What happens to people before and after disability? Focusing effects, lead effects, and adaptation in different areas of life

Is time a gift for health and life satisfaction? Exploring the relationship between time allocation and adaptation to a breast cancer diagnosis

Existing studies on adaptation to health shocks primarily focus on whether health and well-being return to baseline levels over time. However, little is known about the factors associated with the extent of adaptation. This study examines how patterns of time use across daily activities relate to the extent of adaptation. Focusing on women diagnosed with breast cancer, with women without a cancer diagnosis as a comparison, we apply an event study design to examine whether time spent on paid work and physical leisure are associated with varying degrees of adaptation, measured by self-reported health status and life satisfaction. Our findings suggest that full-time paid work and more than 10 h of physical leisure per week at baseline are associated with slower and less complete adaptation in the domain of self-reported health. Conversely, the degree of adaptation in the domain of life satisfaction does not significantly vary based on baseline levels of paid work and physical leisure. Furthermore, a reduction in time allocated to paid work or physical leisure following a cancer diagnosis is associated with slower adaptation in the domain of self-reported health compared to maintaining pre-diagnosis levels. These findings suggest an interplay between pre- and post-diagnosis time allocation that warrants further investigation.

Voices unheard, insights into the lives of people with disabilities: A needs assessment study

BACKGROUND

The phenomenon of disability in society is as ancient as human history itself. Approximately one billion people worldwide experience some form of disability, with a fifth of these individuals facing significant disabilities. Disability affects various life dimensions, including access to health services. This study aimed to identify the needs and challenges encountered by people with disabilities and to propose solutions for these issues.

MATERIALS AND METHODS

This qualitative content analysis research was conducted at Isfahan University of Medical Sciences in 2019. Participants included faculty members from the rehabilitation school, senior students, therapists, disabled individuals, and their families (23 interviews in total). These participants were chosen for their extensive knowledge of the challenges faced by people with disabilities. Semi-structured interviews were conducted, with informed consent obtained before each interview. The interviews were analyzed using the Graneheim and Lundman content analysis method and MAXQDA software. To ensure data accuracy, the criteria of conformability, credibility, dependability, and transferability were applied.

RESULTS

The analysis of the interviews yielded two main categories and 10 subcategories. In the category of disability-related problems, family problems, therapeutic problems, psychological problems, academic problems, and social problems were identified as the most significant. As for solutions, educational solutions, therapeutic solutions, social solutions, research solutions, and solutions for reintegrating patients into normal life were proposed to address the problems faced by disabled individuals.

CONCLUSION

People with disabilities are an integral part of any country's society. To adequately address their therapeutic needs, it is essential to equip our health workers with the knowledge and skills tailored to the specific needs and challenges of disabled individuals.

Does becoming an informal caregiver make your health worse? A longitudinal analysis across Europe

OBJECTIVE

To determine whether becoming an informal caregiver in Europe has a significant effect on health status, compared with non-informal caregivers, distinguishing by place of residence (in or outside the home of the care receivers) and country. And to determine whether there is an adaptation effect after the passage of time.

METHODS

The Survey of Health, Aging and Retirement in Europe (2004-2017) was used. Propensity score matching was applied to analyse the differences in the health status of people who became informal carers between different periods and those who did not. We considered short-term (2-3 years after the shock) and medium-term effects (4-5 years).

RESULTS

In the short term, the probability of those who became informal caregivers being depressed was 3.7% points (p.p.) higher than among their counterparts, being higher among those who lived in the care recipients' homes (12.8 p.p.) and those providing care outside and at home (12.9 p.p.). Significant differences in the probability of being depressed were also observed by country (Southern and Eastern Europe), and in countries with low expenditure on long-term care (LTC). Those effects remained in the medium term. No significant effects were found in cancer, stroke, heart attack and diabetes.

CONCLUSIONS

The results might help to concentrate a major effort of any policy in the field of mental health on the period immediately after the negative shock, especially for those caregivers who live with the care receiver, for those in Southern and Eastern Europe and in countries with low expenditure on LTC.

