How is subjective well-being related to quality of life? Do we need two concepts and both measures?

Subjective well-being (SWB) and subjective quality of life (QoL) are key concepts describing experience, capacities, states, behaviours, appraisals, and emotional reactions to circumstances. Used widely in public discourse, policy, and research, their theoretical and empirical relations remain little explored. The present research aimed to develop an integrated model of SWB and QoL through empirically testing its overlapping and exclusive dimensions. Survey data was obtained from N = 2533 in 11 countries. Adults completed the WHOQOL Spirituality, Religion and Personal Beliefs (SRPB) instrument which assesses 33 QoL facets in 6 domains. The facets operationalize components of the hedonic SWB model, extended with eudaimonia, as SWB+. Network analyses, and regression models with random effect for cultural centre, assessed the differential contributions of SWB+ and QoL in predicting general QoL, explanatory power, and model parsimony. When all SWB+ and QoL variables are assessed together, the final model explains more variance in general QoL than either of the competing models; also it shows the most parsimonious fit. This fully integrated model contains only positive feelings from SWB+, with 13 other QoL facets drawn from all six domains, when adjusted for health status and educational level. These findings provide the foundation for a new Life Quality and Well-being (LQW) model that awaits confirmation. The LQW model improves on existing models of SWB+ and QoL by better explaining general QoL than facets of either model on its own. The 14 selected facets potentially offer a new, single measure with considerable conceptual breadth, and international foundations.

Quality of life and depression in chronic sexually transmitted infections in UK and Greece: The use of WHOQOL-HIV/STI BREF.

This is a comparative study aiming to investigate quality of life (QoL) and depression in individuals diagnosed either with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), or genital warts (GW) and genital herpes (GH), in two healthcare settings, in the United Kingdom (UK) or in Greece (Gr). Using a matched-pairs design, two equalized patient samples with sexually transmitted infections (STI) were recruited: from UK (n=43) and from Greece (n=43). QoL was assessed with WHOQOL-HIV BREF for HIV patients and WHOQOL-STI BREF -a newly adapted instrument- for genital warts and genital herpes patients. Depressive symptomatology was measured by the Centre for Epidemiological Studies- Depression Scale (CES-D) along with sociodemographic data. Results indicate that in both country- healthcare settings, a high percentage of individuals diagnosed with any type of STI, reported considerable depressive symptomatology: 35.7% for UK and 41.5% for Greek participants respectively. Regarding QoL, participants in the Greek healthcare settings reported significantly lower scores in the environment domain, and even lower scores were reported by the GW/GH group, in comparison to HIV. Specifically, these groups indicated significantly lower values in the following WHOQOL-BREF environment facets: (i) physical safety and security, (ii) participation in and opportunities for recreation/leisure activities, (iii) home environment, (iv) accessibility and quality in health and social care, and (v) transport facilities. Regarding correlation of QoL and depression, regression analysis provided significant evidence for depression having a differential effect on WHOQOL-BREF QoL domains. Evidence of increased depressive symptomatology in both STI patient- cohorts may shed light into unmet healthcare needs that should be addressed by healthcare providers in UK and Greece respectively. Furthermore, all types of Greek STI participants reported lower QoL, particularly the GW/GH group, indicating important unmet QoL needs in the environment domain, such as health and social care accessibility and quality, or environmental and social resources, all lowering everyday QoL. The present findings may provide guidelines for tailored mental health interventions alleviating depressive symptomatology in STI patients. Provision of targeted-interventions at healthcare and social-environmental levels will contribute to QoL/ health improvement in STI patients.

Adjusting for cross-cultural differences in computer-adaptive tests of quality of life.

