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Garbade M, Kappler S, Eglinsky J, Kindler H, Rosner R, Sachser C, Pfeiffer E. Quality of life in unaccompanied young refugees: the role of traumatic events, post-migration stressors and mental distress. BMC Psychiatry 2025; 25:544. [PMID: 40420054 PMCID: PMC12105295 DOI: 10.1186/s12888-025-06975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 05/13/2025] [Indexed: 05/28/2025] Open
Abstract
BACKGROUND Unaccompanied young refugees (UYRs) are exposed to numerous potentially traumatizing events and post-migration stressors before, during, and after migration. These adverse experiences may affect their mental health and their quality of life. Consequently, this study aimed to focus on the quality of life of UYRs and identify factors that may influence it. METHODS Potentially traumatic events (PTEs) and posttraumatic stress symptoms (CATS-2), depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), as well as post-migration stressors (DSSYR) and quality of life (WHOQOL-BREF) were assessed in N = 158 UYRs (MAge = 16.92, SDAge = 1.41, 84.2% male) residing in different child welfare facilities in Germany. Serial mediation models were used to examine the influence of the above-mentioned factors on quality of life. RESULTS UYRs reported a mean of 6.18 (SD = 3.27) PTEs and 9.72 (SD = 4.49) post-migration stressors. The average quality of life ranged between M = 57.72 (SD = 16.46) for environmental quality of life to M = 66.39 (SD = 20.71) for social quality of life. PTEs significantly reduced the reported physical (b = -1.78, p <.001), psychological (b = -1.15, p =.025), and social quality of life (b = -1.98, p <.001) of UYRs. However, these direct effects were mediated by post-migration stressors alone and in series with mental distress. CONCLUSIONS The quality of life of UYRs was not only associated with traumatic experiences but also with post-migration stressors and mental distress. Quality of life captures additional aspects of well-being and therefore, psychosocial care should not only address mental distress but also consider quality of life to achieve a sustainable improvement in the well-being of UYRs. Changes at the political-structural level, aiming to reduce post-migration stressors, could potentially improve the quality of life of UYRs. TRIAL REGISTRATION German Clinical Trials Register DRKS00017453. Registered on December 11, 2019.
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Affiliation(s)
- Maike Garbade
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany.
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany.
- Department of Clinical Psychology and Child and Adolescent Psychotherapy, Catholic University Eichstätt-Ingolstadt, Ingolstadt, Germany.
| | | | - Jenny Eglinsky
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
- Department of Clinical Child and Adolescent Psychology, Otto Friedrich University Bamberg, Bamberg, Germany
| | | | - Rita Rosner
- Department of Clinical and Biological Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
- Department of Clinical Child and Adolescent Psychology, Otto Friedrich University Bamberg, Bamberg, Germany
| | - Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
- German Center for Mental Health (DZPG), partner site Ulm, Ulm, Germany
- Department of Clinical Psychology and Child and Adolescent Psychotherapy, Catholic University Eichstätt-Ingolstadt, Ingolstadt, Germany
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Aarø LE, Knapstad M, Smith OR. Positive mental wellbeing or symptoms of depression? Discriminant validity of the Warwick-Edinburgh Mental Wellbeing Scale. BMC Psychiatry 2025; 25:487. [PMID: 40375190 DOI: 10.1186/s12888-025-06922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/29/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND Scales for the measurement of mental wellbeing and psychological distress are often used as if they measure different underlying concepts. This assumption is addressed in the present study by examining the discriminant validity of the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) with respect to the Patient Health Questionnaire (PHQ-9). METHODS The present study is based on data (n = 1690) from a baseline data collection which was carried out as part of the evaluation of 'Prompt Mental Health Care' (PMHC), the Norwegian Version of the British 'Improving Access to Psychological Therapies' (IAPT) services. PMHC offers low-threshold treatment for patients with mild to moderate depression or anxiety. Three out of four of the sample were women and three out of four were in the age range 21-50 years. Data were examined by means of structural equation- and latent variable modeling, including bifactor analysis and MIMIC models. Both the 7-item and 14-item versions of the WEMWBS were considered. RESULTS (i) The correlations between PHQ-9 and the WEMWBS scales were strong and negative, approaching -0.80 in the latent model analyses with the full (14 items) WEMWBS scale. (ii) Psychometric indices derived from the bifactor models suggested that the WEMWBS-7 and PHQ-9 jointly, and the WEMWBS-14 and PHQ-9 jointly were essentially unidimensional. (iii) The associations between PHQ-9 and a set of demographic variables were similar to associations between the WEMWBS scales and the same set of demographic variables, only with reversed signs. (iv) Associations between the residual WEMWBS scales and a set of demographic variables decreased strongly when removing the reliable variance accounted for by the general depressive symptoms factor. CONCLUSION The results of our study suggest that the WEMWBS may lack discriminant validity with regard to the PHQ-9 in a sample of primary care patients with mild-to-moderate anxiety and/or depression.
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Affiliation(s)
- Leif Edvard Aarø
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gt. 7, Bergen, NO-5015, Norway.
| | - Marit Knapstad
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gt. 7, Bergen, NO-5015, Norway
| | - Otto Robert Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes Gt. 7, Bergen, NO-5015, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, PO Box 4404, Nydalen, NO-0403, Norway
- Department of Teacher Education, NLA University College, PO Box 74, Sandviken, NO-5812, Norway
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Petkari E, Lapin B, Boehnke JR. Quality of life dimensions in people living with mental disorders: moving beyond global scores. Qual Life Res 2025; 34:589-591. [PMID: 39549143 DOI: 10.1007/s11136-024-03844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2024]
Affiliation(s)
- Eleni Petkari
- School of Psychology, University of Malaga, Malaga, Spain.
