Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder

Sociodemographic factors and use of pain medication are associated with health-related quality of life: results from an adult community mental health service in Norway

PURPOSE

Health-related quality of life (HRQoL) is an important aspect of mental health outcomes. There are few studies on HRQoL in heterogeneous patient populations seeking help at community mental health services. The aims of the study were to compare how HRQoL, measured by the EuroQol five dimensions with five levels (EQ-5D-5L), was distributed compared to other samples from national and international studies, and to explore what factors are associated with HRQoL.

METHODS

In a cross-sectional study, 1379 Norwegian outpatients reported their HRQoL before starting treatment. Associations with demographic variables, job status, socio-economic status, and use of pain medication were examined using multiple regression analysis.

RESULTS

Most of the sample, 70% to 90%, reported problems with usual activities, pain/discomfort, and anxiety/depression; 30% to 65% reported that these problems were of a moderate to extreme degree. Forty percent reported problems with mobility, and about 20% reported problems with self-care. The sample's HRQoL was considerably lower than the general population, and comparable to patient-groups from specialist mental health services. Originating from a developing country, lower level of education, lower yearly household income, being on sick leave or unemployed, and using pain medication were associated with lower HRQoL. Age, gender, and relationship status were not associated with HRQoL. This is the first study to simultaneously examine the unique contribution of these variables in one study.

CONCLUSION

The most impacted domains of HRQoL were pain/discomfort, anxiety/depression, and usual activities. Lower HRQoL was associated with several socio-demographic factors and use of pain medication. These findings might have clinical implications and suggest that mental health professionals should routinely measure HRQoL in addition to symptom severity, to identify areas that should be targeted to improve HRQoL.

Variables Associated with Emotional Symptom Severity in Primary Care Patients: The Usefulness of a Logistic Regression Equation to Help Clinical Assessment and Treatment Decisions

The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources.

Grading disorder severity and averted burden by access to treatment within the GBD framework: a case study with anxiety disorders

BACKGROUND

The Global Burden of Disease Study (GBD) estimates burden by cause with major relevance for resource allocators globally. Non-fatal burden estimates are influenced by disorder severity. However, for many disorders, global severity is sourced from a single high-income country survey. We aimed to estimate severity distributions that vary by Healthcare Access Quality Index (HAQI) using anxiety disorders as a case study and present the usefulness of this method in simulating averted and avoidable burden globally.

METHODS

In this case study, we estimated treatment use among respondents with anxiety disorder in the 1997 Australian National Survey of Mental Health and Wellbeing (NSMHWB), the source used to estimate severity of anxiety disorders in GBD. Treatment effects were sourced from the Cochrane Database of Systematic Reviews and pooled via network meta-analysis. Severity distribution was established via a meta-regression of their disability weights, derived from 12-item short form survey scores. We simulated the shift in severity across scenarios without access to treatment and with full access to optimal treatment (cognitive behavioural therapy and antidepressants). We interpolated this shift linearly along the HAQI, extrapolated country-specific severity from HAQI scores, and calculated averted and avoidable burden.

FINDINGS

The database review sourced 56 reviews, of which eight were eligible for inclusion. These eight reviews reported on 156 randomised controlled trials, with 194 treatment effects. Respondents to the 1997 NSMHWB consisted of 5936 women (55·8%) and 4705 (44·2%) men aged 18 years or older (mean age and ethnicity data not available). The survey-weighted treatment effect size was -0·28 (95% uncertainty interval -0·45 to -0·12). The pooled treatment effect for full coverage optimal treatment was -1·07 (-1·47 to -0·64). The sequela-weighted disability weight among people with anxiety disorder in the NSMHWB was 0·141 (0·042 to 0·275). The estimated disability weight was 0·188 (0·070 to 0·341) after removing the benefits of treatment and 0·056 (0·013 to 0·140) after providing all people with anxiety disorder access to optimal treatment. Globally, 12·5% (4·6 to 21·5) of anxiety disorder burden was averted because of available treatment. However, 71·1% (46·2 to 87·6) of global anxiety disorder burden could be averted if all people with anxiety disorders had access to optimal treatment.

INTERPRETATION

Because it is based on guidance from a single survey done in one high-income country, the burden of anxiety disorders in low-income and middle-income countries is probably underestimated by GBD. Despite the availability of effective treatments, low use of these treatments means that most burden is still avoidable. Most of the burden could be averted if all people with anxiety disorders had access to optimal treatment, highlighting the importance of public promotion and referral pathways of treatment for anxiety disorders. Location-specific severity distributions in GBD would greatly increase precision in burden estimates and highlight avertable burden to clinicians, public health practitioners, and policy makers.

FUNDING

Queensland Health and Bill & Melinda Gates Foundation.

Cost-effectiveness of internet-supported cognitive behavioral therapy for university students with anxiety symptoms: A Markov-model analysis

Background and aim

High prevalence of anxiety symptoms has been reported globally in the university students. Cognitive behavioral therapy (CBT) is the recognized treatment for anxiety and is traditionally conducted face-to-face (f-CBT). The efficacy of internet-based CBT (i-CBT) for anxiety has been extensively studied, yet evidence on its cost-effectiveness is scarce. We aimed to evaluate the cost-effectiveness of guided low-intensity i-CBT for university students with mild anxiety symptoms from the societal perspective of Hong Kong.

Methods

A 5-year Markov model was designed to compare outcomes of guided i-CBT and f-CBT in a hypothetical cohort of university students with mild anxiety symptoms. Model inputs of cost and healthcare resources associated with anxiety were retrospectively collected from a cohort of university students with anxiety symptoms. Clinical and utility model inputs were retrieved from published literature. Model outcome measures were anxiety-related total cost (including direct medical and indirect costs) and quality-adjusted life-year (QALY). Sensitivity analyses were performed to examine the robustness of base-case results.

Results

In base-case analysis, i-CBT gained higher QALYs (2.9956 versus 2.9917) at lower total cost (US$6,101 versus US$6,246) than f-CBT. In one-way sensitivity analysis, the QALY gained by i-CBT was sensitive to the relative patient acceptance and adherence to CBT. In probabilistic sensitivity analysis, i-CBT was cost-effective in 90.9% of the time at the willingness-to-pay threshold of 138,210 per QALY (3× GDP per capita in Hong Kong). The probability of i-CBT to be cost-effective was 99.9% at a willingness-to-pay threshold of zero.

Conclusions

Guided i-CBT appears to be cost-saving and effective for management of university students with mild symptoms of anxiety from the societal perspective of Hong Kong. The cost-effectiveness of i-CBT is highly subject to the individual acceptance and adherence of CBT delivered by the internet platform.

