Health-related quality of life in non-alcoholic fatty liver disease: A cross-cultural study between Spain and the United Kingdom.

BACKGROUND: It is unclear what biopsychosocial factors influence the impact of NAFLD on health-related quality of life (HRQoL), and if these factors are equally important predictors between different nationalities. METHODS: HRQoL (CLDQ) was measured in both Southern European (Spain, n = 513) and Northern European (United Kingdom -UK-, n = 224) cohorts of patients with NAFLD in this cross-sectional study. For each cohort, participant data were recorded on histological grade of steatohepatitis, stage of fibrosis and biopsychosocial variables. Regression analysis was used to explore which of these variables predicted HRQoL. Moderated mediation models were conducted using SPSS PROCESS v3.5 macro. RESULTS: Participants with severe fibrosis reported more fatigue, systemic symptoms and worry, and lower HRQoL than those with none/mild fibrosis, regardless of place of origin. In addition, body mass index (BMI) and gender were found to be significant predictors of HRQoL in both Spanish and UK participants. Female gender was associated with worse emotional function, higher BMI and more fatigue, which predicted lower participants' HRQoL. UK participants showed more systemic symptoms and worry than Spanish participants, regardless of liver severity. The negative effects of gender on HRQoL through emotional function, BMI and fatigue were reported to a greater degree in UK than in Spanish participants. CONCLUSIONS: UK participants showed a greater impairment in HRQoL as compared to Spanish participants. Higher fibrosis stage predicted lower HRQoL, mainly in the Spanish cohort. Factors such as female gender or higher BMI contributed to the impact on HRQoL in both cohorts of patients and should be considered in future multinational intervention studies in NAFLD.

Significance of Post-Traumatic Growth and Mental Health for Coping in Multiple Sclerosis Caregivers.

We investigated the influence of post-traumatic growth (PTG) and mental health (MH) on multiple sclerosis (MS) caregivers' uses of coping strategies and identified biopsychosocial predictors of proactive or reactive coping. The Short Form Health Survey (SF-12), General Health Questionnaire (GHQ-28), Post-Traumatic Growth Inventory (PGI-21), Brief COPE Questionnaire (COPE-28), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to evaluate 209 caregivers. Higher PTG was related to greater use of emotional support, positive reframing, religion, active coping, instrumental support, planning, denial, self-distraction, self-blaming, and venting. Better MH was associated with greater use of acceptance, while behavioral disengagement and self-distraction were associated with poorer MH. The PTG dimensions relating to others and new possibilities, SF-12 dimensions of physical and emotional roles as well as partnership, not living with the patient, and significant others' social support were predictors of proactive coping. Reactive coping was positively predicted by the PTG dimension relating to others, depression, vitality, other than partner relation, and physical role, and negatively predicted by mental health level and emotional role. In summary, higher MH was associated with proactive coping strategies, whereas post-traumatic growth was related to the use of a wide range of proactive coping as well as reactive coping strategies.

Survival of patients with severe mental disorders: Influence of social functioning.

BACKGROUND: Patients with severe mental disorders have a high risk of premature death due to the interaction of various factors. Social functioning is a strategic functional factor in understanding the course of psychotic disorders. AIM: Analyze the relationship between social functioning and its various dimensions and survival during a 10-year follow-up. METHOD: The Social Functioning Scale (SFS) was administered to 163 close relatives of patients under treatment at a Community Mental Health Unit. Survival was described by Kaplan-Meier analysis and any differences in survival by level of social functioning were found by long-rank analysis. Finally, Cox regression was used to predict premature mortality. RESULTS: Significant differences in mortality were identified in the interpersonal behavior dimension of social functioning, while there were no significant gender or diagnostic differences in the rest of the dimensions. The interpersonal behavior dimension and age were found to be factors predicting premature death. CONCLUSION: These findings show the protective effect of social functioning retained by patients with psychotic disorders on their survival, and the need to apply evidence-based psychotherapy focused on recovery of social functioning in the early stages of the disorder.

Coping with multiple sclerosis: reconciling significant aspects of health-related quality of life.