Adaptation in life satisfaction and self-assessed health to disability - Evidence from the UK

Experiencing deteriorating health has implications for your quality of life. The theory of adaptation suggests that with time spend living in a health state individuals can adapt, resulting in observed quality of life levels to revert or stagnate despite persistently decreased health. Adaptation has implications for the use of subjective quality of life indicators when quantifying the impact of health changes or the benefits from new medical technologies. As both the impact from ill health and the benefit from new interventions might be disease- or subgroup-specific adaptation further raises ethical concerns but empirical evidence on its existence, magnitude, and heterogeneity remains inconclusive. This paper uses a general population sample of 9,543 individuals that participate in the UK Understanding Society survey and experience the onset of a long-standing illness or disability to provide evidence on these questions. Using ordered-response fixed effects models we explore longitudinal changes in self-assessed health and life satisfaction around the onset of disability. Our results indicate that disability onset is associated with large decreases in subjective health and well-being. Over time this initial decrease in subjective quality of life indicators attenuates, especially in life satisfaction and to a lesser extent for self-assessed health. While the relative difference in adaptation across these two measures remains persistent, we find that across demographic and severity groups the initial impact of disability onset and adaptation differs considerably in its magnitude. These results have important implications for studies aiming to quantify the impact of health conditions on quality of life outcomes, especially when using observational datasets.

Disability-related inequalities in health and well-being are mediated by barriers to participation faced by people with disability. A causal mediation analysis

Large inequalities in health and well-being exist between people with and without disability, in part due to poor socio-economic circumstances, and potentially also related to societal factors including issues associated with accessibility and participation. To better understand the contribution of societal factors, we used a unique longitudinal survey of disability in Great Britain to quantify the extent to which barriers to participation contribute to poorer health and well-being. We used data from 2354 individuals who participated in three waves of the Life Opportunities Survey between 2009 and 2014 and compared five health and well-being outcomes (self-rated health, anxiousness, life satisfaction, life worth, happiness) between adults who acquired an impairment and those who remained disability-free. Causal mediation analysis was conducted to quantify how much of the effect of disability acquisition on each outcome was explained by barriers to participation in employment, economic life, transport, community, leisure and civic activities, social contact, and accessibility. People who recently acquired a disability had poorer health and well-being compared to people with no disability. Barriers to participation explained 15% of inequalities in self-rated health, 28% for anxiousness, 32% for life satisfaction, 37% for life worth, and 70% for happiness. A substantial proportion of the inequalities in health and well-being experienced by people with recently acquired disability were socially produced, driven by barriers to participation in different life domains. Furthermore, there was evidence that barriers to participation mediated the effect of well-being measured to a greater extent than the more clinically aligned measures, self-reported health and anxiousness. These findings highlight modifiable factors amenable to public health interventions that could lead to substantial improvements in health and well-being for people with disability.

Prospective associations between coffee consumption and psychological well-being

OBJECTIVE

Prior work indicates a robust relationship between coffee consumption and lower depression risk, yet no research has examined links with psychological well-being (e.g., happiness, optimism). This study tested whether coffee intake is prospectively associated with greater psychological well-being over time. Secondarily, associations in the reverse direction were also examined to determine whether initial levels of psychological well-being were related to subsequent coffee consumption.

METHODS

Among women in the Nurses' Health Study, coffee consumption was examined in 1990 and 2002 in relation to sustained levels of happiness reported across multiple assessments from 1992-2000 (N = 44,449) and sustained levels of optimism assessed from 2004-2012 (N = 36,729). Associations were tested using generalized estimating equations with a Poisson distribution adjusted for various relevant covariates. Bidirectional relationships were evaluated in secondary analyses of baseline happiness (1992) and optimism (2004) with sustained moderate coffee consumption across multiple assessments through 2010.

RESULTS

Compared to minimal coffee consumption levels (<1 cup/day), moderate consumption (1-3 cups/day) was unrelated to happiness, whereas heavy consumption (≥4 cups/day) was associated with a 3% lower likelihood of sustained happiness (relative risk, RR = 0.97, 95% CI = 0.95-0.99). Only moderate coffee consumption was weakly associated with a greater likelihood of sustained optimism (RR1-3cups/day = 1.03, 95% CI = 1.00-1.06). Secondary analyses showed high levels of optimism but not happiness levels were modestly associated with increased likelihood of sustained moderate coffee intake (RRoptimism = 1.06, 95% CI = 1.02-1.10; RRhappiness = 1.01, 95% CI = 0.99-1.04).

CONCLUSIONS

Associations between psychological well-being and coffee consumption over up to two decades were largely null or weak. Although coffee consumption may protect individuals against depression over time, it may have limited impact on facets of psychological well-being.

The impact of widowhood on wellbeing, health, and care use: A longitudinal analysis across Europe

OBJECTIVE

To estimate whether becoming widowed had a significant effect on individual's health status as well as on healthcare and non-healthcare resources use, compared to people who remained in a couple in Europe.

DATA AND METHOD

It was used the Survey of Health, Aging and Retirement in Europe from 2004 to 2015. The statistical technique used was genetic matching which analysed the differences in wellbeing, mental health, health status, risk of death, health care resources and long-term care utilization of people who have become widowed, comparing with people who remained married or with a partner. We considered shortterm and medium-term effects.

