Incidence of mental disorders in the general population aged 1-30 years disaggregated by gender and socioeconomic status.

PURPOSE: The objective of this study was to estimate the incidence and age of onset of mental disorders diagnosed by gender and socioeconomic status (SES) in children, adolescents, and young adults up to 30 years of age in the whole population of the Basque Country (Spain). METHODS: All mental health diagnoses documented in Basque Health Service records from 1 January 2003 to 31 December 2018, were classified into eight clusters: anxiety, attention deficit hyperactivity disorder (ADHD), conduct disorders, depression, psychosis/personality disorders, substance use, eating disorders, and self-harm. We calculated incidence and cumulative incidence for each cluster, disaggregated by gender, and socioeconomic status (SES). Poisson regression analyses were performed. RESULTS: Overall, 9,486,853 person-years of observation were available for the 609,281 individuals included. ADHD and conduct disorders were diagnosed in the first decade, anxiety and depression disorders in the second and third decades, and psychosis/personality and substance use in the third. The cumulative incidence at 18 years of age for any type of disorder was 15.5%. The group with low SES had a statistically significantly higher incidence of all eight clusters. The incidence of ADHD, conduct disorders, depression, psychosis/personality disorders, and substance use was higher in males and that of anxiety, eating disorders and self-harm was higher in females. CONCLUSIONS: The incidence of mental disorders is high among children, adolescents, and young adults in the Basque Country underlining the need for preventive interventions. Marked differences by gender and SES highlight mental health inequalities, especially for depression and psychosis in low SES males.

Resilience moderates the associations between bipolar disorder mood episodes and mental health / La resiliencia modera la asociación entre los episodios anímicos del trastorno bipolar y la salud mental

Resilience could moderate the impact of bipolar disorder (BD) on patients’ quality of life (QoL) and psychosocial functioning. This study aimed to (1) explore the relationships between bipolar disorder mood episodes (depression, [hypo]mania, and euthymia) and mental health outcomes of QoL, personal recovery, impaired work, and psychosocial functioning in individuals with BD; and (2) determine whether resilience domains were moderators of these associations. A clinical adult sample of 97 individuals diagnosed with BD (63.90% female, mean age = 45.02 years) completed a battery of BD-specific measures of resilience and mental health-related variables. Multiple regression showed that self-management of BD resilience domain moderated the negative relationship between (hypo)manic episode and personal recovery. Furthermore, self-confidence moderated the positive relationships between (hypo)manic and depressive episodes and impaired functioning. We suggest that BD patients experiencing (hypo)manic or depressive episodes may improve their mental health and wellbeing through interventions that promote disorder-specific resilience factors. (AU)

La resiliencia podría moderar el impacto del trastorno bipolar (TB) en la calidad de vida (CV) y funcionamiento psicosocial de los pacientes. Los objetivos del presente estudio fueron: (1) explorar la asociación entre los episodios anímicos bipolares (depresión, [hipo]manía y eutimia) y los resultados de la CV en cuanto a salud mental, la recuperación personal y el deterioro del funcionamiento laboral y psicosocial de personas con TB y (2) determinar si los dominios de resiliencia moderaban esta asociación. Una muestra clínica de 97 personas adultas diagnosticadas de TB (63.90% mujeres, edad media = 45.02) cumplimentaron una batería de medidas específicas de TB sobre resiliencia y variables relacionadas con la salud mental. La regresión múltiple mostró que el dominio de la resiliencia de autogestión del TB moderó la relación negativa entre el episodio (hipo)maníaco y la recuperación personal. Además, la confianza en uno mismo moderó la asociación positiva entre los episodios (hipo)maníacos y depresivos y el deterioro del funcionamiento. Se sugiere que la salud mental y bienestar de los pacientes con TB en episodios (hipo)maníacos o depresivos podrían mejorar mediante intervenciones que desarrollen aspectos de resiliencia específicos de este trastorno mental. (AU)

Relevance of well-being, resilience, and health-related quality of life to mental health profiles of European adolescents: results from a cross-sectional analysis of the school-based multinational UPRIGHT project.

PURPOSE: The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe. METHODS: Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles. RESULTS: Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification. CONCLUSION: Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed. TRIAL REGISTRATION NUMBER (TRN) AND DATE OF REGISTRATION: ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019.

