Subjective quality of life in war-affected populations

Comparison of subjective quality of life domains in schizophrenia, mood, and anxiety disorders; an individual patient data meta-analysis

This study sought to compare satisfaction with different subjective quality of life domains across individuals with three different mental health disorders. Samples from four separate studies were combined to conduct a one-step individual patient data meta-analysis. 5329 individuals with either a schizophrenia (n = 1839), mood (n = 1650), or anxiety disorder (n = 1840) were included. Mean satisfaction ratings for each life domain were compared across disorders. Associations between satisfaction ratings and personal characteristics were investigated using multivariable mixed effect models. Results showed that individuals with an anxiety disorder had the widest range of scores and reported lower satisfaction in most domains compared to those with a schizophrenia or mood disorder. Individuals with a schizophrenia disorder rated domains to do with 'others', such as relationships with family and sex life, as lower than individuals with a mood or anxiety disorder. Satisfaction ratings were often more impacted by personal characteristics, such as employment status, than by diagnostic category. These results demonstrate that specific life areas are impacted differently in the three mental health disorders studied. However, further research needs to consider the impact of personal characteristics across disorders, and the subjective quality of life in individuals with anxiety disorders in particular warrants further investigation.

The quality of life and its inter-relationship with posttraumatic stress disorder and social support in two post-conflict communities in Nigeria

The study aimed to compare the quality of life (QoL) in two communities with different exposures to conflict and investigate the inter-relationship between posttraumatic stress disorder (PTSD), social support, and QoL. This is a cross-sectional with 413 participants. Study instruments included the PTSD module of the Composite International Diagnostic Interview (CIDI), the World Health Organization Quality of Life BREF (WHOQoL-BREF), and the Multidimensional Scale of Perceived Social Support (MSPSS). The family domain of social support was protective of both PTSD and QoL. Except for the relationship between community's location and the physical subscale of the QoL, a hierarchical regression analysis showed that all the independent variables were significantly associated with the QoL domains. Direct exposure to crises impaired QoL more than areas indirectly exposed. PTSD and the family domain of social support play a significant role in the QoL outcome. This suggests that therapeutic intervention to improve QoL should target these key variables.

Quality of life and mental health outcomes: the role of sociodemographic factors in the Palestinian context

The Mental health of Palestinians has been described as among the lowest in the world, with over half of Palestinian adults meeting the diagnostic threshold for depressive symptoms and a significant portion of Palestinians experiencing mental distress and anxiety. The aim of the current study was to test the correlation between quality of life (QoL) and mental health outcomes, and the role of sociodemographic variables in predicting mental health outcomes (depression, anxiety, and stress) among Palestinian adults during a challenging period of political conflict. The sample of our study consisted of 957 participants, 283 males and 674 females they were recruited using online methods; online advertisements, e-mail campaigns and social media. Our findings showed that QoL negatively correlated with stress (r = - 0.43, p < 0.01), anxiety (r = - 0.46, p < 0.01), and depression (r = - 0.47, p < 0.05). Moreover, stress positively correlated with anxiety (r = 0.81, p < 0.01), and depression (r = 0.89, p < 0.01). Finally, anxiety positively correlated with depression (r = 0.82, p < 0.01). Results of hierarchical regression analysis to predict stress, anxiety and depression, indicated that QoL, educational level, gender, region of residence, and age explained in a significant way variance in depression, anxiety and stress. Our findings are promising to conduct other studies in order to understand better how current study variables correlate to each other, so appropriate clinical interventions to mitigate the negative effects of depression, anxiety, and stress through enhancing quality of life and positive coping strategies can be developed and implemented by mental health providers.