RESULTS

In the short term, those who became widowed had a worse wellbeing and mental health, in addition to a greater probability of receiving formal care and informal care from outside the household. There seems to be a significant effect in the use of formal and informal care from outside the household in the medium term.

CONCLUSIONS

The results might help to concentrate a major effort of any policy or strategy, not only in the field of health but also in the provision of long-term care, immediately after the negative shock occurs.

Life satisfaction: The role of domain-specific reference points

In the evaluation of well-being, it is not only important what people have in absolute terms, but also how this compares to reference points in relative terms. We explore the relevance of relative comparisons by testing the effect of people's self-rated position on potential reference points for income and health on their subjective well-being. We used Multiple Discrepancies Theory as a framework to identify seven potentially relevant reference points for income and health. A representative sample (N = 550) of the Netherlands assessed their income and health relative to these reference points. In addition, we elicited monthly household income, health status (EQ-5D-5L), and subjective well-being (SWLS). In line with the literature, we found a negative convex relationship between subjective well-being and age and a positive relationship with being employed, income, and health. For income, subjective well-being was also associated with how current income compared to respondents' needs and progression over time, and for health especially with how current health compared to what they felt they deserved. Our findings suggest that income and health are important for subjective well-being both in absolute and relative terms. We found negative effects on life satisfaction if some of the domain specific reference points were not met.

Association of vision problems with psychosocial factors among middle-aged and older individuals: findings from a nationally representative study

Objectives: Little is known about the specific association of vision loss and psychosocial outcome measures in contrast to other health limitations. The aim of this study was to identify whether vision problems are associated with psychosocial outcomes among middle-aged and older adults and to compare it with the association between other chronic health conditions and psychosocial factors.Method: Cross-sectional data came from wave 5 (2014) of the German Ageing Survey which is a representative sample of non-institutionalized individuals ≥ 40 years in Germany. Psychosocial outcomes (life satisfaction, positive affect, negative affect, depressive symptoms, optimism, general self-esteem, and social isolation) were assessed using well-established and widely used scales. Self-rated trouble reading the newspaper due to vision problems and self-rated difficulties recognizing known people on the street due to vision problems were used as independent variables of interest.Results: Regressions showed that both 'vision problems: reading the newspaper' and 'vision problems: difficulties recognizing people' are consistently associated with worse psychosocial outcomes (decreased life satisfaction, decreased positive affect, increased negative affect, increased depressive symptoms, decreased optimism, decreased self-esteem and increased social isolation). In contrast, none of the physical illnesses was consistently associated with all psychosocial outcome measures.Conclusion: Adjusting for various potential confounders and in contrast to various chronic diseases, our findings emphasize an association between vision problems and worse psychosocial outcomes in middle-aged and older adults. Future longitudinal studies are needed to validate our findings.

The Onset of Falls Reduces Subjective Well-Being. Findings of a Nationally Representative Longitudinal Study

Introduction: The prevalence of older individuals experiencing a fall is high. Moreover, falls can have deleterious effects on health status. Additionally, falls can affect the subjective well-being of individuals. However, there is a lack of studies examining the link between falls and subjective well-being. Therefore, the objective of this study was to investigate whether the onset of falling is associated with (intraindividual) decreases in subjective well-being in men and women. Materials and Methods: Longitudinal data (from wave 5 to wave 6) were taken from a population-based sample of individuals residing in private households in Germany [in our analytical sample: 3,906 observations (men), and 3,718 observations (women)]. Positive and negative affect were quantified using the Positive and Negative Affect Schedule (PANAS). Life satisfaction was assessed using the Satisfaction with Life Scale (SWLS). Results: Adjusting for various potential confounders, fixed effects regressions showed that the onset of falls was associated with a decrease in positive affect (β = 0.08, p < 0.01), and an increase in negative affect (β = 0.07, p < 0.01) among men. While the onset of falls was not associated with changes in positive affect in women, it was associated with a decrease in negative affect in women (β = 0.06, p < 0.05). Sex differences were significant. The onset of falls was not associated with decreases in life satisfaction in men, nor in women. Discussion: The present study particularly highlights the link between the onset of falls and reduced affective well-being among men. Avoiding falls may contribute to maintaining affective well-being among middle-aged and older men.

Does ageing alter the contribution of health to subjective well-being?