Cost Effectiveness of Digital Interventions for Generalised Anxiety Disorder: A Model-Based Analysis

BACKGROUND

Digital interventions (DIs) are increasingly being used in mental health care, despite limited evidence regarding their value for money. This study aimed to evaluate the cost effectiveness of DIs for generalised anxiety disorder (GAD), in comparison with alternative care options, from the perspective of the UK health care system.

METHODS

An open-source decision analytic cohort model was used to extrapolate the results of a network meta-analysis over a patient's lifetime and estimate the costs and outcomes (quality-adjusted life-years) of DIs and their comparators. The net monetary benefit (NMB) and probability of cost effectiveness was estimated for each comparator, and we conducted a Value of Information analysis to evaluate the scale and drivers of uncertainty.

RESULTS

DIs were associated with lower NMB compared with medication and with group therapy, but greater NMB compared with non-therapeutic controls and with usual care. DIs that were supported by a clinician, an assistant or a lay person had higher delivery costs than purely patient-self-directed DIs, yielding a greater NMB when opportunity cost was above £3000/QALY. There was considerable uncertainty in the findings driven largely by uncertainty in the estimated treatment effects. The value of further research to establish the effectiveness of DIs for GAD was substantial, at least £12.9 billion.

CONCLUSIONS

The high uncertainty about these results does not allow for recommendations based on the cost effectiveness of DIs. However, the analysis highlights areas for future research, and demonstrates that apparent cost savings associated with DIs can be offset by reduced effectiveness.

The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death. PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep. Thus, increased symptoms may lead to increased end-of-life healthcare utilization.

OBJECTIVES

To determine if veterans with PTSD have increased end-of-life healthcare utilization or medication use and to examine predictors of medication administration.

DESIGN

Secondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center.

SUBJECTS

Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011.

MAIN MEASURES

Emergency room (ER) visits, hospitalizations, and medication administration in the last 7 days of life.

KEY RESULTS

Of 5341 veterans, 468 (8.76%) had PTSD. Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalizations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001). PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943). Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598, 95% CI 1.194-2.138).

CONCLUSIONS

PTSD's association with increased end-of-life healthcare utilization and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD. Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients.

TRIAL REGISTRATION

NCT00234286.

Correlates associated with mental health and nutritional status in Lebanese older adults: A cross-sectional study

OBJECTIVE

To assess correlates of mental and nutritional health among elderly in Lebanon, inside nursing homes compared to their private homes.

METHODS

This cross-sectional study was conducted between June and August 2016 on 500 elderly.

RESULTS

Higher somatic (Beta = 0.259) and cognitive anxiety (Beta = 0.508), increased age (Beta = 0.174) were significantly associated with higher depression, whereas having a secondary (Beta = -4.006) and a university (Beta = -6.829) levels of education compared to illiteracy, living home (Beta = -2.557) compared to living in a nursing home and male gender (Beta = -1.280) were significantly associated with lower depression. Increased BMI (Beta = 0.056), a married (Beta = 0.687) and a widowed (Beta = 1.022) status compared to a single status were associated with a better nutritional status, whereas an increased somatic anxiety (Beta = -0.061), secondary (Beta = -0.79) and university (Beta = -1.196) educational levels compared to illiteracy were significantly associated with a worse nutritional status. Increased cognitive (Beta = 1.160) and affective (Beta = 0.788) anxiety and age (Beta = 0.191) were associated with higher stress, whereas a primary (Beta = -6.991), secondary (Beta = -11.812) and university (Beta = -13.927) educational levels, male gender (Beta = -2.015) were significantly associated with lower stress compared to females. A significantly higher mean depression score was found in patients living in nursing homes compared to those living at home (13.74 vs. 11.18). No difference was found between the two groups concerning the nutritional status and stress score.

CONCLUSION

Living in nursing homes was associated with more malnutrition and depression. An increased awareness of the personnel working in nursing homes and family members of these older adults can help improve their psychological status.

Risk Factors, Clinical Presentations, and Functional Impairments for Generalized Anxiety Disorder in Military Personnel and the General Population in Canada

OBJECTIVE

This study sought to examine differences in sociodemographic risk factors, comorbid mental conditions, clinical presentations, and functional impairments associated with past-year generalized anxiety disorder (GAD) between Canadian Armed Forces (CAF) Regular Force personnel and the Canadian general population (CGP).

METHOD

Data were from 2 nationally representative surveys collected by Statistics Canada: 1) the Canadian Community Health Survey on Mental Health, collected in 2012 ( N = 25,113; response rate = 68.9%); and 2) the Canadian Forces Mental Health Survey, collected in 2013 ( N = 8,161; response rate = 79.8%).

RESULTS

The prevalence of lifetime and past-year GAD was significantly higher in the CAF (12.1% and 4.7%) than in the CGP (9.5% and 3.0%). Comorbid mental disorders were strongly associated with GAD in both populations. Although the content area of worry and the GAD symptoms endorsed were similar, CAF personnel were significantly more likely to endorse specific types of worries (i.e., success at school/work, social life, mental health, being away from home or loved ones, and war or revolution) and specific symptoms of GAD (i.e., restless, keyed up, or on edge and more irritable than usual) than civilians, after adjusting for sociodemographic covariates and comorbid mental disorders. CAF personnel with past-year GAD reported significantly higher functional impairment at home than civilians with past-year GAD.

CONCLUSION

GAD is a substantial public health concern associated with significant impairment and disability in both military and civilian populations. GAD in military and civilian populations shows similarities and differences: Key similarities include its extensive comorbidity and significant functional impairment, whereas key differences include the focus of worries and symptom profile.

Health state utility values of high prevalence mental disorders in Australia: results from the National Survey of Mental Health and Wellbeing

PURPOSE

High prevalence mental disorders including depression, anxiety and substance use disorders are associated with high economic and disease burden. However, there is little information regarding the health state utility values of such disorders according to their clinical severity using comparable instruments across all disorders. This study reports utility values for high prevalence mental disorders using data from the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB).

METHODS

Utility values were derived from the AQoL-4D and analysed by disorder classification (affective only (AD), anxiety-related only (ANX), substance use only (SUB) plus four comorbidity groups), severity level (mild, moderate, severe), symptom recency (reported in the past 30 days), and comorbidity (combination of disorders). The adjusted Wald test was applied to detect statistically significant differences of weighted means and the magnitude of difference between groups was presented as a modified Cohen's d.

RESULTS

In total, 1526 individuals met criteria for a 12-month mental disorder. The mean utility value was 0.67 (SD = 0.27), with lower utility values associated with higher severity levels and some comorbidities. Utility values for AD, ANX and SUB were 0.64 (SD = 0.25), 0.71 (SD = 0.25) and 0.81 (SD = 0.19), respectively. No differences in utility values were observed between disorders within disorder groups. Utility values were significantly lower among people with recent symptoms (within past 30 days) than those without; when examined by diagnostic group, this pattern held for people with SUB, but not for people with ANX or AD.