PURPOSE: Previous studies using the WHOQOL measures have demonstrated that the relationship between individual items and the underlying quality of life (QoL) construct may differ between cultures. If unaccounted for, these differing relationships can lead to measurement bias which, in turn, can undermine the reliability of results. METHODS: We used item response theory (IRT) to assess differential item functioning (DIF) in WHOQOL data from diverse language versions collected in UK, Zimbabwe, Russia, and India (total N = 1332). Data were fitted to the partial credit 'Rasch' model. We used four item banks previously derived from the WHOQOL-100 measure, which provided excellent measurement for physical, psychological, social, and environmental quality of life domains (40 items overall). Cross-cultural differential item functioning was assessed using analysis of variance for item residuals and post hoc Tukey tests. Simulated computer-adaptive tests (CATs) were conducted to assess the efficiency and precision of the four items banks. RESULTS: Splitting item parameters by DIF results in four linked item banks without DIF or other breaches of IRT model assumptions. Simulated CATs were more precise and efficient than longer paper-based alternatives. DISCUSSION: Assessing differential item functioning using item response theory can identify measurement invariance between cultures which, if uncontrolled, may undermine accurate comparisons in computer-adaptive testing assessments of QoL. We demonstrate how compensating for DIF using item anchoring allowed data from all four countries to be compared on a common metric, thus facilitating assessments which were both sensitive to cultural nuance and comparable between countries.

How appropriate is the WHOQOL-BREF for assessing the quality of life of adolescents?

BACKGROUND: Using mixed-methods research, we investigated whether the adult version of the WHOQOL-BREF was acceptable and feasible to use with adolescents (13-19), and what features might need to be changed to develop it. Differences from young adults quality of life (QoL) (20-30 years) could add justification. METHODS: Preliminary psychometric properties of the adult WHOQOL-BREF were examined in 208 adolescents and 204 young adults. Unhealthy adolescents diagnosed with acne or elevated depressive symptoms (CES-D) were compared with healthy adolescents. Cognitive interviewing used 'think aloud' techniques with six healthy adolescents during WHOQOL-BREF completion. Concepts and wording were thematically analysed for relevance, comprehension and comprehensiveness. RESULTS: Little data were missing from the WHOQOL-BREF suggesting some feasibility and acceptability to adolescents. Compared with adults, adolescents perceived greater access to information, a better home environment, worse pain, and medication dependency. Internal consistency reliability for adolescents was good (α = .89), especially psychological and environmental QoL. Content validity especially for social and environment domains was supported. Domains validly discriminated between high- and low-depressive symptoms but not acne groups. Additional new facets on autonomy, altruism and physical fitness and changed item contents are proposed. CONCLUSION: The evidence indicates that developing a new adolescent version is justifiable. Cross-cultural research should build on these preliminary findings.

Quality of life in newly diagnosed children with specific learning disabilities (SpLD) and differences from typically developing children: a study of child and parent reports.

INTRODUCTION: Research on quality of life (QoL) of school children with specific learning disabilities (SpLD) and their parents is scarce. The present study explores QoL deficits in newly diagnosed children with SpLD and their parents, in comparison to a similar age group of typically developing children. Possible associations between parental and child QoL were statistically explored in both groups of children. METHODS: 70 newly diagnosed children with SpLD [International Classification of Diseases-10 (ICD-10) criteria] (38 boys, 32 girls, mean age 10.1 years) and a control group of 69 typically developing children of the same age (40 boys, 29 girls, mean age 10.6 years) were recruited. Children were of normal intelligence quotient, attending mainstream schools. Their parents were also recruited so a child's scores could be associated with corresponding parental scores (mother or father). Children's QoL was assessed by the German questionnaire for measuring quality of life in children and adolescents (KINDL(R) ) questionnaire and parental QoL by World Health Organization Quality of Life brief questionnaire (WHOQOL-BREF) of the World Health Organization. RESULTS: Children with SpLD in comparison to typically developing children reported according to the KINDL(R) measurement poorer emotional well-being, lower self-esteem and satisfaction in their relationships with family and friends. Surprisingly, school functioning was not reported by these children as an area of concern. Parents of children with SpLD indicated experiencing lower satisfaction in the WHOQOL-BREF domains of social relationships and environment. Correlational and regression analysis with parental-child QoL scores provided evidence that in the SpLD group, parental scores on WHOQOL-BREF social relationships and psychological health domains could be predictors of the child's emotional well-being, satisfaction with family, friends and school functioning. Stepwise regression analysis verified the effect of parents' WHOQOL-BREF social relationships domain on several dimensions of children's KINDL(R) QoL. CONCLUSIONS: The results may suggest certain significant effects of the SpLD condition on newly diagnosed children's QoL. Emotional and social deficits seem to be experienced by this cohort of children and their parents. Investigation into the possible interrelationships between parental and child QoL seems to indicate that parental social wellbeing may to a certain extend influence some dimensions of the child's QoL. The findings are useful for policy making and specialized interventions for children with SpLD and their families.

