Health-related quality of life among women of reproductive age: Behavioral Risk Factor Surveillance System (BRFSS), 1998-2001

Untreated Depression During Pregnancy and Its Effect on Pregnancy Outcomes: A Systematic Review

Depression is characterized by sad, irritated, or empty moods, as well as somatic and cognitive changes such as loss of concentration, anhedonia, hopelessness, loss of appetite, sleep disturbances, and suicidal ideation, all of which have a negative impact on an individual's ability to function. Depression that occurs during pregnancy is known as antenatal depression. The occurrence of depression during pregnancy and afterward is quite high. Women having a history of depression before pregnancy have a high probability of getting depression during pregnancy again. The purpose of the study is to review the effect of untreated depression during pregnancy on maternal and neonatal outcomes. The primary outcomes of this review were the identification of studies showing the relationship between untreated depression during the pregnancy indicated by depression measures and any associated adverse birth outcomes; specifically, low birth weight, small for gestational age, preterm birth, postpartum depression, and infant neurodevelopmental outcome. We reviewed 20 population-based contemporary cohort studies with a range of populations from 54 to 194,494, all of them representing the population of gestational age located in multiple jurisdictions. It was found that maternal depression during pregnancy has a positive association with preterm birth, small for gestational age, stillbirth, low birth weight, and maternal morbidity including perinatal complications, increased operative delivery, and postpartum depression. To prevent these adverse outcomes, depression should be screened, monitored, and managed appropriately keeping risk-benefit in consideration.

Research trends and hotspots of health-related quality of life: a bibliometric analysis from 2000 to 2019

BACKGROUND

The number of research articles on health-related quality of life (HRQoL) has been strikingly increasing. This study aimed to explore the general trends and hotspots of HRQoL.

METHODS

Based on the Web of Science database, research on HRQoL published between 2000 and 2019 were identified. A bibliometric analysis was performed based on the number of articles, citations, published journals, authors' addresses, and keywords. Descriptive analysis, visualization of geographic distribution and keyword clustering analysis were applied to the collected data.

RESULTS

The annual number of articles showed growth over the past twenty years, but the annual total citations and annual citations per article were both in decreasing trends. Articles about HRQoL were more likely to be published in journals of multi-subject categories. The HRQoL research was mainly distributed across North America and Europe throughout the twenty years and ushered in a vigorous development worldwide after 2015. Cooperation strength between domestic institutions was much greater than that of international institutions. HRQoL research had six concentrated clusters: HRQoL, Depression, Obesity, Disability, Oncology, Fatigue.

CONCLUSION

This study provided an overall perspective of global research trends and hotspots in HRQoL, and a potential insight for future research. HRQoL research had experienced significant increasing development during 2000-2019, especially the HRQoL measurement instruments, however, there were significant regional disparities in scientific output in HRQoL.

Prenatal Depression: Assessment and Outcomes among Medicaid Participants

This study used bivariate and regression-adjusted analyses of participant-level survey and medical data to investigate prevalence of depression among pregnant Medicaid participants, correlates of depression, and the relationship between depression and pregnancy outcomes. The sample included Medicaid participants with a single gestation and valid depression data who were enrolled in Strong Start for Mothers and Newborns 2, a national preterm birth prevention program, from 2013 to 2017 (N = 37,287; 85% of total enrollment). Depression rates in Strong Start were high (27.5%). Depression was associated with being black; having other children, an unplanned pregnancy, or challenges accessing prenatal care; not having a co-resident spouse or partner; and experiencing intimate partner violence. After these and other risk factors were controlled for, depression remained associated with higher rates of preterm birth. Systematic screening and holistic approaches to prenatal care that address depression and associated risks could help reduce rates of preterm birth and other poor pregnancy outcomes.