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, USA
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
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Dagnew B, Honan CA, Laslett LL, Taylor BV, Campbell J, Blizzard L, van der Mei I. Impact of sleep quality on health-related quality of life domains and the mediating effects of symptoms in people with multiple sclerosis. Qual Life Res 2025; 34:563-575. [PMID: 39537977 DOI: 10.1007/s11136-024-03836-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE Many people living with multiple sclerosis (PwMS) experience poor sleep, which is associated with diminished overall health-related quality of life (HRQoL). We quantified associations between sleep quality and HRQoL domains and examined the extent to which other MS symptoms could account for these associations. METHODS In this cross-sectional survey of 1,717 Australians with MS, we used Assessment of Quality of Life (AQoL) 8D and Pittsburgh Sleep Quality Index (PSQI) to assess HRQoL and sleep quality, respectively. Total, direct, and indirect effects of sleep quality on HRQoL domains were determined using mediation regression analysis. RESULTS Poor sleep quality was significantly associated with all domains of HRQoL, with strongest associations seen for mental health (β=-0.08) and pain (β=-0.11), and weaker associations for independent living (β=-0.05) and senses (β=-0.03). Poor sleep quality had the largest direct effect on mental health (60.8%), happiness (48.7%), and pain (49.7%). MS symptom clusters mostly contributing to indirect effects were "feelings of anxiety and depression" for psychosocial, and "pain and sensory symptoms" for physical HRQoL super dimensions. CONCLUSION Improving sleep could lead to substantial improvements in all HRQoL domains and the improvement in HRQoL could be partially achieved through indirect improvements in sleep on MS symptoms.
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Affiliation(s)
- Baye Dagnew
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Cynthia A Honan
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
| | - Laura L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Julie Campbell
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
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Havnen A, Lindberg MS, Lundqvist J, Brattmyr M, Hjemdal O, Solem S. Health-related quality of life in psychiatric outpatients: a cross-sectional study of associations with symptoms, diagnoses, and employment status. Qual Life Res 2024; 33:3093-3105. [PMID: 39110377 PMCID: PMC11541330 DOI: 10.1007/s11136-024-03748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 11/07/2024]
Abstract
BACKGROUND This cross-sectional study aimed to explore health-related quality of life (HRQoL) in a large heterogeneous patient sample seeking outpatient treatment at a specialist mental health clinic. METHOD A sample of 1947 patients with common mental disorders, including depressive-, anxiety-, personality-, hyperkinetic- and trauma-related disorders, completed the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) to assess HRQoL. We investigated clinical and sociodemographic factors associated with the EQ-5D index and the EQ Visual Analogue Scale (VAS) using regression analyses. RESULTS The sample reported lower HRQoL compared with the general population and primary mental health care patients. Sick leave, disability pension, work assessment allowance, and more symptoms of anxiety and depression were associated with lower EQ-5D index and EQ VAS scores. Furthermore, being male, use of pain medication and having disorders related to trauma were associated with reduced EQ-5D index scores, while hyperkinetic disorders were associated with higher EQ-5D index scores. CONCLUSION HRQoL of psychiatric outpatients is clearly impaired. This study indicated a significant association between employment status, symptom severity, and HRQoL in treatment-seeking outpatients. The findings highlight the importance of assessing HRQoL as part of routine clinical assessment.
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Affiliation(s)
- Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, NO-7491, Norway.
- Division of Psychiatry, Nidaros Community Mental Health Centre, St. Olav's University Hospital, Trondheim, Norway.
| | - Martin Schevik Lindberg
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
- Health and welfare, Trondheim Municipality, Norway
| | - Jakob Lundqvist
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, NO-7491, Norway
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Belay YB, Mihalopoulos C, Lee YY, Engel L. Health-related quality of life and utility values among patients with anxiety and/or depression in a low-income tertiary care setting: a cross-sectional analysis. Qual Life Res 2024; 33:2819-2831. [PMID: 39012559 PMCID: PMC11452469 DOI: 10.1007/s11136-024-03735-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES To describe the health-related quality of life (HRQoL), estimate the associated health state utility values (HSUVs) and explore factors associated with HRQoL of patients with anxiety and/or depression in a resource-limited hospital setting. METHODS A cross-sectional survey involving 462 participants was conducted in a hospital setting. The Amharic version of the EQ-5D-5 L assessed HRQoL, while the GAD-7 and PHQ-9 measured severity of anxiety and depression symptoms respectively. HSUVs were analysed based on clinical and demographic profiles; mean differences were compared using t-tests and one-way ANOVA; Scheffe's post hoc comparisons and effect sizes (Cohen's d statistic) were used to assess the magnitude of group differences. Factors associated with HRQoL were explored using regression analysis. RESULTS The mean HSUV was 0.87 (SD = 0.17) and the EQ VAS was 71.4 (SD = 19.1). Patients with both anxiety and depression scored significantly lower (HSUV = 0.83 [0.16], EQ VAS = 64.4 [17.9]) compared to those with either anxiety only (HSUV = 0.88 [0.17], EQ VAS = 75.3 [17.9]) or depression only (HSUV = 0.89 [0.18], EQ VAS 74.4 [19.7]). Males had slightly higher mean scores than females, while those aged 18-35 years demonstrated the highest scores on both the EQ-5D-5 L and EQ VAS. Older age (β=-0.002), higher PHQ-9 scores (β=-0.008) and comorbid hypertension (β=-0.07) associated with lower HSUVs. Lower EQ VAS scores were associated with being female (β=-4.4), having comorbid hypertension (β=-7.4) and higher PHQ-9 scores (β=-0.86), while a positive association was found with having 'more than enough' income (β = 11.8). CONCLUSIONS Older age, severity or co-diagnosis of anxiety or depression and comorbid conditions were associated with lower HRQoL, highlighting the need for better interventions to improve the HRQoL of patients with anxiety and depression in Ethiopia.
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Affiliation(s)
- Yared Belete Belay
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- School of Pharmacy, Mekelle University, Mekelle, Ethiopia.
