Impact of axial spondyloarthritis on mental health in Europe: results from the EMAS study.

OBJECTIVE: To determine the presence of mental disorder risk and associated factors in European patients with axial spondyloarthritis (axSpA). METHODS: Data from 2,166 patients with axSpA in 12 European countries were collected from 2017 to 2018 through the European Map of Axial Spondyloarthritis online survey. Risk of mental disorders was assessed using the 12-item General Health Questionnaire. Possible predictors included age, gender, relationship status, patient organisation membership, job status, educational level, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), functional limitation (0-54) and self-reported depression or anxiety. Bivariate analyses were conducted to determine predictors of risk of mental disorders (Mann-Whitney and χ2) and multivariable analysis identified factors associated with risk of mental disorders. RESULTS: 60.7% of patients reported risk of mental disorders: they were younger (41.7 vs 46.0 years), more likely female (68.2% vs 57.9%), unemployed (7.5% vs 2.7%), on temporary (15.9% vs 5.4%) or permanent sick leave (13.2% vs 8.0%), reported depression (45.2% vs 14.2%) or anxiety (41.3% vs 12.5%), higher disease activity (BASDAI ≥4; 87.6% vs 62.3%) and functional limitation (16.5 vs 10.8). The factors most associated with risk of mental disorders were disease activity (OR=2.80), reported depression (OR=2.42), anxiety (OR=2.39), being unemployed or on sick leave (OR=1.98), functional limitation (OR=1.02) and younger age (OR=0.97). CONCLUSIONS: Compared with the general population, patients with axSpA show disproportionately worse mental health associated mainly with disease activity and employment status. Healthcare professionals should pay close attention to patients with high disease activity and address internally or refer to specialist services, where appropriate to ensure optimal patient outcomes.

Influence of Depression and Anxiety on Hemodialysis Patients: The Value of Multidisciplinary Care.

Affective disorders promote poorer outcomes in hemodialysis patients. According to the presence or not of depression/anxiety in these patients, aims were to analyze differences in sociodemographic, clinical and/or psychological factors and to identify predictors. One hundred eighty-six hemodialysis patients were classified based on their depression/anxiety status. Basal characteristics showed differences between groups where mainly male sex (Depression: OR 0.2; Anxiety: OR 0.3) albumin (Depression: OR 0.1; Anxiety: OR 0.2) and calcium levels (Depression: OR 0.5; Anxiety: OR 0.4), impaired quality of life (Depression: OR 1.4; Anxiety: OR 1.2) and psychological inflexibility (Depression: OR 1.3; Anxiety: OR 1.2) were associated (all p < 0.01) to these mental conditions. Multivariate models showed that worse quality of life (OR 1.3; p < 0.001) predicted depression while marital status (with a partner; OR 0.3; p = 0.025) and albumin levels (OR 0.1; p = 0.027) were protective factors. Depression represented a risk factor for anxiety (OR 1.2; p = 0.001), although calcium levels (OR 0.5; p = 0.039) would protect this state. Interestingly, psychological inflexibility predicted both disorders (Depression: OR 1.2, p < 0.001 and Anxiety: OR 1.1; p = 0.002). Results highlight the relevance of well-trained multidisciplinary hemodialysis units to control the influence of these factors on the presence of depression/anxiety, and thus, their impact on the patients' outcomes.

Gender differences in patient journey to diagnosis and disease outcomes: results from the European Map of Axial Spondyloarthritis (EMAS).

INTRODUCTION/OBJECTIVES: To evaluate the journey to diagnosis, disease characteristics and burden of disease in male and female patients with axial spondyloarthritis (axSpA) across Europe. METHOD: Data from 2846 unselected patients participating in the European Map of Axial Spondyloarthritis (EMAS) study through an online survey (2017-2018) across 13 countries were analysed. Sociodemographic characteristics, lifestyle, diagnosis, disease characteristics and patient-reported outcomes (PROs) [disease activity -BASDAI (0-10), spinal stiffness (3-12), functional limitations (0-54) and psychological distress (GHQ-12)] were compared between males and females using chi-square (for categorical variables) and student t (for continuous variables) tests. RESULTS: In total, 1100 (38.7%) males and 1746 (61.3%) females participated in the EMAS. Compared with males, females reported considerable longer diagnostic delay (6.1 ± 7.4 vs 8.2 ± 8.9 years; p < 0.001), higher number of visits to physiotherapists (34.5% vs 49.5%; p < 0.001) and to osteopaths (13.3% vs 24.4%; p < 0.001) before being diagnosed and lower frequency of HLA-B27 carriership (80.2% vs 66.7%; p < 0.001). In addition, females reported higher degree of disease activity in all BASDAI aspects and greater psychological distress through GHQ-12 (4.4 ± 4.2 vs 5.3 ± 4.1; p < 0.001), as well as a greater use of alternative therapies. CONCLUSION: The patient journey to diagnosis of axSpA is much longer and arduous in females, which may be related to physician bias and lower frequency of HLA-B27 carriership. Regarding PROs, females experience higher disease activity and poorer psychological health compared with males. These results reflect specific unmet needs in females with axSpA needing particular attention. Key Points • Healthcare professionals' perception of axSpA as a predominantly male disease may introduce some bias during the diagnosis and management of the disease. However, evidence about male-female differences in axSpA is scarce. • EMAS results highlight how female axSpA patients report longer diagnostic delay and higher burden of the disease in a large sample of 2846 participants of 13 European countries. • Results reflect unmet needs of European female patients. Healthcare professionals should pay close attention in order to accurately diagnose and efficiently manage axSpA cases while further research should be developed on the cause of reported gender differences.