Measuring Resilience Across Participating Regions in the UPRIGHT EU Horizon 2020 Project: Factor Structure and Psychometric Properties of the Resilience Scale for Adolescents.

Resilience is the process and outcome of healthy adaptation despite significant adversity. Proliferation of research on the resilience construct has led to scientific concerns about the operationalization and measurement of resilience for assessment science and practice. Various studies that have investigated the psychometric properties and construct validity of the Resilience Scale for Adolescents (READ) have yielded inconsistent findings, which could partly be due to variations in the methodological approaches. This study investigated the factor structure and construct validity of the READ in four European regions participating in the Universal Preventive Resilience Intervention Globally Implemented in Schools to Improve and Promote Mental Health for Teenagers (UPRIGHT) project. Participants included adolescents aged 10-15 years from Spain (n = 391, females = 51%), Iceland (n = 379, females = 55%), Italy (n = 460, females = 55%), and Poland (n = 316, females = 51%). The five-factor model of the READ was similar across gender and participating regions. Construct validity of the READ was supported. After establishing construct separability, incremental validity was supported (except for the social competence subscale). The READ is a valid and reliable measure of protective factors involved in resilience and demonstrates promise for cross-cultural applicability. Recommendations for measuring resilience and validating the READ in future investigations are provided.

UPRIGHT, a resilience-based intervention to promote mental well-being in schools: study rationale and methodology for a European randomized controlled trial.

BACKGROUND: Adolescence is crucial period for laying the foundations for healthy development and mental well-being. The increasing prevalence of mental disorders amongst adolescents makes promotion of mental well-being and prevention interventions at schools important. UPRIGHT (Universal Preventive Resilience Intervention Globally implemented in schools to improve and promote mental Health for Teenagers) is designed as a whole school approach (school community, students and families) to promote a culture of mental well-being and prevent mental disorders by enhancing resilience capacities. The present article aims at describing the rationale, conceptual framework, as well as methodology of implementation and evaluation of the UPRIGHT intervention. METHODS: UPRIGHT project is a research and innovation project funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No. 754919 (Duration: 48 months). The theoretical framework has been developed by an innovative and multidisciplinary approach using a co-creation process inside the UPRIGHT Consortium (involving seven institutions from Spain, Italy, Poland, Norway, Denmark, and Iceland). Resulted is the UPRIGHT programme with 18 skills related to 4 components: Mindfulness, Coping, Efficacy and Social and Emotional Learning. Among the five Pan-European regions, 34 schools have been currently involved (17 control; 17 intervention) and around 6000 adolescents and their families are foreseen to participate along a 3-year period of evaluation. Effectiveness of the intervention will be evaluated as a randomized controlled trial including quantitative and qualitative analysis in the five Pan-European regions representative of the cultural and socioeconomic diversity. The cost-effectiveness assessment will be performed by simulation modelling methods. DISCUSSION: We expect a short- to medium-term improvement of mental well-being in adolescents by enhancing resilience capacities. The study may provide robust evidence on intrapersonal, familiar and social environmental resilience factors promoting positive mental well-being. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03951376 . Registered 15 May 2019.

Validation of the Spanish Version of the Work and Social Adjustment Scale in a Sample of Individuals With Bipolar Disorder.

The aim of the current study was to validate the Work and Social Adjustment Scale (WSAS), a measure of psychosocial functional impairment, in Spanish-speaking individuals with bipolar disorder. A sample of 120 patients with bipolar disorder and 97 healthy individuals completed the WSAS to analyze its factor structure and reliability. Patients also completed measures of personal recovery and quality of life (QOL). Confirmatory factor analysis indicated that a one-factor model explained data adequately, with all factor loadings proving to be significant. Cronbach's alphas indicated excellent internal consistency in the sample of individuals with bipolar disorder and the sample of healthy individuals. Significant negative correlations between the WSAS and personal recovery and QOL demonstrated good concurrent validity. Impairment on the WSAS was higher for the patient sample, confirming known-group validity of the scale. Thus, Spanish validation of the WSAS demonstrated it to be a sound self-reported measure of psychosocial functioning impairment in individuals with bipolar disorder. [Journal of Psychosocial Nursing and Mental Health Services, 57(5), 44-51.].

Longitudinal associations between resilience and quality of life in eating disorders.