Mental Disorders and Suicide Attempts in the Pregnancy and Postpartum Periods Compared with Non-Pregnancy: A Population-Based Study

OBJECTIVE

To compare the rate of mental disorders (i.e., mood and anxiety, substance use, psychotic disorders) and suicide attempts within the same group of women across the pre-pregnancy, pregnancy, and postpartum periods, and between this perinatal cohort and a non-perinatal reference group.

METHOD

Data were from an administrative repository of residents in Manitoba, Canada. The perinatal cohort consisted of women aged 18 to 45 years who experienced >1 live birth pregnancy between 2011 and 2014 (n = 45,362). Pre-pregnancy, pregnancy, and postpartum periods were defined over consecutive 40-week intervals. The non-perinatal cohort consisted of age-matched women with no pregnancies during the same period (n = 139,705). A reference 40-week interval was defined from the individual's birthdate in the year they entered the cohort. Rate ratios of diagnosed mental disorders were adjusted (aRR) for demographic factors, parity, and mental health history.

RESULTS

Within the perinatal cohort, pregnancy was associated with a lower rate of diagnosed mood or anxiety disorder, substance use disorder, and suicide attempt relative to pre-pregnancy (aRR range, 0.22-0.82). Pregnancy also had lower rates of all outcomes compared with the postpartum period (aRR, 0.44-0.87). Postpartum had a higher rate of psychotic disorder compared with pre-pregnancy (aRR, 1.61; 95% CI, 1.17-2.21), but a lower rate of mood or anxiety disorder and suicide attempt. Compared with non-perinatal women, pregnancy was associated with lower rates of all outcomes (aRR range, 0.25-0.87).

CONCLUSIONS

Compared with a non-perinatal period, the rate of a diagnosed mental disorder is lower during pregnancy but begins to rise in the postpartum period, highlighting an important period for early identification and rapid access to intervention.

Quality of life in patients with peripheral artery disease

Background

Vascular diseases have a direct influence on quality of life (QoL) and directly affect patients’ biopsychosocial aspects. Quality of life is therefore an important element for evaluation of vascular interventions.

Objective

To assess QoL in inpatients with peripheral arterial disease at a vascular surgery service in a charitable tertiary hospital.

Methods

This is an exploratory study, with a cross-sectional design, conducted at a vascular surgery service in a charitable tertiary hospital, assessing patients with peripheral arterial disease using two questionnaires, one on quality of life (the WHOQOL-Bref short form) and the other on sociodemographic conditions.

Results

It was observed that the physical domain, environment domain and total QoL scores were the lowest for the whole sample of 127 interviewees. Additionally, an intragroup analysis showed that men scored higher in all domains when compared with women, with the exception of the social relationships domain.

Conclusions

Women with peripheral arterial disease exhibited lower scores than men in all domains of the QoL questionnaire, except for social relationships.

Health-related quality of life determinants among Rwandan women after delivery: does antenatal care utilization matter? A cross-sectional study

BACKGROUND

Despite the widespread use of antenatal care (ANC), its effectiveness in low-resource settings remains unclear. In this study, self-reported health-related quality of life (HRQoL) was used as an alternative to other maternal health measures previously used to measure the effectiveness of antenatal care. The main objective of this study was to determine whether adequate antenatal care utilization is positively associated with women's HRQoL. Furthermore, the associations between the HRQoL during the first year (1-13 months) after delivery and socio-economic and demographic factors were explored in Rwanda.

METHODS

In 2014, we performed a cross-sectional population-based survey involving 922 women who gave birth 1-13 months prior to the data collection. The study population was randomly selected from two provinces in Rwanda, and a structured questionnaire was used. HRQoL was measured using the EQ-5D-3L and a visual analogue scale (VAS). The average HRQoL scores were computed by demographic and socio-economic characteristics. The effect of adequate antenatal care utilization on HRQoL was tested by performing two multivariable linear regression models with the EQ-5D and EQ-VAS scores as the outcomes and ANC utilization and socio-economic and demographic variables as the predictors.