CONCLUSIONS

Health state utility values of people with high prevalence mental disorders differ significantly by severity level, number of mental health comorbidities and the recency of symptoms, which provide new insights on the burden associated with high prevalence mental disorders in Australia. The derived utility values can be used to populate future economic models.

Mobile and traditional cognitive behavioral therapy programs for generalized anxiety disorder: A cost-effectiveness analysis

Background

Generalized anxiety disorder (GAD) is a debilitating mental health illness that affects approximately 3.1% of U.S. adults and can be treated with cognitive behavioral therapy (CBT). With the emergence of digital health technologies, mobile CBT may be a cost-effective way to deliver care. We developed an analysis framework to quantify the cost-effectiveness of internet-based CBT for individuals with GAD. As a case study, we examined the potential value of a new mobile-delivered CBT program for GAD.

Methods

We developed a Markov model of GAD health states combined with a detailed economic analysis for a cohort of adults with GAD in the U.S. In our case study, we used pilot program efficacy data to evaluate a mobile CBT program as either prevention or treatment only and compared the strategies to traditional CBT and no CBT. Traditional CBT efficacy was estimated from clinical trial results. We calculated discounted incremental costs and quality-adjusted life-years (QALYs) over the cohort lifetime.

Case study results

In the base case, for a cohort of 100,000 persons with GAD, we found that mobile CBT is cost-saving. It leads to a gain of 34,108 QALYs and 81,492 QALYs and a cost reduction of $2.23 billion and $4.54 billion when compared to traditional CBT and no CBT respectively. Results were insensitive to most model inputs and mobile CBT remained cost-saving in almost all scenarios.

Limitations

The case study was conducted for illustrative purposes and used mobile CBT efficacy data from a small pilot program; the analysis should be re-conducted once robust efficacy data is available. The model was limited in its ability to measure the effectiveness of CBT in combination with pharmacotherapy.

Conclusions

Mobile CBT may lead to improved health outcomes at lower costs than traditional CBT or no intervention and may be effective as either prevention or treatment.

Prevalence of Insomnia and Associated Factors in Outpatients With Generalized Anxiety Disorder Treated in Psychiatric Clinics

Sleep disturbance is one of the key diagnostic criteria for generalized anxiety disorder (GAD). In this cross-sectional, prospective, observational, and multicenter study, factors associated with the prevalence of insomnia and the impact of insomnia-associated factors on quality of life were evaluated. Using multivariate analyses, the factor most strongly associated with the presence of insomnia (ISI ≥ 8) was the severity of the disorder (Odds Ratio [OR]: 9.253 for severe GAD; 95% Confidence Interval [CI]: 1.914-44.730; p = 0.006), pain interference and symptoms of depression (OR: 1.018; 95% CI 1.003-1.033; p = 0.016 and OR: 1.059; 95% CI 1.019-1.101; p = 0.004, respectively). Insomnia was not related to quality of life. Our results show insomnia to be a common health condition among patients with GAD, associated with the severity of anxiety and depressive symptoms and pain interference.

Initial and Follow-Up Evaluations of Integrated Psychological Services for Anxiety and Depression in a Safety Net Primary Care Clinic

OBJECTIVE

Despite the recognized importance of integrated behavioral health, particularly in safety net primary care, its effectiveness in real world settings has not been extensively evaluated. This article presents 2 successive studies examining the effectiveness of integrated behavioral care in a safety net setting.

METHOD

Study 1 compared the depression and anxiety scores of predominately low-income and minority patients who underwent brief interventions (N = 147) to those of patients from a demographically similar comparison clinic without integrated psychological services, matched on baseline levels of anxiety and depression and length of time between assessments (N = 139). Study 2 did not include a control group but served as a long-term follow-up assessment of anxiety and depression for a subset of 47 patients who finished treatment and could be reached by telephone within 6-18 months of their last session.

RESULTS

Study 1 found that patients from the clinic with integrated psychology services experienced greater decreases in depression and anxiety scores than patients in the control clinic. These effects did not differ as a function of age, gender, or race. Study 2 found that patients continued to decline in depression and anxiety over time, with lower scores at the last session and even lower scores after longer-term follow-up ranging from 6 to18 months. These improvements remained significant when controlling for other interim mental health treatments.

CONCLUSION

These results support the short- and long-term treatment effects of brief primary care behavioral interventions, further strengthening the case for integrated behavioral healthcare in safety net settings.

Prevalence, correlates, comorbidity and severity of generalized anxiety disorder in Singapore

Despite its pervasiveness and associated impairment, generalized anxiety disorder (GAD) remains a poorly recognized disorder. Furthermore, given that GAD has been relatively understudied in Asia, the current study examined the prevalence, correlates and co-morbid conditions of this disorder in a multi-ethnic population of Singapore. Data was utilized from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among the adult population (n=6616) aged 18 years and above. The Composite International Diagnostic Interview version 3.0 (CIDI v3.0) was used to assess co-morbidity as well as the life-time and 12-month prevalence of disorders. Functional impairment and treatment-seeking behavior were also assessed. The life-time (0.9%) and 12-month (0.4%) prevalence estimates in the current study were found to be lower than those reported in Western populations but comparable to the prevalence estimates found in Asian countries. The relatively lower prevalence rate of GAD in this study suggests the possible role of culture in reporting and manifestation of anxiety symptomatology. The failure of a substantial proportion of individuals to seek treatment despite self-reported impairment was also identified as an area of concern.

Prevalência de transtornos ansiosos e algumas comorbidades em idosos: um estudo de base populacional

RESUMO Objetivo Avaliar a prevalência de transtornos ansiosos e fatores associados em uma amostra populacional de idosos do Sul de Santa Catarina. Métodos Estudo transversal com base em dados populacionais, que avaliou 1.021 indivíduos idosos entre 60 e 79 anos. Foram realizadas entrevistas domiciliares para aferição de variáveis sobre transtornos ansiosos, por meio do questionário MINI, dados sociodemográficos, hipertensão arterial sistêmica (HAS), infarto agudo do miocárdio (IAM) e dosagem de colesterol. Resultados As prevalências entre os transtornos ansiosos foram de 22,0% para o transtorno de ansiedade generalizada (TAG); 14,8% para fobia social (FS); 10,5% para transtorno do pânico (TP); e 8,5% para o transtorno obsessivo-compulsivo (TOC). Além disso, 40,5% dos indivíduos apresentaram pelo menos um transtorno de ansiedade. A distribuição dos transtornos foi semelhante nos dois gêneros; TAG foi mais prevalente nos indivíduos de menor escolaridade; TOC foi mais presente em indivíduos casados ou em união estável. Em relação às variáveis clínicas, HAS foi associada à presença de TOC; FS foi associada com IAM; TOC e FS foram associados com HDL > 40 mg/dL. Conclusão Os dados demonstram que os quadros de ansiedade são muito frequentes em idosos da comunidade, se sobrepõem de forma significativa e estão associados a algumas variáveis clínicas cardiovasculares.