OBJECTIVE: This study examined the longitudinal reciprocal associations between resilience factors, quality of life (QoL) domains, and symptoms of eating disorders (EDs). Hypotheses included predictive paths from resilience factors of "acceptance of self and life" and "personal competence" to increased QoL and predictive paths from previous levels of QoL to resilience. METHOD: A total of 184 patients with EDs (mean age = 29.55, SD = 9.17, 94.8% women) completed measures of resilience, QoL, and EDs symptoms over three waves spaced six month apart. Hypotheses were tested by path analysis. RESULTS: Resilience factors predicted improvements in psychological health and social relationship domains of QoL and a reduction of ED symptoms over time. In addition, psychological health increased acceptance of self and life consistently over time, whereas physical health increased the competence component of resilience. DISCUSSION: The relationships between resilience factors and QoL are reciprocal, with several mediational paths. A spiral of recursive influences between resilience factors and QoL can take place in people with EDs. This possibility offers new perspectives to understanding the process of recovery in patients with ED.

The Resilience Questionnaire for Bipolar Disorder: Development and validation.

The goal of this research project was to develop a new questionnaire to assess resilience in Bipolar Disorder (BD), the Resilience Questionnaire for Bipolar Disorder (RBD). To examine its psychometric properties, a sample of 125 patients diagnosed with BD and a comparison sample of 107 people completed the new RBD and established measures of generic resilience and health-related outcomes. Exploratory factor analysis for the RBD yielded a 23-item 5-factor solution, and confirmatory factor analysis indicated adequate fit indices. Internal consistency, stability, concurrent validation and known-groups' validity were also supported. The RBD obtained higher responsiveness (6-month follow-up) than the generic resilience scale (BD sample). The RBD is a robust measure to monitor resilience in BD.

Factors related to a decline in upper extremity function among patients with a wrist fracture due to a fall.

AIMS: The aim of this study was to identify factors related to a decline in function following a wrist fracture. METHODS: Observational, prospective cohort study done in five public hospitals of the Basque Health Service. We recruited adults aged 65 or older with a wrist fracture due to a fall who attended the emergency department (ED) of one of these hospitals. Sociodemographic and clinical data were collected, along with information about health-related quality of life (HRQoL) and functionality. RESULTS: A decline in function 6 months after the fracture was more likely among women (OR=3.409; 95% CI=1.920-6.053), patients receiving institutional help before the fracture (OR=5.717; 95% CI=1.644-19.883), patients who developed fracture-related complications within 6 months of the fall (OR=5.015; 95% CI=1.377-18.268), patients who visited an ED within 6 months of the fall (OR=1.646; 95% CI=1.058-2.561), patients with a displaced fracture (OR=1.595; 95% CI=1.106-2.300), and patients who broke the dominant hand (OR=1.464; 95% CI=1.019-2.103). Better baseline HRQoL and function were associated with smaller declines in function 6 months after the fall. Eighteen months after the fall, decline in function was more likely among women (OR=2.172; 95% CI=1.138-4.144) and patients visiting an ED because of fracture-related complications (OR=1.722; 95% CI=1.113-2.663). Better HRQoL and dependency level at baseline were associated with less decline in function 18 months after the fracture. DISCUSSION: Two different models identified several parameters related to declines in upper extremity function 6 and 18 months after the fracture. CONCLUSIONS: These results can help develop preventive actions needed to avoid or reduce the consequences of these falls.

Wrist fractures and their impact in daily living functionality on elderly people: a prospective cohort study.