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yong Yi Lee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Wiehn J, Kurth T, Ravens-Sieberer U, Prugger C, Piccininni M, Reiss F. Effect of elevated depressive symptoms during adolescence on health-related quality of life in young adulthood-a six-year cohort study with repeated exposure measurements. Front Pediatr 2024; 12:1252964. [PMID: 39055620 PMCID: PMC11269264 DOI: 10.3389/fped.2024.1252964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Objectives Depression is a major contributor of young people's burden of disease. In this study we aim to estimate the effect of elevated depressive symptoms on physical health-related quality of life. Design We used self-reported information from the prospective BELLA cohort study, which included adolescents selected from the general population in Germany. The baseline assessment (2003-2006) and the 1-, 2-, and 6-year follow-up waves provide the data basis. Participants The baseline study population consisted of 1,460 adolescents between the ages of 12 and 17 who, according to their caregivers, did not suffer from depression. Variables The primary outcome, as measured by the physical component score (PCS) of the SF-36 at a 6-year follow-up (range: 0-100), is physical health-related quality of life. The exposure of interest is depressive symptoms, as measured by the Center for Epidemiological Studies Depression Scale for Children (CES-DC) at baseline, 1-year follow-up and 2-year follow-ups (range: 0-60). We dichotomized the exposure into subthreshold (≤15) and elevated depressive symptoms (>15). For the main analyses we considered a cumulative index for elevated depressive symptoms across the three time points (range: 0-3). Considered confounders are sex, age, socioeconomic status, migrant background, social support, anxiety symptoms, physical activity, chronic diseases, and sleeping problems. Statistical methods We used multiple imputation to account for missing values. Within each imputed dataset, we applied inverse probability weighting (IPW) to estimate the effect of the cumulative index for elevated depressive symptoms at baseline, 1- and 2-year follow-up on physical health-related quality of life at 6-year follow-up. We derived 95% confidence intervals by bootstrapping. Results After adjusting with IPW, the effect of the cumulative index per one unit increase of elevated depressive symptoms on the physical component score was -1.71 (95% CI: -3.51 to -0.04). The adjusted effect estimates of single exposure of elevated depressive symptoms on physical health-related quality of life were -0.83 (95% CI: -3.69 to 1.87) at baseline, -2.96 (95% CI: -4.94 to -0.52) at 1-year follow-up and -1.32 (95% CI: -3.85 to 1.15) at 2-year follow-up. Conclusion Findings suggest that elevated depressive symptoms during adolescence decrease physical health-related quality of life in young adulthood.
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Affiliation(s)
- Jascha Wiehn
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christof Prugger
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Piccininni
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Reiss
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ecker AH, Shivaji S, Plasencia M, Kauth MR, Hundt NE, Fletcher TL, Sansgiry S, Cully JA. The role of symptom reduction in improving health-related quality of life through brief cognitive behavioral therapy. Psychother Res 2024:1-9. [PMID: 38861659 DOI: 10.1080/10503307.2024.2349992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/25/2024] [Indexed: 06/13/2024] Open
Abstract
Brief cognitive behavior therapy (bCBT) is effective in reducing symptoms of depression and anxiety disorders and improving health-related quality of life (HRQoL). However, the mechanisms through which cognitive behavior therapy impact HRQoL are not well understood. This study evaluated whether anxiety and depression symptom reduction is a mechanism of treatment for HRQoL outcomes. METHOD Using secondary data from a multisite, pragmatic, randomized trial, this study evaluated bCBT vs enhanced usual care in 16 VA community-based outpatient clinics. Ordinary least-squares path analysis testing multiple mediators was used to evaluate the role of change in depression and anxiety symptoms in the relationship between treatment condition and HRQoL. RESULTS Receiving bCBT (vs. enhanced usual care) was significantly negatively associated with change (reduction) in depression and anxiety scores. The indirect effect of treatment on mental HRQoL was significant with change in depression scores as mediator. A similar pattern was observed for physical HRQoL and change in anxiety scores as mediator. CONCLUSION Findings suggest reduction of depression and anxiety symptoms as a mechanism through which bCBT for depression promoted improvements in HRQoL, with important implications for understanding how CBT impacts functioning, as well as the utility of bCBT in nontraditional mental health settings. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02466126.
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Affiliation(s)
- Anthony H Ecker
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Maribel Plasencia
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michael R Kauth
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- LGBTQ+ Health Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, DC, USA
| | - Natalie E Hundt
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Terri L Fletcher
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Shubhada Sansgiry
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Cully
- Houston VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Li X, Wang P, Jiang Y, Yang Y, Wang F, Yan F, Li M, Peng W, Wang Y. Physical activity and health-related quality of life in older adults: depression as a mediator. BMC Geriatr 2024; 24:26. [PMID: 38182991 PMCID: PMC10770982 DOI: 10.1186/s12877-023-04452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/02/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Physical activity(PA) is associated with health-related quality of life (HRQoL) among older adults, and both are associated with mood, such as depression. However, the indirect effects of PA on HRQoL in older adults have not been clearly established. This study explained how different types and intensities of PA were associated with HRQoL while considering the effects of depression in older adults. METHODS A cross-sectional study was conducted with 7,518 community-dwelling older adults aged 60 years and older. PA (leisure-time, household, and work-related), depression, and HRQoL were measured using the Physical Activity Scale for the Elderly (PASE), the 30-item Geriatric Depression Scale (GDS-30), and the 36-Item Short-Form Health Survey (SF-36), respectively. Information on age, gender, education, monthly income, activities of daily living, smoking, and alcohol drinking was also collected. Regression analysis was used to explore the relationship between PA, depression and HRQoL, and a mediation effect test process was used to verify the mediating mechanism of the depression on this relationship. RESULTS The study showed that after adjusting for a set of covariates, SF-36 Physical Component Summary (PCS) scores were negatively associated with depression (B = -2.046, 95% CI [2.584, -1.509]) and positively with PA (p < 0.001). Similarly, SF-36 Mental Component Summary (MCS) scores were negatively associated with depression (B = -11.657, 95% CI [-12.190, -11.124]). In mediation analyses, we found that depression partially mediated the relationship between different types and intensities PA and PCS (moderate leisure-time PA: B = 0.223, 95%CI [0.153,0.293], P < 0.001; vigorous leisure-time PA: B = 0.323, 95%CI [0.232,0.413], P < 0.001; moderate household PA: B = 0.092, 95%CI [0.045,0.139], P < 0.001; vigorous household PA: B = 0.137, 95%CI [0.085,0.190], P < 0.001; work-related PA: B = 0.193, 95%CI [0.658,0.190], P < 0.001) and MCS (moderate leisure-time PA: B = 1.243, 95%CI [1.008,1.479], P < 0.001; vigorous leisure-time PA: B = 1.800, 95%CI [1.585,2.015], P < 0.001; moderate household PA: B = 0.496, 95%CI [0.274,0.718], P < 0.001; vigorous household PA: B = 0.742, 95%CI [0.521,0.963], P < 0.001; work-related PA: B = 1.026, 95%CI [0.819,1.234], P < 0.001). CONCLUSIONS This study suggested that leisure-time, household, and work-related PA were negatively associated with depression, while positively affecting HRQoL in Chinese older adults. The relationships between different types and intensities of PA and HRQoL were mediated by depression. Interventions aimed at promoting purposeful exercise and different types of PA may have mental health benefits. It is recommended that geriatric health managers and healthcare planners prioritize interventions to help improve PA intensities, alleviate depressive symptoms to promote beneficial effects on HRQoL in older adults.
