Low Subjective Wellbeing Is Associated with Psychological Distress in People Living with Inflammatory Bowel Disease

BACKGROUND

Inflammatory bowel disease (IBD) is a common and debilitating disease of the gastrointestinal tract. Psychological distress is highly comorbid to IBD, especially during periods of active disease. However, a controversy exists on how to best manage its symptoms in the IBD population.

AIMS

This study aimed to explore protective and risk factors of psychological distress in IBD.

METHODS

A cross-sectional online survey was conducted via social media and online patient forums. Respondents (N = 235) filled out questionnaires on demographics, health characteristics and a range of psychological variables. Measures of pain, disease activity, comorbid functional symptom severity, social support, subjective wellbeing, sleep quality, fatigue, stress, age, BMI and gender were entered into the Classification and Regression Tree Analysis model.

RESULTS

Overall, 87 participants (37%) reported distress. Self-reported stress significantly discriminated between cases of probable psychological distress. In those with high stress, patients with and without probable psychological distress were separated by subjective wellbeing. Among patients with low stress, fatigue was the primary discriminator.

CONCLUSIONS

Monitoring patients for low subjective wellbeing and high stress in clinical settings could offer an opportunity to engage in early intervention to limit psychological distress development. Monitoring for fatigue in patients who seem otherwise psychologically well could offer preventative benefits.

Mindfulness Practice Is Associated With Subjective Wellbeing Homeostasis Resilience in People With Crohn's Disease but Not Ulcerative Colitis

OBJECTIVES

People with Crohn's disease and ulcerative colitis (inflammatory bowel disease: IBD), commonly experience high levels of depressive symptoms and stress and low levels of subjective wellbeing (SWB). Mindfulness is increasingly considered an adjuvant IBD treatment. The relationships between depression, disease symptoms and mindfulness have not previously been considered within the theory of SWB homeostasis. This theory states that SWB is normally maintained by a homeostatic system around a setpoint range but can fail when psychological challenges dominate consciousness. This study explored the relationship among SWB and patient-reported psychological and IBD symptoms and investigated whether mindfulness practice is independently associated with SWB homeostatic resilience.

DESIGN

This cross-sectional study recruited participants through online IBD support groups.

METHODS

Participants (n = 739; 62% Crohn's disease) detailed symptoms of depression and stress, patient-reported disease symptoms, and regularity of mindfulness practice.

RESULTS

The sample had significantly lower SWB (hedges g = -0.98) than normative data. A logistic regression found mindfulness practice doubled the Crohn's disease participants' odds of reporting SWB within the normal homeostatic range, after controlling for psychological, physical, and demographic variables (OR 2.15, 95% CI: 1.27, 3.66). A one-point increase of patient-reported bowel symptoms reduced the participant's odds of reporting SWB in the normal homeostatic range by about a third (OR 0.66, 95% CI: 0.50, 0.85). However, the influence of mindfulness or disease symptoms on SWB was not observed for people with ulcerative colitis.

CONCLUSION

These findings provide initial evidence for an association between mindfulness and SWB homeostatic resilience in a clinical population.

Linking Homeostatically Protected Mood, Mindfulness, and Depression: A Conceptual Synthesis and Model of Moodfulness

Mindfulness is an ancient practice, derived from Buddhism and recently adapted for the treatment of depression and other psychological conditions. The mechanism of action is thought to involve the extinction of habitual or conditioned responses to internal cognitive and emotional content. In turn, this relies on mechanisms of attentional control and emotion regulation. The resulting state of consciousness is sometimes described as equanimity. This conceptual review paper explores the process of achieving equanimity within a homeostatic framework. The result is a model of moodfulness, which combines mindfulness with Homeostatically Protected Mood to provide a new theoretical view of recovery from symptoms of depression. This model presents a case for mindfulness restoration of mood homeostasis following homeostatic defeat.