Intolerance of uncertainty in body dysmorphic disorder

Intolerance of uncertainty (IU) is a transdiagnostic construct associated with several anxiety and related disorders. Three studies were conducted to explore the potential relationship between IU and body dysmorphic disorder (BDD). Study 1 revealed a positive relationship between IU and BDD symptoms above symptoms of anxiety and depression in an unselected student sample (N=88). Study 2 demonstrated a similar relationship between IU and BDD symptoms above negative affectivity and intolerance of ambiguity in a community sample (N=116). Study 3 found that a clinical BDD sample (N=23) reported greater IU than healthy controls (N=20), though this relationship was accounted for by symptoms of anxiety and depression. Greater IU predicted functional impairment in the clinical sample above BDD symptoms and past-week anxiety and depression. The observed relationship between IU and BDD symptoms provides preliminary support for the relevance of IU to this population.

Predictors of impaired quality of life in patients with rheumatic diseases

Quality of life (QoL) is a complex outcome and rheumatologic patients typically exhibit several comorbidities with a negative impact. In this study, we analyzed with respect to QoL for the first time a wide range of physical and psychological factors, including individual, clinical and disease-related parameters, mental health disorders, sexual dysfunction, and cardiovascular comorbidities among consecutive rheumatologic patients. QoL was evaluated using the EuroQol 5D (EQ-5D) utility index. The Health Assessment Questionnaire (HAQ) Disability Index, and the HAQ Pain Visual Analogue Scale were used as measures of physical disability and arthritis-related pain, respectively. The Hamilton Anxiety Scale and Zung Self-Rating Depression Scale, the International Index of Erectile Function and the Female Sexual Functioning Index were completed by all patients. In total, 360 patients were included, 301 females and 59 males. In the univariate analysis, pain, physical disability (p < 0.001 for both), disease duration (p = 0.014), anxiety and depression (p < 0.001 for both), as well as sexual dysfunction (p = 0.001 for females, p = 0.042 for males), correlated with QoL. Female sex (p < 0.001), advanced age (p = 0.029), lower educational level (p = 0.005), and cardiovascular factors (hypertension, dyslipidemia, diabetes, lack of systemic exercise) also appeared to negatively affect QoL. However, in the multiple regression model, only anxiety, pain, physical disability (p < 0.001 for all), and disease duration (p = 0.019) remained significant predictors of QoL. The emotional side and the disease-related physiological mode of rheumatic diseases appear as major independent correlates of QoL among rheumatologic patients, who may thus benefit the most from combined supportive psychological and pain-relieving interventions.

A history of health-related quality of life outcomes in psychiatry

Health-related quality of life (HRQoL) is a multidimensional concept that includes subjective reports of symptoms, side effects, functioning in multiple life domains, and general perceptions of life satisfaction and quality. Rather than estimating it from external observations, interview, or clinical assessment, it is best measured by direct query. Due to a perception that respondents may not be reliable or credible, there has been some reluctance to use self-report outcomes in psychiatry. More recently, and increasingly, HRQoL assessment through direct patient query has become common when evaluating a range of psychiatric, psychological, and social therapies. With few exceptions, psychiatric patients are credible and reliable reporters of this information. This article summarizes studies that highlight the development, validation, and application of HRQoL measures in psychiatry. Thoughtful application of these tools in psychiatric research can provide a much-needed patient perspective in the future of comparative effectiveness research, patient-centered outcomes research, and clinical care.

The impact of medication on health-related quality of life in patients with generalized anxiety disorder

BACKGROUND AND OBJECTIVE

Generalized anxiety disorder (GAD) is a psychiatric disorder characterized by excess worry and anxiety. GAD impacts overall health-related quality of life (HRQL), level of functioning, and disability. This literature review was conducted to understand the impact of pharmacological treatments on HRQL and functional outcomes.

METHODS

A literature review was conducted to identify randomized controlled trials (RCTs) comparing GAD pharmacological treatments with one or more patient-reported outcome (PRO) measure assessing HRQL, disability, functioning, or work productivity. Four databases were searched (PubMed, EMBASE, Cochrane Reviews, PsycInfo). Limits included English-language publications from 2004-2014. Abstracts and articles were reviewed to select articles reporting results of RCTs of pharmacological treatments for GAD that included one or more PRO measure. Article abstraction and summarization focused on key elements of the study design and PRO results.

RESULTS

One hundred sixty-three abstracts were reviewed; 44 articles were requested; 12 articles, representing 19 studies, were deemed relevant. The Sheehan Disability Scale (SDS) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were the most frequently utilized PRO measures. In clinical trials with significant anxiety symptom reductions, the SDS and Q-LES-Q also improved with treatment and differentiated from placebo. Two trials included a measure of work productivity; both demonstrated significant improvements with short-term treatment.

CONCLUSION

Treatments that reduce anxiety symptoms are also associated with improvements in patient-reported HRQL, function, and disability. In addition to evaluation of treatment impacts on anxiety symptoms, clinical trials should include PRO measures of HRQL, disability, and functioning.

Subjective well-being among primary health care patients

BACKGROUND

The psychological importance of subjective well-being for a healthy life has been well recognized. It is also well known that depressive and anxiety disorders have a negative effect on subjective well-being. The aim of this cross-sectional, descriptive study was to assess the subjective well-being status of a group of primary healthcare patients in relation to socio-demographic characteristics, personal health and mood-status.

METHODS

A total of 284 patients participated in the study. The Oxford Happiness Scale, Life Satisfaction Scale, DASS-42 (Depression, Anxiety and Stress Scales-42) and a questionnaire about socio-demographic characteristics were completed by the participants.

RESULTS

In general, the participants were found to be moderately happy and satisfied with their lives. They had mild levels of depression, anxiety and stress. In terms of happiness, an older age (≥40 years), educated to secondary level or higher and not having depression or anxiety were found to be factors increasing happiness. In terms of life satisfaction, female gender, an older age (≥40 years), educated to secondary level or higher, being single and not having depression were found to increase life satisfaction.

CONCLUSION

Primary healthcare providers should give more importance to the mood status of their patients. Screening for depression and anxiety should be applied at the primary healthcare level because negative mood status is more important than some socio-demographic characteristics in respect of unhappiness and dissatisfaction.