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Affiliation(s)
- Xiuxiu Li
- School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Pengfei Wang
- School of Public Health, Fudan University, Shanghai, China
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Yihua Jiang
- Minhang District Mental Health Center of Shanghai, Fudan University, Shanghai, China
| | - Yinghua Yang
- Clinical Laboratory Center in Shanghai, Shanghai, China
| | - Feng Wang
- Minhang District Mental Health Center of Shanghai, Fudan University, Shanghai, China
| | - Fei Yan
- School of Public Health, Fudan University, Shanghai, China
| | - Ming Li
- Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
| | - Wenjia Peng
- School of Public Health, Fudan University, Shanghai, China.
| | - Ying Wang
- School of Public Health, Fudan University, Shanghai, China.
- NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
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Lu A, Li J, Liu Y, Du X, Wang Y, Wang X. Dietary fiber intake is positively associated with health-related quality of life in patients with hypertension: The mediating role of anxiety in mental component summary. Nutr Res 2023; 118:94-103. [PMID: 37603904 DOI: 10.1016/j.nutres.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023]
Abstract
Few studies have focused on the exploration of the relationship between dietary fiber intake (DFI) and health-related quality of life (HRQoL) and its mediators in hypertensive patients. This study is a cross-sectional survey and the data were obtained from hypertensive patients from Suzhou, China. The DFI, office systolic blood pressure and diastolic blood pressure, anxiety and depression, and HRQoL were investigated. We hypothesized that blood pressure, anxiety, and depression mediated the association between DFI and HRQoL, and used Pearson correlations, linear regression, and bootstrap tests to validate this relationship. A total of 211 hypertensive patients aged 20 to 64 years were included in this study. The average DFI was 12.4 ± 5.2 g/d, and the scores of physical component summary and mental component summary (MCS) were 46.5 ± 6.1 and 46.4 ± 6.4, respectively. DFI was positively correlated with physical component summary (r = 0.17, p = 0.014) and MCS (r = 0.27, P < .001). After controlling for sociodemographic and clinical characteristics, neither systolic blood pressure nor diastolic blood pressure showed mediating effects in the mediated model of DFI on MCS, whereas anxiety (b = -0.30; 95% confidence interval, -0.41 to -0.18) fully mediated the improvement in MCS by DFI (F = 11.14, P < .001). Because the MCS of HRQoL encompassed the assessment of depression, we did not analyze the mediating effect of depression in this model in order to avoid variable duplication. The decreased DFI is a risk factor for lower HRQoL, and anxiety mediated the relationship between DFI and MCS. Further research should focus on increasing DFI and reducing anxiety levels in hypertensive patients to improve their quality of life.
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Affiliation(s)
- Anping Lu
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; School of Nursing, Medical College, Soochow University, Suzhou 215006, China.
| | - Jingjing Li
- Department of Rheumatology and Immunology, Shenzhen People's Hospital, Shenzhen 518020, China.
| | - Yuanyuan Liu
- Division of Digestion, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Xiaojiao Du
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Yun Wang
- Nephrology Department, The Second Affiliated Hospital of Soochow University, Suzhou 215006, China.
| | - Xiaohua Wang
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
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Maguire S, Davison J, McLaughlin M, Simms V, Bunting B. Exploring the psychometric properties of self-report instruments used to measure health-related quality of life and subjective wellbeing of adolescents with intellectual disabilities: A Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) systematic review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:899-915. [PMID: 37101341 DOI: 10.1111/jar.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Studies that have systematically reviewed the psychometric properties of health-related quality of life (HRQoL) and subjective wellbeing instruments for adolescents with intellectual disabilities narrowly focus on disease or health-specific conditions. This review aimed to critically appraise the psychometric properties of self-report instruments used to measure HRQoL and subjective wellbeing of adolescents with intellectual disabilities. METHOD A systematic search was undertaken in four databases. The quality of the included studies and their psychometric properties was assessed according to the COnsensus-based Standards for the selection of health Measurement Instruments Risk of Bias checklist. RESULTS Seven studies reported psychometric properties of five different instruments. Only one instrument identified as having potential to be recommended for use but requires further validation research to assess its quality for this population. CONCLUSIONS There is insufficient evidence to support the recommendation of a self-report instrument to assess HRQoL and subjective wellbeing of adolescents with intellectual disabilities.