Efficacy of a Smartphone App Intervention for Reducing Caregiver Stress: Randomized Controlled Trial

BACKGROUND

Caregivers play a pivotal role in maintaining an economically viable health care system, yet they are characterized by low levels of psychological well-being and consistently report unmet needs for psychological support. Mobile app-based (mobile health [mHealth]) interventions present a novel approach to both reducing stress and improving well-being.

OBJECTIVE

This study aims to evaluate the effectiveness of a self-guided mobile app-based psychological intervention for people providing care to family or friends with a physical or mental disability.

METHODS

In a randomized, single-blind, controlled trial, 183 caregivers recruited through the web were randomly allocated to either an intervention (n=73) or active control (n=110) condition. The intervention app contained treatment modules combining daily self-monitoring with third-wave (mindfulness-based) cognitive-behavioral therapies, whereas the active control app contained only self-monitoring features. Both programs were completed over a 5-week period. It was hypothesized that intervention app exposure would be associated with decreases in depression, anxiety, and stress, and increases in well-being, self-esteem, optimism, primary and secondary control, and social support. Outcomes were assessed at baseline, postintervention, and 3-4 months postintervention. App quality was also assessed.

RESULTS

In total, 25% (18/73) of the intervention participants were lost to follow-up at 3 months, and 30.9% (34/110) of the participants from the wait-list control group dropped out before the postintervention survey. The intervention group experienced reductions in stress (b=-2.07; P=.04) and depressive symptoms (b=-1.36; P=.05) from baseline to postintervention. These changes were further enhanced from postintervention to follow-up, with the intervention group continuing to report lower levels of depression (b=-1.82; P=.03) and higher levels of emotional well-being (b=6.13; P<.001), optimism (b=0.78; P=.007), self-esteem (b=-0.84; P=.005), support from family (b=2.15; P=.001), support from significant others (b=2.66; P<.001), and subjective well-being (b=4.82; P<.001). On average, participants completed 2.5 (SD 1.05) out of 5 treatment modules. The overall quality of the app was also rated highly, with a mean score of 3.94 out of a maximum score of 5 (SD 0.58).

CONCLUSIONS

This study demonstrates that mHealth psychological interventions are an effective treatment option for caregivers experiencing high levels of stress. Recommendations for improving mHealth interventions for caregivers include offering flexibility and customization in the treatment design.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry ACTRN12616000996460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371170.

A Rasch Analysis of the Personal Well-Being Index in School Children

The personal well-being index-school children (PWI-SC) is designed as a cross-cultural instrument to measure subjective well-being among high school-aged children. Several published cross-cultural studies have confirmed adequate psychometric performance in terms of reliability, validity, and measurement invariance. This study adds to this literature by applying the Rasch approach to estimate invariant comparison in a cross-cultural context, applied to both Australian and Portuguese high school students. Participants were an age- and gender-matched convenience sample of 1,040 adolescents (520 cases in each group, 51.54% male) who ranged in age from 12 to 18 years (M = 14.25 years, SD = 1.71 years). It is found that both Portuguese and Australian data fit the Rasch measurement model, with excellent levels of reliability at a country level. However, when all of the data were combined, a slight misfit was found. This was resolved by removing some issues with item thresholds in standard of living among the Australian data and splitting the data by country on health. This allowed both Australian and Portuguese cases to differ on the health item. We conclude that the PWI-SC is unidimensional, with some evidence of mild, but acceptable local dependency. This study further supports the cross-cultural validity of the PWI-SC and the use of this measure in the Australian and Portuguese context but also indicates a potential direction that development of the PWI-SC might proceed.