Multiple sclerosis (MS) symptoms and unpredictability can damage patient well-being. This study is aimed to investigate the relation between sociodemographic and clinical characteristics and the use of coping strategies as well as social support on health-related quality of life (HRQOL). We evaluated 314 MS outpatients of Virgen Macarena University Hospital in Sevilla/Spain (mean age 45 years, 67.8% women) twice over an 18-months period by Brief COPE Questionnaire (COPE-28), Multidimensional Scale of Perceived Social Support (MSPSS) and 12-Item Short Form Health Survey (SF-12). Female gender was significantly related to religion (r= 0.175, p< 0.001), self-distraction (r= 0.160, p< 0.001) and self-blame (r= 0.131, p< 0.05). Age correlated positively with religion (r= 0.240, p< 0.001), and self-blame (r= 0.123, p< 0.05). Progressive MS as well as functional impairment (EDSS) showed a positive relation with denial (r= 0.125, p< 0.05; r= 0.150, p< 0.001). Longer duration since diagnosis was related to lower perceived support from family (r= -0.123, p< 0.05). EDSS (ß= -0.452, p< 0.001) was the strongest negative predictor of physical HRQOL followed by age (ß= -0.123, p< 0.001), whereas family support was a protective factor (ß= 0.096, p< 0.001). Denial (ß= -0.132, p< 0.05), self-blame (ß= -0.156, p< 0.05), female gender (ß= -0.115, p< 0.05) and EDSS (ß= -0.108, p< 0.05) negatively impacted on mental HRQOL 18 months later, whereas positive reframing (ß= 0.142, p< 0.05) was a protective factor. Our study could identify sociodemographic and clinical variables associated with dysfunctional coping strategies, such as self-blame and denial, which specifically predict worse mental HRQOL as opposed to positive reframing. Diminishing dysfunctional coping and supporting cognitive reframing may contribute to improve HRQOL in MS.

Coping Strategies Furthering Post-Traumatic Growth in Multiple Sclerosis: A Longitudinal Study.

(1) Background: Patients' behavioral attempts in dealing with Multiple sclerosis (MS) play an important role in post-traumatic growth (PTG). In a longitudinal study, we aimed to identify coping strategies predicting PTG. (2) Methods: 260 MS patients answered the Post-traumatic Growth Inventory and the Brief COPE Questionnaire at three time points during a 36-month follow-up period. (3) Results: an interaction effect between PTG level and assessment time was found for emotional support, positive reframing, active coping, and planning coping strategies. Positive reframing, emotional support, instrumental support, religion, planning, and self-distraction positively predicted PTG. (4) Conclusions: to encourage PTG development, early interventions in MS patients are recommended to promote adaptive coping, particularly positive reframing, social support, active coping, planning, religion, and self-distraction.

Vitality, mental health and role-physical mediate the influence of coping on depressive symptoms and self-efficacy in patients with non-alcoholic fatty liver disease: A cross-sectional study.

OBJECTIVE: Our aim was to determine whether the association between active coping and depressive symptoms in patients with non-alcoholic fatty liver disease (NAFLD) was mediated by vitality, and whether diabetes and obesity could impact on this relationship. We also wanted to find out whether mental health and role-physical modulated the relationship between passive/avoidance coping and self-efficacy, and the role of liver fibrosis. METHODS: Depressive symptoms (BDI-II), self-efficacy (GSE), coping (COPE-28) and quality of life (SF-12) were evaluated in 509 biopsy-proven NAFLD patients in this cross-sectional study. Mediation and moderated mediation models were conducted using the SPSS PROCESS v3.5 macro. RESULTS: Vitality mediated the relationship between active coping and depressive symptoms (-2.254, CI = -2.792 to -1.765), with diabetes (-0.043, p = 0.017) and body mass index (BMI) (-0.005, p = 0.009) moderating the association. In addition, mental health (-6.435, CI = -8.399 to -4.542) and role-physical (-1.137, CI = -2.141 to -0.315) mediated the relationship between passive/avoidance coping and self-efficacy, with fibrosis stage (0.367, p < 0.001) moderating this association. Specifically, the presence of diabetes and significant fibrosis, and a higher BMI, were associated with greater negative impact on participant depressive symptoms or self-efficacy. CONCLUSION: A maladaptive coping style was associated with poorer vitality, mental health and role-physical in NAFLD patients, which along with the presence of metabolic comorbidity (diabetes and obesity) and significant fibrosis predicted more depressive symptoms or poorer self-efficacy in these patients. These results suggested incorporating emotional and cognitive evaluation and treatment in patients with NAFLD.

