Did past economic prosperity affect the health related quality of life predictors? A longitudinal study on a representative sample of Slovenian family medicine patients

BMC Public Health

Polona Selic¹  Janko Kersnik¹  Igor Svab¹  Anja Cerne¹ 

[1] Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, Slovenia

关键词: Anxiety;    Stress;    Depression;    Psychosocial determinants;    Family medicine;    Quality of life;   

Others  :  1161465
DOI  :  10.1186/1471-2458-13-1160

 received in 2012-11-14, accepted in 2013-11-26,  发布年份 2013

【 摘 要 】

Background

Health related quality of life (HRQOL) as an important measure of medical outcomes has been shown to be associated with demographic factors and the most common mental and chronic somatic diseases. This study’s aim was to identify factors predicting changes in HRQOL over a follow-up period in a representative sample of Slovenian family medicine patients.

Methods

In a longitudinal multi-centred study between 2003 and 2005, data were collected from 1118 consecutive attendees from 60 family medicine practices in Slovenia on quality of life, socio-demographic factors and the presence of mental disorders, with follow-up after 6 and 24 months. Retrospective information on chronic diseases was obtained from patients` health records. In three time-sequential multiple linear regression models, data on 601 patients (53.8%) was analysed to determine factors associated with each component score of quality of life.

Results

At baseline the patients were 48.58 (SE = 0.58) years of age, over half were women (386 (64.2%)) and most were Slovenian (548 (91.2%)). Quality of life was seen to improve over the two-year period. Factors significantly and consistently associated with a better mental component score of quality of life were social support, satisfactory circumstances in patients` household and absence of anxiety. Major life events in the past year and depression were shown to be risk factors for mental and physical components, while level of education, absence of long-term disability and chronic pain were identified as predictors of the physical component.

Conclusions

Detection and successful treatment of depression and anxiety has a potential to lead to improved quality of life in family medicine attendees; family physicians should be alert for the early onset of these conditions, knowing that symptoms of chronic pain, depression and anxiety often overlap in patients. Poorly educated patients and those lacking social support and/or satisfactory household circumstances should be recognised and empowered, and appropriate coping mechanisms should be introduced.