Using dynamic factor analysis to provide insights into data reliability in experience sampling studies

The past 2 decades have seen increasing use of experience sampling methods (ESMs) to gain insights into the daily experience of affective states (e.g., its variability, as well as antecedents and consequences of temporary shifts in affect). Much less attention has been given to methodological challenges, such as how to ensure reliability of test scores obtained using ESM. The present study demonstrates the use of dynamic factor analysis (DFA) to quantify reliability of test scores in ESM contexts, evaluates the potential impact of unreliable test scores, and seeks to identify characteristics of individuals that may account for their unreliable test scores. One hundred twenty-seven participants completed baseline measures (demographics and personality traits), followed by a 7-day ESM phase in which positive and negative state affect were measured up to 6 times per day. Analyses showed that although at the sample level, scores on these affect measures exhibited adequate levels of reliability, up to one third of participants failed to meet conventional standards of reliability. Where these low reliability estimates were not significantly associated with personality factors, they could-in some cases-be explained by model misspecification where a meaningful alternative structure was available. Despite these potential differences in factor structure across participants, subsequent modeling with and without these "unreliable" cases showed similar substantive results. Hence, the present findings suggest typical analyses based on ESM data may be robust to individual differences in data structure and/or quality. Ways to augment the DFA approach to better understand unreliable cases are discussed. (PsycINFO Database Record

Meaning in Life in Earlier and Later Older-Adulthood: Confirmatory Factor Analysis and Correlates of the Meaning in Life Questionnaire

OBJECTIVE

To validate the Meaning in Life Questionnaire (MLQ) in earlier and later older-adulthood, and examine its correlates.

METHOD

Participants in earlier ( n = 341, M age = 68.5) and later older-adulthood ( n = 341, M age = 78.6) completed the MLQ and other measures. Confirmatory multigroup analysis, correlations, and regression models were conducted.

RESULTS

A two-factor (presence and search), eight-item model of the MLQ had a good fit and was age-invariant. Presence and search for meaning were largely unrelated. Meaning was associated with life satisfaction, well-being across a range of domains, and psychological resources. Searching for meaning correlated negatively with these variables, but to a lesser degree in later older-adulthood.

DISCUSSION

The MLQ is valid in older-adulthood. Meaning in life is psychologically adaptive in older-adulthood. Searching for meaning appears less important, especially in later older-adulthood. Findings are discussed in the context of aging and psychosocial development.

The dyadic interaction of relationships and disability type on informal carer subjective well-being

PURPOSE

Care-related factors have frequently been associated with elevated levels of distress and diminished subjective well-being. However, these variables have traditionally been considered independently. The objectives of this study were to explore the subjective well-being of informal carers in Australia and to specifically examine the effect of the dyadic interaction between the caring relationship and type of disability on the subjective well-being of informal carers.

METHODS

Informal carers (n = 4,096) completed the Personal Wellbeing Index (PWI) and Depression and Stress Scales. Analysis of covariance was used to compare the subjective well-being of carers to the general population while controlling for socio-demographic factors. To examine the dyadic relationship, a multivariate analysis of covariance was employed.

RESULTS

After socio-demographic variables were controlled, informal carers reported significantly lower PWI scores compared to the general population. The results of the multivariate analysis of covariance revealed a significant interaction between the caring relationship and the type of disability being managed on subjective well-being. No differences were found for symptoms of depression and stress.

CONCLUSIONS

The findings of this study imply that the detrimental effect of caring on subjective well-being is magnified for carers who support a child with a mental illness or multiple types of disabilities. These carers displayed the lowest levels of subjective well-being, highlighting the dyadic effects of care-related variables. Consideration of these factors is essential to target effective intervention programs for those most at risk of diminished well-being.

The Comprehensive Quality of Life Scale: A Psychometric Evaluation with an Adolescent Sample

The term quality of life (QOL) generally refers to the overall evaluation of an individual's life condition, on both objective and subjective dimensions. Quality of life research has focused on global evaluations of life satisfaction in adults. The life quality of adolescents and the performance of central life domains have largely been ignored. This study describes the psychometric properties of the Comprehensive Quality of Life Scale (ComQol) with an adolescent sample. In line with recent conceptualisations of QOL, ComQol assesses subjective and objective QOL on seven life domains. ComQol was administered along with two other self-report instruments (measuring fear and anxiety) to a sample of 264 school-based adolescents aged between 12 and 18 years. The scale yielded life satisfaction data that lay within the normative range for adults. Test-retest reliability and internal consistency analyses indicated that the scale has adequate reliability. In support of convergent validity, fear and anxiety were generally found to be significantly associated with lower levels of life quality. The present study supports the psychometric adequacy of ComQol as an instrument to measure the life quality of adolescents.