Efficacy of once-daily extended release quetiapine fumarate in patients with different levels of severity of generalized anxiety disorder

This study is a pooled, post-hoc analysis evaluating once-daily extended release quetiapine fumarate (quetiapine XR) monotherapy in patients with generalized anxiety disorder (GAD). Three previously reported positive, 8-week, randomized, double-blind, placebo-controlled studies evaluated quetiapine XR therapy (50, 150, 300 mg/day) in patients with GAD [Hamilton Anxiety Rating Scale (HAM-A) total score ≥ 20]. Patients were stratified by baseline severity: HAM-A total score ≥ 22, ≥ 24, < 26, ≥ 26, ≥ 28. We report HAM-A total score change, response (≥ 50% reduction in HAM-A total score), and remission (HAM-A total score ≤ 7 and ≤ 9). Quetiapine XR significantly improved HAM-A total scores compared with placebo at Weeks 1 and 8 in the HAM-A ≥ 22, ≥ 24, and ≥ 26 cohorts (all doses), at Week 1 (all doses) and Week 8 (quetiapine XR 150 mg/day) in the < 26 cohort, and at Week 1 (all doses) and Week 8 (quetiapine XR 50 and 150 mg/day) in the HAM-A ≥ 28 group (P<0.05). Week 8 effect sizes for 50, 150, and 300 mg/day were as follows: 0.29, 0.47, 0.17 (HAM-A ≥ 22); 0.35, 0.55, 0.22 (HAM-A ≥ 24); 0.18, 0.32, 0.10 (HAM-A < 26); 0.41, 0.59, 0.24 (HAM-A ≥ 26); 0.60, 0.64, 0.22 (HAM-A ≥ 28), respectively. Acute quetiapine XR monotherapy significantly improves anxiety compared with placebo in patients with moderate or severe GAD, with symptom improvements seen as early as Week 1.

Validity and reliability of the Chinese version of the Short Form of Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF)

PURPOSE

The Short Form version of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) was designed to measure patients' subjective experience of enjoyment and satisfaction. However, it had not yet been validated for Chinese societies. This paper reports on the validation of the Chinese version of the Q-LES-Q-SF among primary care patients in Taiwan.

METHODS

The study included adult patients in primary care clinics. The participants completed the Q-LES-Q-SF, the Patient Health Questionnaire, and the Short Form Health Survey. After that, the trained researchers interviewed the patients using the mood module of the Schedules for Clinical Assessment in Neuropsychiatry and the 17-item Hamilton Rating Scale for Depression. A subsample of participants was reassessed with Q-LES-Q-SF within a 2-week interval.

RESULTS

A total of 1,482 patients completed the Q-LES-Q-SF. The content validity was good, with no significant floor/ceiling effect. The internal consistency of the Q-LES-Q-SF proved to be substantial as well as the test-retest reliability. The factor structure was examined by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA yielded a 2-factor structure, which was confirmed by a CFA with acceptable fit indices. Known-group validity of the Q-LES-Q-SF was satisfactory in distinguishing patients with and without depression, according to hierarchical regression analyses. Evidence of concurrent validity was provided for the Q-LES-Q-SF, and its two subscales identified significant correlations with other measures.

CONCLUSION

The Chinese Q-LES-Q-SF was shown to have adequate validity and reliability. It may be a useful tool to measure patients' quality of life in Chinese societies.

Patient and societal value functions for the testing morbidities index

BACKGROUND

We developed preference-based and summated scale scoring for the Testing Morbidities Index (TMI) classification, which addresses short-term effects on quality of life from diagnostic testing before, during, and after testing procedures.

METHODS

The two TMI preference functions use multiattribute value techniques; one is patient-based and the other has a societal perspective, informed by 206 breast biopsy patients and 466 (societal) subjects. Because of a lack of standard short-term methods for this application, we used the visual analog scale (VAS). Waiting tradeoff (WTO) tolls provided an additional option for linear transformation of the TMI. We randomized participants to 1 of 3 surveys: The first derived weights for generic testing morbidity attributes and levels of severity with the VAS; a second developed VAS values and WTO tolls for linear transformation of the TMI to a "dead-healthy" scale; the third addressed initial validation in a specific test (breast biopsy). The initial validation included 188 patients and 425 community subjects. Direct VAS and WTO values were compared with the TMI. Alternative TMI scoring as a nonpreference summated scale was included, given evidence of construct and content validity.

RESULTS

The patient model can use an additive function, whereas the societal model is multiplicative. Direct VAS and the VAS-scaled TMI were correlated across modeling groups (r = 0.45-0.62). Agreement was comparable to the value function validation of the Health Utilities Index 2. Mean absolute difference (MAD) calculations showed a range of 0.07-0.10 in patients and 0.11-0.17 in subjects. MAD for direct WTO tolls compared with the WTO-scaled TMI varied closely around 1 quality-adjusted life day.

CONCLUSIONS

The TMI shows initial promise in measuring short-term testing-related health states.

Perceived discrimination and health-related quality of life: testing the Reserve Capacity Model in Hispanic Americans

This study tested aspects of the Reserve Capacity Model (Gallo & Matthews, 2003; Gallo, Penedo Espinosa de los Monteros, & Arguelles, 2009) as a means of understanding disparities in health-related quality of life appraisals among Hispanic Americans. Questionnaire data were collected from 236 Hispanic participants, including measures of perceived discrimination, optimism, social support, symptoms of trait anxiety, and physical and mental health-related quality of life. Path analysis indicated direct, negative associations between perceived discrimination and both forms of health-related quality of life. Results also showed that these relationships were partially mediated by the reserve capacity variable of optimism and by symptoms of anxiety, though evidence for mediation by anxiety was stronger than for optimism. Findings suggest that perceived discrimination depletes intrapersonal reserves in Hispanic Americans, which, in turn, induces negative emotions. Implications for community-level interventions are discussed.

The cost effectiveness of pharmacological treatments for generalized anxiety disorder

BACKGROUND

Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders, with important implications for patients and healthcare resources. However, few economic evaluations of pharmacological treatments for GAD have been published to date, and those available have assessed only a limited number of drugs.

OBJECTIVE

To assess the cost effectiveness of pharmacological interventions for patients with GAD in the UK.

METHODS

A decision-analytic model in the form of a decision tree was constructed to compare the costs and QALYs of six drugs used as first-line pharmacological treatments in people with GAD (duloxetine, escitalopram, paroxetine, pregabalin, sertraline and venlafaxine extended release [XL]) and 'no pharmacological treatment'. The analysis adopted the perspective of the NHS and Personal Social Services (PSS) in the UK. Efficacy data were derived from a systematic literature review of double-blind, randomized controlled trials and were synthesized using network meta-analytic techniques. Two network meta-analyses were undertaken to assess the comparative efficacy (expressed by response rates) and tolerability (expressed by rates of discontinuation due to intolerable side effects) of the six drugs and no treatment in the study population. Cost data were derived from published literature and national sources, supplemented by expert opinion. The price year was 2011. Probabilistic sensitivity analysis was conducted to evaluate the underlying uncertainty of the model input parameters.