Les Misérables: An analysis of low SWB across the world

Global trends indicate that the prevalence of low subjective wellbeing is on the rise, though not all regions are equal in terms of both absolute levels and their trajectories. In this paper, we explore the relative importance of individual- and country-level factors in predicting low SWB. Put differently, we ask if a person found themselves behind a veil of ignorance, should they want to know who they will be or what country they will live in to better understand their risk of having low wellbeing. To answer this question, we leverage data from the most extensive wellbeing survey in the world-the Gallup World Poll. We explore people's likelihood of reporting low evaluative wellbeing (that their life is close to the worst possible life on the Cantril ladder) and low experiential wellbeing (reporting having felt angry, sad, stressed, and worried for most of the day yesterday). Using multilevel models on both measures, we show that individual factors have the greatest explanatory power across both measures, but that country level factors are almost four times more important in explaining the variation in low evaluative wellbeing than low experiential wellbeing around the world. We also present evidence that individual and country-level factors interact, suggesting that a complex system of people and places determines people's likelihood of reporting low SWB.

Post-traumatic stress disorders among Syrian refugees residing in non-camp settings in Jordan

OBJECTIVES

To measure the prevalence and severity of post-traumatic stress disorders (PTSD) among Syrian refugees and explore its association with various factors.

METHODS

A cross-sectional study was carried out among a convenience snowball sample of Syrian refugees residing in non-camp settings in Jordan in 2019. A 4-part self-administered structured questionnaire was used to collect data. Part one included socio-demographic data, part 2 included an Arabic version of Harvard Trauma Questionnaire (HTQ) (part I: trauma event and part IV: trauma symptoms), part 3 was related to participants' physical symptoms, and part 4 to participants' satisfaction with the healthcare they received.

RESULTS

Study participants (n=279; mean age 32 years (SD=10.45), 52% were males) reported high prevalence of traumatic symptoms (86.2%); of these, 68.5% were considered symptomatic for PTSD (HTQ-16 sub-scale or the entire symptom scale HTQ-45 mean item score of >2.5), regardless of the type of trauma. Those who were middle-aged, a female, unemployed, sexually abused or raped, had a family member who died in the conflict, witnessed catastrophic events like burning, or razing of residential areas, and have received the body of a family member while being prohibited from expressing grief and doing funeral rites, were more likely to be considered as a case of PTSD.

CONCLUSION

Majority of the refugees residing in non-camp settings in Jordan suffer from PTSD. Refugees have low satisfaction with the healthcare services provided.

Feasibility evaluation of psychosocial intervention for internally displaced youth in Kenya

BACKGROUND

There is limited evidence on the cultural appropriateness of first-stage psychosocial interventions for youth with mental health problems who experience conflict and disadvantage in low- and middle-income countries (LMIC).

AIMS

To evaluate the feasibility of such an intervention (Writing for Recovery - WfR) among youth with emerging emotional problems following internal displacement in Kenya.

METHOD

Fifty-four youth aged 14-17 years were randomly allocated to a six-session intervention or a waiting list control group. They completed measures of stressful life events; post-traumatic stress, depressive and anxiety symptoms; quality of life; and free text on their experience of the intervention.

RESULTS

Young participants reported high levels of trauma exposure and emotional problems. The intervention was perceived as flexible and culturally acceptable, with reported short-term impact. This was found to have promising post-intervention effect in reducing post-traumatic stress, but not depressive or anxiety symptoms; and in enhancing quality of life scores.

CONCLUSIONS

Similar psychosocial interventions that can be delivered by paraprofessionals are important for resource-constrained LMIC settings, but need to be integrated within a comprehensive scaled service model.

The relationship between employment and health for people from refugee and asylum-seeking backgrounds: A systematic review of quantitative studies

Background

For the general population, the positive effects of paid employment on health and wellbeing are well established. However, less is known for people from refugee and asylum-seeking backgrounds. This review aims to systematically summarise the quantitative literature on the relationship between employment and health and wellbeing for refugees and asylum seekers.

Method

A search strategy was conducted in online databases, including MEDLINE, PsychINFO, EMCARE, SCOPUS, CINHAL, ProQuest and Web of Science. Articles were screened against inclusion and exclusion criteria. Studies published in English between 2000 to October 2021 were included if they used quantitative methods to consider the relationship between employment and health for refugees and asylum seekers in resettlement countries. Study quality was assessed using The Joanna Briggs Institute's Critical Appraisal Tools. Findings were synthesised using a narrative approach.