BACKGROUND: Wrist fractures are the most common arm fractures in older adults. The impact of wrist fractures on daily functionality has been less studied than that of other types and so, less is known about the complexity of factors related to the functional impact of these fractures. This study is aimed to assess the role of individual and health care factors and its association with daily living functional changes after a wrist fracture. METHODS: A prospective cohort of patients aged 65 or more, affected by a fracture due to a fall, was conducted. These patients were identified at the emergency rooms of the six participating hospitals. As independent factors, the following were studied: socio-demographic data, characteristics of the fracture, health-related quality of life, wrist function and provided treatment. The main outcome was functional status measured by the Barthel Index for daily living basic activities and the Lawton Instrumental Activities of Daily Living (IADL) Scale for daily living instrumental activities. Data were collected at baseline just after the fall and after six months of follow-up. Patients were considered to have deteriorated if their functional status as measured by Barthel Index or Lawton IADL scores decreased in a significant way during the six months of follow up. RESULTS: Barthel Index and/or Lawton IADL scores fell at six months after the fracture in 33% of participants. This functional decline was more frequent in patients with comorbidity (p < 0.0001), polypharmacy (p < 0.0001), low health-related quality of life prior to the fall (p < 0.0001) and lower educational level (p = 0.009). The derived multivariate models show that patients that become dependent six months after the fall, have advanced age, severe chronic diseases, low functional performance prior to the fracture, and repeated episodes of accidental falls. This profile is consistent with a frailty phenotype. CONCLUSIONS: Wrist fractures are associated to the occurrence of dependence, especially in frail patients. These patients could benefit from being identified at the time the fracture is treated, in order to tackle their complex needs and so, prevent some of the burden of dependence generated by these fractures.

Individualised Versus Standardised Assessment of Quality of Life in Eating Disorders.

Individualised measures of quality of life (QoL) refer to instruments that encourage the respondent to actively elicit which areas of their life are most relevant for his/her QoL. The aim of this study is to compare individualised versus standard measures of QoL in a sample of patients with eating disorder (ED). The Schedule for the Evaluation of the Individual Quality of Life (SEIQoL) and a generic measure of QoL [World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF)] were applied on two occasions (one-year follow-up) to a sample of 165 patients with ED, 57 recovered patients with ED, and 349 women from the general population. The areas of 'family', 'education/career or job', 'friends', 'leisure', 'romantic partner' and 'health' were identified as the most important for their QoL for all groups, both times. The WHOQOL-BREF was more sensitive than the SEIQoL in detecting changes that occurred over time. Clinical interventions for ED should consider social components as objectives of intervention.

Resilience in eating disorders: A qualitative study.

The objectives of the authors in this study were two-fold: (1) to explore the role of resilience in recovery from eating disorders (EDs), and (2) to develop a model of resilience in women with EDs. Semi-structured interviews with ten women were conducted in April 2011, along with two focus groups with women who had recovered from EDs (n  = 5 women each; conducted in April 2012 at the University of Deusto, Spain), one focus group with clinical experts (n = 8; conducted in April 2012 at the Foundation Against EDs of Biskay, Spain), and six narratives from primary caregivers of ED patients living in Biskay, Spain (conducted in November 2012). All data were analyzed using a grounded theory approach. All female participants acknowledged experiencing resilience in their recovery. The analysis resulted in a conceptual model of resilience composed of the following categories: deep dissatisfaction with life, turning point, acceptance, hope, determination to change, accountability for the ED, active coping, getting social support, gaining self-knowledge, getting information about EDs, increase well-being, trait resilience, initiating new projects and living in the here and now. According to the model presented, resilience preceded the experience of recovery in women with EDs in this sample and could be a useful asset for future interventions.

Resilience in family caregivers of persons with acquired brain injury.

PURPOSE/OBJECTIVE: The authors' purpose was to develop the Questionnaire of Resilience in Caregivers of Acquired Brain Injury (QRC-ABI) and explore its psychometric properties The QRC-ABI was developed to measure the process of resilience, including resilient factors that, according to the literature, are the most relevant for caregivers. RESEARCH METHOD/DESIGN: This is a cross-sectional study of Spanish primary caregivers of individuals with ABI. It included 237 caregivers (77.6% women and 21.1% men) who completed the QRC-ABI, the Posttraumatic Growth Inventory (Weiss & Berger, 2006), the World Health Organization Quality of Life-BREF (Skevington, Lotfy, O'Connell, & the WHOQOL Group, 2004) assessment, and the Positive Aspects of Caregiving (Tarlow et al., 2004) assessment. RESULTS: An item pool of 36 items was developed, from which 17 were finally selected based on a consensus among researchers and adequate symmetry indexes and kurtoses. Confirmatory factor analysis of the QRC-ABI confirmed a hierarchical solution in which 4 resilience dimensions were explained by a broader general resilience factor. The internal consistency of each scale was >.80. Convergent validity was supported through positive correlations of the QRC-ABI with quality of life, positive aspects of caregiving, and posttraumatic growth, and a negative correlation with perceived burden. CONCLUSION/IMPLICATIONS: The new QRC-ABI showed good reliability and validity. Our results are consistent with previous studies that have argued that resilient qualities are important for a healthy and positive adaptation to the challenging adversities faced by caregivers of individuals with ABI. Future interventions based on resilience should promote these factors in caregivers.