RESULTS

Sertraline was the best drug in limiting discontinuation due to side effects and the second best drug in achieving response in patients not discontinuing treatment due to side effects. It also resulted in the lowest costs and highest number of QALYs among all treatment options assessed. Its probability of being the most cost-effective drug reached 75 % at a willingness-to-pay threshold of £20,000 per extra QALY gained.

CONCLUSION

Sertraline appears to be the most cost-effective drug in the treatment of patients with GAD. However, this finding is based on limited evidence for sertraline (two published trials). Sertraline is not licensed for the treatment of GAD in the UK, but is commonly used by primary care practitioners for the treatment of depression and mixed depression and anxiety.

Childhood respiratory symptoms and mental health problems: the role of intergenerational smoking

OBJECTIVE

The aim of this study was to investigate the potential role of youth smoking, parental cigarette smoking and parental anxiety/depressive disorders in the relationship between respiratory symptoms and mental health problems among youth.

WORKING HYPOTHESIS

Adjusting for both parental smoking and parental anxiety/depressive disorders in the association between respiratory symptoms and mental health problems among young persons will significantly reduce the strength of the observed relationship.

STUDY DESIGN

Prospective cohort study. PATIENT-SUBJECT SELECTION: Data were drawn from a school-based sample of 1709 young persons in Oregon.

METHODOLOGY

Physical and mental health data were collected on youth.

RESULTS

Respiratory symptoms were associated with significantly increased odds of mental health problems among youth. After adjusting for youth smoking, the relationship between respiratory symptoms and depressive disorders was no longer statistically significant. The relationships between respiratory symptoms and anxiety and depressive disorders were no longer significant after adjusting for parental smoking. Parental anxiety/depressive disorders did not appear to influence these relationships.

CONCLUSIONS

These results provide initial evidence that exposure to parental smoking may play a role in the observed co-occurrence of respiratory and mental health problems in youth, and youths' own smoking appears to influence the link with depressive disorders, but not anxiety disorders.

A comparison between child psychiatric outpatients with AD/HD and anxiety/depression

BACKGROUND

Studies have shown that children with attention-deficit/hyperactivity disorder (AD/HD) have a lower quality of life (QoL), and lower school and psychosocial functioning than healthy children.

AIMS

This is the first study to compare these domains and child competence between children with AD/HD- and anxiety/depression-related problems and healthy children using data from multiple informants.

METHOD

Children were matched by age and sex, resulting in two clinical groups consisting of 62 children with AD/HD-related problems, 49 children with anxiety/depression-related problems and a reference group of 65 healthy schoolchildren. The Inventory of Life Quality for Children and Adolescents (parent and child report), the Child Behaviour Checklist (parent report), the Teacher's Report Form and the Children's Global Assessment Scale (therapist evaluation) were used. Differences between group means were analysed by t-tests and analysis of variance.

RESULTS

The AD/HD group reported a significantly higher QoL than did the Anxiety/Depression group. However, no significant differences in QoL were found between the two clinical groups by parent proxy report. The AD/HD group reported a significantly higher QoL than shown by parent proxy evaluation. According to parent and teacher reports, both clinical groups showed significantly lower school functioning than the group of healthy children. Further, the AD/HD group showed significantly lower school functioning and total competence than the Anxiety/Depression group.

CONCLUSION

To obtain a full clinical picture of subgroups of patients with AD/HD- and anxiety/depression-related problems referred to child mental health outpatient treatment, clinicians should always use multiple informants to evaluate symptoms/problems, functioning and QoL.

Humanistic and economic burden of generalized anxiety disorder in North America and Europe

BACKGROUND

To review the humanistic and economic burden of generalized anxiety disorder (GAD).

METHODS

MEDLINE, EMBASE and the Cochrane Library, limited to articles published in English, between 1987 and 2010, in North America, Europe and Australia. The key focus was humanistic or functional outcomes, cost of illness and economic outcomes. Ninety articles fitting criteria on (a) GAD study population, (b) United States, Europe or Australia, and (c) humanistic burden or economic burden were reviewed. Methods and findings were summarized by two researchers; inconsistencies were resolved by a third reviewer.

RESULTS

GAD was associated with increased impairments in psychosocial functioning, role functioning, work productivity and health-related quality of life (HRQL). The HRQL impairments were comparable with those associated with depression or panic disorder. Patients with GAD and co-morbid depression reported significantly greater impairment in HRQL than did those with either disorder alone. GAD patients had significantly higher median medical costs than primary care patients without GAD (US $2375 versus $1448). The mean annual medical cost of GAD was $2138 higher than for other anxiety disorders (mean $6475). Finally, GAD was frequently under-recognized in primary care, and available studies reported that only 20% to 32% of patients were adequately treated.

LIMITATIONS

The review was limited to pharmacologic treatments for GAD and to publications in English.

CONCLUSIONS

GAD is associated with significant burden on patient functioning and well-being, leading to increased health care utilization and medical costs. Patients with GAD are often suboptimally treated, which adds to the HRQL burden of this disorder.

Health-related quality of life among children with acute lymphoblastic leukemia

BACKGROUND

The objective was to quantify the health-related quality of life (HRQL) of children treated for acute lymphoblastic leukemia (ALL) and identify specific disabilities for remediation.

PROCEDURE

Two types of subjects were included: ALL patients 5 plus years old in a multi-center clinical trial and general population control groups. Patients were assessed during all four major phases of active treatment and approximately 2 years after treatment. Health status and HRQL were measured using HEALTH UTILITIES INDEX® (HUI®) Mark 2 (HUI2) and Mark 3 (HUI3). HRQL scores were used to calculate quality-adjusted life years (QALYs). Excess disability rates identified attributes for remediation.

RESULTS

HUI assessments (n = 749) were collected during the five phases. Mean HRQL increased from induction through the post-treatment phase (P < 0.001). There were no significant demographic or treatment effects on HRQL, except for type of asparaginase during continuation therapy (P = 0.005 for HUI2 and P = 0.007 for HUI3). Differences in mean HRQL scores between patients and controls were important (P < 0.001) during the active treatment phases but not during the post-treatment phase. Relative to controls, patients lost approximately 0.2 QALYs during active treatment. Disability was evident in mobility/ambulation, emotion, self-care and pain, and declined over time.

CONCLUSIONS

Patients with ALL experienced important but declining deficits in HRQL during active treatment phases: Equivalent to losing approximately 2 months of life in perfect health. HRQL within the 2-years post-treatment phase was similar to controls. The policy challenge is to develop new treatment protocols producing fewer disabilities in mobility/ambulation, emotion, self-care, and pain without compromising survival.