Results

Seventy-two papers were identified. The majority of papers (N = 58, 81%) examined the association between employment and mental health outcomes. Overall, while there were inconsistencies in the findings, employment had a positive effect on mental health particularly in reducing levels of psychological distress and depression. Though more limited in number, the papers examining physical health suggest that people who are employed tend to have better physical health than unemployed persons. There was some evidence to support the bi-directional relationship between employment and health. Poor mental and physical health negatively impacted the odds of employment and occupational status of refugees.

Conclusion

Good quality employment is an essential component of refugee resettlement and this review found that in general employment is also beneficial for refugee health, particularly aspects of mental health. More research regarding the effects of employment on physical health is required. The effects of refugee-specific factors such as gender roles, torture, and trauma on the relationship between employment and health also require further investigation.

The lasting impact of war experiences on quality of life in long-lived retirement homes residents: The birth cohort 1906–1928

Only a few studies have been conducted so far on the long-term impact of war. We investigated whether a life-long impact of the war experiences could be detected in advanced-agers who have successfully overcome all life's challenges. The participants in this study were oldest-old (80+ years) residents of retirement homes in Zagreb (Croatia), who were divided into two groups – ‘war-exposed’ and ‘not-exposed’ – according to their direct war experience (First World War, Second World War, Croatian Homeland War). Within this 1906–1928 birth cohort, a higher percentage of participants with war experiences reached extreme longevity (95+ years). We found no significant difference (p < 0.01) between the two groups concerning demographic and socio-economic characteristics, their life satisfaction, their self-rated current health and functional ability status. Despite numerous similarities, several traits related to life-history, current quality of life, attitudes and reflections distinguish the group of participants with direct war experience. The kind of war involvement – active military service, imprisonment in concentration camps or prisons, forced migration due to war and war-related death of close family members – stretched through various aspects of the life-history features, quality of life and attitudes. It differed for men and women, so it is no wonder that the significance pattern in the two genders mostly seems mutually exclusive. Socio-economic situations strongly differed by gender and according to the kind of war exposure, amplifying the differences within the ‘war-exposed’ group in terms of the life-long impact of wars on their lives. Therefore, we could claim that the war experiences were not the same for everybody, and that they had lasting consequences on the lifecourse of persons who directly faced war-related events. The results also point to the high resilience capacity as a common feature among persons who survived direct exposure to at least two wars and yet survived to exceptionally old age.

A Questionnaire for Rating Health-related Quality of Life

Background

Translations of instruments for measuring quality of life developed in certain, mostly more developed, parts of the world usually do not cover regionally specific aspects of health-related quality of life, even after transcultural validation. The aim of this study was to develop and validate a reliable questionnaire in Serbian, Croatian, Bosnian, and Montenegrin languages suitable for measuring health-related quality of life in adults.

Methods

The study was of a cross-sectional type, assessing the reliability and validity of a newly developed questionnaire for measuring health-related quality of life (HRQoL) in adults residing in western Balkan states (WB-HRQoL). It was conducted on a sample of 489 adults from Serbia, Croatia, Bosnia & Herzegovina, and Montenegro, with a mean age of 52.2±14.4 years and a male/female ratio of 195/294 (39.9%/60.1%).

Result

The definitive version of the WB-HRQoL scale with 19 items showed very good reliability, with Cronbach's alpha 0.905. The scale was temporally stable, and satisfactory results were obtained for divergent and convergent validity tests. Exploratory factorial analysis brought to the surface four domains of health-related quality of life, namely the physical, psychical, social, and environmental.

Conclusion

The WB-HRQoL scale is a reliable and valid generic instrument for measuring HRQoL that takes into account the cultural specifics of the western Balkan region.