【 授权许可】

   
2013 Cerne et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Alonso J, Ferrer M, Gandek B, Ware JE Jr, Aaronson NK, Mosconi P, Rasmussen NK, Bullinger M, Fukuhara S, Kaasa S, Leplège A: Health-related quality of life associated with chronic conditions in eight countries: results from the international quality of life assessment (IQOLA) project. Qual Life Res 2004, 13:283-298.
• [2]Coons SJ, Rao S, Keininger DL, Hays RD: A comparative review of generic quality-of-life instruments. Pharmacoeconomics 2000, 17(1):13-35.
• [3]The World Health Organization Quality of Life Assessment (WHOQOL): Development and General Psychometric Properties. Soc Sci Med 1998, 46:1569-1585.
• [4]Farquhar M: Definitions of quality of life: a taxonomy. J Adv Nurs 1995, 22:502-508.
• [5]Howes CJ, Reid MC, Brandt C, Ruo B, Yerkey MW, Prasad B, Lin C, Peduzzi P, Ezekowitz MD: Exercise tolerance and quality of life in elderly patients with chronic atrial fibrillation. J Cardiovasc Pharmacol Ther 2001, 6:23-29.
• [6]Xuan J, Kirchdoerfer LJ, Boyer JG, Norwood GJ: Effects of comorbidity on health-related quality-of-life score: an analysis of clinical trial data. Clin Ther 1999, 21:383-403.
• [7]Prutkin JM, Feinstein AR: Quality-of-life measurements: origin and pathogenesis. Yale J Biol Med 2002, 75:79-93.
• [8]Testa MA, Simonson DC: Assesment of quality-of-life outcomes. N Engl J Med 1996, 334:835-840.
• [9]Wilson IB, Cleary PD: Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 1995, 273:59-65.
• [10]Serrano-Aguilar P, Ramallo-Fariña Y, Trujillo-Martín Mdel M, Muñoz-Navarro SR, Perestelo-Perez L, De-las-Cuevas-Castresana C: The relationship among mental health status (GHQ-12), health related quality of life (EQ-5D) and health-state utilities in a general population. Epidemiol Psichiatr Soc 2009, 18:229-239.
• [11]Ormel J, VonKorff M, Ustun TB, Pini S, Korten A, Oldehinkel T: Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care. JAMA 1994, 272:1741-1748.
• [12]Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WA: Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004, 420:38-46.
• [13]Judd LL, Akiskal HS, Zeller PJ, Paulus M, Leon AC, Maser JD, Endicott J, Coryell W, Kunovac JL, Mueller TI, Rice JP, Keller MB: Psychosocial disability during the long-term course of unipolar major depressive disorder. Arch Gen Psychiatry 2000, 57:375-380.
• [14]Stein MB, Heimberg RG: Well-being and life satisfaction in generalized anxiety disorder: comparison to major depressive disorder in a community sample. J Affect Disord 2004, 79:161-166.
• [15]Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L: Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ 1992, 305:160-164.
• [16]Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT: The SF-36 health survey questionnaire: An outcome measure suitable for rutine use with the NHS? BMJ 1993, 306:1440-1444.
• [17]Jenkinson C, Coulter A, Wright L: Short Form 36 (SF36) health survey questionnaire: Normative data for adults of working age. BMJ 1993, 306:1437-1440.
• [18]Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL, Maltais D: Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes 2004, 2:51. BioMed Central Full Text
• [19]Zalihić A, Markotić V, Zalihić D, Mabić M: Gender and quality of life after cerebral stroke. Bosn J Basic Med Sci 2010, 10:94-99.
• [20]Lippmann QK, Crockett SD, Dellon ES, Shaheen NJ: Quality of life in GERD and Barrett's esophagus is related to gender and manifestation of disease. Am J Gastroenterol 2009, 104:2695-2703.
• [21]Zahran HS, Kobau R, Moriarty DG, Zack MM, Holt J, Donehoo R: Health-related quality of life surveillance–United States, 1993–2002. MMWR Surveill Summ 2005, 54:1-35.
• [22]Walker AE: Multiple chronic diseases and quality of life: patterns emerging from a large national sample, Australia. Chronic Illn 2007, 3:202-218.
• [23]Farkas J, Pahor M, Zaletel-Kragelj L: Self-rated health in different social classes of Slovenian adult population: nationwide cross-sectional study. Int J Public Health 2011, 56:45-54.