Alcohol use patterns and trajectories of health-related quality of life in middle-aged and older adults: a 14-year population-based study

OBJECTIVE

A 14-year multiwave panel design was used to examine relationships between longitudinal alcohol-consumption patterns, especially persistent moderate use, and change in health-related quality of life among middle-aged and older adults.

METHOD

A nationally representative sample of 5,404 community-dwelling Canadians ages 50 and older at baseline (1994/1995) was obtained from the longitudinal National Population Health Survey. Alcohol-consumption patterns were developed based on the quantity and frequency of use in the 12 months before the interview. Health-related quality of life was assessed with the Health Utilities Index Mark 3 (HUI3). Latent growth curve modeling was used to estimate the change in HUI3 for each alcohol pattern after adjusting for covariates measured at baseline.

RESULTS

Most participants showed stable alcohol-consumption patterns over 6 years. Persistent non-users, persistent former users, those decreasing their consumption levels, and those with unstable patterns (i.e., U shaped and inverted U shaped) had lower HUI3 scores at baseline compared with persistent moderate drinkers. A more rapid decline in HUI3 scores than that observed for persistent moderate users was seen only in those with decreasing consumption (p < .001). In a subgroup identified as consistently healthy before follow-up, longitudinal drinking patterns were associated with initial HUI3 scores but not rates of change.

CONCLUSIONS

Persistent moderate drinkers had higher initial levels of health-related quality of life than persistent nonusers, persistent former users, decreasing users, U-shaped users, and inverted U-shaped users. However, rates of decline over time were similar for all groups except those decreasing their consumption, who had a greater decline in their level of health-related quality of life than persistent moderate users.

Treatment patterns and costs in patients with generalised anxiety disorder: one-year retrospective analysis of data from national registers in Sweden

PURPOSE

To investigate medication use, direct healthcare costs and comorbidities in patients with generalised anxiety disorder (GAD) within specialised care in Sweden 2006-2007.

METHODS

A retrospective study was conducted using data from the National Patient Register and the Swedish Prescribed Drug Register. All patients with a primary GAD (ICD-10) diagnosis in 2006 were followed for 12 months to study medication use and health care consumption. Resource use was evaluated from the number of hospitalisation episodes, number of visits to outpatient care and medication dispensed. Costs were calculated by multiplying the number of visits and hospitalisation episodes with the corresponding unit costs. Descriptive statistics were used for all analyses.

RESULTS

Three thousand seven hundred and one patients with a primary GAD diagnosis were included in the study. Thirty-four percent of the patients (n=1246) had at least one secondary comorbid diagnosis. SSRIs/SNRIs were the most commonly dispensed medications, followed by benzodiazepine-anxiolytics, hypnotics and antihistamines. The mean number of treatment days for all medications prescribed and dispensed was highest (1144 days) for elderly women aged 65 years or more (treatment days per patient could exceed 365 days due to multiple concomitant medication use). Elderly patients were frequently prescribed benzodiazepine-anxiolytics (n=92/117 men [79%]; n=238/284 women [84%]) and hypnotics (n=70 men [60%]; n=178 women [63%]) compared to the overall study population (n=612/1303 men [47%] and n=935/2398 women [39%], respectively). GAD-related direct costs accounted for 96% of all direct costs. Mean number of hospitalisation days and corresponding costs were high (19 days; SEK 92,156; n=358 [9.7%]) in relation to medication (SEK 5520; n=3352 [91%]) and outpatient costs (SEK 7698; n=3461 [94%]).

CONCLUSIONS

The high rate of polypharmacy, significant psychiatric comorbidity and widespread use of benzodiazepine-anxiolytics and medications not indicated for GAD suggest that the disease burden is high. Total direct costs associated with the disease were high but still likely to be underestimated.

Prevalence of anxiety and its correlates among older adults in Latin America, India and China: cross-cultural study

BACKGROUND

Anxiety is a common mental disorder among older people who live in the Western world, yet little is known about its prevalence in low- and middle-income countries.

AIMS

We investigated the prevalence of anxiety and its correlates among older adults in low- and middle-income countries with diverse cultures.

METHOD

Cross-sectional surveys of all residents aged 65 or over (n = 15 021) in 11 catchment sites in 7 countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru) were carried out as part of the 10/66 collaboration. Anxiety was measured by using the Geriatric Mental State Examination (GMS) and the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) diagnostic algorithm.

RESULTS

The age- and gender-standardised prevalence of anxiety varied greatly across sites, ranging from 0.1% (95% CI 0.0-0.3) in rural China to 9.6% (95% CI 6.2-13.1) in urban Peru. Urban centres had higher estimates of anxiety than their rural counterparts with adjusted (age, gender and site) odds ratios of 2.9 (95% CI 1.7-5.3). Age, gender, socioeconomic status and comorbid physical illnesses were all associated with a GMS/AGECAT diagnosis of anxiety, and so was disability (World Health Organization Disability Assessment Schedule II).

CONCLUSIONS

Anxiety is common in Latin America. Estimates from this region are similar to the ones from high-income European countries found in the literature. As demographic change will occur more rapidly in these countries, further research exploring the mental health of older people in developing areas is vital, with the inclusion of other specific anxiety disorders, along with evidence for strategies for supporting those with these disorders.

Correlates of quality of life and functional disability in individuals with body dysmorphic disorder

OBJECTIVE

Body dysmorphic disorder (BDD) is a chronic mental illness characterized by low quality of life and functional disability across multiple domains. Despite the clinical importance of understanding impairment in BDD, there has been little research examining the factors that contribute to these constructs. The present study was designed to examine sociodemographic and clinical correlates of quality of life and disability (work, social, and family) in a sample of individuals with moderately severe BDD symptoms.

METHOD

Participants completed an internet survey with questions about demographics, BDD phenomenology, treatment, and impairment. Only participants who completed all study measures and received a score≥16 on the 10-item Yale-Brown Obsessive Compulsive Scale, Modified for BDD (BDD-YBOCS), indicating the presence of clinical BDD symptoms, were included in the analysis (n=256). Multivariate regression with backwards variable selection was used to identify significant predictors of quality of life and functional disability, assessed with the Quality of Life Enjoyment and Satisfaction Scale-Short Form (QLESQ-SF) and the Sheehan Disability Scale (SDS), respectively.

RESULTS

BDD symptom severity was inversely associated with quality of life and directly associated with disability in all domains. After controlling statistically for BDD symptom severity, sociodemographic and clinical factors such as age, gender, ethnicity, marital status, insurance, body parts of concern, depression symptoms, and anxiety symptoms were significantly associated with impairment.