Patient-Reported Impact of Axial Spondyloarthritis on Working Life: Results From the European Map of Axial Spondyloarthritis Survey.

OBJECTIVE: To evaluate work-related issues (WRIs) and their determinants in patients with axial spondyloarthritis (SpA) across Europe. METHODS: The European Map of Axial Spondyloarthritis is a cross-sectional online survey (2017-2018) of unselected patients with self-reported axial SpA from 13 European countries. Participants were classified as active or inactive members of the labor force according to the International Labor Organization standards. Those employed reported WRIs due to axial SpA in the past 12 months. Sociodemographic characteristics and patient-reported outcomes were compared between patients with and without WRIs. Stepwise regression analysis was conducted to identify independent determinants of WRIs. RESULTS: The sample comprised 2,846 patients with axial SpA, 1,653 were active members of the labor force, 1,450 were employed, and of those employed, 67.7% reported at least 1 WRI. The most frequently reported WRIs were taking sick leave (56.3%), difficulty fulfilling working hours (44.6%), and missing work for doctor's appointments (34.6%). Of the total sample, 74.1% declared that they had faced or would face difficulties finding a job due to axial SpA. Patients with WRIs were more often female, were less likely to be married or in a relationship, and had a higher educational level, poorer patient-reported outcomes, and a greater prevalence of anxiety and depression. Multivariable regression showed that WRIs were associated with a higher Bath Ankylosing Spondylitis Disease Activity Index score (odds ratio [OR] 1.30 [95% confidence interval (95% CI) 1.16-1.45]) and the 12-item General Health Questionnaire score (OR 1.15 [95% CI 1.09-1.22]), and were negatively associated with inflammatory bowel disease (OR 0.58 [95% CI 0.36-0.91]). CONCLUSION: Approximately two-thirds of employed patients experienced WRIs due to axial SpA. Association between disease activity and psychological distress with WRIs suggests the need to ensure that axial SpA patients receive the required support to cope with their working life.

Inflexibilidad psicológica e impacto clínico: adaptación del Cuestionario de Aceptación y Acción-II en una muestra de pacientes en tratamiento de hemodiálisis / Psychological inflexibility and clinical impact: Adaptation of the acceptance and action questionnaire-II in a sample of patients on haemodialysis treatment

ANTECEDENTES Y OBJETIVOS: Apenas existen estudios que hayan investigado el papel que la inflexibilidad psicológica (IP) pudiera tener en el contexto de la IRC. El objetivo primario de este estudio fue analizar las propiedades psicométricas, la fiabilidad y la validez de la versión española del Acceptance and Action Questionnaire-II adaptada al contexto de pacientes en tratamiento de hemodiálisis. El objetivo secundario fue analizar la relación entre IP y parámetros relacionados con la adhesión al tratamiento y calidad de vida en este tipo de pacientes. MATERIALES Y MÉTODOS: Estudio transversal prospectivo con pacientes en hemodiálisis (n = 186). RESULTADOS: El índice de tejido graso (15,56 ± 5,72 vs. 18,99 ± 8,91; p = 0,033), los niveles de fósforo (3,92 ± 1,24 vs. 4,66 ± 1,38; p = 0,001) y la ganancia de peso interdiálisis (1,56 ± 0,69 vs. 1,89 ± 0,93; p = 0,016) fueron mayores en los pacientes con más puntuación en IP. Los niveles de fósforo (p = 0,013) explicaron de forma significativa la variabilidad de los niveles de IP, la cual también se mostró como un predictor significativo (p = 0,026) de la variabilidad de los niveles de fósforo. CONCLUSIONES: La adaptación del cuestionario Acceptance and Action Questionnaire-II al contexto de hemodiálisis da lugar a una medida válida y fiable de la IP para este tipo de pacientes, y los resultados de este estudio parecen apoyar el papel de la IP con relación a parámetros de salud y calidad de vida en el ámbito de las enfermedades crónicas

