Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship

BMC Health Services Research

Michael Rufer³  Gerhard Krautstrunk³  Stefan CA Hegemann⁴  Dominik Straumann¹  Annette B Bruehl²  Steffi Weidt³ 

[1] Department of Neurology, University Hospital Zurich, Zurich, Switzerland;Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland;Department of Psychiatry and Psychotherapy, University Hospital Zurich, Culmannstrasse 8, Zurich CH–8091, Switzerland;Department of Otolaryngology, Head & Neck Surgery, University Hospital Zurich, Zurich, Switzerland

关键词: Impairment;    Emotional distress;    Dizziness;    Health-related quality of life;   

Others  :  1126921
DOI  :  10.1186/1472-6963-14-317

 received in 2013-10-03, accepted in 2014-07-11,  发布年份 2014

【 摘 要 】

Background

Dizziness is frequently encountered in medical practice, often takes a chronic course and can impair the health related quality of life (HRQoL). However results on the extent of this impairment of HRQoL are mixed. Furthermore, the relationship between dizziness and the HRQoL is only partially understood. The role of clinical symptoms of dizziness and psychosocial factors such as emotional distress on this relationship is for the most part unknown.

Methods

The cross-sectional study evaluated the HRQoL in 203 patients suffering from dizziness, using the Medical Outcomes Studies 36-Item Short-Form Health-Survey (SF-36). The results were correlated with the severity of dizziness, using the Dizziness Handicap-Inventory (DHI), with emotional distress, using the Hospital Anxiety and Depression-Scale (HADS) and with further clinical symptoms and psychosocial parameters. In a multivariate hierarchical regression analysis associated variables which explain significant variance of the mental and physical HRQoL (MCS-36, PCS-36) were identified.

Results

Patients suffering from dizziness showed a markedly reduced mental and physical HRQoL. Higher DHI and HADS scores were correlated with lower MCS-36 and PCS-36 scores. Taken together DHI and vertigo characteristics of dizziness explained 38% of the variance of PCS-36. Overall explained variance of PCS-36 was 45%. HADS and living with a significant other explained 66% of the variance of MCS-36 (overall variance explained: 69%).

Conclusion

Both the physical and mental HRQoL are significantly impaired in patients with dizziness. While the impairment in PCS-36 can be explained by clinical symptoms of the dizziness, MCS-36 impairment is largely associated with psychosocial factors. To improve the patient’s overall well-being significantly and permanently doctors have to keep in mind both, the clinical symptoms and the psychosocial factors. Therefore, in addition to the physical examination doctors should integrate a basic psychological examination into the daily routine with dizziness patients.