• [24]King M, Weich S, Torres-González F, Svab I, Maaroos HI, Neeleman J, Xavier M, Morris R, Walker C, Bellón-Saameño JA, Moreno-Küstner B, Rotar D, Rifel J, Aluoja A, Kalda R, Geerlings MI, Carraça I, de Almeida MC, Vicente B, Saldivia S, Rioseco P, Nazareth I: Prediction of depression in European general practice attendees: the PREDICT study. BMC Public Health 2006, 6:6. BioMed Central Full Text
• [25]King M, Walker C, Levy G, Bottomley C, Royston P, Weich S, Bellón-Saameño JA, Moreno B, Svab I, Rotar D, Rifel J, Maaroos HI, Aluoja A, Kalda R, Neeleman J, Geerlings MI, Xavier M, Carraça I, Gonçalves-Pereira M, Vicente B, Saldivia S, Melipillan R, Torres-Gonzalez F, Nazareth I: Development and validation of an international risk prediction algorithm for episodes of major depression in general practice attendees: the PredictD study. Arch Gen Psychiatry 2008, 65:1368-1376.
• [26]Jenkinson C, Layte R, Jenkinson D, Lawrence K, Petersen S, Paice C, Stradling J: A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med 1997, 19:179-186.
• [27]Kessler RC, Ustun TB: The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004, 13:93-121.
• [28]Spitzer RL, Kroenke K, Williams JB: Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders: patient health questionnaire. JAMA 1999, 282:1737-1744.
• [29]Barbor TF, de la Fuente JR, Saunders J, Grant M: Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption–II. Addiction 1993, 88:791-804.
• [30]Klemenc-Ketis Z, Kersnik J, Tratnik E: The presence of anxiety and depression in the adult population of family practice patients with chronic diseases. Zdrav Var 2009, 48:170-176.
• [31]Hopman WM, Berger C, Joseph L, Towheed T, VandenKerkhof E, Anastassiades T, Adachi JD, Ioannidis G, Brown JP, Hanley DA, Papadimitropoulos EA: The natural progression of health-related quality of life: Results of a five-year prospective study of SF-36 scores in a normative population. Qual Life Res 2006, 15:527-536.
• [32]Hopman WM, Berger C, Joseph L, Towheed T, vanden Kerkhof E, Anastassiades T, Cranney A, Adachi JD, Ioannidis G, Poliquin S, Brown JP, Murray TM, Hanley DA, Papadimitropoulos M, Tenenhouse A: Stability of Normative Data for the SF-36 Health Survey: Results of a three-year prospective study in middle-aged Canadians. Can J Public Health 2004, 95:387-391.
• [33]Solari A, Ferrari G, Radice D: A longitudinal survey of self-assessed health trends in a community cohort of people with multiple sclerosis and their significant others. J Neurol Sci 2006, 243:13-20.
• [34]Hazell ML, Morris JA, Linehan MF, Frank TL: Temporal change in health-related quality of life: a longitudinal study in general practice 1999–2004. Br J Gen Pract 2009, 59:839-843.
• [35]Hopman WM, Coo H, Pavlov A, Day AG, Edgar CM, McBride EV, Brunet DG: Multiple Sclerosis: Change in Health-Related Quality of Life Over Two Years. Can J Neurol Sci 2009, 36:554-561.
• [36]Miller DM, Rudick RA, Baier M, Cutter G, Doughtery DS, Weinstock-Guttman B, Mass MK, Fisher E, Simonian N: Factors that predict health-related quality of life in patients with relapsing-remitting multiple sclerosis. Mult Scler 2003, 9:1-5.
• [37]Hopman WM, Coo H, Brunet DG, Edgar CM, Singer MA: Longitudinal assessment of health-related quality of life (HRQOL) of patients with multiple sclerosis. Int J MS Care 2000, 2:15-26.
• [38]Wandell PE, Brorsson B, Aberg H: Quality of life in relation to comorbidity among diabetic patients followed for three years in Swedish primary health care. Diabetes Metab 1999, 25:424-428.
• [39]Eurostat - Tables, Graphs and Maps Interface (TGM) table: Real Gross Domestic Product (GDP) Growth Rate – Volume. http://epp.eurostat.ec.europa.eu/tgm/table.do?tab=table&init=1&plugin=1&language=en&pcode=tec00115 webcite
• [40]Petek Ster M, Svab I, Zivcec KG: Factors related to consultation time: experience in Slovenia. Scand J Prim Health Care 2008, 26:29-34.
• [41]Selic P, Svab I, Repolusk M, Gucek NK: What factors affect patients' recall of general practitioners' advice? BMC Fam Pract 2011, 12:141. BioMed Central Full Text
• [42]Parker PA, Baile WF, Moor-de C, Cohen L: Psychosocial and demographic predictors of quality of life in a large sample of cancer patients. Psychooncology 2003, 12:183-193.