Is quality of life poorer for older adults with HIV/AIDS? International evidence using the WHOQOL-HIV.

Increasingly older adults are being diagnosed with HIV/AIDS. In 2002, UNAIDS indicated that 13 aspects of quality of life (QoL) were poorer for older adults, but only sparse, inconsistent cross-cultural evidence is available. This statement was investigated using a reliable, valid measure (the WHOQOL-HIV) distributed in nine cultures (eight countries). HIV positive and well adults (n = 2089) were assessed across 30 QoL facets; 403 were 40+ years. It was confirmed that sleep, fatigue and sex-life were poorer areas of QoL for older HIV adults than younger. Furthermore, they could be misinterpreted as normal ageing signs. Moreover, older people reported greater dependency on medication. However, older HIV adults had better QoL than expected on 11 dimensions; negative feelings, social inclusion, and several environmental and spiritual facets. This highlights the extent of poor QoL in younger adults. After accounting for culture and gender, overall QoL and health in older HIV adults was explained by eight facets comprising 61.3% of the variance. Social relationships were paramount, especially personal relationships (41%), but support and sex-life also. Energy, negative feelings, cognitions, financial resources and HIV symptoms also contributed. Social interventions for ageing communities would improve well-being. This evidence could support global ageing and HIV policy.

Does the subjective quality of life of children with specific learning disabilities (SpLD) agree with their parents' proxy reports?

PURPOSE: The aim of the present study was to investigate agreement between child-parent proxy reports on quality of life (QoL) in children with specific learning disabilities (SpLD) and in a control group of typically developing children. METHODS: One hundred and sixteen children aged 8-14 years with SpLD, and 312 same age typically developing children with their parents (one or both), respectively, completed the child and parent versions of the KINDL(R) questionnaire. Values were analyzed with ANOVA and intra-class correlation coefficient (ICC). RESULTS: Significant mean differences were found between children with SpLD and their mother's proxy ratings. So, mothers reported significantly lower scores in the dimension of everyday functioning in school, but significantly higher scores regarding the child's physical and emotional well-being. For typically developing children, significant differences between children and parents' proxy ratings were found in physical well-being and self-esteem with both parents reporting higher scores. Concerning ICC, correlations were few and low in the SpLD group but more robust in the typically developing child-parent proxy ratings with values ranging from 0.22 to 0.46. CONCLUSION: In the case of SpLD, the child's problem area, which is reflected in the KINDL(R) dimension of everyday functioning in school, seems to be an issue of controversial value that may be differentially perceived by children and their mothers. Further, it can be argued that as mothers seemed to perceive in a more negative way the child's QoL at school, they were at the same time attempting to counterbalance their reactions by overestimating the child's physical and emotional well-being. Besides differences, there is a tendency even low for mothers and children with SpLD to converge toward similar perceptions regarding the child's physical and emotional well-being and satisfaction with friends that is showing some rather common understanding of the child's overall well-being and his/her relationships with peers. In the control group, agreement between children and parents seems to be more even and evident. Proxy assessments in children with SpLD and their parents may be useful for planning targeted support interventions for these families.