RESULTS

Adequate ANC utilization affected women's HRQoL when the outcome was measured using the EQ-VAS. Social support and living in a wealthy household were associated with a better HRQoL using both the EQ-VAS and EQ-5D. Cohabitating, and single/unmarried women exhibited significantly lower HRQoL scores than did married women in the EQ-VAS model, and women living in urban areas exhibited lower HRQoL scores than women living in rural areas in the ED-5D model. The effect of education on HRQoL was statistically significant using the EQ-VAS but was inconsistent across the educational categories. The women's age and the age of their last child were not associated with their HRQoL.

CONCLUSIONS

ANC attendance of at least four visits should be further promoted and used in low-income settings. Strategies to improve families' socio-economic conditions and promote social networks among women, particularly women at the reproductive age, are needed.

Self-reported health and personal social networks of older people living with HIV/AIDS in Lomé, Togo

Personal social networks and their association with the health of older people have been explored, but there are few studies that examined the relationship between the general health of older people living with HIV/AIDS (OPLWHA) and their personal social networks. This exploratory study investigates the characteristics of personal networks among OPLWHA and the relationship between the self-rated health and personal social networks of OPLWHA in Lomé, Togo. Forty-nine OPLWHA were interviewed via an egocentric survey. We examined the composition and size of the networks of OPLWHA. Also, the correlation between networks and self-reported health was examined. Findings show that the OPLWHA had personal social networks that included three types of people: immediate kin, extended kin, and non-kin. Additionally, these networks varied by size. While the mean number of people in the smaller network (people from whom the OPLWHA can borrow an important sum of money) was less than one person (0.55), the mean number of people in the larger network was three (people with whom the OPLWHA enjoy socializing). Furthermore, only the network of people with whom OPLWHA enjoy socializing had a significant positive correlation on the self-rated health of OPLWHA. Consistent with prior research, we found that the mere existence of a network does not imply that the network has a positive correlation with the subject or that the network provides the social support needed to positively influence health. A study of the correlation between social network characteristics and health in the population of older people with HIV/AIDS is important as the number of OPLWHA continues to grow.

Health indicators for military, veteran, and civilian women

BACKGROUND

Women who have served in the military are a rapidly growing population. No previous studies have compared directly their health status to that of civilians.

PURPOSE

To provide estimates of several leading U.S. health indicators by military service status among women.

METHODS

Data were obtained from the 2010 Behavioral Risk Factor Surveillance Survey, a U.S. population-based study. Health outcomes were compared by military status using multivariable logistic regression among the female participants (274,399 civilians, 4221 veterans, 661 active duty, and 995 National Guard or Reserves [NG/R]). Data were analyzed in August 2011.

RESULTS

Veterans reported poorer general health and greater incidence of health risk behaviors, mental health conditions, and chronic health conditions than civilian women. Active duty women reported better access to health care, better physical health, less engagement in health risk behaviors, and greater likelihood of having had a recent Pap than civilian women. Women from the NG/R were comparable to civilians across most health domains, although they had a greater likelihood of being overweight or obese and reporting a depressive and anxiety disorder.

CONCLUSIONS

Compared with civilian women, NG/R women rated their health and access to health care similarly and active duty women rated theirs better on several domains, but veterans consistently reported poorer health.

Characteristics of vibrator use by gay and bisexually identified men in the United States

INTRODUCTION

Recent reports indicate that vibrator use during solo and partnered sexual activities is common among heterosexual men and women in the United States. However, little research has comprehensively assessed vibrator use among gay and bisexually identified men.

AIMS

This study sought to document the extent to which gay and bisexually identified men report using vibrators, the sexual and relational situations within which they use them, and how men use vibrators on their own and their partners' bodies.

METHODS

Data were collected from 25,294 gay and bisexually identified men from 50 U.S. states and from the District of Columbia via an internet-based survey.