BACKGROUND AND OBJECTIVES: Few studies have investigated the role psychological inflexibility (PI) could have in the context of chronic renal failure. The primary objective of this study was to analyse the psychometric features, the reliability and the validity of the Spanish version of the Acceptance and Action Questionnaire-II (AAQ-II) adapted to the context of patients undergoing haemodialysis (HD). The secondary objective was to assess the relationship between PI and parameters related to the adherence to treatment and quality of life in these types of patients. MATERIALS AND METHODS: Prospective cross-sectional study with patients on haemodialysis (n = 186). RESULTS: The fat tissue index (15.56 ± 5.72 vs. 18.99 ± 8.91, P = .033), phosphorus levels (3.92 ± 1.24 vs. 4.66 ± 1.38; P = .001) and interdialytic weight gain (1.56 ± 0.69 vs. 1.89 ± 0.93, P = .016) were higher in patients with a higher PI score. Phosphorus levels (P = .013) significantly explained the variability of PI levels. PI was also shown as a significant predictor (P = .026) of the variability of phosphorus levels. CONCLUSIONS: The adaptation of the AAQ-II questionnaire to the HD context led to a valid and reliable measurement of PI in these types of patients and our results also seem to support the relationship between PI and health and quality of life parameters in patients with chronic conditions

Psychological inflexibility and clinical impact: Adaptation of the acceptance and action questionnaire-II in a sample of patients on haemodialysis treatment. / Inflexibilidad psicológica e impacto clínico: adaptación del Cuestionario de Aceptación y Acción-II en una muestra de pacientes en tratamiento de hemodiálisis.

BACKGROUND AND OBJECTIVES: Few studies have investigated the role psychological inflexibility (PI) could have in the context of chronic renal failure. The primary objective of this study was to analyse the psychometric features, the reliability and the validity of the Spanish version of the Acceptance and Action Questionnaire-II (AAQ-II) adapted to the context of patients undergoing haemodialysis (HD). The secondary objective was to assess the relationship between PI and parameters related to the adherence to treatment and quality of life in these types of patients. MATERIALS AND METHODS: Prospective cross-sectional study with patients on haemodialysis (n=186). RESULTS: The fat tissue index (15.56±5.72 vs. 18.99±8.91, P=.033), phosphorus levels (3.92±1.24 vs. 4.66±1.38; P=.001) and interdialytic weight gain (1.56±0.69 vs. 1.89±0.93, P=.016) were higher in patients with a higher PI score. Phosphorus levels (P=.013) significantly explained the variability of PI levels. PI was also shown as a significant predictor (P=.026) of the variability of phosphorus levels. CONCLUSIONS: The adaptation of the AAQ-II questionnaire to the HD context led to a valid and reliable measurement of PI in these types of patients and our results also seem to support the relationship between PI and health and quality of life parameters in patients with chronic conditions.

The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective-an Analysis of 2846 Patients Across 13 Countries.

PURPOSE OF REVIEW: Scientific research in axial spondyloarthritis (axSpA) has grown significantly. Nevertheless, the patient perspective remains insufficiently explored. Using a cross-sectional survey, the European Map of Axial Spondyloarthritis (EMAS) describes how patients living with self-reported axSpA experience their disease physically, psychologically, and socially. RECENT FINDINGS: 2846 patients participated: mean age 43.9 ± 12.3 years, 61.3% female, mean disease duration was 17.2 ± 12.4 years, and 71.3% were HLA-B27 positive. Mean diagnostic delay was 7.4 ± 8.4 years. Mean BASDAI score was 5.5 ± 2.0 and 75.7% reported moderate/severe spinal stiffness throughout the day. Daily life was substantially impaired: 74.1% reported difficulties finding a job due to the disease, and 61.5% reported psychological distress. EMAS results showed long diagnostic delay and substantial physical and psychological burden, indicating important unmet needs for patients. Furthermore, axSpA restricted patients' ability to participate in their daily routine and lead a productive work life. Understanding the patient's perspective can improve both health outcomes and shared decision-making between patient and rheumatologist.