Older adults regularly report rising levels of Subjective Well-Being (SWB) over time, despite a concomitant decline in their health. One possible explanation is that individuals develop psychological mechanisms to diminish the contribution of health to their well-being as they get older. This research examines whether observational data are consistent with this hypothesis of hedonic adaptation to health decline with ageing, in all aspects of SWB, and for different births cohorts over time. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2007 and 2015 in 10 European countries for respondents aged 50 onwards (4 waves, 41,258 individuals), we estimated panel fixed-effects models for outcomes measuring the three aspects of SWB: evaluative (life satisfaction), experienced (positive and negative affectivity) and eudemonic well-being (sense of purpose and meaning in life). We decomposed age in birth cohort and time fixed effects. Changes over time in the contribution of health to SWB were estimated by interaction terms between health and time fixed effects. Results showed that the value of health changes over time and for different birth cohorts in ways that depend on the measure of SWB. Ageing increases the importance of health for both eudemonic and experienced well-being. By contrast, the association between health and life satisfaction weakens with age, except for individuals aged 80 and above for which it strengthens. Our results thus offer only little support for hedonic adaptation to health decline with age, restricted to life satisfaction and individuals under 80 years of age. These findings caution against the use of mean estimations over the lifespan to determine the value of health as well as against the use of the various forms of SWB interchangeably in public policy analysis and economic evaluations of healthcare.

Quality of Life Changes With Duration of Chronic Breathlessness: A Random Sample of Community-Dwelling People

INTRODUCTION

Chronic breathlessness is associated with poorer quality of life (QoL). This population study aimed to define dimensions of QoL and duration and dominant causes of breathlessness that most diminished QoL.

METHODS

This cross-sectional, population-based, and randomized survey of adults (n = 2977) in South Australia collected data on demographics, modified Medical Research Council (mMRC) breathlessness, and QoL (EuroQoL five-dimension five-level [EQ-5D-5L] measure; Short Form 12 quality-of-life measure). Data weighted to the census were analyzed for relationships between EQ-5D-5L and its dimensions with mMRC. Regression models controlled for age, sex, education, rurality, and body mass index.

RESULTS

About 2883 responses were analyzed: 49% were males; mean age was 48 years (SD 19). As mMRC worsened, EQ-5D-5L and its dimensions worsened. More severe chronic breathlessness was iteratively associated with lower mobility, daily activities, and worse pain/discomfort. For self-care and anxiety/depression, impairment was only with the most severe breathlessness. Respondents who had chronic breathlessness for two to six years had the worst QoL scores. People who attributed their breathlessness to cardiac failure had poorer QoL. Respondents who reported a cardiac cause for their breathlessness had worse mobility, poorer usual activities, and more pain than the other causes. The regression analyses showed that worse chronic breathlessness was associated with worsening QoL in each dimension of EQ-5D-5L, with the exception of the self-care, which only worsened with the most severe breathlessness.

CONCLUSIONS

This is the first study to report on chronic breathlessness and impairment across dimensions of QoL and differences by its duration. Mobility, usual activity, and pain drive these reductions.

Happy with Your Capabilities? Valuing ICECAP-O and ICECAP-A States Based on Experienced Utility Using Subjective Well-Being Data

Background. The ICECAP-O and the ICECAP-A are validated capability well-being instruments. To be used in economic evaluations, multidimensional instruments require weighting of the distinguished well-being states. These weights are usually obtained through ex ante preference elicitation (i.e., decision utility) but could also be based on experienced utility. Objective. This article describes the development of value sets for ICECAP-O and ICECAP-A based on experienced utility and compares them with current decision utility weights. Methods. Data from 2 cross-sectional samples corresponding to the target groups of ICECAP-O and ICECAP-A were used in 2 separate analyses. The utility impacts of ICECAP-O and ICECAP-A levels were assessed through regression models using a composite measure of subjective well-being as a proxy for experienced utility. The observed utility impacts were rescaled to match the 0 to 1 range of the existing value set. Results. The calculated experienced utility values were similar to the decision utility weights for some of the ICECAP dimensions but deviated for others. The largest differences were found for weights of the ICECAP-O dimension enjoyment and the ICECAP-A dimensions attachment and autonomy. Conclusions. The results suggest a different weighting of ICECAP-O and ICECAP-A levels if experienced utility is used instead of decision utility.