【 授权许可】

   
2014 Weidt et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Bird JC, Beynon GJ, Prevost AT, Baguley DM: An analysis of referral patterns for dizziness in the primary care setting. Br J Gen Pract 1998, 48(437):1828-1832.
• [2]Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T: Burden of dizziness and vertigo in the community. Arch Intern Med 2008, 168(19):2118-2124.
• [3]Yardley L, Owen N, Nazareth I, Luxon L: Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract 1998, 48(429):1131-1135.
• [4]Karatas M: Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist 2008, 14(6):355-364.
• [5]Sloane PD, Coeytaux RR, Beck RS, Dallara J: Dizziness: state of the science. Ann Intern Med 2001, 134(9 Pt 2):823-832.
• [6]Sloane PD: Dizziness in primary care. Results from the National Ambulatory Medical Care Survey. J Fam Pract 1989, 29(1):33-38.
• [7]Colledge NR, Barr-Hamilton RM, Lewis SJ, Sellar RJ, Wilson JA: Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ 1996, 313(7060):788-792.
• [8]Branch WT, Barton JJ: Approach to the patient with dizziness. UpToDate®; 2014.
• [9]Ten Voorde M, Zaag-Loonen HJ, Leeuwen RB: Dizziness impairs health-related quality of life. Qual Life Res 2012, 21(6):961-966.
• [10]Best C, Eckhardt-Henn A, Diener G, Bense S, Breuer P, Dieterich M: Interaction of somatoform and vestibular disorders. J Neurol Neurosurg Psychiatry 2006, 77(5):658-664.
• [11]Eckhardt-Henn A, Tschan R, Best C, Dieterich M: Somatoform vertigo syndrome. Nervenarzt 2009, 80(8):909-917.
• [12]Ronel J, Lahmann C: Vertigo und Psyche. Nervenheilkunde 2008, 27(9):846-852.
• [13]Yardley L, Putman J: Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study. Clin Otolaryngol Allied Sci 1992, 17(3):231-236.
• [14]Hannaford PC, Simpson JA, Bisset AF, Davis A, McKerrow W, Mills R: The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland. Fam Pract 2005, 22(3):227-233.
• [15]Fallowfield L: What is quality of life. In What is? Volume 2. Hayward Medical Communications; 2009.
• [16]George LK: Perceived quality of life. In Handbook of Aging and the Social Science. 6th edition. Burlington: Academic Press; 2006:320-336.
• [17]Ware JE Jr, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992, 30(6):473-483.
• [18]Enloe LJ, Shields RK: Evaluation of Health-Related Quality of Life in Individuals With Vestibular Disease Using Disease-Specific and General Outcome Measures. Phys Ther 1997, 77(9):890-903.
• [19]Yardley L, Dibb B, Osborne G: Factors associated with quality of life in Menière's disease. Clin Otolaryngol Allied Sci 2003, 28(5):436-441.
• [20]Hsu L-c H, H-h WW-j, S-j W, Y-o L, C-m C: Quality of life in elderly patients with dizziness: analysis of the short-form health survey in 197 patients. Acta Oto-laryngologica 2005, 125(1):55-59.
• [21]Fielder H, Denholm SW, Lyons RA, Fielder CP: Measurement of health status in patients with vertigo. Clin Otolaryngol Allied Sci 1996, 21(2):124-126.
• [22]Gámiz MJ, Lopez-Escamez JA: Health-Related Quality of Life in Patients over Sixty Years Old with Benign Paroxysmal Positional Vertigo. Gerontology 2004, 50(2):82-86.
• [23]Herrmann C, Brand-Driehorst S, Buss U, Ruger U: Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing. J Psychosom Res 2000, 48(4–5):455-462.
• [24]Hallam RS, Stephens SDG: Vestibular disorder and emotional distress. J Psychosom Res 1985, 29(4):407-413.
• [25]Tschan R, Best C, Beutel M, Knebel A, Wiltink J, Dieterich M, Eckhardt-Henn A: Patients’ psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease. J Neurol 2011, 258(1):104-112.
• [26]Bullinger M: German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med 1995, 41(10):1359-1366.
• [27]Bullinger M: SF-Fragebogen zum Gesundheitszustand. Göttingen: Hogrefe; 1998.
• [28]Jacobson GP, Newman CW: The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990, 116(4):424-427.
• [29]Kurre A, van Gool CJ, Bastiaenen CH, Gloor-Juzi T, Straumann D, de Bruin ED: Translation, cross-cultural adaptation and reliability of the german version of the dizziness handicap inventory. Otol Neurotol 2009, 30(3):359-367.
• [30]Hermann C, Buss U: Vorstellung und Validierung einer deutschen Version der "Hospital Anxiety and Depression Scale" (HAD-Skala): Ein Fragebogen zur Erfassung des psychischen Befindens bei Patienten mit körperlichen Beschwerden. Diagnostica 1994, 40:143-154.
• [31]Herrmann C: International experiences with the Hospital Anxiety and Depression Scale–a review of validation data and clinical results. J Psychosom Res 1997, 42(1):17-41.
• [32]Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67(6):361-370.
• [33]Cosco TD, Doyle F, Ward M, McGee H: Latent structure of the Hospital Anxiety And Depression Scale: a 10-year systematic review. J Psychosom Res 2012, 72(3):180-184.
• [34]Kammerlind A-S, Bergquist Larsson P, Ledin T, Skargren E, ouml, rn: Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium. Adv Physiother 2005, 7(3):96-107.
• [35]Durbin J, Watson GS: Testing for Serial Correlation in Least Squares Regression. II. Biometrika 1951, 38(1/2):159-177.
• [36]Myers R: Classical and modern regression with applications. 2nd edition. Boston: Brooks/Cole; 1990.
• [37]Bowerman BL, Connell RT O: Linear statistical models: an applied approach. 2nd edition. Belmont: PWS-Kent Pub; 1990.
• [38]Menard S: Applied logistic regression analysis. Thousand Oaks: SAGE Publications; 1995.
• [39]Downey RG, King C: Missing data in Likert ratings: A comparison of replacement methods. J Gen Psychol 1998, 125(2):175-191.
• [40]Fox-Wasylyshyn SM, El-Masri MM: Handling missing data in self-report measures. Res Nurs Health 2005, 28(6):488-495.
• [41]Grauvogel J, Kaminsky J, Rosahl SK: The impact of tinnitus and vertigo on patient-perceived quality of life after cerebellopontine angle surgery. Neurosurgery 2010, 67(3):601-609. discussion 609–610
• [42]Pratt RTC, McKenzie W: Anxiety states following vestibular disorders. The Lancet 1958, 272(7042):347-349.
• [43]Neuhauser HK, Lempert T: Vertigo: epidemiologic aspects. Semin Neurol 2009, 29(5):473-481.
• [44]Soderman AC, Bagger-Sjoback D, Bergenius J, Langius A: Factors influencing quality of life in patients with Meniere's disease, identified by a multidimensional approach. Otol Neurotol 2002, 23(6):941-948.
• [45]Santos EM, Gazzola JM, Gananca CF, Caovilla HH, Gananca FF: Impact of dizziness on the life quality of elderly with chronic vestibulopathy. Pro Fono 2010, 22(4):427-432.
• [46]Kirby SE, Yardley L: Cognitions associated with anxiety in Meniere's disease. J Psychosom Res 2009, 66(2):111-118.
• [47]Yardley L, Beech S, Weinman J: Influence of beliefs about the consequences of dizziness on handicap in people with dizziness, and the effect of therapy on beliefs. J Psychosom Res 2001, 50(1):1-6.
• [48]Furman JM, Jacob RG: A clinical taxonomy of dizziness and anxiety in the otoneurological setting. J Anxiety Disord 2001, 15(1–2):9-26.
• [49]Loughran S, Gatehouse S, Kishore A, Swan IR: Does patient-perceived handicap correspond to the modified clinical test for the sensory interaction on balance? Otol Neurotol 2006, 27(1):86-91.
• [50]Krosnick JA: Survey research. Annu Rev Psychol 1999, 50(1):537-567.
• [51]Pérez N, Martin E, Garcia-Tapia R: Dizziness: Relating the Severity of Vertigo to the Degree of Handicap by Measuring Vestibular Impairment. Otolaryngol Head Neck Surg 2003, 128(3):372-381.