A prospective trial of the effects of isotretinoin on quality of life and depressive symptoms.

BACKGROUND: Isotretinoin is an efficacious treatment for acne, but has been controversially linked with depression. OBJECTIVES: This study aimed to examine the effects of isotretinoin on quality of life(QoL) and depression using a prospective design. METHODS: The WHOQOL-BREF QoL measure and Centre for Epidemiological Studies Depression Scale were administered to consecutive outpatients with acne who were prescribed either isotretinoin (n = 65) or antibiotic treatment (n = 31).Patients and physicians rated acne severity independently. Groups were compared at baseline with a matched community sample (n = 94) and measurements repeated at 3 months for treatment groups. RESULTS: There were no differences between the three groups at baseline in terms of age, gender, depression or overall QoL. Acne was more severe in the treatment groups (P < 0·001). Depression was negatively correlated with QoL (P < 0·001)and hence was included as a covariate in repeated-measures analyses of QoL.Acne improved over time in both treatment groups (F = 48·2, P < 0·001). There was no detectable deterioration in depression score in either group (F = 1·1, not significant). QoL in the physical and social domains improved (P < 0·001) while psychological and environmental QoL was unchanged over time. The improvement in social QoL was greater in the isotretinoin group (P < 0·05). Those patients with higher baseline depression scores showed greater improvements in physical, psychological and social QoL (P < 0·001). CONCLUSIONS: Treatment of acne improves QoL, particularly in those with more depressive symptoms at the outset. Mood deterioration was not detected, but the possibility of subtle or rare mood effects of isotretinoin cannot be ruled out.

Predicting quality of life for people living with HIV: international evidence from seven cultures.

The need for a validated quality of life (QOL) model focussing on people living with HIV/AIDS has led to an international re-evaluation and extension of the Chronic Illness Quality of Life model using complex latent modelling techniques. After reoperationalising six model variables and including independence and sex-life, the WHOQOL-HIV was administered to 1281 people with asymptomatic-HIV (42%), symptomatic-HIV (40%) or AIDS (18%; 34 years; 62% male) living in Australia, Brazil, India (north & south), Italy, Thailand and Ukraine. The overall model fit was acceptable. Social inclusion did not directly improve QOL, but increased positive feelings, social support and perceived improvements of access to health and social care; all three improved QOL. Social inclusion increased perceived physical health indirectly through positive feelings. Better physical health improved sex-life and gave greater independence; both improved QOL. Gender and disease stage models were acceptable, fitting best for men and asymptomatic-HIV. Similar aspects of QOL were depleted for women and some disease stages. Increased social support did not consistently improve independence or positive feelings. Positive feelings improved the sex-life of men and those with asymptomatic-HIV. This cross-cultural approach combining assessment with theory, could guide future international interventions and practice.

A measure for quality of life assessment in chronic pain: preliminary properties of the WHOQOL-pain.

Chronic pain has a considerable impact on patient-reported outcomes such as quality of life (QoL). To assess QoL in people with chronic pain, a pain and discomfort module (PDM) was developed for use with the WHOQOL-100 and its psychometric properties assessed. Sixteen items covered four facets on pain relief; anger and frustration; vulnerability, fear and worry; and uncertainty. Chronic low back pain patients (n = 133) (age 56; pain duration 85 months; 65% female) completed the WHOQOL-100 and PDM, McGill Pain Questionnaire, and SF-12. The PDM showed good internal consistency reliability (alpha = .88) (alphas .66-.81). Except for anger, all facets associated most strongly with their 'parent' domain. Pain and poorer QoL were strongly associated, supporting construct validity. The SF-12 physical health component associated strongly with pain relief, and the mental health score with other facets, indicating good concurrent validity. Discriminant validity tests showed that PDM scores distinguished between ill and well patients, and between those reporting different health statuses. The PDM has fair to good psychometric properties indicating its value as a patient-reported outcome measure for clinical trials.

