = 30), designed to investigate the use of both questionnaires in determining quality of life and health state valuations in a Dutch sample of elderly. Results Seventy percent of the South African respondents indicated that they preferred the visual analogue scale (VAS) method, when compared to the time trade-off (TTO). In both the South African and the Dutch pilot studies, the respondents, with different dependency levels, were able to use both questionnaires to determine health state descriptions and valuations. When ranking the profiles from fewer to more problems, the EQ-5D + C exhibits a gradual downwards trend, with a maximum of 100 and minimum VAS value of 41. The CAF also exhibits a gradual downwards trend, with a maximum of 1.00 and minimum VAS value of 36. Conclusions The results indicate that individuals from different parts of the world are able to complete, describe, and value the questionnaires. It is our recommendation that a comprehensive study should be done, which includes both the EQ-5D + C questionnaire and the CAF questionnaire, since the two questionnaires have proven to be feasible in providing information on quality of life and well-being of elderly people

Compassion for Others and Self-Compassion:Levels, Correlates, and Relationship with Psychological Well-being

Compassion for others and self-compassion are assumed to be closely related concepts. Yet, as they have been mostly studied separately, little is known about their relationship and to what extent they differ or resemble each other with respect to their correlates. This cross-sectional study aimed to gain knowledge on their mean levels, interrelationship, and relationships to psychological well-being and demographic factors. A community sample of 328 adults completed a series of standardized self-report questionnaires to assess compassion for others, self-compassion, depressive symptoms, negative affect, and positive affect. Results showed that compassion for others and self-compassion were not significantly related. Self-compassion was more strongly related to negative and positive indicators of affect than compassion for others. Compassion for others was higher in women than in men, and in low educated individuals compared to higher educated individuals. In contrast, self-compassion was lower in low educated individuals. Future research can build up on these findings to enlarge the understanding of how compassion for others and self-compassion relate and differ from each other

Why Do Adult Patients With Cancer Not Seek Help for Their Depressive Symptoms?:The Role of Illness Perceptions, Coping, and Social Support

Background: Up to 75% of cancer patients with depressive symptoms do not make use of psychological care.Objective: To examine how perceptions of and coping with depressive symptoms and perceived social support in adults with cancer are associated with their need for psychological care, concurrently and over time.Methods: In this longitudinal study, 127 participants who received a cancer diagnosis in the past 5 years, experienced at least moderate depressive symptoms, and were not receiving psychological help, completed 2 self-report questionnaires (3 months apart) including the brief Illness Perception Questionnaire and brief Coping Orientation to Problems Experienced Inventory and Social Support List.Results: Participants with stronger belief in the efficacy of psychological care and more likely to use avoidant coping reported a greater need for psychological care at both data points. Social support was not significantly associated with perceived need for psychological care.Conclusions: Stronger perceived treatment control and greater use of avoidant coping were significantly associated with a greater perceived need for psychological care.Implications for practice: People with cancer may benefit from being informed about the efficacy of depression treatment. Furthermore, health care professionals should be aware that avoidant coping may complicate psychological care seeking for a group of adults with cancer experiencing depressive symptoms and having a need for psychological care.Foundational: Illness perceptions and coping mechanisms can predict cancer patients’ need for psychological care. Providing information about treatment options and its efficacy, together with targeting avoidant coping may increase adequate decision-making and possibly the uptake of psychological care

Socioeconomic Status and the Course of Quality of Life in Older Patients with Coronary Heart Disease

BACKGROUND: Previous research suggests that socioeconomic status (SES) might be related to the course of quality of life (QoL) in coronary heart disease (CHD) patients. The authors sought to determine whether there are differences in the course of QoL before and after the incidence of CHD among older persons of differing SES. METHOD: Two hundred two CHD patients were followed up longitudinally using a community-based survey. Data on patients' QoL were collected before the diagnosis and at three follow-up assessments. RESULTS: High SES patients reported better outcomes at the premorbid assessment with fewer depressive feelings and better physical functioning. In physical functioning, similar results were repeated 6 and 12 months after the diagnosis. Additionally, high SES patients showed better role and social functioning 1 year after CHD. A multivariate analysis of variance revealed differential longitudinal pathways in relation to SES in role, social, and physical functioning. CONCLUSION: CHD modulates premorbid differences in depressive feelings. Conversely, high SES leads to better outcomes in all functional domains in the long-term after diagnosis. Postmorbid differences in physical functioning are not directly related to CHD, but rather the reestablishment of a premorbid situation. In contrast, socioeconomic inequalities in social and role functioning are a direct response to the impact of the disease