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Affiliation(s)
| | - Jenny Davison
- School of Psychology, University of Ulster, Coleraine, UK
| | | | - Victoria Simms
- School of Psychology, University of Ulster, Coleraine, UK
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12
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Belson PJ, Pike NA, Eastwood JA, Brecht ML, Berry JL, Hays RD. Vision-related quality of life compared to generic measures in retinoblastoma survivors. Qual Life Res 2023; 32:1095-1105. [PMID: 36520266 PMCID: PMC9753081 DOI: 10.1007/s11136-022-03315-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To (1) Compare vision-related quality of life (VRQOL) in adolescent and young adult (AYA) unilateral versus bilateral retinoblastoma (RB) survivors using a vision-targeted measure and a generic health-related quality of life (HRQOL) measure and (2) Assess associations among VRQOL and generic HRQOL domains and overall QOL and estimate associations of the VRQOL and HRQOL domains with overall QOL. METHODS The National Institute for Health (NIH) Toolbox® VRQOL instrument, PROMIS®-29 Profile v 2.1, and a single-item QOL measure were administered in a cross-sectional study of 101 RB survivors. Reliability for multi-item scales was estimated. Product-moment and Spearman rank correlation coefficients and stepwise ordinary least squares were used to measure associations of other variables with overall QOL. RESULTS Significantly worse VRQOL was reported by bilateral than unilateral RB survivors. Cronbach's alpha coefficients for all VRQOL scales ranged from 0.83 to 0.95. Medium to large correlations were found between all NIH Toolbox® VRQOL scales and the PROMIS®-29 measures. Depression and ability to participate in social roles and activities from the PROMIS®-29 Profile accounted for 38% of the variance in overall QOL with the psychosocial domain of the NIH Toolbox® VRQOL explaining 16% of the variance. CONCLUSION VRQOL is impaired in bilateral RB survivors. VRQOL is associated substantially with the PROMIS-29 generic HRQOL measure but has significant unique associations with overall QOL. The NIH Toolbox® VRQOL measure provides important information about the vision-related effects on daily life of AYA RB survivors.
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Affiliation(s)
- Paula J. Belson
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd. Mailstop #12, CA 90027 Los Angeles, USA
| | - Nancy A. Pike
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd. Mailstop #12, CA 90027 Los Angeles, USA
- School of Nursing, University of California, Los Angeles, CA USA
| | - Jo-Ann Eastwood
- School of Nursing, University of California, Los Angeles, CA USA
| | - Mary-Lynn Brecht
- School of Nursing, University of California, Los Angeles, CA USA
| | - Jesse L. Berry
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd. Mailstop #12, CA 90027 Los Angeles, USA
- USC Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, CA USA
| | - Ron D. Hays
- RAND Corporation, Santa Monica, CA USA
- School of Medicine, School of Public Health, University of California. Los Angeles, Los Angeles, USA
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13
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Clarke EL, Allott K, Anderson JFI, Gao CX, Filia KM, Killackey E, Cotton SM. Heterogeneity of quality of life in the later stages of first-episode psychosis recovery. Qual Life Res 2023; 32:769-780. [PMID: 36378390 PMCID: PMC9992035 DOI: 10.1007/s11136-022-03277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE First-episode psychosis (FEP) is characterised by wide heterogeneity in terms of symptom presentation and illness course. However, the heterogeneity of quality of life (QoL) in FEP is not well understood. We investigated whether subgroups can be identified using participants' responses on four QoL domains (physical health, psychological, social relationships, and environmental) 18-months into the recovery phase of FEP. We then examined the discriminant validity of these subgroups with respect to clinical, cognitive, and functioning features of FEP. METHOD Demographic and clinical characteristics, QoL, cognition, and functioning were assessed in 100 people with FEP at the 18-month follow-up of a randomised controlled trial of Individual Placement Support, which aims to facilitate vocational recovery. QoL was measured using the World Health Organisation's QoL-BRIEF. A two-stage clustering approach using Ward's method and Squared Euclidean Distance with a k-means confirmation was conducted. Multinomial logistic regressions were used to establish external validity. RESULTS Three QoL subgroups emerged: a 'good' subgroup with relatively high QoL across all domains (31%), an 'intermediate' subgroup with relatively low psychological QoL (48%) and a 'poor' subgroup with markedly low social relationship QoL (21%). Negative symptoms, depressive symptoms, social/occupational functioning, and social inclusion at follow-up predicted subgroup membership. Sensitivity analysis found similar results. CONCLUSION Although some individuals with FEP have QoL comparable to individuals without mental ill health, QoL can remain concerningly low despite treatment efforts. Future research on interventions that target factors associated with poor QoL, such as low social inclusion, is required to counteract prolonged poor QoL in FEP.
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Affiliation(s)
- E L Clarke
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - K Allott
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - C X Gao
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - K M Filia
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - E Killackey
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - S M Cotton
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
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14
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Strobl R, Harajli S, Huppert D, Zwergal A, Grill E. Impact of episodic and chronic vestibular disorders on health-related quality of life and functioning-results from the DizzyReg patient registry. Qual Life Res 2023; 32:1717-1726. [PMID: 36698042 DOI: 10.1007/s11136-023-03345-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Vertigo and dizziness belong to the most frequent syndromes in the primary, secondary and tertiary setting and can be divided into vertigo with episodic or chronic persistent complaints. Episodic vertigo (EVS) is characterized by recurrent attacks of vertigo or dizziness with intermittent symptom-free periods, while chronic vertigo (CVS) presents with persistent vertigo. It is still not completely understood how EVS or CVS affect health-related quality of life (HRQoL) and functioning. METHODS Data originates from the DizzyReg patient registry, an ongoing prospective clinical patient registry situated at tertiary clinic at the university hospital, Munich. HRQoL and functioning was measured by self-report. CVS and EVS was categorized after comprehensive neuro-otological work-up in line with the diagnostic guidelines. Association of CVS and EVS was assessed with multivariable linear regression models adjusting for potential risk factors and confounders. RESULTS The study included 548 patients (57% female, mean age 51.35). Patients with EVS were significantly younger (48.5 vs. 59.6 years) and were more often female (60 vs. 49%). EVS patients reported significantly better functioning (42.1 vs. 47.8) and HRQoL (63.87 vs. 58.08) than CVS patients. The effect was stable after adjusting for potential confounders. CONCLUSION This is the first study to show worse HRQoL in patients with CVS compared to EVS. The results of the study underpin the experience from clinical practice that mobility and balance control are especially important for patients with CVS.