The quality of life of people in chronic pain: developing a pain and discomfort module for use with the WHOQOL.

This article reports the development of a pain and discomfort module (PDM) designed to assess the full impact of quality of life (QoL) relating to chronic pain, which could be used with the generic World Health Organisation Quality of Life Assessment (WHOQOL). First, cognitive interviewing was completed with nine participants with chronic pain, for 108 items representing 10 pain-specific facets of QoL. Sixty-eight QoL items and 16 importance questions on pain were relevant, comprehensive, comprehensible and acceptable to users, and were confirmed to assess their purported concepts. Secondly, these items were pilot tested using a cross-sectional survey of 216 people with chronic pain, to investigate the preliminary psychometric properties of the PDM, and reduce its items statistically. All new facets were important to those with chronic pain. Sixteen items within four facets of pain relief, anger and frustration, vulnerability/fear/worry, and uncertainty were retained, and demonstrated acceptable to good internal consistency reliability (α = 0.77-0.85). The PDM is a self-administered, multidimensional subjective assessment of pain-related QoL, with potential to evaluate pain-relieving interventions, identify sufferer's needs, and for survey use.

Relationships among adolescents' weight perceptions, exercise goals, exercise motivation, quality of life and leisure-time exercise behaviour: a self-determination theory approach.

Exercise has an important role to play in the prevention of child and adolescent obesity. Recent school-based interventions have struggled to achieve meaningful and lasting changes to exercise levels. Theorists have suggested that this may, in part, be due to the failure to incorporate psychosocial mediators as they relate to behaviour change. Using a sample of 580 British schoolchildren, a model grounded in self-determination theory was explored to examine the effects of exercise goals on exercise motivation, leisure-time exercise behaviour and quality of life (QoL). Results of structural equation modelling revealed that adolescents perceiving themselves to be overweight and pressurized to lose weight, endorsed extrinsic weight-related goals for exercise. Extrinsic goals negatively predicted, whereas intrinsic goals positively predicted, self-determined motivation, which in turn positively predicted QoL and exercise behaviour. Furthermore, self-determined motivation partially mediated the effects of exercise goals on reported exercise behaviour and QoL. Multi-sample invariance testing revealed the proposed model to be largely invariant across gender. Results suggest that holding extrinsic exercise goals could compromise exercise participation levels and QoL. A role for teachers and parents is proposed with the aim of orienting young people towards intrinsic goals in an attempt to enhance future exercise behaviour and QoL.

How does psoriasis affect quality of life? Assessing an Ingram-regimen outpatient programme and validating the WHOQOL-100.

UNLABELLED: BACKGROUND, OBJECTIVES AND METHODS: This paper reports a longitudinal study of the quality of life (QOL) of outpatients receiving treatment for psoriasis in secondary care that was designed to validate a new QOL measure for use in psoriasis: the WHOQOL-100. Additional aims were to monitor the changes to the QOL of psoriasis patients (n = 83) following a course of topical treatment--a modified Ingram regimen--and to compare their QOL with healthy people (n = 105). RESULTS: General QOL was much improved following treatment; psychological facets of body image and appearance, self-esteem and negative feelings were particularly responsive to clinical change, in addition to positive feelings and cognitive capacity. Domains on spirituality, independence and physical health also improved. Compared with healthy controls, pretreatment psoriasis patients showed poorer physical, psychological, independence and spiritual QOL. Validity and reliability were investigated and found to be good to excellent. Internal consistency was very good in 23 facets out of 25. Domains and facets were strongly correlated (weaker for spirituality) largely reaffirming the WHOQOL concept. While physical, independence and psychological domains have some components similar to the Short Form-36, the social and environment domains represent novel conceptual areas for the WHOQOL. Facets about positive and negative feelings were validated by results from the Profile of Mood States. Psoriasis severity was associated with QOL in only six facets out of 25. CONCLUSIONS: The WHOQOL-100 is reliable and valid, and hence a new and important measure for assessing quality of life in psoriasis.