Beyond the Boundaries of Disease-Significant Post-traumatic Growth in Multiple Sclerosis Patients and Caregivers.

Despite the negative repercussions of a chronic disease, multiple sclerosis (MS) might also lead to positive consequences. This longitudinal study explored post-traumatic growth in MS patients and attempted to identify possible determinants. Post-traumatic growth of 260 patients and their caregivers was compared. A subset of 209 patients and caregivers were evaluated at baseline. Patients filled in the Posttraumatic Growth Inventory and General Health Questionnaire at three different times over a 36-month follow-up period. Patient post-traumatic growth significantly increased over the follow-up period (p < 0.001) with large effect sizes on almost every subscale. Higher score on the Expanded Disability Status Scale, higher pain severity, female gender, and higher anxiety were positive predictors of post-traumatic growth, while more interference of pain, higher level of education, and more social dysfunction were negative predictors. Post-traumatic growth did not differ significantly between patients and caregivers. Our results showed significant positive intrapsychic changes of MS patients over a 36-month follow-up period up to 12 years from diagnosis. The potential influence of clinical, demographic, and mental health variables underlines the need for a personalized approach to be able to understand and sustain these processes. Comparable post-traumatic growth levels in patient-caregiver dyads at baseline suggest interdependently driven cognitive processes stabilizing well-being. Future research is recommended for further insight into the underlying cognitive processes.

Ten-year follow-up of social functioning and behaviour problems in people with schizophrenia and related disorders.

BACKGROUND: In recent years, several variables in the course of schizophrenia and related psychotic disorders have been studied. However, an instrumental analysis of the evolution of social functioning and behaviour problems has scarcely been explored. AIM: To analyse the evolution of social functioning and behaviour problems and find any diagnosis or gender differences. METHOD: The Social Functioning Scale (SFS) and the Behaviour Problems Inventory (BPI) were administered in Stages I (2003-2007) and II (2014-2017) to 100 close relatives of patients under treatment at a Community Mental Health Unit. A related samples t-test, analysis of variance and multivariate analysis of variance were performed to study the evolution and differences in social functioning and behaviour problems. Then a stepwise multiple linear regression analysis was done to predict the evolution of social functioning. RESULTS: No deterioration in the evolution of social functioning or behaviour problems was observed, and schizophrenia patient scores were lower. Women scored higher in withdrawal/social engagement, interpersonal behaviour, independence-performance, independence-competence and total social functioning, with no significant differences in behaviour problems. Previous social functioning, underactivity/social withdrawal and education are predictive factors in the evolution of social functioning. Conclusion: The results show the need for implementing psychosocial intervention programs that promote functional recovery and keep problems from becoming chronic.

Influence of Psychological Biomarkers on Therapeutic Adherence by Patients with Non-Alcoholic Fatty Liver Disease: A Moderated Mediation Model.

Our aim was to analyze whether depressive symptoms mediated the association between physical quality of life (QoL) and adherence to physical activity in patients with non-alcoholic fatty liver disease (NAFLD), as well as the association between social support and adherence to diet. We also examined whether self-efficacy exerted a moderating role in these associations. QoL (SF-12), social support (MSPSS), depressive symptoms (HADS), self-efficacy (GSE), physical activity (IPAQ) and diet (MEDAS) were evaluated in 413 biopsy-proven NAFLD patients. Mediation and moderated mediation models were conducted using the SPSS PROCESS v3.5 macro. Results showed that depressive symptoms mediated the relationship between physical QoL and adherence to physical activity (indirect effect = 6.248, CI = 1.917-10.727), as well as the relationship between social support and adherence to diet (indirect effect = 0.148, CI = 0.035-0.275). Self-efficacy also moderated the indirect effects of QoL and social support on therapeutic adherence through depressive symptoms. Specifically, the higher self-efficacy was, the lower the negative impact on the NAFLD patient's mental health. In conclusion, self-efficacy is defined as a protective factor for therapeutic adherence by NAFLD patients with a psychosocial risk profile. Self-efficacy should, therefore, be a main psychological target in future multidisciplinary NAFLD approaches.