Impact of Family Separation on Subjective Time Pressure and Mental Health in Refugees from the Middle East and Africa Resettled in North Rhine-Westphalia, Germany: A Cross-Sectional Study

Little is known about social determinants among refugees resettled in Germany. This study aims to examine the impact of family separation on refugees' subjective time pressure and mental health. Data come from the FlueGe Health Study (n = 208), a cross-sectional study administered by Bielefeld University. We used logistic regression analysis to investigate the effect of family separation on (i) being time-stressed and (ii) having a high risk for adverse mental health, considering sociodemographic and postmigration factors. As a result, more than 30% of participants with a spouse or partner and about 18% with a child or children reported separation. Multiple logistic regression showed that family separation was not associated with being time-stressed, but separation from at least one child was associated with adverse mental health (OR = 3.53, 95% CI = [1.23, 10.11]). In conclusion, family separation primarily contributes to adverse mental health among refugees from the Middle East and Africa resettled in North Rhine-Westphalia, Germany. Therefore, policies and practices that facilitate family reunification can contribute significantly to the promotion of refugees' mental health and well-being.

Relationship between shortage of basic life needs and quality of life of medical students in Yemen: A study utilizing validity and reliability of WHOQOL-BREF questionnaire

Purpose:

This study examines quality of life of medical students in Yemen by evaluating validity and reliability of the World Health Organization Quality of Life questionnaire (WHOQOL) and assessing potential influencing factors.

Methods:

This is a single-centered cross-sectional study conducted in Hadramout University College of Medicine, Mukalla, Yemen during the academic year of 2019. The WHOQOL questionnaire was distributed among medical students. For validity, item discriminate validity and confirmatory factor analysis were assessed and for reliability, Cronbach's α test was examined. Independent sample t-test and one-way Analysis of Variance (ANOVA) were used to examine the academic level, gender, academic performance, and basic life necessities including water, electricity supply, sewage treatment and type of residence.

Results:

A total of 495 medical students have responded to this questionnaire which has demonstrated an adequate validity and good reliability. The mean score for students' self-rating of their quality of life in the major domains was found to be in a descending order (Mean ± SD): psychological health (55.18 ± 17.84), environmental (52.14 + 17.60), physical health (48.15 + 14.73) and social relations (45.09 ± 20.81). Demographics and basic life needs exhibit relationship with Quality of Life among medical students.

Conclusion:

The WHOQOL-BREF is a valid and reliable tool among medical students in Hadramout University. Demographics and basic life needs seem to impact Yemeni medical students' Quality of Life. Wellness and mentoring programs should be considered to ameliorate effects related to deteriorating medical students' Quality of Life in Hadramout University.

Quality of life of women from families of martyred individuals in the Kurdistan region of Iraq as a conflict area in the Middle East

Background

Quality of life (QOL) research develops data and insight into issues that pertain not only to the individual, but that can also apply to the population as a whole. This study aimed to analyze the QOL of Kurdish women from families of martyred individuals in the Kurdistan region of Iraq.

Methods

A cross-sectional study of 380 women from families of martyred individuals was conducted. All women were patients at the Medical Center of Martyr Families in Erbil City from January 2018 to April 2019. Data were collected through interviews and the WHOQOL-BREF scale was used to measure QOL. The women’s QOL scores were divided into four categories (i.e., quartiles): 1st, 2nd, 3rd and 4th quartile. Kruskal-Wallis and Chi-Square tests were used for data Analysis.

Results

The women’s QOL scores fell into the following quartiles: Overall QOL and General Health (n = 66.6%) in the 1st quartile, Physical and Psychological Health (n = 56.9%) in the 2nd quartile, Social Relationships (n = 47.9%) in the 3rd quartile, Environmental health (n = 85.6%) in the 2nd and 3rd quartile. The total QOL of more than half (n = 52.1%) of the women studied were in 1st and 2nd quartiles.

Conclusion

Women from families of martyred individuals were not satisfied with their QOL, especially in terms of Physical and Psychological Domains. International political and humanitarian actions are needed to reduce the destructive consequences of war and conflict on these suffering women.

