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PubMed2000

Measuring health status in Israeli patients with fibromyalgia syndrome and widespread pain and healthy individuals: utility of the short form 36-item health survey (SF-36).

OBJECTIVES: To examine the usefulness of the Medical Outcomes Study Short Form-36 (MOS SF-36) in measuring health-related quality of life (QOL) in fibromyalgia syndrome (FMS) patients, and to determine whether subscale scores of SF-36 could distinguish patients with FMS from patients with widespread pain alone, and from healthy individuals. METHODS: The study population included three groups of women: 90 patients with FMS, 96 patients with widespread pain, and 50 healthy controls. In all subjects, health-related QOL was assessed by SF-36. The Health Assessment Questionnaire was used to evaluate functional disability, helplessness and psychological status. FMS-related symptoms and tenderness also were assessed. RESULTS: The 8 subscales of SF-36 showed a consistent pattern for physical function, physical role functioning, body pain, general health, vitality, and social function, with the lowest scores in patients with FMS, intermediate scores in patients with widespread pain alone, and the highest scores in healthy subjects. Emotional role functioning and mental health scores were significantly higher among healthy controls than among patients. The SF-36 subscales of physical functioning, bodily pain, and social functioning were highly correlated with another measure of functional disability (from the Health Assessment Questionnaire) in all patient groups. Most of the subscales were associated with psychological variables (helplessness, depression, and anxiety). All eight subscales of SF-36 were strongly correlated with the mean score of another measure of quality of life, QOL-16. CONCLUSIONS: Most of the SF-36 subscales represent health dimensions relevant to patients with FMS and widespread pain alone. The severity of functional impairment as assessed by the SF-36, distinguishes patients with FMS and widespread pain alone from healthy individuals, and also discriminates between patients with widespread pain alone and FMS patients.

Activities of Daily Living↗
PubMed2001

Change in psychosocial functioning and social relations among women in residential substance abuse treatment.

PURPOSE: The purpose of this study was to examine the degree to which psychosocial functioning and social relationships changed during the first 3 months of treatment among women in a residential substance abuse program that emphasizes the importance of developing healthy relationships. METHODS: Participants included 77 female clients admitted to the Salvation Army First Choice (FC) Program in Fort Worth, TX. Assessments of psychological functioning, family relations, and peer relations were administered at treatment entry and again after 3 months. Relationships with clients in treatment and friends outside treatment were measured separately. RESULTS: Repeated-measures analyses of variance (ANOVA) indicated that interpersonal relationships improved. Family networks increased, family cohesion increased, and family conflict decreased. Peer networks changed as well, due in part to new relationships with other clients in treatment. The number of drug-using friends decreased, peer deviance and negative influence decreased, and social conformity among friends increased. There was a corresponding improvement in psychosocial functioning. IMPLICATIONS: Results suggested that relationship-centered treatment for women was effective. Clients reestablished connections with family members, disassociated from drug-using peers, and improved the quality of relationships with family members and friends. Further research is needed in order to examine the influence of specific treatment components and the potential long-term effects of changes in women's relationships.

Adult↗
PubMed1988

[Prognosis of social reintegration following stroke].

From the socio-economic point of view, early prediction of outcome after stroke is of essential value. The longterm prognosis of 310 patients suffering from ischemic stroke, was therefore investigated by means of questionnaires. The mean follow-up period was 62.5 (S.D. 21.9) months. The results of patients who had suffered cerebrovascular accidents other than ischemic stroke or only transient ischemic attacks were not included. It had been the aim of the study to determine the predictive value of some clinical variables and symptoms in the subacute stage as regards the familial and social functioning handicaps to be expected later on. Between the number of strokes as well as the severity of some clinical signs (motor deficits, sensory deficits, speech disorders, organic mental syndrome) on the one hand, and the restrictions experienced in familial functioning on the other hand, a clear cut correlation was found. As regards social functioning, two additional predictors of unfavourable outcome could be identified: age, and lesion within the left hemisphere. The findings indicate that some clinical variables and symptoms in the subacute stage are of great predictive value concerning the ensuing handicap in familial and social functioning. These variables may help to develop individual strategies as regards the further social management and support (e.g. discharge arrangements, care services, rehabilitation programs).

Adolescent↗
PubMed1998

Family functioning and social support in the adaptation of caregivers of children with sickle cell syndromes.