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Affiliation(s)
- Ralf Strobl
- Institute for Medical Information Processing, Biometrics and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Saly Harajli
- Institute for Medical Information Processing, Biometrics and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
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The impact of depression and physical multimorbidity on health-related quality of life in China: a national longitudinal quantile regression study. Sci Rep 2022; 12:21620. [PMID: 36517510 PMCID: PMC9750988 DOI: 10.1038/s41598-022-25092-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
The co-occurrence of mental and physical chronic conditions is a growing concern and a largely unaddressed challenge in low-and-middle-income countries. This study aimed to investigate the independent and multiplicative effects of depression and physical chronic conditions on health-related quality of life (HRQoL) in China, and how it varies by age and gender. We used two waves of the China Health and Retirement Longitudinal Study (2011, 2015), including 9227 participants aged ≥ 45 years, 12 physical chronic conditions and depressive symptoms. We used mixed-effects linear regression to assess the effects of depression and physical multimorbidity on HRQoL, which was measured using a proxy measure of Physical Component Scores (PCS) and Mental Component Scores (MCS) of the matched SF-36 measure. We found that each increased number of physical chronic conditions, and the presence of depression were independently associated with lower proxy PCS and MCS scores. There were multiplicative effects of depression and physical chronic conditions on PCS (- 0.83 points, 95% CI - 1.06, - 0.60) and MCS scores (- 0.50 points, 95% CI - 0.73, - 0.27). The results showed that HRQoL decreased markedly with multimorbidity and was exacerbated by the presence of co-existing physical and mental chronic conditions.
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16
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Sanchez-Luengos I, Lucas-Jiménez O, Ojeda N, Peña J, Gómez-Esteban JC, Gómez-Beldarrain MÁ, Vázquez-Picón R, Foncea-Beti N, Ibarretxe-Bilbao N. Predictors of health-related quality of life in Parkinson's disease: the impact of overlap between health-related quality of life and clinical measures. Qual Life Res 2022; 31:3241-3252. [PMID: 35842497 PMCID: PMC9546987 DOI: 10.1007/s11136-022-03187-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE This study aimed to determine predictors of health-related quality of life (HRQoL) in Parkinson's disease (PD) and to explore their predictive value before and after controlling overlapping items between HRQoL and clinical variables. METHODS One hundred and eight PD patients underwent motor, anxiety, depression, apathy, fatigue, and neurocognition assessment. HRQoL was assessed by the Parkinson's Disease Questionnaire-39 (PDQ-39). In order to determine predictors of HRQoL in PD, stepwise multiple regression analyses were performed in two ways: before and after removing the emotional well-being dimension from PDQ-39 to control the overlap between depression and anxiety, and HRQoL. RESULTS HRQoL total index was predicted by anxiety, fatigue, motor symptoms, and depression, explaining 26.9%, 7.2%, 2.8%, and 1.9% of the variance. However, after removing overlapping items, HRQoL total index was predicted by fatigue (16.5%), anxiety (6.1%), motor symptoms (3.9%), and neurocognition (2.5%), but not depression. Regarding HRQoL dimensions, mobility and activities of daily living were predicted by fatigue (19.7% and 5%) and UPDRS-III (4% and 10.2%); emotional well-being by fatigue (7.9%); social support by anxiety (12.2%) and UPDRS-III (8.6%); communication by neurocognition (5.3%) and UPDRS-III (3.4%); cognition by anxiety (10.6%) and bodily discomfort by anxiety (23%) and fatigue (4.1%). CONCLUSION These findings showed the importance of identifying and controlling overlapping items of HRQoL and clinical measures to perform an accurate interpretation. HRQoL dimensions showed different predictors before and after controlling the overlap. Based on these results fatigue, anxiety, motor symptoms, and neurocognition, but not depression are the main predictors of HRQoL in PD patients.
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Affiliation(s)
| | - Olaia Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | | | | | | | - Nerea Foncea-Beti
- Department of Neurology, Hospital of Galdakao, Galdakao-Usansolo, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
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Rutherford C, Boehnke JR. Introduction to the special section "Reducing research waste in (health-related) quality of life research". Qual Life Res 2022; 31:2881-2887. [PMID: 35907111 DOI: 10.1007/s11136-022-03194-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Claudia Rutherford
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia. .,Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Sydney, Australia. .,The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia.
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
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Pinto Barbosa S, Marques L, Sugawara A, Toledo F, Imamura M, Battistella L, Simis M, Fregni F. Predictors of the Health-Related Quality of Life (HRQOL) in SF-36 in Knee Osteoarthritis Patients: A Multimodal Model With Moderators and Mediators. Cureus 2022; 14:e27339. [PMID: 36042993 PMCID: PMC9415726 DOI: 10.7759/cureus.27339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The study aimed to examine associations between the 36-item short form health survey (SF-36) in clinical and neurophysiological measures to identify its predictors in patients with knee osteoarthritis (KOA) in a rehabilitation program. Methods We analyzed data from our cohort study (DEFINE cohort). We analyzed data from our KOA arm, with 107 patients, including clinical assessments, demographic data, pain scales, motor function (Timed Up and Go Test (TUG), 10 meters walk test, and 6-minute walk), balance (BBS), sleepiness (ESS), and Transcranial Magnetic Stimulation (TMS) and Electroencephalography (EEG). Results Our results showed 83.19% of patients were female with an average age of 68.6 years and an average number of days of pain was 96 days; around 31.86% were using more than five medications per day. Regarding the multimodal model to explain SF-36, the main variables relevant to the quality of life (QoL) were related to emotional aspects, such as anxiety and depression. Moreover, our study added findings with polymorphism (OPRM1/rs1799971) predicting mental aspects. Cognitive variables were important in predicting the mental health, emotional, and social support dimensions of the SF-36. In the physical domain, pain-related variables predominantly predicted QoL in these relationships. The domain of vitality significantly predicted all dimensions studied, except for mental and general health. Conclusion The results help in understanding the aspects that contribute to QoL and are discussed considering the general literature on physical rehabilitation and specific to this clinical group. Furthermore, the statistical methods allowed us to explore and effectively understand the dimensions related to QoL.