Can time heal all wounds? An empirical assessment of adaptation to functional limitations in an older population

Chronic diseases and functional limitations may have serious and persistent consequences for one's quality of life (QoL). Over time, however, their negative impact on QoL may diminish because of adaptation. Understanding how much people adapt helps to correctly separate the effects attributable to interventions from those arising from adaptation and thus facilitates a better estimation of the effects of disease and treatment on QoL. To date, however, there is little empirical evidence on adaptation in older populations. In particular, it is unclear to which extent dimensions of QoL like health and overall experience with life are influenced by adaptation. This paper studies adaptation to functional limitations in 5000 respondents of the Survey of Health, Ageing and Retirement in Europe (SHARE) who develop disabilities during the span of the 5 waves of data collection between 2004 and 2015. To examine the association between time since the onset of functional limitations and self-perceived health and life satisfaction, a fixed effects ordered logit model is used. We found evidence supporting adaptation in life satisfaction, corresponding to a return to pre-onset levels of life satisfaction. Also in the self-perceived health dimension, adaptation does occur, but it does not occur fast enough to offset the negative changes in underlying health. This means that observational studies that measure one of these two outcome measures should be aware that part or all of the effects found are due to adaptation.

Adaptation to health states: Sick yet better off?

Healthcare funding decisions in the UK rely on health state valuations of the general public. However, it has been shown that there is disparity between the valuation of the impact of hypothetical conditions on health and the reported health by those experiencing them. Patients' adaptation to health states is among the most common explanations for this discrepancy. Being diagnosed with a disease appears to affect individual perception of health over time so that better subjective health may be reported over a disease trajectory. This paper examines adaptation to health states using a longitudinal dataset. We use four waves of the British Cohort Study (BCS70), which tracks a sample of British individuals since birth in 1970 and contains information on self-assessed health (SAH), morbidity, and socioeconomic characteristics. We implement a dynamic ordered probit model controlling for health state dependence. Results are supportive of the existence of adaptation: Time since diagnosis has a positive impact on SAH. Moreover, adaptation happens over relatively long durations. We do not find significant results proving different adaptation paths for patients reporting prior better SAH. The analysis by specific conditions generally supports the existence of adaptation, but results are statistically significant only for a subset of conditions.

The longitudinal association between informal caregiving and body mass index in the second half of life: findings of the German Ageing Survey

OBJECTIVE

We aimed to investigate the relation between informal caregiving and body mass index (BMI) longitudinally.

STUDY DESIGN

The data were drawn from wave 2 (2002) to wave 5 (2014) of the German Ageing Survey. This is a representative sample of the community-dwelling population aged 40 years and above in Germany.

METHODS

Self-rated BMI was used. Individuals were asked whether they provide informal care on a regular basis. Adjusting for employment status, age, marital status, morbidity and depressive symptoms, fixed effects regressions were used.

RESULTS

The fixed effects regressions showed that the onset of informal caregiving was not associated with changes in BMI in the total sample and in women, whereas the onset of informal caregiving was associated with increasing BMI in men (β = 0.15, P < 0.05). In addition, an increase in BMI was positively associated with ageing, an increase in morbidity and a decrease in frequency of sports activities in the total sample and in both sexes.

CONCLUSIONS

Our findings stress the longitudinal relation between informal caregiving and BMI in men. Consequently, it might be helpful to generate weight management strategies specifically designed for male informal caregivers.

Changes in Smoking Behavior over Family Transitions: Evidence for Anticipation and Adaptation Effects

The study of changes in smoking behaviors over the life course is a promising line of research. This paper aims to analyze the temporal relation between family transitions (partnership formation, first childbirth, separation) and changes in smoking initiation and cessation. We propose a discrete-time logistic model to explore the timing of changes in terms of leads and lags effects up to three years around the event in order to measure both anticipation and adaptation mechanisms. Retrospective biographical data from the Santé et Itinéraires Professionnels (SIP) survey conducted in France in 2006 are used. Partnership formation was followed for both genders by a fall in smoking initiation and an immediate rise in smoking cessation. Childbirth was associated with increased smoking cessation immediately around childbirth, and additionally, females showed an anticipatory increase in smoking cessation up to two years before childbirth. Couple separation was accompanied by an anticipatory increase in smoking initiation for females up to two years prior to the separation, but this effect only occurred in males during separation. Our findings highlight opportunities for more targeted interventions over the life course to reduce smoking, and therefore have relevance for general practitioners and public policy elaboration.

Sleep duration, life satisfaction and disability

BACKGROUND

Although sleep is considered an essential part of individuals' lives, there are no previous studies analysing how sleep duration affects the levels of life satisfaction reported by males and females with disabilities.

OBJECTIVE/HYPOTHESIS

To analyse and compare the impact of hours of sleep on life satisfaction scores reported by people without and with disabilities (stratified by sex) in Germany.

METHODS

Using data taken from the German Socio-Economic Panel for the period 2008-2013, we estimate life satisfaction equations for males and females (running a fixed-effects model) which include a set of variables measuring the number of sleep hours on workdays and weekends.