Quality of Life in Adolescence: The Role of Perceived Control, Parenting Style, and Social Support

Adult levels of subjective quality of life (SQOL) are remarkably stable on a population basis. This has been explained through the operation of a homeostatic system that acts to maintain each individual's SQOL within a narrow range. However, there are good reasons to expect this homeostatic system to come under severe challenge during adolescence. Many of the variables thought to be involved in the homeostatic process are undergoing marked change during this period, including the balance between primary and secondary control, perceived social support, and interaction with parents. In order to test the stability of SQOL and the influence of these other variables, a sample of 279 adolescents between the ages of 12 to 17 years were recruited. It was found that the SQOL of the older adolescents lay below the predicted range for adults, thereby supporting the idea of a strong challenge to homeostasis during this period. A new scale to measure perceived control was found to possess a useful two-factor structure of primary and secondary control. Moreover, both of these factors, together with social support, predicted levels of SQOL, even though the levels of primary control decreased with age. Finally, adolescents who perceived an authoritarian parenting style experienced a higher SQOL than those who perceived an unengaged style. These findings contribute to our understanding of SQOL homeostasis.

Meehl's "crud" factor, subjective wellbeing, and religiosity: a critique'

Researchers in the area of subjective wellbeing are now building on a body of research that spans more than three decades and includes many thousands of articles. It is time to move from exploratory studies to those based on accumulated psychometric understanding and theory. Two aspects of the article by Abdel-Khalek (2011) warrant attention from this perspective: the choice of scale and the issue of shared variance.

Primary and secondary control over eating behaviors

The relationships between subjective control, body image, and eating behaviors were examined within the framework of the Optimization in Primary and Secondary Control model (OPS model; Heckhausen, 1999). This model characterizes control as an adaptive and strategic process in which the target of control includes internal as well as external states, and in which the purpose is either to facilitate goal pursuit by engaging with the goal or managing the consequences of goal failure by disengaging from the goal. A convenience sample of 180 Australian women (age: M=26.49, SD=5.03) completed the Optimization of Primary and Secondary Control Scale (OPS scale Heckhausen, 1999), as well as measures of attitudinal and behavioral factors comprising Stice's (1994) dual-pathway model of bulimia. A series of path analyses revealed that the control strategies involved in goal engagement are directly associated with increased dietary restraint and purging, whereas the control strategies involved in goal disengagement are indirectly associated with these factors, and with negative affect, by way of reduced body dissatisfaction and reduced frequency of appearance comparisons. These results suggest that goal engagement strategies, which are typically adaptive in other contexts, are associated with potentially hazardous attitudes and behaviors in the context of the body. The results also suggest that an ability to disengage from body weight goals is associated with a reduced likelihood of developing disordered eating.

Fluency disorders and life quality: subjective wellbeing vs. health-related quality of life

It seems intuitive that people with a fluency disorder, such as stuttering, must experience a low life quality. Yet this is not necessarily so. Whether measured life quality is lower depends on several factors, the most important of these being methodological. This is because the disciplines of medicine and the social sciences utilize quite different technologies to measure the construct. Within medicine, health-related quality of life (HRQOL) is measured through constellations of perceived symptoms. Thus, if the symptoms chosen to represent HRQOL match the pathological characteristics of the fluency disorder, the relationship is self-fulfilling. Psychology, on the other hand, uses subjective wellbeing to represent life quality. Here, the relationship between symptoms and perceived life quality is much less certain. It is proposed that this partial disconnection is due to the presence of a homeostatic system which manages subjective wellbeing in an attempt to keep it positive. The paper that follows examines the construct of life quality from both disciplinary perspectives, and then reports on the findings from each discipline in relation to fluency disorders. It is concluded there is no necessary link between fluency disorders and life quality provided subjective wellbeing is used as the indicator variable.