MAIN OUTCOME MEASURE

Measures included sociodemographics, health-related indicators, sexual behaviors, and those related to recent and past use of vibrators during solo and partnered sexual interactions with other men.

RESULTS

Approximately half (49.8%) of gay and bisexually identified men reported having used vibrators. Most men who had used a vibrator in the past reported use during masturbation (86.2%). When used during partnered interactions, vibrators were incorporated into foreplay (65.9%) and intercourse (59.4%). Men reported frequent insertion of vibrators into the anus or rectum when using them during masturbation (87.3%), which was also common during partnered interactions (∼60%), but varied slightly for casual and relationship sex partners. For both masturbation and partnered interactions, men overwhelmingly endorsed the extent to which vibrator use contributed to sexual arousal, orgasm, and pleasure.

CONCLUSIONS

Vibrator use during both solo and partnered sexual acts was common among the gay and bisexually identified men in this sample and was described by men as adding to the quality of their sexual experiences.

Disparities in health-related quality of life: a comparison of lesbians and bisexual women

OBJECTIVES

We investigated the association of health-related quality of life (HRQOL) with sexual orientation among lesbians and bisexual women and compared the predictors of HRQOL between the 2 groups.

METHODS

We used multivariate logistic regression to analyze Washington State Behavioral Risk Factor Surveillance System population-based data (2003 to 2007) in a sample of 1496 lesbians and bisexual women and examined determinants of HRQOL among lesbians and bisexual women.

RESULTS

For lesbians and bisexual women, frequent mental distress and poor general health were associated with poverty and lack of exercise; poor general health was associated with obesity and mental distress. Bisexual women showed a higher likelihood of frequent mental distress and poor general health than did lesbians. The odds of mental distress were higher for bisexual women living in urban areas as compared with nonurban areas. Lesbians had an elevated risk of poor general health and mental distress during midlife.

CONCLUSIONS

Despite the standard practice of collapsing sexual minority women into a single group, lesbian and bisexual women in this study emerge as distinct groups that merit specific attention. Bisexual women are at elevated risk for poor HRQOL.

The relationship between mental disorders, quality of life, and pregnancy: findings from a nationally representative sample

BACKGROUND

The present study examined health-related quality of life (HRQOL) and the prevalence of mental disorders in pregnant and past-year pregnant women compared to non-pregnant women.

METHOD

Data came from the National Epidemiologic Survey on Alcohol and Related Conditions. Three groups of women (ages 18-44) were compared: currently pregnant (n=451), past-year pregnant (n=1061), and not pregnant (n=10,544). Past-year mood, anxiety and substance use disorders were assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. HRQOL was measured by the Medical Outcomes Study Short Form (SF-12). All analyses included sociodemographics as covariates.

RESULTS

Multiple logistic regression analyses showed that pregnant women were less likely than non-pregnant women to have depression and alcohol abuse or dependence; and less likely than past-year pregnant women to have depression and mania. Past-year pregnant women were less likely than non-pregnant women to have social phobia and alcohol dependence or abuse. Multiple linear regression analyses demonstrated that pregnant and non-pregnant women had higher mental component scores than past-year pregnant women. Physical component scores were lower in pregnant women than in non-pregnant and past-year pregnant groups.

LIMITATIONS

This was a cross-sectional survey and the causality of relationships cannot be inferred.

CONCLUSIONS

Results suggest that pregnant women have a lower likelihood of mental disorder than both non-pregnant and past-year pregnant women.

Patterns of health-related quality of life and patterns associated with health risks among Rhode Island adults

Background

Health-related quality of life (HRQOL) has become an important consideration in assessing the impact of chronic disease on individuals as well as in populations. HRQOL is often assessed using multiple indicators. The authors sought to determine if multiple indicators of HRQOL could be used to characterize patterns of HRQOL in a population, and if so, to examine the association between such patterns and demographic, health risk and health condition covariates.