RESULTS

A higher number of sleep hours on workdays increase life satisfaction for all males and females. However, the contribution of each hour of sleep on workdays is greater for males with disabilities in terms of life satisfaction, whereas for females no significant differences by disability status have been found. Although sleep hours on weekends also increase life satisfaction, the magnitude of the coefficients is relatively higher than that found for the corresponding hours of sleep on workdays, but only for the male sample (disabled or not).

CONCLUSIONS

The participation and commitment of policymakers, governments, trade unions, employers, and health care professionals are key aspects for developing and formulating new guidelines and specific measures that promote a healthy lifestyle and increase sleep duration. Such guidelines and measures are of essence for people with disabilities who are employed (e.g. using brief sleep opportunities during prolonged work periods, which can contribute to reducing fatigue, stress and anxiety).

Effect of Health Comparisons on Functional Health and Depressive Symptoms - Results of a Population-Based Longitudinal Study of Older Adults in Germany

Objective

To investigate the effect of health comparisons on functional health and depressive symptoms in a longitudinal approach. Gender differences were examined.

Methods

The German Ageing Survey (DEAS) is a nationwide, representative longitudinal study of community dwelling individuals living in Germany aged 40 and older. The surveys in 2008 and 2011 were used, with n = 3,983 respondents taking part in both waves. Health comparisons were quantified by the question “How would you rate your health compared with other people your age” (Much better; somewhat better; the same; somewhat worse, much worse). Functional health was assessed by the subscale “physical functioning” of the 36-Item Short Form Health Survey (SF-36) and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Adjusting for sociodemographic factors, self-assessed health, social network, self-efficacy and optimism, and morbidity, fixed effects regressions revealed that functional health decreased significantly and considerably with negative health comparisons in the total sample (transitions from ‘the same’ to ‘much worse’: β = -11.8), predominantly in men. The effects of negative health comparisons (transitions from ‘the same’ to ‘much worse’: β = 4.8) on depressive symptoms were comparable (in terms of significance) to the effects on functional health, with stronger effects in women. Positive comparisons did not affect functional health and depressive symptoms.

Conclusion

Our findings underline the relevance of negative health comparisons on functional health (men) and depressive symptoms (women). Comparison effects are asymmetric and mostly upwards.

The Effect of Intra- and Intergenerational Caregiving on Subjective Well-Being--Evidence of a Population Based Longitudinal Study among Older Adults in Germany

Objective

To examine whether intra- and intergenerational caregiving affect subjective well-being (SWB) of the caregivers longitudinally.

Methods

Data were drawn from the German Ageing Survey (DEAS), which is a population-based longitudinal study of individuals living in Germany aged 40 and over. The waves in 2002, 2008 and 2011 were used (with 10,434 observations). SWB was examined in a broad sense, covering affective (AWB) and cognitive well-being (CWB), positive (PA) and negative affect (NA) as well as functional and mental health. While intragenerational caregiving was defined as providing care for spouse/partner, intergenerational caregiving was defined as providing care for mother, father, mother-in-law, father-in-law, partner’s mother or partner’s father.

Results

Fixed effects regressions adjusting for sociodemographic factors, social network, self-efficacy and morbidity showed that intergenerational informal care did not affect the various SWB outcome measures. Intragenerational caregiving affected CWB (women) and mental health (total sample and men), whereas it did not affect the other outcome variables.

Conclusion

Our findings highlight the importance of intragenerational caregiving for mental health (men) and cognitive well-being (women). Consequently, interventions to avoid mental illness due to intragenerational caregiving are urgently needed.

An anatomy of old-age disability: Time use, affect and experienced utility

Complementing the commonly used concepts of evaluative wellbeing and decision utility, emotional wellbeing and experienced utility are important welfare criteria to assess individuals' subjective wellbeing, especially for valuing health and disability. Yet, almost all empirical evidences on the link between disability and experienced wellbeing come from developed countries. This paper studies the relationship between old-age disability and experienced utility in five low- and middle-income countries. Using data on individual time use and activity-specific affective experiences from an abbreviated version of the Day Reconstruction Method, we document a strong negative association between disability and experienced utility. These differences in experienced utility by disability status are exclusively due to worse activity-specific affective experiences among persons with disabilities. By contrast, disability-related differences in time use provide small compensating effects. Interventions or technologies that facilitate daily life hold most promise to improve experienced utility among persons with disabilities in the developing world.