OBJECTIVE: To examine moderating effects of family functioning and social support on the relationship of child-related stressors to caregivers' psychological adaptation in a sample of caregivers of children with a chronic illness. METHOD: Participants were 67 caregivers of children and adolescents with sickle cell syndromes. We conducted MANOVAs and subsequent effect size calculations to determine if family functioning would buffer the effects of caring for difficult-to-manage children with this illness. RESULTS: Findings supported a moderator effect of family functioning on the association of children's externalizing behavioral problems to caregivers' symptoms of hostility. Greater levels of cohesive and adaptive family functioning buffered the potential detrimental effects of caring for children perceived as hard to manage. No significant associations were obtained between measures of caregivers' psychological adaptation and the severity of their children's disease. CONCLUSIONS: We make recommendations for family systems interventions, particularly for caregivers of children with behavior problems.

Adaptation, Psychological↗
PubMed1998

Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls.

PURPOSE: Quality of life of breast cancer survivors 8 years after diagnosis was compared with that among similarly aged women who had never confronted cancer (controls). METHODS: Survivors of a consecutive series of 227 breast cancer patients first treated in 1984 were approached for this study. Random-digit dialing was used to identify controls with the same age and residential distribution as the survivors. Quality of life was assessed in terms of physical health, functional status, psychologic distress, and social functioning. RESULTS: Participation was obtained from 96% (n = 124) of 129 eligible survivors and 61% (n = 262) of 427 potentially eligible controls. Consistently smaller proportions of survivors reported positive quality-of-life outcomes compared with controls, but these differences were generally small and nonsignificant statistically. When limited to women who remained free of disease over the entire follow-up period (n = 98), survivors' quality of life was similar to that among controls, with the exception of arm problems and sexual satisfaction for those women who lived with a partner. In contrast, survivors who developed recurrence or new primary breast cancer (n = 26) experienced a worse quality of life in all domains except social functioning. CONCLUSION: In most domains and for women without further disease events after diagnosis, quality of life does not seem to be permanently and globally impaired by breast cancer. Consequently, breast cancer survivors who remain free of disease probably do not need organized late psychosocial follow-up to improve quality of life. However, arm problems and sexuality are two areas in which additional effort may be still needed to improve quality of life of long-term survivors.

Activities of Daily Living↗
PubMed1995

Moderating effects of family functioning on the social adjustment of children with liver disease.

In this study, we examined the moderating effects of family functioning on parent- and child-reported indices of social functioning in 30 children with liver disease. Consistent with previous research, children with liver disease exhibited significantly lower levels of social functioning compared to normative data. Hierarchical multiple-regression analyses were conducted to examine the relative influence of cognitive functioning, disease severity, and family functioning (i.e., family cohesion and adaptability, parenting stress, and parenting esteem) on children's social functioning. Family functioning accounted for an additional 23% of the variance in parent-reported social functioning and only 4% of the variance in child-reported social competence after controlling for cognitive functioning and disease severity. These preliminary results underscore the importance of considering family factors in designing interventions to enhance the social functioning of children with liver disease.

Child↗
PubMed2004

Psychological well-being among hospital personnel: the role of family demands and psychosocial work environment.

BACKGROUND: This study investigates the effect of gender role and the psychosocial work environment on the psychological well-being of hospital staff in two general hospitals in the province of Valencia (Spain). METHOD: A cross-sectional survey was carried out among 313 workers by means of a self-answered questionnaire. The outcome variable (psychological well-being) was evaluated with four dimensions of the "SF-36 Health Survey" (mental health, vitality, limitations in the emotional role and limitations in the social function). The explanatory variables were: characteristics related to gender role, professional characteristics and the psychosocial working environment evaluated according to Karasek and Johnson's demand-control-support model. The adjusted odds ratios (ORs) and their 95% confidence intervals were calculated by logistical regression. RESULTS: Those who have very good marital relationship have less risk of presenting bad mental health, OR 0.43 (0.24-0.78), and limitation in the social function, OR 0.43 (0.24-0.77), and in the emotional role, OR 0.35 (0.16-0.74). Those who dedicate more than 30 h a week to domestic chores have a higher risk of limitation of social function, OR 2.48 (1.16-5.31). Those exposed to high psychological demands present a higher probability of having bad mental health, OR 1.77 (1.04-3.00). Those exposed to low job social support have a higher risk of bad mental health, OR 1.86 (1.09-3.19), low vitality, OR 2.21 (1.30-3.77), and limitation in the social function, OR 1.88 (1.10-3.22). CONCLUSION: Gender role and psychosocial work environment have a negative influence on the psychological well-being of hospital staff.