Predicting improvement of quality of life and mental health over 18-months in multiple sclerosis patients.

BACKGROUND: Multiple sclerosis (MS) is a chronic neurodegenerative disease that can negatively affect functioning across a wide spectrum of domains. This study aims to investigate the development of mental health and quality of life in MS patients over 18-months and to identify predictive factors. METHOD: 314 MS outpatients of Virgen Macarena University Hospital in Sevilla/Spain (mean age 45 years, 67.8% women, on average 12.1 years since diagnosis) participated in the study. Health-related quality of life (HRQOL) and mental health were assessed by the 12-Item Short Form Health Survey (SF-12) and the General Health Questionnaire-28 (GHQ-28) twice over an 18-months follow up period. RESULTS: HRQOL and mental health significantly improved in almost all domains, except for a worsening of vitality. Mental and physical HRQOL improved by a large effect size. Binomial logistic regression models showed that disability status (Expanded Disability Status Scale) predicted both components of HRQOL and age the physical component of HRQOL. Sex, educational level, and disease duration predicted mental health. CONCLUSIONS: Our findings confirm the possibility of a significant large-sized improvement of HRQOL in the course of 18-months even 12 years after MS diagnosis on average. The study showed the importance of sociodemographic as well as clinical variables to predict HRQOL and mental health. Further longitudinal research is needed to better understand their impact on patients' outcomes.

Quality of Life and Coping in Nonalcoholic Fatty Liver Disease: Influence of Diabetes and Obesity.

Our aim was to analyze how type 2 diabetes and obesity influence quality of life (QoL) and coping in patients with nonalcoholic fatty liver disease (NAFLD), and which coping strategies predict diabetic or obese participants' QoL. QoL (SF-12, CLDQ-NAFLD) and coping strategies (COPE-28) were evaluated in 307 biopsy-proven NAFLD patients with absence or presence of diabetes or obesity. QoL was compared with normality tables for the general Spanish population. Interactive effects were found in physical functioning (p = 0.008), role-physical (p = 0.016) and activity (p = 0.014). Diabetic patients reported worse scores when they were also obese and vice versa, that is, obese patients scored worse when they were also diabetic. Both diabetic and obese patients had lower QoL than those without metabolic pathology or the general population, and obese patients also reported more passive/avoidance coping. Active coping, positive reframing and acceptance predicted better QoL, while denial, self-blame, self-distraction, disengagement and religion predicted lower QoL. In conclusion, diabetes and obesity were associated with lower QoL in patients with NAFLD. Obesity was also associated with more passive/avoidance coping. Furthermore, passive/avoidance coping strategies predicted lower QoL than active, recommending modification of maladaptive coping strategies in future multidisciplinary NAFLD treatments.

Quality of life in adults with multiple sclerosis: a systematic review.

OBJECTIVE: In recent years, quality of life (QoL) in multiple sclerosis (MS) has been gaining considerable importance in clinical research and practice. Against this backdrop, this systematic review aimed to provide a broad overview of clinical, sociodemographic and psychosocial risk and protective factors for QoL in adults with MS and analyse psychological interventions for improving QoL. METHOD: The literature search was conducted in the Scopus, Web of Science and ProQuest electronic databases. Document type was limited to articles written in English, published from January 1, 2014, to January 31, 2019. Information from the selected articles was extracted using a coding sheet and then qualitatively synthesised. RESULTS: The search identified 4886 records. After duplicate removal and screening, 106 articles met the inclusion and exclusion criteria for qualitative synthesis and were assessed for study quality. Disability, fatigue, depression, cognitive impairment and unemployment were consistently identified as QoL risk factors, whereas higher self-esteem, self-efficacy, resilience and social support proved to be protective. The review analysed a wide spectrum of approaches for QoL psychological intervention, such as mindfulness, cognitive behavioural therapy, self-help groups and self-management. The majority of interventions were successful in improving various aspects of QoL. CONCLUSION: Adequate biopsychosocial assessment is of vital importance to treat risk and promote protective factors to improve QoL in patients with MS in general care practice.