Methods

Data from Rhode Island's 2004 Behavioral Risk Factor Surveillance System (BRFSS) were used for this analysis. The BRFSS is a population-based random-digit-dialed telephone survey of adults ages 18 and older. In 2004 RI's BRFSS interviewed 3,999 respondents. A latent class regression (LCR) model, using 9 BRFSS HRQOL indicators, was used to determine latent classes of HRQOL for RI adults and to model the relationship between latent class membership and covariates.

Results

RI adults were categorized into four latent classes of HRQOL. Class 1 (76%) was characterized by good physical and mental HRQOL; Class 2 (9%) was characterized as having physically related poor HRQOL; Class 3 (11%) was characterized as having mentally related poor HRQOL; and Class 4 (4%) as having both physically and mentally related poor HRQOL. Class 2 was associated with older age, being female, unable to work, disabled, or unemployed, no participation in leisure time physical activity, or with having asthma or diabetes. Class 3 was associated with being female, current smoking, or having asthma or disability. Class 4 was associated with almost all the same predictors of Classes 2 and 3, i.e. older age, being female, unable to work, disabled, or unemployed, no participation in leisure time physical activity, current smoking, with having asthma or diabetes, or with low income.

Conclusion

Using a LCR model, the authors found 4 distinct patterns of HRQOL among RI adults. The largest class was associated with good HRQOL; three smaller classes were associated with poor HRQOL. We identified the characteristics of subgroups at higher-risk for each of the three classes of poor HRQOL. Focusing interventions on the high-risk populations may be one approach to improving HRQOL in RI.

Modifiable characteristics of a healthy lifestyle in U.S. older adults with or without frequent mental distress: 2003 Behavioral Risk Factor Surveillance System

OBJECTIVE

To examine the associations between frequent mental distress (FMD; 14 or more mentally unhealthy days during the previous 30 days), health behaviors, body weight, and use of preventive services among adults >or=65 years using the 2003 Behavioral Risk Factor Surveillance System (BRFSS).

METHODS

Participants (N = 52,600) were asked how many days during the past 30 days that their mental health was not good. Having a healthy weight (body mass index 18.5-24.9 kg/m(2)), not smoking, consuming <or=1 alcoholic beverage per day, consuming of at least five fruits or vegetables daily, participating in moderate-to-vigorous physical activity during the average week, receiving an annual influenza immunization, and ever receiving a pneumococcal immunization were examined in addition to combinations of these behaviors.

RESULTS

People with FMD were less likely than those without FMD to be nonsmokers (adjusted odds ratio [AOR] = 0.67, confidence interval [CI] = 0.53-0.85), to consume at least five fruits or vegetables daily (AOR = 0.80, CI = 0.70-0.91), and to participate in moderate-to-vigorous physical activity during the average week (AOR = 0.82, CI = 0.68-0.99). However, there was no difference between those with and without FMD in the consumption of <or=1 alcoholic beverage per day, having a healthy weight, receiving an annual influenza immunization, and ever receiving a pneumococcal immunization.

CONCLUSIONS

Older adults with FMD are less likely to engage in many health behaviors and to use preventive services than those without FMD.

Associations between health-related quality of life and demographics and health risks. Results from Rhode Island's 2002 behavioral risk factor survey

BACKGROUND

Health-Related Quality of Life (HRQOL) has received much attention in recent years. HRQOL indicators have been used to track population trends, identify health disparities, and monitor progress in achieving national health objectives for 2010. Prior studies have examined health risks and HRQOL at the national level as well as at the state level. This paper examines multiple indicators of HRQOL by demographic characteristics and selected health behaviors for Rhode Island adults.

METHODS

Data from Rhode Island's 2002 Behavioral Risk Factor Surveillance System (BRFSS), a random digit dialled telephone survey, were used for this study. The state wide sample contained a total of 3,843 respondents ages 18 and older. Multiple Imputation (MI) was applied to handle missing data, and data were modelled for each of 10 HRQOL indicators using multivariable logistic regression.