The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group.

Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.

Preliminary development of the World Health Organsiation's Quality of Life HIV instrument (WHOQOL-HIV): analysis of the pilot version.

The assessment of quality of life (QoL) is central to understanding how people's lives are affected by HIV infection. A reliable and valid measurement tool developed for cross-cultural use will be important in evaluating the global impact of the disease. This paper reports on the development and preliminary assessment of the WHOQOL-HIV pilot instrument that is designed for use with the WHOQOL-100 for persons living with HIV and AIDS (PLWHA). In this study, 900 people with a mean age of 32 from six culturally diverse sites completed the WHOQOL-100 along with 115 HIV specific items. Respondents were HIV asymptomatic (23%), HIV symptomatic (23%), had AIDS (20%) or were well (34%). Analyses to select the best items from the piloted instrument resulted in the inclusion of 33 items covering 12 new facets for a field trial version of the WHOQOL-HIV instrument; e.g. symptoms of HIV, body image, social inclusion, death and dying, and forgiveness. The results indicate excellent internal consistency for the scale (alpha=0.98) and its domains (alpha=0.87-0.94). For PLWHA, pain and discomfort, positive feelings, dependence on medication, sexual activity, financial resources and spiritual connection were particularly poor, indicating that the severest impact of HIV extends beyond physical well-being to the psycho-social-spiritual and environmental areas of QoL. Comparisons using ANOVA showed that persons who are at later stages of HIV infection, or are currently ill report poorer QoL than those that were well (p<0.01). Women report poorer QoL than men for almost every facet (p<0.01) and older persons (>30) reported lower negative feelings, and better social inclusion, spiritual connection, forgiveness and spiritual experience than younger persons. Finally, those with no education, or only primary education showed some of the poorest means. It is concluded that these new items and facets add value for measurement of QoL in PLWHA.

Do bowel cancer patients participate in treatment decision-making? Findings from a qualitative study.

The views of bowel cancer patients towards treatment decision-making and the extent to which they participate in this process were investigated. A prospective longitudinal qualitative study was conducted based on 55 new consultations between oncologists and bowel cancer patients and interviews with 37 recently diagnosed patients, 28 of whom were re-interviewed after 6 months. The interview and consultation data were transcribed verbatim and coded. Theoretical comparisons were made between the interviews and themes emerging from the consultation narratives. The analysis revealed that most bowel cancer patients preferred a limited role in the treatment decision-making process, preferring to delegate the responsibility to the clinician. However, they did not always consider themselves as 'passive' participants within the consultation and many felt that they had made the final decision to accept or refuse treatment. The consultation data shows that when a treatment recommendation was not forthcoming from the oncologist, patients became more proactive in the consultation, often taking the initiative to participate. It is concluded that patients who indicate a desire to participate in these types of consultations should be encouraged to do so and oncologists should try to identify those patients who could benefit from a greater role in treatment decision-making.

Validation of the WHOQOL-100: pain management improves quality of life for chronic pain patients.

OBJECTIVE: The study aimed to validate a new, multidimensional, multilingual instrument (the WHOQOL-100) for assessing QOL in chronic pain patients. METHODS: Chronic pain patients (N = 106) who agreed to participate in an established pain management program (PMP) were assessed for quality of life (QOL) before and one month after the intervention. The WHOQOL-100 is a generic profile containing 25 facets of QOL organized in 6 domains. It was administered concurrently with the MOS Short Form-36, the Beck Depression Inventory, and measures of pain intensity, duration, disruption and distress. RESULTS: The patients were outpatients and inpatients with a mean age of 44 years and mean pain duration of 8 years. The sample included 70 (66%) women. After the PMP, QOL had significantly improved generally. and in the physical, psychological and independence domains, as well as in 10 facets of QOL including pain and discomfort. Good QOL is consistently associated with low levels of pain severity and pain distress and little pain disruption. Overall internal consistency reliability was good and for most facets and domains but marginal for the pain facet. When compared with the SF-36. the WHOQOL-100 shows good concurrent validity, greater comprehensiveness and very good responsiveness to clinical change. DISCUSSION: The WHOQOL-100 indicates significant improvements to QOL for those entering a PMP and is validated for the clinical assessment of chronic pain patients and for use in multi-national clinical trials, clinical governance and audit.