Adult↗
PubMed2005

Pain and pain-related fear are associated with functional and social disability in an occupational setting: evidence of mediation by pain-related fear.

This study examined the role of work-related, psychosocial and psychological factors in predicting functional and social disability in working employees. In a cross-sectional design, 890 working employees (reporting at least 1 day of back pain during the past year) completed self-report measures of back pain, disability, pain-related fear, negative and positive affectivity, job satisfaction, job stress and physical work load. Regression analyses revealed that pain intensity was a strong predictor of functional (beta = .69, p < .001) and social disability (beta = .67, p < .001). Fear of (re)injury due to movement (beta = .25, p < .001; beta = .28, p < .001) had additional predictive value in both models. Further, (singular) mediation tests indicated that fear for (re)injury partially mediated the relation between pain intensity and disability, and between negative affectivity and disability. Finally, path analyses revealed both fear and pain intensity as mediators between negative affectivity and disability. Overall, our findings point at the relevance of the cognitive-behavioral model of avoidance in occupational settings.

Adult↗
PubMed2005

Domains of life satisfaction in social anxiety disorder: relation to symptoms and response to cognitive-behavioral therapy.

A general sense of satisfaction with life has been shown to be discriminable from symptom levels and disability in clinical populations. The current study focused on the utility of identifying domains of life satisfaction in social anxiety disorder and differential changes in these domains following cognitive-behavioral group therapy (CBGT). An exploratory principal axis factor analysis of the items of the Quality of Life Inventory in clients with a principal diagnosis of social anxiety disorder (N=138) yielded four domains of life satisfaction: (1) Achievement, (2) Social Functioning, (3) Personal Growth, and (4) Surroundings. Prior to treatment, clients reported dissatisfaction in the Achievement and Social Functioning domains. Further, levels of satisfaction in these domains were significantly related to severity of social anxiety and depressive symptoms. Finally, analyses of a subsample of clients completing 12-weeks of cognitive-behavioral group therapy revealed significant improvements in the Achievement and Social Functioning factors. These findings provide further support for the assertion that social anxiety disorder has important implications for clients' quality of life and that CBGT can successfully impact several domains of satisfaction.

Achievement↗
PubMed2005

The social adjustment of people with severe mental illness in São Paulo, Brazil.

OBJECTIVE: To investigate the social adjustment of individuals with severe mental illness living in the community in a large urban center of a developing country, and the characteristics associated with poor social functioning. METHOD: A cross-sectional study was performed in the city of Sao Paulo. Eligible subjects were residents of a defined geographic area, aged between 18 and 65, with a diagnosis of functional psychosis who had had contact with any public psychiatric service during a defined period. Structured assessments were used to obtain information on social-demographic characteristics, diagnosis (ICD-10), psychiatric symptoms (PANSS), and social adjustment (DAS). RESULTS: One hundred and eighty-eight subjects were included, of whom, 120 (63.8%) had some degree of impairment in social functioning. The most frequently affected areas of social functioning were work performance and sexual role. Twenty-four patients (12.8%) showed poor or very poor social adjustment in the month prior to the interview. Negative symptoms, number of previous admissions and general symptoms showed statistically significant associations with global social adjustment scores. CONCLUSIONS: The proportion of patients showing any degree of impairment in social adjustment was as high as in more developed societies. In order to successfully implement the new mental health policy in Brazil, better provision of community-based mental health services for those with severe mental illnesses is needed.

Adult↗
PubMed1991

Life satisfaction and psychosocial functioning in chronic depression: effect of acute treatment with antidepressants.

Social functioning was evaluated in 61 chronically depressed adults with early onset. Patients were treated for 6 weeks in a double-blind trial of phenelzine, imipramine, L-deprenyl, or placebo and functioning was reassessed. The posttreatment social functioning of patients who received drug treatment was superior to the placebo group in the following areas: work functioning, house functioning, relationship with relatives, sex frequency and life satisfaction. These results suggest that psychosocial impairment in some chronic depressives may be a sequaela of depression, rather than a global manifestation of characterological pathology.

Activities of Daily Living↗
PubMed2006

Neuropsychological functioning and social anhedonia: results from a community high-risk study.