The Role of Identity Integration in Hedonic Adaptation to a Beneficial Life Change: The Example of "Coming Out" for Lesbians and Gay Men

After apparently beneficial life changes, people are expected to experience elevated well-being. However, research suggests that some individuals adapt quickly to change, so their well-being increases little in the long-term. We propose this phenomenon is explained by the integration of the changes into identity, in interaction with perceived valence of the changes. We hypothesized that higher integration would be associated with smaller increases in well-being for changes perceived as positive. For changes perceived as negative, higher integration would be associated with larger increases in well-being. Lesbians and gay men (N = 80) completed a questionnaire on well-being, perceived valence of coming out and its integration into identity. Moderated regressions supported the hypotheses, revealing the importance of considering identity integration and perceived valence in research on adaptation to changes. The results question the merits of interventions promoting identity integration.

Personality change associated with chronic diseases: pooled analysis of four prospective cohort studies

BACKGROUND

Common chronic conditions, such as heart disease and cancer, are associated with increased psychological distress, functional limitations and shortened life expectancy, but whether these diseases alter aspects of personality remains unclear.

METHOD

To examine whether the onset of heart disease, stroke, diabetes, cancer, hypertension, arthritis and respiratory disease is associated with subsequent changes in personality traits of the five-factor model, we pooled data from the Health and Retirement Study, the Midlife in the United States Survey, and the graduate and sibling samples of the Wisconsin Longitudinal Study for an individual-participant meta-analysis (total n=17,493; mean age at baseline 55.8 years).

RESULTS

After adjustment for age, we observed consistent decreases in extraversion [-0.25 T-scores per one disease; 95% confidence interval (CI) -0.40 to -0.10], emotional stability (-0.40, 95% CI -0.61 to -0.19), conscientiousness (-0.44, 95% CI -0.57 to -0.30) and openness to experience (-0.25, 95% CI -0.37 to -0.13) but not in agreeableness (-0.05, 95% CI -0.19 to 0.08) after the onset of chronic diseases. The onset of each additional chronic disease accelerated the average age-related personality change by 2.5 years in decreasing extraversion, 5.5 years in decreasing conscientiousness, and 1.6 years in decreasing openness to experience, and attenuated the increasing levels of emotional stability by 1.9 years. Co-morbid conditions were associated with larger changes than single diseases, suggesting a dose-response association between morbidity and personality change.

CONCLUSIONS

These results support the hypothesis that chronic diseases influence personality development in adulthood.

Is shared misery double misery?

The literature has shown strong associations between health, financial and social life events and mental health. However, no studies as yet have looked at the temporal nature of the effects of life events on stated mental health nor have they included the effects of the events befalling partners within a household. This paper looks at the spillover in mental health, measured with the SF-36 scale, from one partner to the other, using life events to identify this relationship. We propose a new model that allows for both a temporal spacing of effects (anticipation and adaptation) as well as a spillover factor, which we define as the degree to which the events that are experienced by the partner affect us in the same way as if these events were to happen to us. We use data from 51,380 person-year observations of the Household, Income and Labour Dynamics in Australia survey (2002-10) which consistently measures nine distinct events, including illnesses, social shocks and financial shocks. We find that the events befalling a partner on average have an effect about 15% as large as the effect of own events. We use the estimates to compute the compensation required to offset own and partner's life events. The methodology in this paper is potentially useful for estimating other spillover parameters such as the effects of others in the family or in the neighbourhood.

Health-related quality of life and psychosocial developmental trajectory in young female beneficiaries with JIA

OBJECTIVES

It is generally recognized that for all children the fulfilling of age-specific psychosocial developmental tasks in childhood is of great importance to adjustment in adult life, including participation in society. For young adults with JIA this is more difficult. We assume that the achievement of psychosocial milestones while growing up (psychosocial developmental trajectory) is also related to labour participation. A proportion of all young adults with JIA have to apply for disability benefits. This study assessed the health-related quality of life (HRQOL) and the psychosocial developmental trajectory of young female beneficiaries with JIA compared with peers from the Dutch general population.

METHODS

Young females with disability benefits because of JIA completed the RAND-36 (HRQOL) and the Course of Life Questionnaire (psychosocial developmental trajectory). Differences between respondents and the peer group were tested using analysis of variance and logistic regression analysis by group and age.

RESULTS

The beneficiaries reported worse HRQOL than the peer group and achieved fewer milestones, or achieved the milestones at a later age than the peer group in the autonomy, social and psychosexual domain.

CONCLUSIONS

Young females with JIA who have to apply for disability benefits are at risk for impaired HRQOL and a delay in their psychosocial developmental trajectory. Parents, physicians and other health-care providers should pay systematic attention to the development of social and independent functioning of children with JIA in order to optimize their adaptation to society at the time of transition to adulthood.