Partner support and distress in women with breast cancer:The role of patients' awareness of support and level of mastery

The aim of the present study was to investigate the associations between partners' ways of providing support (both active engagement and protective buffering) and distress in women with breast cancer as a function of patients' awareness of the support received and their sense of mastery. These associations were investigated both cross-sectionally and longitudinally (i.e. changes in distress over time). At 3 months (T1) after diagnosis, women with breast cancer and their partners (n = 82 couples) were assessed regarding partners' supportive behaviour. Women also indicated their sense of mastery. At both 3 and 9 months (T2) after diagnosis, women reported their level of distress. Cross-sectional as well as longitudinal analyses showed that active engagement was unrelated to distress, regardless of patients' awareness of the support received and their feelings of mastery. In contrast, perceived protective buffering was found to be associated with more concurrent distress (i.e. cross-sectionally). Moreover, protective buffering that was reported by partners but remained unnoticed by patients was associated with higher levels of concurrent distress, but only for patients who were low in mastery. Over time, protective buffering that remained unnoticed by patients was associated with more distress, regardless of women's sense of mastery

Positive affect and functional somatic symptoms in young adults

Background Functional Somatic Symptoms (FSS) are symptoms for which an underlying pathology cannot be found. High negative affect (NA) has been linked to the etiology of FSS, but little is known about the role of Positive Affect (PA). Objective: The aim of this study was to test if PA is related to current and future lower levels of FSS. We also examined the interactions between PA and NA, and PA and sex on FSS. Method: Data from the Dutch Tracking Adolescents' Individual Lives Survey (TRAILS) cohort were used (N = 1247 cases, 60% females, mean age T5 = 22.2, T6 = 25.6). PA was measured with the PANAS schedule and FSS with the Adult Self Report questionnaire (ASR). A Principal Component Analysis (PCA) was performed on the physical complaints subscale of the ASR. Regression analyses with bootstrapping were performed to assess the associations and interactions. Results: PA had a significant negative association with current FSS when adjusted for NA, age, sex and socioeconomic status (B = 0.004; BCa 95% CI = [ -0.006; -0.002]), but the association was not significant longitudinally. No interactions were found. In secondary analysis, PA was significantly related to the component "General Physical Symptoms" (B = -0.019; BCa 95% CI = [ -0.0028; -0.011]) but not to the component "Gastrointestinal Symptoms" (B = -0.008; BCa 95% CI = [ -0.016;0.001]) in the cross-sectional analysis. Conclusion: In conclusion, high PA was significantly related to current lower levels of FSS, but the effect was small. Further research on individual variations in affect is needed to obtain more insight in their contribution to FSS

Effect of adaptive abilities on utilities, direct or mediated by mental health?

<p>Abstract</p> <p>Background</p> <p>In cost-utility analyses gain in health can be measured using health state utilities. Health state utilities can be elicited from members of the public or from patients. Utilities given by patients tend to be higher than utilities given by members of the public. This difference is often suggested to be explained by adaptation, but this has not yet been investigated in patients. Here, we investigate if, besides health related quality of life (HRQL), persons' ability to adapt can explain health state utilities. Both the direct effect of persons' adaptive abilities on health state utilities and the indirect effect, where HRQL mediates the effect of ability to adapt, are examined.</p> <p>Methods</p> <p>In total 125 patients with Rheumatoid Arthritis were interviewed. Participants gave valuations of their own health on a visual analogue scale (VAS) and time trade-off (TTO). To estimate persons' ability to adapt, patients filled in questionnaires measuring Self-esteem, Mastery, and Optimism. Finally they completed the SF-36 measuring HRQL. Regression analyses were used to investigate the direct and mediated effect of ability to adapt on health state utilities.</p> <p>Results</p> <p>Persons' ability to adapt did not add considerably to the explanation of health state utilities above HRQL. In the TTO no additional variance was explained by adaptive abilities (Δ R²= .00, β = .02), in the VAS a minor proportion of the variance was explained by adaptive abilities (Δ R²= .05, β = .33). The effect of adaptation on health state utilities seems to be mediated by the mental health domain of quality of life.</p> <p>Conclusions</p> <p>Patients with stronger adaptive abilities, based on their optimism, mastery and self-esteem, may more easily enhance their mental health after being diagnosed with a chronic illness, which leads to higher health state utilities.</p