Social anhedonia has shown promise as a vulnerability marker for schizophrenia-spectrum pathology. Validity data have come, in part, from findings indicating that cognitive deficits occurring in schizophrenia are also evident in individuals with elevated levels of social anhedonia. However, prior research on this topic has been limited because it has been based almost exclusively on the study of selective samples of college students. The present article reports baseline findings of neuropsychological functioning in social anhedonics and controls from a representative community sample. Data on a wide array of neuropsychological abilities from 18-19 year-old participants with (n = 85) vs. without (n = 87) elevated levels of social anhedonia were analyzed. We hypothesized that, compared to controls, social anhedonics would show impairments in memory and sustained attention. Additionally, we sought to determine if more severe cognitive impairment in anhedonics was associated with greater schizophrenia-spectrum pathology and poorer overall functioning. Compared to controls, socially anhedonic participants performed more poorly on two visual-spatial memory tasks and a test of visual-spatial construction. The groups did not statistically differ on any of the other neuropsychological measures including general cognitive ability and sustained attention. Group differences were not the result of depression, bipolar or substance abuse disorders. Neuropsychological functioning showed little relationship to current clinical symptoms and functioning. Longitudinal assessment of these participants as they move through the risk period should provide important insights into the neuropsychological correlates of the schizophrenia prodrome.

Adult↗
PubMed2002

Community rehabilitation service for patients with severe psychotic disorders: the Slovene experience.

BACKGROUND: Rehabilitation can be carried out at various sites. METHOD: Two groups of patients with severe mental disorders were compared: those included in community rehabilitation service and those only attending an outpatient clinic regarding their clinical status, social functioning, standard of living and quality of life. RESULTS: We found no significant global differences in group characteristics, social functioning and clinical status, but we did prove the lower social status of the group included in the rehabilitation service and their satisfaction with the services they use. CONCLUSIONS: The community rehabilitation services in Slovenia are coping with existential social needs of their users but this study failed to demonstrate their success in improving health or social functioning.

Adaptation, Psychological↗
PubMed2001

Subjective health measures and acute treatment outcomes in geriatric depression.

BACKGROUND: Prior research suggests that elderly patients are less likely to respond to antidepressant treatment if they have low self-rated health. However, successful treatment for depression has been associated with improvement in self-rated health and other health measures. OBJECTIVES: To examine measures of self-rated health, physical disability, and social function as predictors of treatment response in late-life depression, and to assess these same health measures as treatment outcomes. We hypothesized that greater impairment in these measures would predict poorer treatment response, and that these measures would show significant improvements with recovery from depression. METHOD: Subjects were enrolled in a depression intervention study for people aged 60 and older with recurrent unipolar major depression; they were assessed with measures of self-rated health, physical disability, and social functioning at baseline and at the end of treatment. Baseline measures were compared between the 88 remitters, 11 non-remitters, and seven dropouts. Additionally, changes in the measures were examined in subjects who recovered from the index depressive episode. RESULTS: Subjects with poorer self-rated health at baseline were more likely both to drop out of treatment and to not respond to adequate treatment. This relationship was independent of demographic measures, severity of depression, physical and social functioning, medical illness, personality, hopelessness, overall medication use, and side effects or non-compliance with treatment. CONCLUSION: Although this finding is preliminary because of the small number of dropouts and non-remitters, it suggests that lower self-rated health may independently predict premature discontinuation of treatment for depression. Additionally, subjects who recovered from depression showed significant improvements in self-rated health, physical disability, and social functioning.

Activities of Daily Living↗
PubMed2003

Psychological assessment of adult survivors of childhood sexual abuse within a naturalistic clinical sample.

This study investigates the long-term effects of childhood sexual abuse (CSA). Differences between abused and nonabused individuals in psychiatric symptomatology, interpersonal functioning, social and occupational functioning, personality dynamics, and therapeutic alliance were examined. The relationship between abuse severity and long-term effects was also analyzed. Data were gathered from 51 patients seeking individual psychotherapy at a community outpatient clinic. Findings suggested that CSA survivors tend to experience greater psychiatric distress and poorer interpersonal functioning than nonabused clinical controls. No significant differences were found in social and occupational functioning or in alliance developed by the end of the therapeutic assessment process. Abuse severity was significantly related to increased symptomatology and poorer interpersonal functioning. Findings support and extend existing literature and are especially useful for clinicians working with abuse survivors.