Psychological Biomarkers and Fibrosis: An Innovative Approach to Non-alcoholic Fatty Liver Disease.

Background: It is unknown how perceived social support and the progression of liver damage influence the psychosocial profile of patients with non-alcoholic fatty liver disease (NAFLD). In the present study, we therefore investigated which biomarkers influence the quality of life, mental health, and coping strategies of NAFLD patients. Methods: Quality of life (SF-12 and CLDQ-NAFLD), mental health (HADS and BDI-II), and coping strategies (COPE-28) were evaluated by high or low perceived social support (MSPSS) and the presence of non-alcoholic steatohepatitis (NASH) and significant fibrosis in 492 biopsy-proven NAFLD patients. The results were compared with quality of life normality tables for the general Spanish population. We also determined whether liver histology and biopsychosocial variables predicted participants' quality of life. Results: Interactive effects were found in vitality (p = 0.05), activity (p = 0.005), anxiety (p = 0.04), and denial (p = 0.04), with NASH patients showing a higher-risk biopsychosocial profile when they perceived less social support. Furthermore, patients with low perceived social support showed lower quality of life, worse mental health, and more maladaptive coping than those with high perceived social support, regardless of NASH presence. Patients with significant fibrosis showed lower quality of life compared to those without or the general Spanish population. Patients with significant fibrosis also reported worse mental health and more maladaptive coping. Lastly, significant fibrosis, female sex, greater anxiety and depressive symptoms, and worse physical and mental health-related quality of life were found to be independent determinants of worse disease-specific quality of life in these patients. Conclusions: Low perceived social support, significant fibrosis, and female sex were independently associated with a higher-risk psychosocial profile in NAFLD. These findings support the role of psychological biomarkers based on quality of life, mental health, and coping strategies in the management of these patients and suggest the potential benefits of a psychological intervention.

Caring for Family Members With Alzheimer's and Burnout Syndrome: Impairment of the Health of Housewives.

Being a housewife may already be a psychosocial risk factor leading to chronic stress and burnout, and this may be aggravated when the housewife must also become the caregiver of a family member with Alzheimer's. The burnout syndrome and how it can affect general health and the presence of emotional disorders were studied in housewives who were family caregivers of an Alzheimer's patient. The sample selected was made up of 193 housewives, 96 of whom were also caregivers for a family member with Alzheimer's. Sociodemographic measures used were the Maslach Burnout Inventory and The General Health Questionnaire. Burnout was found in a significant percentage of participants. Emotional exhaustion, effect on general health, and presence of emotional disorders were higher in caregivers. Emotional exhaustion, general health, and anxiety were more influential, while depersonalization affected the appearance of depressive symptoms more. Being a caregiver and emotional exhaustion appeared to be the best predictors of emotional disorders. It was confirmed that emotional exhaustion influenced appearance of anxiety and depression equally in both groups. In the case of caregivers, an exhaustion-illness spiral was produced. In this group, emotional exhaustion seemed to become more severe as a consequence of the presence of chronic illnesses, and possibly influence the number of hours spent on care and having children living at home. Future research should analyze in greater depth and in a larger sample, the role of these variables and widen the focus of attention to personal variables that could be acting as protective factors and could be subject to intervention. The discussion concludes with some actions that should be included in prevention programs for the groups studied.

Inflexibility of beliefs and jumping to conclusions in active schizophrenia.