Predictors of coping in a group of Turkish patients with physical disability

AIM AND OBJECTIVE

To describe coping strategies used and determine the influence of demographic/health-related variables and perceived social support to the prediction of coping strategies in patients with physical disabilities.

BACKGROUND

The period of psychosocial adaptation following a physical disability is very stressful. The use of effective coping strategies may be helpful in adapting to disability. However, no information is available about the coping strategies used by Turkish patients with physical disability.

DESIGN

The study was designed as a cross-sectional survey. The data were obtained from 51 patients with physical disability in a rehabilitation centre in Ankara, Turkey between May 2004-September 2005.

METHODS

Data were collected using a questionnaire form, the Multidimensional Scale of Perceived Social Support and the Coping Strategy Indicator. Descriptive statistics, reliability analysis, Mann-Whitney U tests, Kruskal-Wallis test, chi-square test, Pearson's correlation coefficients and stepwise multivariate regression analysis were conducted.

RESULTS

The most frequently used coping strategy was problem-solving, followed by avoidance coping and seeking social support. Significant predictors of overall coping strategies were age, financial status, the caregiver's presence and perceived social support, after controlling for specific variables.

CONCLUSIONS

This study demonstrated that patients who were older and had a caregiver were more likely to use problem-solving strategy. Seeking social support was more common among patients who had a caregiver and those with more perceived support from friends, whereas patients who had financial difficulties used more avoidance coping.

RELEVANCE TO CLINICAL PRACTICE

Better understanding the coping strategies used by individuals with physical disabilities and factors affecting coping is provide interventions that reduce the stress and support their adaptation. Nurses should be aware of the factors that affect to coping strategies used to deal with stress.

Comparison of hypothetical and experienced EQ-5D valuations: relative weights of the five dimensions

PURPOSE

EQ-5D tariffs are typically based on general population valuations studies, but whether valuations of experienced health (EH) or hypothetical health (HH) are more appropriate is disputed. Previous comparisons of valuations of EH and HH have focused on absolute differences in dimension-specific regression coefficients. We examined differences in the relative importance attributed to the EQ-5D dimensions between EH and HH valuations of EQ-5D states in the United States.

METHODS

We used the regression model from the US EQ-5D valuation study on EH ratings from the 2000-2003 Medical Expenditure Panel Survey and on HH ratings from the US EQ-5D valuation study conducted in 2001. We then compared patterns in the relative magnitudes of coefficients that corresponded to the five dimensions.

RESULTS

In the HH model, self-care and pain/discomfort were the most important dimensions, while usual activities were the least important. In the EH model, usual activities were the most important dimension, while self-care was one of the least important.

DISCUSSION

The findings reveal considerable differences between stated preferences for HH and ratings of EH, particularly for self-care and usual activities. The findings accentuate the importance of the debate about which groups' values should be used in medical priority setting.

How do children at special schools and their parents perceive their HRQoL compared to children at open schools?

Background

There has been some debate in the past as to who should determine values for different health states for economic evaluation. The aim of this study was to compare the Health Related Quality of Life (HRQoL) in children attending open schools (OS) and children with disabilities attending a special school (SS) and their parents in Cape Town South Africa.

Methods

The EQ-5D-Y and a proxy version were administered to the children and their parents were requested to fill in the EQ-5D-Y proxy version without consultation with their children on the same day.

Results

A response rate of over 20% resulted in 567 sets of child/adult responses from OS children and 61 responses from SS children. Children with special needs reported more problems in the "Mobility" and "Looking after myself" domains but their scores with regard to "Doing usual activities", "Pain or discomfort" and "Worried, sad or unhappy" were similar to their typically developing counterparts. The mean Visual Analogue Scale (VAS) score of SS children was (88.4, SD18.3, range 40-100) which was not different to the mean score of the OS respondents (87.9, SD16.5, range 5-100).

The association between adult and child scores was fair to moderate in the domains. The correlations in VAS scores between Open Schools children and female care-givers' scores significant but low (r = .33, p < .001) and insignificant between Special School children and adult (r = .16, p = .24).

Discussion

It would appear that children with disabilities do not perceive their HRQoL to be worse than their able bodied counterparts, although they do recognise their limitations in the domains of "Mobility" and "Doing usual activities".

Conclusions

This finding lends weight to the argument that valuation of health states by children affected by these health states should not be included for the purpose of economic analysis as the child's resilience might result in better values for health states and possibly a correspondingly smaller resource allocation. Conversely, if HRQoL is to be used as a clinical outcome, then it is preferable to include the children's values as proxy report does not appear to be highly correlated with the child's own perceptions.