Systematic review of factors associated with quality of life of asylum seekers and refugees in high-income countries

The stressful experiences that many asylum seekers and refugees (AS&R) are exposed to during forced migration, and during resettlement in host countries, can have a profound impact on their mental health. Comparatively less research attention has been allocated to exploring other indices of quality of life (QoL) in AS&R populations. This review aimed to (i) synthesize the predictors and correlates of QoL of AS&R populations in high-income countries, and (ii) to identify the methodological strengths and weaknesses of this body of research. Fourteen databases were systematically searched (Medline, PsychINFO, CINAHL, Cochrane Library, Health Technology Assessment, National Health Service Economic Evaluation, Educational Resource Index and Abstracts, BiblioMap, Scopus, Social Sciences Citation Index, Evidence Aid, DARE, Web of Science and PubMed). Eligibility criteria included: adults seeking asylum or refuge in a high-income country, primary quantitative data, the use of a measure based on the WHO's definition of QoL, published in a peer-reviewed journal. A narrative synthesis approach was used, and the quality was assessed using the AXIS tool for cross-sectional studies and the CASP tool for longitudinal studies. Of the 13.656 papers identified, 23 met the eligibility criteria. A wide range of factors were found to have significant associations with QoL. Both positive and negative correlates of QoL were largely dominated by social (e.g. social networks) and mental health factors (e.g. depression). Although all of the cross-sectional studies met over half of the quality criteria, only 12 met 75% or more of these criteria. For the longitudinal studies, for all but one study lacked statistical precision and the results cannot be applied to the local population. Key findings across the various forms of QoL (overall, physical, psychological, social and environmental) were that having established social networks and social integration were associated with higher QoL, whereas having mental disorders (i.e. PTSD or depression) was strongly associated with reduced QoL. More research is needed into physical and environmental predictors and correlates of QoL. The findings of the review can be used to inform policies and interventions aimed at supporting AS&R and promoting the integration and wellbeing of these populations.

Temperament, Character, and Subjective Well-Being in Croatian War Veterans Suffering From Posttraumatic Stress Disorder

Subjective well-being is decreased in war-affected populations. However, no previous research has investigated the role of temperament and character dimensions in life satisfaction among war veterans with posttraumatic stress disorder (PTSD). This study enrolled 148 Croatian male war veterans being treated for combat-related PTSD. The participants completed the Beck Depression Inventory-Second Edition, Satisfaction with Life Scale, and Temperament and Character Inventory-Revised. Two multivariate regression analyses with life satisfaction as a dependent variable and temperament and character dimensions, respectively, as predictor variables, were performed. Temperament dimensions harm avoidance and novelty seeking as well as character dimensions self-directedness and cooperativeness were unique predictors of life satisfaction, while controlling for the influence of depressive symptoms, education level, and employment status. Given the influence of personality dimensions on life satisfaction, the routine assessment of these dimensions might help to establish the individually tailored treatment among war veterans with PTSD.

Posttraumatic stress disorders and depression among male inpatient adults involved in the Lebanese war

PURPOSE

to evaluate factors associated with posttraumatic stress disorder (PTSD) and depression in a sample of hospitalized Lebanese adult males who directly or indirectly were involved in armed conflicts.

DESIGN

Cross-sectional.

METHODS

Seventy-seven hospitalized males were enrolled between June and December 2016. The Hamilton Anxiety and Depression Scale and the Mini International Neuropsychiatric Interview were used to assess anxiety, depression, and PTSD.

RESULTS

Participation in war (adjusted odds ratio [ORa] = 6.35) and depression (ORa = 1.08) were associated with higher PTSD, whereas age (ORa = 0.94) and substance use (ORa = 0.19) were associated with lower PTSD. Anxiety (β = .87), substance use (β = 6.27) and PTSD (β = 8.78; P = .008) were associated with higher depression.

PRACTICE IMPLICATIONS

People who experienced war conflicts (directly or indirectly) are more prone to suffer from mental health disorders.

Conflict and well-being: a comparative study of health-related quality of life, stress, and insecurity of university students in the West Bank and Jordan

PURPOSE

A significant body of research indicates that the conflict environment is detrimental to the quality of life and well-being of civilians. This study assesses the health-related quality of life, stress, and insecurity of the West Bank, which has been engaged in conflict for seven decades, in comparison to a demographically and culturally similar population in Jordan, a neighboring nation with no conflict. We expect the Jordanian sample to report better functioning.