EDUCATIONAL OBJECTIVES

The reader will be able to describe: (i) contemporary issues in quality of life measurement; (ii) the relationship between fluency disorders and life quality; (iii) the conceptual limitations of health-related quality of life.

The SARS (Severe Acute Respiratory Syndrome) pandemic in Hong Kong: effects on the subjective wellbeing of elderly and younger people

OBJECTIVES

This study examined the impact of the Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong in 2003, on the subjective wellbeing (SWB) of elderly people and a younger comparative sample. The Personal Wellbeing Index (PWI), a contemporary instrument employed to measure SWB, was also examined for its psychometric performance to substantiate its use.

METHOD

A total of 302 older adults (age 65 + years) and 158 younger adults (age 35-46 years) were recruited from different districts. Data were collected by individual face-to-face interviews.

RESULT

While elderly people living in severely infected districts showed significantly lower levels of SWB, these levels and those of the younger sample were found to remain within the normative range. A major mitigating factor was an increased sense of community-connectedness. Other characteristics linked to low wellbeing levels included chronic illness, female gender, low education and unemployment. The living districts, characterized by varying extents of infection, had stronger associations with SWB than participants' age. The PWI demonstrated good psychometric performance and also more robustness with elderly people, including its sensitivity to the sense of population threat.

CONCLUSION

Psychological resilience was identified among both the elderly and younger age-groups in Hong Kong during the SARS pandemic. The PWI is verified as a suitable instrument for SWB measurements.

Moving from the quality of life concept to a theory

BACKGROUND

The Special Interest Quality of Life Group has updated its set of statements defining the quality of life (QOL) construct to reflect emerging areas of agreement and the framework for understanding better the QOL construct.

METHOD

This article examines the major areas currently under discussion involving the objective-subjective dichotomy, needs, and core domains.

RESULTS

It is concluded that while the new statements constitute a significant advance, further progress requires testable theory. In order to facilitate such future research, a conceptual model is proposed that distinguishes causal and indicator variables within the framework of a homeostatic management system.

CONCLUSION

Several lines of empirical investigation are suggested to test this and similar theoretical models with a view to taking our conceptualization of QOL to the next level.

Self-perceived quality of life of children and adolescents with physical disabilities in Hong Kong

Although illnesses and diseases are thought to adversely affect quality of life (QoL), whether children who have physical disabilities (PD) from a young age adapt to the effect of developmental disabilities has rarely been investigated. This study attempted to assess the subjective wellbeing, and examine the correlation between objective and subjective QoL, of children with PD. Using a self-reported non-disease-specific questionnaire, the QoL of 72 young persons (13.5+/-2.0 years) with PD was contrasted with those who do not have disabilities (n = 510; age-matched). MANOVA analyses revealed that the PD group had lower objective QoL score (63.0+/-7.4 vs. 66.8+/-5.7, p < 0.001) but the two groups were not significantly different in subjective QoL score (70.9+/-11.4 vs. 69.6+/-13.6, p = 0.466). No correlation was found between objective and subjective QoL in the PD group (r ranged from 0.06 to 0.19), while weak to medium correlations (r ranged from 0.03 to 0.41) were observed for the controls. The apparent detachment of subjective feeling and objective circumstances in the PD group may reflect adjustment to developmental disabilities.

How Employees Remain Happy: Explaining a Paradox

This paper draws on subjective quality of life theory to explain findings from three studies of quality of work life. The studies were conducted with 346 regional process workers, metropolitan employment officers and nurses. The results support the adoption of the theory of homeostasis as an explanation for findings on subjective wellbeing at work surveys. This research goes some way in explaining the paradox that perceived job and work satisfaction remain stable over time, while working conditions may vary widely.