Jumping to conclusions (JTC) has been questioned as sufficient cognitive bias for the onset, maintenance, and severity of delusions compared to the bias of inflexibility of beliefs. The WIT (What is this?) test was designed to evaluate JTC and its capacity for classifying participants into a group of patients with active schizophrenia and a comparison group. It was also attempted to determine whether the presence/absence of answer choices, considered a measure of induced inflexibility of beliefs, influences decision-making and is related to the tendency to repeat the first decision, or spontaneous inflexibility of beliefs. The sample was made up of 160 participants, 80 patients with schizophrenia diagnosed at hospital admission and 80 healthy controls. The Beads Task and the WIT test were administered. The WIT classified the participants reasonably well (82.7%) compared to the Beads Task (86.3%). The presence of answer choices favored JTC (d = 0.33), decreasing the number of lines necessary to make a decision (d = 1.78), and influencing keeping to the original answer (d = 1.36), in interaction with the group (d = 0.42). The WIT test overcame some limitations of the Beads Task. The presence/absence of answer choices influenced decision-making and how thinking was flexibilized, more clearly in the case of controls.

Relationship Between Self-Perceived Health, Vitality, and Posttraumatic Growth in Liver Transplant Recipients.

Our objective was to analyze the differences in posttraumatic growth in 240 liver transplant recipients based on two factors. First, self-perceived health: better (Group 1 = G1) and worse (Group 2 = G2). Second, vitality: more (Group 3 = G3) and less (Group 4 = G4). The Posttraumatic Growth Inventory, SF-36 Health Survey (Item 2) and SF-12 Health Survey (vitality dimension) were used. Firstly, analyzing main effects recipients with better (G1) compared to worse (G2) self-perceived health, showed greater posttraumatic growth. Interaction effects were found on essential posttraumatic growth domains such as new possibilities (p = 0.040), personal strength (p = 0.027), and appreciation of life (p = 0.014). Statistically significant differences showed that among transplant recipients with worse self-perceived health (G2), those with more vitality had higher levels on abovementioned posttraumatic growth dimensions. However, in transplant recipients with better self-perceived health (G1) respective dimensions were not significantly influenced by the level of vitality. Among the recipients with less vitality (G4), those with better self-perceived health showed higher scores on abovementioned posttraumatic growth dimensions. We conclude that positive self-perceived health might compensate for a lack of vitality as well as a high level of vitality may compensate for negative self-perceived health regarding the development of crucial aspects of posttraumatic growth after liver transplantation.

Validation of a Spanish version of the Brief Experiential Avoidance Questionnaire (BEAQ) in clinical population.

BACKGROUND: The Brief Experiential Avoidance Questionnaire (BEAQ) has been suggested as the most appropriate instrument for measuring experiential avoidance. However, no Spanish validation has been published. The aim of this study was to validate a Spanish version of the BEAQ in a clinical sample treated at a community mental health unit. METHODS: Participants ( N = 332) completed the BEAQ as well as other self-report measures of experiential avoidance and psychopathology. RESULTS: Internal consistency was satisfactory (α = .82). No statistically significant gender differences were found in the BEAQ scores. The data also showed high test-retest reliability after four to six weeks, acceptable concurrent validity with another experiential avoidance measure and acceptable convergent validity with the psychopathology measure. The principal component analysis, forcing the one factor solution proposed in the original scale, produced indicators similar to the English version of the BEAQ. CONCLUSIONS: These results firmly support the reliability and validity of this Spanish validation, stressing its usefulness as a measure of experiential avoidance in clinical populations.

Spanish Adaptation and Validation of the Transplant Effects Questionnaire (TxEQ-Spanish) in Liver Transplant Recipients and Its Relationship to Posttraumatic Growth and Quality of Life.