Problematic Internet use and problematic alcohol use from the cognitive-behavioral model: a longitudinal study among adolescents.

Problematic Internet use (PIU) and problematic alcohol use are two pervasive problems during adolescence that share similar characteristics and predictors. The first objective of this study was to analyze the temporal and reciprocal relationships among the main components of PIU from the cognitive-behavioral model (preference for online social interaction, mood regulation through the Internet, deficient self-regulation, and negative consequences). The second objective was to examine the temporal and reciprocal relationships between PIU components and problematic alcohol use. We also examined whether these relationships differ between males and females. The sample comprised 801 Spanish adolescents (mean age=14.92, SD=1.01) who completed the measures both at Time 1 (T1) and Time 2 (T2) six months apart. We used structural equation modeling to analyze the relationship among the variables. Results showed that deficient self-regulation at T1 predicted an increase in preference for online interactions, mood regulation, and negative consequences of the Internet at T2. In turn, the emergence of negative consequences of PIU at T1 predicted a rise in problematic alcohol use at T2. Longitudinal relationships between different components of PIU and between the components of PIU and problematic alcohol use were invariant across genders. Deficient self-regulation, consisting of diminished self-control over cognition and behaviors related to the Internet, plays a central role in the maintenance of PIU, increasing the preference for online interactions, mood regulation, and negative consequences from Internet use over time. In turn, adolescents who present negative consequences of PIU are vulnerable targets for problematic alcohol use.

Resilience Scale-25 Spanish version: validation and assessment in eating disorders.

OBJECTIVES: To validate into Spanish the Wagnild and Young Resilience Scale - 25 (RS-25), assess and compare the scores on the scale among women from the general population, eating disorder (ED) patients and recovered ED patients. METHOD: This is a cross-sectional study. ED participants were invited to participate by their respective therapists. The sample from the general population was gathered via an open online survey. Participants (N general population=279; N ED patients=124; and N recovered ED patients=45) completed the RS-25, the World Health Organization Quality of Life Scale-BREF and the Hospital Anxiety and Depression Scale. Mean age of participants ranged from 28.87 to 30.42years old. Statistical analysis included a multi-group confirmatory factor analysis and ANOVA. RESULTS: The two-factor model of the RS-25 produced excellent fit indexes. Measurement invariance across samples was generally supported. The ANOVA found statistically significant differences in the RS-25 mean scores between the ED patients (Mean=103.13, SD=31.32) and the recovered ED participants (Mean=138.42, SD=22.26) and between the ED patients and the general population participants (Mean=136.63, SD=19.56). DISCUSSION: The Spanish version of the RS-25 is a psychometrically sound measurement tool in samples of ED patients. Resilience is lower in people diagnosed with ED than in recovered individuals and the general population.

Positive aspects of caregiving in Spanish caregivers of individuals with acquired brain injury.

OBJECTIVE: Taking care of a person with acquired brain injury (ABI) is often associated with symptoms of stress and psychological distress. However, caregiving can also be a source of satisfaction and can contribute toward an improvement in the quality of life both of the caregiver and the person with ABI. The aim of this study is to assess and adapt the Positive Aspects of Caregiving Scale (PACS) to Spanish. METHOD: The PACS was completed by a sample of 141 family members who are the primary caregivers of relatives with ABI (mean age = 58.3 years, SD = 12.2; 78% women). The caregivers also responded to questions evaluating quality of life, burden, and posttraumatic growth. RESULTS: The results confirm the original structure of the PACS, which consists of 2 correlated factors: Self-Affirmation and Outlook on Life. Furthermore, these factors demonstrated adequate indices for internal consistency. The scores obtained from the PACS are positively associated with quality of psychological life, quality of social life, and posttraumatic growth and negatively associated with the perception of burden. CONCLUSIONS: The results highlight how important it is for interventions to emphasize the positive aspects of caregiving in caregivers of people affected by ABI.

Eating disorders: predictors of change in the quality of life of caregivers.