METHODS

We collected 793 surveys from university students (mean age = 20.2) in Nablus, West Bank (398 [50.2%]) and Irbid, Jordan (395 [49.8%]). The survey instrument consisted of the SF-36 to measure HRQoL, the PSS-4 to measure stress, and an insecurity scale, along with demographic characteristics.

RESULTS

Our findings indicate that outcomes in the West Bank were not significantly worse than in Jordan, and in some cases represented better functioning, especially in the SF-36 measures.

CONCLUSIONS

Our counterintuitive results suggest that health and well-being outcomes are dependent on many factors in addition to conflict. For one, it may be that the better perceived health and well-being of the Palestinians is because they have developed a culture of resilience. Additionally, Jordanians are undergoing a period of instability due to internal struggles and surrounding conflicts.

The Effects of Traumatic and Multiple Loss on Psychopathology, Disability, and Quality of Life in Iraqi Asylum Seekers in the Netherlands

Emerging evidence suggests that the loss of loved ones under traumatic circumstances is highly prevalent among refugees and asylum seekers. We evaluated the effects of traumatic and multiple losses of family members and friends on psychopathology, disability, and quality of life in Iraqi asylum seekers in the Netherlands, and investigated mediation of these effects through psychopathology. Respondents (N = 294) completed structured Arabic interviews. Data were analyzed using structural equation modeling. The loss of a loved one was reported by 87.6% of the sample. Traumatic and multiple losses of family members independently predicted psychopathology, taking the effects of other traumatic events, postmigration stressors, and sociodemographic characteristics into account. Effects of traumatic and multiple losses on quality of life and disability were either partially or fully mediated by psychopathology. These findings highlight the need to evaluate and treat the effects of the loss of loved ones when working with asylum seekers and refugees as well as to incorporate grief-related psychopathology in diagnostic classifications.

Evaluation of Health in Context of Life Quality Studying

Introduction: The development and application on novel concepts that integrally describe physical, psychological, emotional, social health, environmental factors, life values and personal skills was analyzed in the article.

The aim of the article was to analyze the latest methodological approaches of life quality and health assessment.

Results: The article deals with the peculiarities of life quality definition formation and role of its subjective and objective components. The life quality models that based on objective and subjective indicators, related to the health and social well-being was analyzed. The health indicators that provide critical information about population health and prevention programs were characterized and divided into 4 groups - medical and demographic, behavioral, administrative, related to physical and social environment. The problem of research methods development that would useful for comparing the health related life quality in different countries, and creation of normative databases for various regions and determination life-style long-term impact on physical and mental health was studied. The peculiarities of quantitative evaluation in international methods (Index of Social Health, Physical Quality of Life Index, Human Developed Index, Health related Quality of Life Index, World Health Organization Quality of Life index, Happiness adjusted life-years) were analyzed.

Conclusions: For a quantitative evaluation of the population life quality significant is selection of single definition, model with structural parts (domains) that include psycho-physical and physical health of people, their life values (micro level) and the socio-economic development of the society (macro level).

Quality of life of Syrian refugees living in camps in the Kurdistan Region of Iraq

The current study explores the perceived quality of life of Syrian refugees who have entered the Kurdistan Region of Iraq. Two hundred and seventy participants residing in refugee camps in the Erbil region in Kurdistan completed the WHOQOL-BREF, which measures Quality of Life (QOL) within four domains; physical, psychological, social relationships and environment. Syrian refugees in Kurdistan scored significantly lower for general population norms on physical health, psychological and environment QOL, and score significantly lower for physical health and psychological QOL for refugees in the Gaza strip. However, respondents in the current sample scored significantly higher on environment QOL compared to refugees in the Gaza strip, and significantly higher on all the QOL domains than those reported for refugees in West Africa. Finally, Syrian refugees in Kurdistan scored significantly higher than general population norms for social relationships QOL. The current findings provide the first report of QOL domain scores among Syrian refugees in the Kurdistan camps and suggest that social relationships and environmental QOL circumstances are relatively satisfactory, and that further investigation might be focused on physical and psychological QOL.