The valid assessment of the impact of transplantation on psychological well-being is highly relevant to optimize treatment. However, to date there is no standardized instrument available in Spain. The Transplant Effects Questionnaire (TxEQ) evaluates the specific problems associated with organ transplantation, such as worry about transplant, guilt regarding the donor, disclosure of having undergone transplantation, adherence to medical treatment and responsibility toward the donor, family, friends, or medical staff. Against this backdrop the English original version of the TxEQ was translated into Spanish and validated in a sample of 240 liver transplant recipients. Participants also filled in the Posttraumatic Growth Inventory (PTGI), and the 12-Item Short Form Health Survey (SF-12v.2). Confirmatory factor analysis of the TxEQ-Spanish revealed a five-factor structure equivalent to the English original version, and satisfactory internal consistency (Cronbach's alpha: worry α = 0.82, guilt α = 0.77, disclosure α = 0.91, adherence α = 0.82, responsibility α = 0.83). Results showed that better mental quality of life was associated with higher adherence and disclosure, as well as less worry and guilt. Higher posttraumatic growth was significantly associated with worry, guilt, and responsibility. Interestingly, the most powerful predictor of posttraumatic growth was worry. Analysis of variance showed an interaction effect of PTG and mental quality of life on adherence, with medium PTG being associated with significantly stronger adherence in participants with better mental quality of life. In conclusion our study could successfully adapt and validate the Spanish version of the TxEQ in a large sample of liver transplant recipients. Our findings show a complex relationship between emotional reactions to transplantation, mental quality of life, and posttraumatic growth, which give further insight into inner processes supporting psychological well-being and adherence after liver transplantation.

Post-traumatic growth and its relationship to quality of life up to 9 years after liver transplantation: a cross-sectional study in Spain.

OBJECTIVE: Little is known concerning post-traumatic growth (PTG) after liver transplantation. Against this backdrop the current study analysed the relationship between PTG and time since transplantation on quality of life. Furthermore, it compared PTG between liver transplant recipients and their caregivers. DESIGN: Cross-sectional case-control study. SETTING: University Hospital in Spain. PARTICIPANTS: 240 adult liver transplant recipients who had undergone only one transplantation, with no severe mental disease, were the participants of the study. Specific additional analyses were conducted on the subset of 216 participants for whom caregiver data were available. Moreover, results were compared with a previously recruited general population sample. OUTCOME MEASURES: All participants completed the Posttraumatic Growth Inventory, and recipients also filled in the 12-Item Short-Form Health Survey. Relevant sociodemographic and clinical parameters were also assessed. RESULTS: In the sample of 240 recipients, longer time since transplantation (>9 years) was associated with more pain symptoms (p=0.026). Regardless of duration, recipients showed lower scores on most quality of life dimensions than the general population. However, high PTG was associated with a significantly higher score on the vitality quality of life dimension (p=0.021). In recipients with high PTG, specific quality of life dimensions, such as bodily pain (p=0.307), vitality (p=0.890) and mental health (p=0.353), even equalled scores in the general population, whereas scores on general health surpassed them (p=0.006). Furthermore, liver transplant recipients (n=216) compared with their caregivers showed higher total PTG (p<0.001) and higher scores on the subscales relating to others (p<0.001), new possibilities (p<0.001) and appreciation of life (p<0.001). CONCLUSIONS: Our findings highlight the protective role of PTG in the long-term outcome of liver transplant recipients. Future studies should analyse and develop psychosocial interventions to strengthen PTG in transplant recipients and their caregivers.

Predictors in use of mental health resources: The role of behaviour problems in patients with severe mental illness.

BACKGROUND: In recent years, more variables are being included in the use of mental health resource prediction models. Some studies have shown that how well the patient can function is important for this prediction. However, the relevance of a variable as important as behaviour problems has scarcely been explored. AIM: This study attempted to evaluate the effect of behaviour problems in patients with severe mental illness on the use of mental health resources. METHOD: A total of 185 patients at a Community Mental Health Unit were evaluated using the Behaviour Problem Inventory. Later, a bivariate logistic regression was done to identify what behaviour problems could be specific predictors of use of mental health resources. RESULTS: The results showed that the general index of behaviour problems predicts both use of hospitalization resources and outpatient attention. Underactivity/social withdrawal is the best predictor of all the different areas. CONCLUSION: These results confirm the role of behaviour problems as predictors of the use of mental health resources in individuals with a severe mental illness.