Eating disorders (EDs) have a strong impact on the quality of life (QoL) of caregivers. This study explores the longitudinal changes in the QoL of ED caregivers at 1 (T1; n=109) and 2 years (T2; n=32) follow-up, and identifies predictors of improvement at 1-year follow-up. ED outpatients also completed a battery of tests at T1 (n=69) and T2 (n=11). Multivariate hierarchical linear mixed models were used, in which the caregivers' 1-year changes in QoL, anxiety and depression scores were analysed as the dependent variables. Predictor variables were the caregivers' perception of burden, perception of the severity of the patient's ED, kinship data, and the ED person's scores on QoL, anxiety depression and ED symptoms. Higher scores in mental health and low perception of burden at baseline predicted improved caregiver QoL at 1-year follow-up. The caregivers' QoL improved if the perception of burden decreased over time and if depression of the patient improved. The results suggest that interventions directed to reduce the caregivers' perception of burden and to improve the mental health of the ED patients would lead to improved caregiver QoL. The high attrition rate at T2 made prediction analyses unviable.

Cross-validation study using item response theory: the health-related quality of life for eating disorders questionnaire-short version.

The Health-Related Quality of Life for Eating Disorder-Short questionnaire is one of the most suitable existing instruments for measuring quality of life in patients with eating disorders. The objective of the study was to evaluate its reliability, validity, and responsiveness in a cohort of 377 patients. A comprehensive validation process was performed, including confirmatory factor analysis and a graded response model, and assessments of reliability and responsiveness at 1 year of follow-up. The confirmatory factor analysis confirmed the two second-order latent traits, social maladjustment, and mental health and functionality. The graded response model results showed that all items were good for discriminating their respective latent traits. Cronbach's alpha coefficients were high, and responsiveness parameters showed moderate changes. In conclusion, this short questionnaire has good psychometric properties. Its simplicity and ease of application further enhance its acceptability and usefulness in clinical research and trials, as well as in routine practice.

Impact of clinical and patient-reported outcomes on patient satisfaction with cataract extraction.

BACKGROUND: To date, factors that influence satisfaction with cataract surgery have not been broadly explored. OBJECTIVE: To identify variables related to patient satisfaction after cataract extraction by phacoemulsification and to determine the relationship between satisfaction and visual acuity (VA) and visual function (VF). DESIGN: Prospective cohort study. SETTING: Five hospitals belonging to the Basque Health Care Service. PARTICIPANTS: 4335 consecutive patients undergoing cataract extraction. INTERVENTIONS: Clinical data on vision were collected before the intervention and 6 weeks afterwards. Before cataract extraction, patients answered a global question about their expectations for the procedure, answered three questions related to specific activities (reading, going out and recognizing people, and doing housework) and completed the Visual Function-14 (VF-14) and Short-Form-36 (SF-36) instruments. Three months after cataract extraction, they again completed the VF-14 and SF-36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities. MAIN OUTCOME MEASURES: Three months after cataract extraction, they again completed the VF-14 and SF-36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities. RESULTS: Pre-intervention VA and VF-14 scores and their post-intervention changes were associated with both global satisfaction and satisfaction with the ability to perform specific activities. Unresolved ocular complications were related to global satisfaction with cataract extraction (OR 95% = 0.39(0.27, 0.55) , P < 0.001). Both the mental and physical component scales of the SF-36 were related to global satisfaction. A group of patients were not satisfied with the intervention in spite of achieving similar vision-related improvements as patients who were quite satisfied with the procedure. CONCLUSION: Satisfaction with cataract extraction is related to clinical outcomes and is also associated with patients' expectations of their improvement in visual function.

Applying a coping with stress questionnaire for cancer patients to patients with non-cancer chronic illnesses.

One of the few instruments to evaluate coping skills among patients with chronic illnesses is the Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO), created initially for cancer patients. We evaluate how well CAEPO applies to patients with non-cancer chronic illnesses. A total of 344 patients (115 with chronic hepatitis C, 120 with inflammatory bowel disease and 109 with recurrent vertigo) completed the CAEPO. Exploratory factor analysis and Cronbach's alpha provide only partial support for the seven factors suggested by the original CAEPO. A streamlined version with fewer dimensions and items may be a better solution for identifying coping strategies among these patients.