CONCLUSION

Results suggest a multidimensional nature of quality of life and functional disability and underscore the importance of developing holistic treatment strategies to address impairment in BDD.

The role of values-consistent behavior in generalized anxiety disorder

BACKGROUND

Theory and research suggest that generalized anxiety disorder (GAD) is associated with diminished quality of life and restriction in valued action. The purpose of this study was to examine the relevance of values-consistent behavior (valued action) in understanding the impairment in quality of life in GAD.

METHOD

Treatment-seeking clients with a principal diagnosis of GAD (n = 30) were compared with demographically matched nonanxious controls (n = 30) using self-report measures.

RESULTS

Participants with GAD reported significantly less valued action compared with controls, and within the GAD group, diminished valued action was not fully explained by depression comorbidity. Valued action was significantly correlated with measures of experiential avoidance, distress about emotions, and quality of life. Further, consistent with a theoretical model of GAD, restrictions in valued action contributed unique variance to diminished quality of life over and above the contributions of gender, GAD severity, experiential avoidance, distress about emotions, and depression comorbidity. Finally, an acceptance-based behavioral therapy significantly improved self-reports of valued action for GAD clients with 40% achieving clinically significant change in this domain.

CONCLUSION

The findings provide preliminary support for the relevance of valued action in understanding the functional impairment associated with GAD, and the beneficial effects of an acceptance-based behavior therapy in increasing valued action.

Translation and cultural adaptation of health utilities index with application to pediatric oncology patients during neutropenia and recovery in Turkey

BACKGROUND

This is a report on the translation and cultural adaptation from English to Turkish languages of a standard HEALTH UTILITIES INDEX® (HUI®) questionnaire for interviewer-administration and proxy assessment of patients' health status, and its use for assessing 50 consecutive pediatric oncology patients during periods of and subsequent recovery from neutropenia.

PROCEDURE

Preparation of the Turkish-language questionnaire was a collaborative effort by physician-researchers in Turkey, senior Health Utilities, Inc. staff with extensive experience in the development and translation of HUI questionnaires, and Turkish-born residents of Canada. Standard HUI questionnaires cover both HUI Mark 2 (HUI2) and HUI Mark 3 (HUI3).

RESULTS

The mean improvement in overall health-related quality of life (HRQL) scores between neutropenic and non-neutropenic phases was clinically important according to both HUI2 and HUI3 instruments. Single-attribute utility scores showed clinically important size improvements between phases for HUI2 mobility, emotion, and HUI2 self-care. Significant reductions in disability rates between phases were also detected for pain (HUI2 and HUI3 rate decreases of 30%, P < 0.001) and HUI3 ambulation (rate decline of 14%, P = 0.020).

CONCLUSIONS

The study results provide evidence that the Turkish-language questionnaire is acceptable, valid and useful for collecting parental assessments of health-status among young cancer patients in Turkey. Neutropenia was associated with important deficits in overall HRQL and disabilities in ambulation/mobility, emotion, self-care, and pain. Treatment plans should include strategies for addressing emotion and pain problems to improve the HRQL of neutropenic patients.

Agreement on perceptions of quality of life in couples dealing with infertility

OBJECTIVE

To examine the extent to which men and women seeking treatment for infertility were able to accurately perceive their partners' ratings of their quality of life (QOL).

DESIGN

Cross-sectional prospective study. Quality of life was measured as a multidimensional construct.

SETTING

Assisted reproduction clinic of a university hospital.

PARTICIPANTS

One hundred and sixty-two couples participated. The men's and women's mean ages were 36.1 and 32.1 years, respectively. Most participants had no children, and no previous assisted reproduction attempts.

METHODS

Men and women completed the World Health Organization-Quality of Life-Brief (WHOQOL-Brief) and the Beck Depression Inventory independently. Paired t tests were used to explore men's perceptions of their wives' QOL ratings and wives' perceptions of their husbands' ratings. Multiple regression and repeated-measures ANCOVA were used to examine the role of depression.

RESULTS

Proxy assessments were consistently lower than self-reports on the domains of QOL. The influence of depression on agreement was minimal, and no gender effect was observed.

CONCLUSION

Findings indicated little agreement in perceptions of the partner's QOL, with each partner tending to underrate the other's view. Practitioners need to consider the differences between partners to enable partners to better understand and support each other.

Valuing health in a racially and ethnically diverse community sample: an analysis using the valuation metrics of money and time

PURPOSE

Limited research in health valuation analyzes samples with high proportions of racial/ethnic minorities within the United States. The primary objective was to explore patterns of health valuation across race/ethnicity using the Collaborative Psychiatric Epidemiology Surveys. A secondary objective was to analyze whether mental health disorder and immigrant status were associated with these estimates.

METHODS

Health valuation questions using different metrics (time and money) were analyzed. Ordered logit models stratified across poor and moderate health tested differences by race/ethnicity, with mental health disorder and immigrant status as covariates.

RESULTS

Asians in moderate health and Latinos were willing to pay more for health than non-Latino whites. Asians in moderate health were willing to trade more time for health. Latinos in poor health were less willing to trade time and gave disproportionate zero-trade responses. Lifetime history of anxiety disorder was positively associated with both metrics. Immigrant status confounded money valuation for Asians in moderate health, and time valuation for Latinos in poor health.

CONCLUSIONS

Health valuation estimates vary across race/ethnicity depending upon the metric. Time valuation scenarios appear less feasible for Latinos in poor health. More research is necessary to understand these differences and the role of immigrant status in health valuation.

Psychological distress as predictor of quality of life in men experiencing infertility: a cross-sectional survey

BACKGROUND

Infertility is associated with impairment in human life. The quality of life (QOL) construct allows measuring the impact of health conditions in a broader way. The study aimed to explore the impact of the psychological distress on QOL's dimensions in men experiencing infertility.

METHODS

162 men were completed a socio-demographic form, SF-36, WHOQOL-BREF, Beck Anxiety Inventory and Beck Depression Inventory. Hierarchical regressions included demographic and clinic variables, and subsequently depression and anxiety were added.

RESULTS AND DISCUSSION

Model 1 was not accurate in predicting QOL. R2 values ranged from 0.029 (Social Functioning) to 0.149 (Mental Health). Eight domains were not associated with any of the predictors. In the second model, a R2increase was observed in all domains. R2 of QOL scores ranged from .209 (Role Physical) to .406 (Social Functioning). The intensity of the depression was a significant predictor for all outcomes. The load of depression was higher than the ones of the socio-demographic and clinical variables. Anxiety levels have also presented the same effect, but with less intensity.

CONCLUSION

Subthreshold depression and anxiety were major predictors of QOL in men experiencing infertility. Health professionals need to include assessment of psychological symptomatology to plan more efficient interventions to infertile patients.