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19
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Schuster B, Peifer C, Ziehfreund S, Tizek L, Biedermann T, Zink A, Schielein MC. Happiness and depression in psoriasis: a cross-sectional study in Germany. Qual Life Res 2022; 31:1761-1773. [PMID: 34532835 PMCID: PMC9098583 DOI: 10.1007/s11136-021-02991-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE Prior research on the psychological consequences of skin diseases has focused on assessing mental comorbidities. The aim of this study was to investigate subjective well-being in a large sample of individuals affected by psoriasis, a chronic inflammatory skin disease, and to explore the associations with depression and disease-related parameters such as disease severity. METHODS A cross-sectional online survey was conducted from March to June 2019. The link to the questionnaire was shared on websites and Facebook pages of psoriasis patient organizations and campaigns. Participants filled in validated scales measuring subjective well-being-operationalized as positive affect (PA), negative affect (NA) and satisfaction with life (SWL); and depression. RESULTS The data of 722 participants were analyzed. Exploratory factor analysis supported the differentiation of PA, NA, SWL, and depression as four different constructs. The respondents reported lower levels of PA than healthy individuals and judged themselves to be less happy and were less satisfied with their lives than the general population (except age group 65 + years). 40.3% of respondents were screened positive for depression. More severe psoriasis was associated with lower affective well-being and a higher risk for depression. CONCLUSION The results of this study empirically supported the differentiation of subjective well-being and depression as different constructs in individuals with psoriasis, and underline the large mental burden of the disease which goes beyond a higher risk for depression. Measures of well-being should thus be incorporated in both research and clinical practice in patients with psoriasis in order to achieve a more comprehensive picture of the mental burden of this disease.
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Affiliation(s)
- Barbara Schuster
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany.
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Pettenkofer School of Public Health, LMU Munich, Munich, Germany.
| | - Corinna Peifer
- Department of Psychology, University of Lübeck, Lübeck, Germany
| | - Stefanie Ziehfreund
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Linda Tizek
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
- Division of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maximilian C Schielein
- Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Pettenkofer School of Public Health, LMU Munich, Munich, Germany
- Division of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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O'Loughlin R, Hiscock H, Pan T, Devlin N, Dalziel K. The relationship between physical and mental health multimorbidity and children's health-related quality of life. Qual Life Res 2022; 31:2119-2131. [PMID: 35094215 PMCID: PMC9188523 DOI: 10.1007/s11136-022-03095-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 12/04/2022]
Abstract
Purpose To examine the relationships between physical health problems, and borderline or clinical levels of mental health symptoms and children’s health-related quality of life (HRQoL). Methods Data were from the Longitudinal Study of Australian Children (2004–2018). Parents reported on their child’s HRQoL (PedsQL), physical health problems and mental health symptoms (Strengths and Difficulties Questionnaire, SDQ). A pooled cross-sectional analysis using linear regressions examined the relationships between physical health and clinical/borderline mental health symptoms, individually and when multi-morbid, and children’s HRQoL, and whether these relationships vary by a range of child, family and social factors. Results The sample comprised 47,567 observations of children aged 4–17 years. Borderline and clinical levels of mental health symptoms were associated with significantly lower HRQoL, equal to more than two-times (10.5 points) and more than three-times (16.8 points) the clinically meaningful difference, respectively. This was a larger difference than that associated with physical health problems (4.4 points). We found a significant interaction effect between physical health problems and clinical mental health symptoms which was associated with even poorer HRQoL after accounting for the individual relationships of both problems. Mental health problems were associated with poorer HRQoL for older versus younger children; and the interaction effect was significant for boys but not girls. Conclusion Findings highlight the importance of identifying and addressing mental health symptoms in children of all ages, even if these problems do not meet formal clinical criteria. Particular attention should be paid to the mental health and HRQoL of children with physical–mental multimorbidity, who are at risk of disproportionately poorer HRQoL. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03095-1. Ongoing physical and mental health problems are common in children and adolescents and, often, children can experience both problems together. Mental and physical health problems can have wide impacts for the child, including their health-related quality of life (HRQoL), which is a measure of the way the child’s health impacts their emotional, social and physical functioning during their day-to-day life. Our study shows that children with high levels of mental health symptoms have much poorer HRQoL than their peers, and we provide new evidence that even milder mental health symptoms are associated with poorer HRQoL than in children with physical health problems. When children have both physical and mental health problems, they are at even greater risk of poorer HRQoL than would be expected. Based on our findings, we recommend that clinicians should monitor and address mental health symptoms in children as young as 4–7 years old, even if these symptoms are milder, and particular attention should be given to children with physical and mental health problems, who are at greater risk of poor HRQoL.