• [43]Cohen S, Wills TA: Stress, social support and the buffering hypothesis. Psychol Bull 1985, 98:310-357.
• [44]Bovier PA, Chamot E, Perneger TV: Perceived stress, internal resources, and social support as determinants of mental health among young adults. Qual Life Res 2004, 13:161-170.
• [45]Lu Y, Nyunt MS, Gwee X, Feng L, Feng L, Kua EH, Kumar R, Ng TP: Life event stress and chronic obstructive pulmonary disease (COPD): associations with mental well-being and quality of life in a population-based study. BMJ Open 2012., 2
• [46]Staniute M, Brozaitiene J, Bunevicius R: Effects of social support and stressful life events on health-related quality of life in coronary artery disease patients. J Cardiovasc Nurs 2013, 28:83-89.
• [47]Spitzer RL, Kroenke K, Linzer M, Hahn SR, Williams JB, deGruy FV 3rd, Brody D, Davies M: Health-related quality of life in primary care patients with mental disorders. Results from the PRIME-MD 1000 Study. JAMA 1995, 274:1511-1517.
• [48]Saarni SI, Suvisaari J, Sintonen H, Koskinen S, Härkänen T, Lönnqvist J: The health-related quality-of-life impact of chronic conditions varied with age in general population. J Clin Epidemiol 2007, 60:1288-1297.
• [49]Hays RD, Wells KB, Sherbourne CD, Rogers W, Spritzer K: Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry 1995, 52:11-19.
• [50]Tomori M, Ziherl S: Psihiatrija. Ljubljana: Litterapicta Ljubljana; 1999.
• [51]Olomu AB, Corser WD, Stommel M, Xie Y, Holmes-Rovner M: Do self-report and medical record comorbidity data predict longitudinal functional capacity and quality of life health outcomes similarly? BMC Health Serv Res 2012, 12:398. BioMed Central Full Text
• [52]Australian Institute of Health and Welfare: Chronic Diseases and Associated Factors in Australia 2001. Canberra: Australian Institute of Health and Welfare (AIHW); 2002.
• [53]Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, Haass M: Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart 2002, 87:235-241.
• [54]Piazza JR, Charles ST, Almeida DM: Living with chronic health conditions: age differences in affective well-being. J Gerontol B Psychol Sci Soc Sci 2007, 62:313-321.
• [55]Michelson H, Bolund C, Brandberg Y: Multiple chronic health problems are negatively associated with health related quality of life (HRQOL) irrespective of age. Qual Life Res 2000, 9:1093-1104. doi:10.1023/A:1016654621784
• [56]Becker N, Thomsen AB, Olsen AK, Sjogren P, Bech P, Eriksen J: Pain epidemiology and health related quality of life in chronic non-malignant pain patients referred to a Danish multidisciplinary pain center. Pain 1997, 73:393-400.
• [57]Hobbs FD, Kenkre JE, Roalfe AK, Davis RC, Hare R, Davies MK: Impact of heart failure and left ventricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. Eur Heart J 2002, 23:1867-1876.
• [58]Svab I, Petek Ster M, Kersnik J, Zivcec Kalan G, Car J: A cross sectional study of performance of Slovene general practitioners (English summary). Zdrav Var 2005, 44:183-192.
• [59]Selic P, Petek D, Pesjak K: Healthy, but are they satisfied? Factors associated with job satisfaction in professional soldiers of the Slovenian armed forces. J Def Manag 2012, 2:1-8.
• [60]Selic P, Svab I, Rifel J, Pavlic DR, Cerne A, King M, Nazareth I: The pattern of physical comorbidity and the psychosocial determinants of depression: a prospective cohort study on a representative sample of family practice attendees in Slovenia. Ment Health Fam Med 2011, 8:147-155.
• [61]Maatouk I, Wild B, Herzog W, Wesche D, Schellberg D, Schöttker B, Müller H, Rothenbacher D, Stegmaier C, Brenner H: Longitudinal predictors of health-related quality of life in middle-aged and older adults with hypertension: results of a population-based study. J Hypertens 2012, 30:1364-1372.
• [62]Schwartz CE, Sprangers MA: Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Soc Sci Med 1999, 48:1531-1548.
• [63]Sprangers MA, Schwartz CE: Integrating response shift into health related quality of life research: a theoretical model. Soc Sci Med 1999, 48:1507-1515.