RESULTS

By examining HRQOL through a multivariable approach we identified the strongest predictors for multiple indicators of poor HRQOL as well as predictors for specific indicators of poor HRQOL. Predictors for multiple indicators of poor HRQOL were: disability, inability to work, unemployment, lower income, lack of exercise, asthma, and smoking (specifically associated with poor mental health).

CONCLUSION

Using multiple measures of HRQOL can help to assess the burden of poor health in a population, identify subgroups with unmet HRQOL needs, inform the development of targeted interventions, and monitor changes in a population's HRQOL over time. Use of these HRQOL measures in longitudinal and intervention studies is needed to increase our understanding of the causal relationships between demographics, health risk behaviors, and HRQOL.

Inequalities in self-reported physical health in the United States, 1993-1999

This study investigated inequalities in physically healthy days in the United States during 1993-1999, by socioeconomic and demographic group. The generalized entropy GE(2) and other indices were computed using data from the Behavioral Risk Factor Surveillance System survey, 1993-1999. The results indicate that GE(2) for the US population increased by 17% during 1993-1999. Low-to-middle income groups had the highest increases in inequalities during this time (51-66%), whereas the least educated, Asian/Pacific Islanders, American Indians/Alaska Natives, the oldest, the youngest, and the richest had the lowest (-14-10%). In 1999, inequalities ranged from 0.0153 (income>or=$50 000) to 0.112 (income<$10 000). Inequalities have increased during 1993-1999 and vary substantially across groups. The American Indians/Alaska Natives experienced the highest inequalities whereas Asians/Pacific-Islanders exhibited the lowest inequalities. More attention should be given to within-group inequalities.

Risk behaviors and health-related quality of life among adults with asthma: the role of mental health status

BACKGROUND

Previous research indicates that asthma is strongly associated with depressive disorders. Depression among persons with asthma is associated with poor adherence to medication regimens, more severe asthma, and poorer disease outcomes. The objective of our study was to examine the association of frequent mental distress (FMD) [ie, > or = 14 days in the past 30 days in which respondents reported that their mental health was not good] with modifiable risk behaviors (ie, smoking, physical inactivity, and obesity) and health-related quality of life among adults with asthma.

METHODS

The Behavioral Risk Factor Surveillance System is an ongoing, state-based survey that is conducted by random-digit dialing of noninstitutionalized US adults aged > or = 18 years. In 2001, all 50 states administered the asthma and risk behavior questionnaires (15,080 questionnaires). A total of 12 states administered the health-related quality-of-life questionnaire (3,226 questionnaires). We estimated prevalences, 95% confidence intervals, odds ratios, and adjusted odds ratios (AORs) using a statistical software program to account for the complex survey design.

RESULTS

The prevalence of FMD among adults with asthma was 18.8%. After adjusting for sociodemographic characteristics, the overall associations between smoking and FMD (AOR, 1.9), and between physical inactivity and FMD (AOR, 1.7) were statistically significant. In addition, among those with asthma, persons with FMD were significantly more likely than those without FMD to report fair/poor general health, frequent physical distress, frequent activity limitations, frequent anxiety, and frequent sleeplessness.

CONCLUSIONS

FMD is highly prevalent among persons with asthma, suggesting an apparent synergistic effect of these two conditions. The assessment of the mental health status of persons with asthma by health-care providers appears to be warranted and may prevent the emergence of risk behaviors yielding deleterious effects on the management of this disease.

Mental and physical distress and high-risk behaviors among reproductive-age women

OBJECTIVE

To examine the prevalence of mental and physical distress indicators among women of reproductive age and the association of these indicators with cigarette smoking and alcohol use, by pregnancy status.

METHODS

The Behavioral Risk Factor Surveillance System data for several years were aggregated across states and weighted for this analysis. Seven measures of self-reported mental and physical distress and general health were examined along with demographic variables.