Measuring health in a vacuum: examining the disability weight of the DALY

The Disability Adjusted Life Year (DALY) is a widely used summary measure of population health combining years of life lost due to mortality and years of healthy life lost due to disability. A feature of the DALY is that, in the assessment of morbidity, each health condition is associated with a disability weight. The disability weight lies on a scale between 0 (indicating the health condition is equivalent to full health) and 1 (indicating the health condition is equivalent to death). The disability weight associated with each health condition is currently fixed across all social, cultural and environmental contexts. Thus blindness in the United Kingdom has the same disability weight as blindness in Niger in spite of structural interventions in the UK that make the disability less severe than in Niger. Although the fixed disability weight is defended on grounds that it supports a strongly egalitarian flavour in the DALY, we argue that the lack of consideration of realistic contexts results in a measure that will underestimate the burden associated with morbidity in disadvantaged populations and overestimate the burden in advantaged populations. There is, consequently, a loss of information on possible non-clinical points of intervention. Disaggregated estimates of the burden of disease such as those in the World Health Report 2000 should be interpreted with caution.

The management of subjective quality of life by short-stay hospital patients: an exploratory study

BACKGROUND

This study tested the homeostatic model of subjective quality of life in a group of 47 short stay patients as they progressed through the stages of hospitalization for surgery.

METHOD

Participants completed a questionnaire measuring subjective quality of life, positive and negative affect, self-esteem, optimism and cognitive flexibility, the day prior to admission (T1), two days post-operation (T2) and one week after discharge (T3). Neuroticism and Extroversion were measured at Time 1.

RESULTS

All variables remained stable across the three times, apart from positive affect, which dropped significantly post-operation but returned to its previous level post discharge.

CONCLUSION

Although the homeostatic model of subjective quality of life was supported at Time 1, the analyses raise doubts about the stability of personality. This finding is consistent with recent discussions of personality.

Defining quality of life for Chinese elderly stroke survivors

PURPOSE

This study aimed to identify the constituents and conceptual characteristics of the quality of life (QOL) of Chinese elderly stroke survivors, living in the community in Hong Kong.

METHOD

A triangulated approach was used to identify the QOL components for this population. This process involved a comparison of QOL components gathered from three different methods, namely, focus group interviews, review of the literature and the contents of the generic Hong Kong Chinese version of the World Health Organization Quality of Life Scale (CWHOQOL-HK). Five health professionals were involved in the comparison process. A percentage of inter-judge agreement was used to determine the reliability of the comparisons made between the judges.

RESULTS

This study identified 36 components considered to contribute to the QOL of Chinese elderly stroke survivors in Hong Kong. The conceptual characteristics of their QOL generally concurred with those identified in the literature.

CONCLUSION

Both similarities and differences were found in the QOL components identified in this study when compared to those identified in studies of Western populations who are elderly and had a stroke. The contents of the CWHOQOL-HK scale were found to lack adequacy in representing the QOL of Chinese elderly stroke survivors in Hong Kong. Recommendations are given, based on the findings of this study, to overcome this limitation for its application as a QOL measure for this population.

Conceptualization, measurement, and application of quality of life for persons with intellectual disabilities: report of an international panel of experts

In this article a number of issues involving the concept of quality of life as applied to persons with intellectual disabilities are summarized, and a number of agreed-upon principles regarding its conceptualization, measurement, and application are presented. We realize that the concepts and models presented in this article will vary potentially from country to country, and even from area to area within countries. The cross-cultural understanding of the concept of quality of life is in its infancy, and we hope that the discourses resulting from the material presented in this article will facilitate both cross-cultural understanding and collaborative work. The article reflects current thought about the conceptualization, measurement, and application of this increasingly important and widely used concept in the field of intellectual disabilities and sets the stage for its continuing development.