Changes in the quality of life of patients receiving antidepressant medication in primary care: validation of the WHOQOL-100.

BACKGROUND: The study arises from the need for good quality of life (QOL) assessment and a new comprehensive generic QOL profile for cross-cultural use. AIMS: To examine changes in the QOL of patients receiving antidepressants from a general practitioner, and to assess the validity and sensitivity of a new QOL measure, the World Health Organization Quality of Life Assessment (100-item version) (WHOQOL-100). METHOD: Patients with moderate depression (n = 106) completed the WHOQOL-100 and Beck Depression Inventory at the start of treatment and again after 6 weeks. RESULTS: Depression decreased significantly over 2 months and 74% reported feeling better. WHOQOL-100 scores increased in 24 of the 25 facets, demonstrating that QOL improves significantly in the 8 weeks following the start of antidepressant treatment. It also shows the instrument's validity and sensitivity to changes in clinical condition. CONCLUSIONS: The UK WHOQOL-100 is confirmed as excellent to good. Antidepressants significantly and comprehensively improve QOL.

Measuring the epidemiology of distress: the rheumatology distress index.

OBJECTIVES: (1) To examine clinical and psychological variables to determine which are associated with psychologic and psychosocial severity or "distress"; (2) to investigate whether patients with the 2 major rheumatic disorders, rheumatoid arthritis (RA) and osteoarthritis (OA), differ in distress variables and distress; and (3) to develop and validate a simple, clinically acceptable index of distress suitable for routine care and research purposes. METHODS: A total of 2,403 patients were evaluated in 2 data sets (N = 1,399 and N = 1,490). The first data set was evaluated in the clinic by a routine clinical examination and administration of the Clinical Health Assessment Questionnaire (CLINHAQ). This instrument includes measures of pain, global severity, functional disability, anxiety, depression, sleep disturbance, fatigue, health satisfaction, and health status. The second data set was evaluated by a mailed questionnaire that included the CLINHAQ, but also coping scales, the Beliefs in Pain Control Questionnaire, the Self Performance Scale, and the Arthritis Helplessness Index. RESULTS: RA and OA groups had similar scores for the variables associated with distress: pain, global severity, functional disability, anxiety, depression, sleep disturbance, fatigue, health satisfaction, and health status. Patients with fibromyalgia (FM) had more abnormal scores for every variable, reflecting overall distress. Using patients with FM as a "gold standard" of distress, we developed an index in data set 2. the Rheumatology Distress Index (RDI), made up of 5 variables, anxiety, depression, global severity, fatigue, and sleep disturbance, that best identified patients with FM compared to other patients. We then validated the instrument on the distress severity clusters formed in data set 1. The correlation between RDI and distress severity cluster was 0.874 with all patients considered and 0.867 with FM patients excluded. In addition, RDI predicted 1,174 of 1,399 (83.9%) cluster memberships correctly. Compared with a battery of psychological and clinical tests that classified 74% of FM and non-FM patients correctly, the RDI and is only slightly less effective, classifying 70.3% correctly. CONCLUSION: Distress is a patient rather than a disease phenomenon. A simple, easy to administer self-report questionnaire can be used to classify patients according to their level of distress. The resulting index, the RDI. accurately identifies distressed and non-distressed patients. Such an index should be useful for patient care and research.