RESULTS

Overall, 6.7% (95% confidence interval [CI] 6.5-6.9) of women reported frequent physical distress, 12.3% (95% CI 12.0-12.6) reported frequent mental distress, 9.9% (95% CI 9.4-10.4) reported frequent depression, 18.4% (95% CI 17.8-19.1) reported feeling anxious, and 34.3% (95% CI 33.5-35.1) reported that they frequently did not get enough rest. At the time of the survey 4.6% of the women were pregnant. Pregnant women were less likely than nonpregnant women to report frequent mental distress. Although there was attenuation of cigarette smoking and alcohol use during pregnancy, those with mental and physical distress were more likely to consume cigarettes and alcohol than were those without such experiences.

CONCLUSION

High proportions of reproductive-age women report frequent mental and physical distress. Women experiencing mental and physical distress were more likely to report consuming cigarettes and alcohol than women without such experiences.

Worsening trends in adult health-related quality of life and self-rated health-United States, 1993-2001

OBJECTIVES

Health-related quality of life and self-rated health complement mortality and morbidity as measures used in tracking changes and disparities in population health. The objectives of this study were to determine whether and how health-related quality of life and self-rated health changed overall in U.S. adults and in specific sociodemographic and geographic groups from 1993 through 2001.

METHODS

The authors analyzed data from annual cross-sectional Behavioral Risk Factor Surveillance System surveys of 1.2 million adults from randomly selected households with telephones in the 50 states and the District of Columbia.

RESULTS

Mean physically and mentally unhealthy days and activity limitation days remained constant early in the study period but increased later on. Mean unhealthy days increased about 14% during the study period. The percentage with fair or poor self-rated health increased from 13.4% in 1993 to 15.5% in 2001. Health-related quality of life and self-rated health worsened in most demographic groups, especially adults 45-54 years old, high school graduates without further education, and those with annual household incomes less than $50,000. However, adults 65 years old or older and people identified as non-Hispanic Asian/Pacific Islander reported stable or improving health-related quality of life and self-rated health. In 18 of the states and the District of Columbia, mean unhealthy days increased, while only North Dakota reported a decrease.

CONCLUSION

Population tracking of adult health-related quality of life and self-rated health identified worsening trends overall and for many groups, suggesting that the nation's overall health goals as identified in the Healthy People planning process are not being met.

Characteristics of people aged 45 years or older with heart disease by frequent mental distress status, 2001

BACKGROUND

Depression commonly occurs after nonfatal cardiac events and is associated with adverse health outcomes.

METHODS

In 2001, the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized adults, administered cardiovascular health questions to 19 states and DC. Among those aged > or = 45 years, we examined the association of frequent mental distress (FMD) (> or = 14 self-reported mentally unhealthy days in the past 30 days) with modifiable adverse behaviors (smoking, physical inactivity, and obesity) and health care coverage.

RESULTS

The prevalence of FMD among adults with heart disease was 14.8%. Age-adjusted odds ratios indicated that adults with heart disease and FMD were more likely to smoke, to be physically inactive, to be obese, and to be without health care coverage than persons without FMD. Although frequent mental distress was associated with only one adverse health behavior (physical inactivity) after fully adjusting when these health behaviors were considered separately, we observed a twofold increased likelihood for the presence of multiple adverse health behaviors among those with FMD as compared to those without FMD.

CONCLUSIONS

Medical counseling on lifestyle changes after cardiac events is accepted as a key part of rehabilitation; however, the mental well-being of patients may also need to be monitored, as it may be a mediating factor in achieving healthy lifestyle goals.

Binge drinking and health-related quality of life: do popular perceptions match reality?

BACKGROUND

Popular culture (movies, television shows, advertising) often portrays drinking to the point of intoxication as either humorous or associated with enjoyable social activities that enhance quality of life. This study examined the association between binge drinking (consuming five or more alcoholic drinks on one occasion) and health-related quality of life (HRQOL) among U.S. adults.