Adaptation, Psychological↗
PubMed1998

Health-related quality of life after liver transplantation.

To gather information regarding how to best assist liver transplant recipients in improving their self-care capacity and well-being, we investigated their total health situation. A retrospective, cross-sectional survey with up to a 10-year follow-up concerning experienced health and quality of life after liver transplantation (LTX) was conducted. The aim of this study was to provide descriptive data on the experienced health and health-related quality of life (HRQOL) after LTX and to evaluate whether the pretransplantation medical conditions affected these parameters. All patients who had undergone LTX, were alive at the time of the study, and had a follow-up of more than 6 months (n = 134) were asked to complete three self-administered questionnaires. The response rate was 95% (n = 120). There was no correlation between pretransplantation Child-Pugh score and HRQOL after LTX. Liver transplant recipients were more limited in their physical health than healthy subjects but were equal in social functioning and mental health. Twenty-six percent suffered from severe bodily pain. A significant difference was reported in all health areas, with the exception of vitality and social functioning, between employed and unemployed transplant recipients. Liver transplant recipients suffered from limited physical functioning many years after transplantation. Their social functioning and mental health were not negatively affected. This study emphasizes that bodily pain and difficulties in performing regular activities because of physical illness are problems frequently experienced by liver transplant recipients.

Adolescent↗
PubMed2006

Association between impaired glucose metabolism and quality of life: results from the Australian diabetes obesity and lifestyle study.

AIMS: We examined the association of quality of life with glucose tolerance status in an Australian population to determine the stage in the development of diabetes that quality of life is impaired. METHODS: The Australian Diabetes, Obesity and Lifestyle study (AusDiab) was a population-based study of 11,247 people from randomly selected areas of Australia. As part of the study, participants underwent an oral glucose tolerance test and completed the SF-36 quality of life questionnaire. RESULTS: Previously diagnosed diabetes was associated with a significantly greater risk of being in the lowest quartile of each dimension of the SF-36 scale (except for mental health) and this association was only partially attenuated by adjustment for age, sex, body mass index (BMI), physical activity and treatment for hypertension and lipid abnormalities (adjusted odds ratios [95% CI]: bodily pain, 1.51 [1.18-1.94]; general health, 2.20 [1.64-2.95]; physical functioning, 1.50 [1.10-2.05]; role limitation (emotional), 1.43 [1.07-1.91]; role limitation (physical), 1.57 [1.13-2.18]; social functioning, 1.93 [1.46-2.54] and vitality, 2.24 [1.56-3.22]. Among those with newly diagnosed diabetes (NDM) and impaired glucose tolerance (IGT), there was also evidence of reduced quality of life on some dimensions of the SF-36 scale (NDM, general health, physical functioning and role limitation (physical); IGT, physical functioning and social functioning) after adjustment for confounders. CONCLUSION: These findings show that diabetes is associated with a reduced quality of life and that this is evident in the early stage of the disease, particularly in relation to the ability to perform physical activities.

Australia↗
PubMed1996

Day hospital/crisis respite care versus inpatient care, Part I: Clinical outcomes.

OBJECTIVE: The authors investigated the clinical feasibility and the outcome for patients of a program designed as an alternative to acute hospitalization. METHOD: This was a random-design study comparing a conventional inpatient program for urban, poor, severely ill voluntary patients who usually require hospitalization to an alternative experimental program consisting of a day hospital linked to a crisis residence. Patients were assessed with standardized measures of symptoms, functioning, social adjustment, quality of life, and satisfaction with clinical services upon admission to the study, at discharge from the index admission, and at follow-ups 2, 5, and 10 months after discharge. RESULTS: One hundred ninety-seven patients were enrolled in the 2-year research program and followed for 10 months. Of the voluntary patients who would have been admitted to the hospital, 83% were appropriate for the experimental program. The clinical, functional, social adjustment, quality of life, and satisfaction outcome measures were not statistically different for the patients in the two treatment conditions; however, there was a slightly more positive effect of the experimental program on measures of symptoms, overall functioning, and social functioning. CONCLUSIONS: The experimental condition, a combined day hospital/crisis respite community residence, seems to have had the same treatment effectiveness as acute hospital care for urban, poor, acutely ill voluntary patients with severe mental illness.

Community Mental Health Services↗