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Affiliation(s)
- Rachel O'Loughlin
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Harriet Hiscock
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, 3010, Australia
- Health Services Research Unit, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
- Health Services, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
| | - Tianxin Pan
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Nancy Devlin
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
- Health Services Research Unit, The Royal Children's Hospital, Parkville, VIC, 3052, Australia
- Health Services, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
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Abstract
Patient-reported outcomes are recognized as essential for the evaluation of medical and public health interventions. Over the last 50 years, health-related quality of life (HRQoL) research has grown exponentially from 0 to more than 17,000 papers published annually. We provide an overview of generic HRQoL measures used widely in epidemiological studies, health services research, population studies, and randomized clinical trials [e.g., Medical Outcomes Study SF-36 and the Patient-Reported Outcomes Measurement Information System (PROMIS®)-29]. In addition, we review methods used for economic analysis and calculation of the quality-adjusted life year (QALY). These include the EQ-5D, the Health Utilities Index (HUI), the self-administered Quality of Well-being Scale (QWB-SA), and the Health and Activities Limitation Index (HALex). Furthermore, we consider hybrid measures such as the SF-6D and the PROMIS-Preference (PROPr). The plethora of HRQoL measures has impeded cumulative science because incomparable measures have been used in different studies. Linking among different measures and consensus on standard HRQoL measurement should now be prioritized. In addition, enabling widespread access to common measures is necessary to accelerate future progress. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University, Stanford, California, USA;
| | - Ron D Hays
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, California, USA
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22
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Pak SS, Miller MJ, Cheuy VA. Use of the PROMIS-10 global health in patients with chronic low back pain in outpatient physical therapy: a retrospective cohort study. J Patient Rep Outcomes 2021; 5:81. [PMID: 34487270 PMCID: PMC8421489 DOI: 10.1186/s41687-021-00360-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023] Open
Abstract
Background Although evidence-based guidelines for physical therapy for patients with chronic low back pain (cLBP) are available, selecting patient-reported outcome measures to capture complexity of health status and quality of life remains a challenge. PROMIS-10 Global Health (GH) may be used to screen for impactful health risks and enable patient-centered care. The purpose of this study was to investigate the interrelationships between PROMIS-10 GH scores and patient demographics, health status, and healthcare utilization in patients with cLBP who received physical therapy. Methods A retrospective review of de-identified electronic health records of patients with cLBP was performed. Data were collected for 328 patients seen from 2017 to 2020 in three physical therapy clinics. Patients were grouped into HIGH and LOW initial assessment scores on the PROMIS-10 Global Physical Health (PH) and Global Mental Health (MH) measures. Outcomes of interest were patient demographics, health status, and healthcare utilization. Mann–Whitney U and chi-square tests were used to determine differences between groups, and binary logistic regression was used to calculate odds ratios (OR) to determine predictors of PH-LOW and MH-LOW group assignments. Results The PH-LOW and MH-LOW groups contained larger proportions of patients who were African American, non-Hispanic, and non-commercially insured compared to PH-HIGH and MH-HIGH groups (p < .05). The PH-LOW and MH-LOW groups also had a higher Charlson comorbidity index (CCI), higher rates of diabetes and depression, and more appointment cancellations or no-shows (p < .05). African American race (OR 2.54), other race (2.01), having Medi-Cal insurance (OR 3.37), and higher CCI scores (OR 1.55) increased the likelihood of being in the PH-LOW group. African American race (OR 3.54), having Medi-Cal insurance (OR 2.19), depression (OR 3.15), kidney disease (OR 2.66), and chronic obstructive pulmonary disease (OR 1.92) all increased the likeihood of being in the MH-LOW group. Conclusions Our study identified groups of patients with cLBP who are more likely to have lower PH and MH scores. PROMIS-10 GH provides an opportunity to capture and identify quality of life and global health risks in patients with cLBP. Using PROMIS-10 in physical therapy practice could help identify psychosocial factors and quality of life in the population with cLBP.
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Affiliation(s)
- Sang S Pak
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, 1500 Owens St., Suite 400, San Francisco, CA, 94158, USA.
| | - Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, 1500 Owens St., Suite 400, San Francisco, CA, 94158, USA.,Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Victor A Cheuy
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, 1500 Owens St., Suite 400, San Francisco, CA, 94158, USA.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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23
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Zhang J, Dewitt B, Tang E, Breitner D, Saqib M, Li D, Siddiqui R, Edwards N, Peipert JD, Hays RD, Hanmer J, Mucsi I. Evaluation of PROMIS Preference Scoring System (PROPr) in Patients Undergoing Hemodialysis or Kidney Transplant. Clin J Am Soc Nephrol 2021; 16:1328-1336. [PMID: 34272256 PMCID: PMC8729576 DOI: 10.2215/cjn.01880221] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/22/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES A preference-based health utility score (PROPr) can be calculated using Patient-Reported Outcomes Measurement Information System domain scores. We assessed the construct validity of PROPr among patients treated with KRT (hemodialysis or kidney transplant). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a secondary analysis of data collected in multicenter, cross-sectional studies of adults treated with KRT, recruited between April 2016 to March 2020 in Toronto, Canada. All participants provided informed consent. The outcome was the PROPr score. Coadministered outcome variables included the Short-Form Six-Domain (SF-6D) and EuroQol Five-Domain Five-Level (EQ-5D-5L) scores. Socioeconomic and clinical variables included age, sex, diabetes, eGFR, serum albumin, hemoglobin, KRT, and Charlson Comorbidity Index. Construct validity was assessed through correlations between PROPr and SF-6D or EQ-5D-5L, and associations between PROPr and other exposure variables. Health-condition impact estimates (coefficients for health conditions compared with a referent category, e.g., dialysis versus kidney transplant) were calculated using multivariable linear regression. RESULTS The mean (SD) age of the 524 participants was 57 (17) years, 58% were male, and 45% were White. Median (interquartile range) score was 0.39 (0.24-0.58) for PROPr, 0.69 (0.58-0.86) for SF-6D, and 0.85 (0.70-0.91) for EQ-5D-5L. Large correlations were observed between PROPr versus SF-6D (0.79; 95% confidence interval [95% CI], 0.76 to 0.82) and EQ-5D-5L (0.71; 95% CI, 0.66 to 0.75). Both PROPr and the other utility indices demonstrated health-condition impact in the expected direction. For example, the estimate for PROPr was -0.17 (95% CI, -0.13 to -0.21) for dialysis (versus kidney transplant), -0.05 (95% CI, -0.11 to 0.01; P=0.08) for kidney transplant recipients with an eGFR of <45 versus ≥45 ml/min per 1.73 m2, and -0.28 (95% CI, -0.22 to -0.33) for moderate/severe versus no/mild depressive symptoms. CONCLUSIONS Our results support the validity of PROPr among patients treated with KRT.
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Affiliation(s)
- Jing Zhang
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Barry Dewitt
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Evan Tang
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Daniel Breitner
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Mohammed Saqib
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Dan Li
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Rabail Siddiqui
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - Nathaniel Edwards
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois.,Northwestern University Transplant Outcome Research Collaborative, Chicago, Illinois
| | - Ron D Hays
- Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Janel Hanmer
- Department of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Istvan Mucsi
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada
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24
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Proudman D, Greenberg P, Nellesen D. The Growing Burden of Major Depressive Disorders (MDD): Implications for Researchers and Policy Makers. PHARMACOECONOMICS 2021; 39:619-625. [PMID: 34013439 PMCID: PMC8134814 DOI: 10.1007/s40273-021-01040-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 05/14/2023]
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