METHODS

Data are from the Behavioral Risk Factor Surveillance System, a continuous random-digit-dial telephone survey of adults aged >/=18 years conducted in all states. This survey included questions about alcohol consumption and HRQOL.

RESULTS

In 2001, 52% of U.S. adults were current drinkers (one or more drinks in the past 30 days). Of current drinkers, 11% were frequent binge drinkers (three or more episodes in past month) and 14% were infrequent binge drinkers (one to two episodes in past month). After adjusting for confounding factors, frequent binge drinkers were more likely than non-binge drinkers to experience >/=14 unhealthy days (physical or mental) in the past month (adjusted odds ratio [AOR]=1.39, 95% confidence interval [CI]=1.24-1.56), primarily because they had more mentally unhealthy days than non-binge drinkers (AOR=1.52, 95% CI=1.32-1.75).

CONCLUSIONS

Frequent binge drinking is associated with significantly worse HRQOL and mental distress, including stress, depression, and emotional problems. Effective interventions to prevent binge drinking should be widely adopted and may help improve quality of life.

Risk behaviors and healthcare coverage among adults by frequent mental distress status, 2001

BACKGROUND

Given the increased emphasis on chronic diseases in the United States, physicians and health survey analysts are now gathering information on patients' subjective measures of health, also known as health-related quality-of-life measures. Studies indicate that these measures can be more powerful predictors of chronic disease-related morbidity and mortality than objective measures.

METHODS

The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of the non-institutionalized U.S. population aged 18 years or older. This study examined frequent mental distress (FMD), defined as self-reported 14 or more mentally unhealthy days in the past 30 days, and its association with adverse health behaviors and lack of healthcare coverage.

RESULTS

In 2001, approximately 10% of adults reported FMD. Persons reporting FMD had a higher prevalence of smoking, drinking heavily, physical inactivity, and obesity than did persons without FMD. They were also more often without healthcare coverage. In addition, persons with FMD were more likely to engage in multiple adverse behaviors than were persons without FMD.

CONCLUSIONS

Persons reporting FMD are at higher risk of chronic diseases because they engage in risky health behaviors and lack healthcare coverage. This study provides further support that mental health screening as well as physical health screening is important in clinical practice. Further research is needed to identify therapeutic or mental health-promoting interventions to reduce mental distress and reinforce healthy behaviors.

The Centers for Disease Control and Prevention's Healthy Days Measures - population tracking of perceived physical and mental health over time

To promote the health and quality of life of United States residents, the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) - with 54 state and territorial health agencies - has supported population surveillance of health-related quality of life (HRQOL). HRQOL was defined as "perceived physical and mental health over time." Commonly-used measures of health status and activity limitation were identified and a set of "Healthy Days" HRQOL measures was developed and validated. A core set of these measures (the CDC HRQOL-4) asks about self-rated general health and the number of recent days when a person was physically unhealthy, mentally unhealthy, or limited in usual activities. A summary measure combines physically and mentally unhealthy days. From 1993 to 2001, more than 1.2 million adults responded to the CDC HRQOL-4 in each state-based Behavioral Risk Factor Surveillance System (BRFSS) telephone interview. More than one fifth of all BRFSS respondents also responded to a set of related questions - including five items that assess the presence, main cause and duration of a current activity limitation, and the need for activity-related personal and routine care; as well as five items that ask about recent days of pain, depression, anxiety, sleeplessness, and vitality. The Healthy Days surveillance data are particularly useful for finding unmet health needs, identifying disparities among demographic and socioeconomic subpopulations, characterizing the symptom burden of disabilities and chronic diseases, and tracking population patterns and trends. The full set of 14 Healthy Days Measures (the CDC HRQOL-14) has shown good measurement properties in several populations, languages, and settings. The brief standard CDC HRQOL-4 is now often used in surveys, surveillance systems, prevention research, and population health report cards.