Escala de actitud favorable hacia la violación: primeras evidencias acerca de su fiabilidad y validez en muestras salvadoreñas / Rape supportive attitude scale: first evidence on its reliability and validity in the salvadorian samples

Las actitudes tolerantes hacia la violencia sexual ejercida contra las mujeres constituyen un factor de riesgo importante a considerar en la explicación de este tipo de conductas agresivas. Uno de los instrumentos para evaluar estas actitudes es la Escala de Actitud Favorable hacia la Violación (EAFV) de Lottes, la cual ha mostrado buenos índices de fiabilidad y validez, tanto en muestras de estudiantes universitarios estadounidenses como españoles. El objetivo de este estudio es explorar sus características psicométricas en El Salvador, para lo cual fue aplicada conjuntamente con la Escala de Doble Moral de Caron, Davis, Haltelman y Stickle (1993) y la Escala de Deseabilidad Social de Crowne y Marlowe (1960) a dos muestras de 505 y 1.499 estudiantes universitarios, respectivamente. Los resultados indican que la estructura unidimensional de la escala se mantiene estable en las dos muestras, alcanzando coeficientes de consistencia interna superiores a 0.80, aunque incluye dos ítems que requieren de una revisión en futuros estudios. En cuanto a la validez, la EAFV es capaz de diferenciar a hombres y mujeres en este tipo de actitudes, y muestra una correlación positiva significativa con la doble moral sexual.

The tolerant attitudes towards sexual violence on women are important risk factor which should be considered whileexplaining this type of aggressive behaviour. One of the instruments to evaluate these attitudes is Rape Supportive Attitude Scale (RSAS) by Lottes. The scale has showed good indexes of reliability and validity in both American and Spanish university students. The purpose of the study is to explore the psychometric characteristics in El Salvador as it has been applied together with the Double Standard Scale by Caron, Davis, Haltelman and Stickle (1993) and Crowne and Marlowe (1960) Social Desirability Scale in two samples which consisted of 505 and 1499 students, respectively. The results indicate that the one-dimensional structure of the scale stays stable in the two samples reaching the coefficients of internal consistence higher than .80, although it includes two items which requires to be reviewed in future studies. Concerning the validity, the RSAS differentiates men and women in these types of attitudes and shows significant positive correlation with double sexual standard.

Análisis de la productividad científica de la Psiquiatría española a través de las tesis doctorales en la base de datos TESEO (1993-2002) / Analysis of the scientific productivity of the spanish psychiatry through doctoral theses in TESEO data base (1993-2002)

Se analiza la productividad científica de la Psiquiatría española a través de las tesisdoctorales dirigidas por el profesorado funcionario de Psiquiatría de las diferentes universidadespúblicas entre 1993 y 2002, de acuerdo con los datos de la base Tesis EspañolasOrdenadas (TESEO). La muestra la conformaron 126 profesores universitarios (catedráticosde universidad y profesores titulares de universidad) y 294 tesis, contabilizándosesólo las tesis en las que el profesor aparecía como director. La proporción de tesis porprofesor es de 2,33. El director más productivo ha dirigido 17 tesis, lo que implica unamedia de casi 2 tesis dirigidas por año. Un total de 28 profesores, que corresponden conel 22,2%, dirigieron 210 tesis, que suponen el 71,42% del total de tesis. La universidad con la tasa más alta de productividad en tesis doctorales de Psiquiatría entre 1993 y 2002es Alcalá de Henares, con una proporción de 20 tesis por profesor, seguida de la Universidadde Cádiz, con 6,66 tesis por profesor y la Universidad de Extremadura, con 5,33tesis por profesor. Finalmente, se discuten estos resultados analizando sus implicacionesy utilidad

Spanish scientific productivity within Psychiatricstudies is measured by analyzing the volume of doctoral dissertations carried out byprofessors of Psychiatry at the different Spanish public universities, between 1993 and2002, and registered on the official data base Tesis Españolas Ordenadas (TESEO). Thesample consists of 126 university professors and associate professors and a total of 294thesis dissertations. In this study, only those dissertations supervised by a doctor havebeen taken into account. The resulting proportion is 2.33 dissertations per professor. Themost productive professor supervised up to 17 theses; hence, these data result in a meanof 2 theses per year. A total of 28 professors, 22.2% of the sample, supervised 210 theses,which represents 71.42 % of the whole production. The university with the highest rateof dissertations on Psychiatry between 1993 and 2002 is the University of Alcalá deHenares, with a proportion of 20 theses per professor, followed by University of Cadizwith 6.66 theses per professor. The University of Extremadura reaches the third placewith 5.33 theses per professor. At the end of this paper, some conclusions about the stateof the art on this topic have been obtained

Propriedades piscométricas de la dysfunctional beliefs and atitudes about sleep scale (DBAS) en una muestra española de sujetos normales / Psychometric properties of the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) in healthy Spanish subjects

There exists evidence supporting the relationship between dysfunctional thoughts concerning sleep and insomnia sustenance. The Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS) is used to detect these thoughts, which according to the author contains five dimensions: Consequences of insomnia, Control and predictability of sleep, Sleep requirement expectations, Causal attributions of insomnia, and Sleep-promoting practices. This study presents the first psychometric data for the Spanish version of the DBAS, in which an item analysis, a factorial analysis, and a reliability study are included, and with the resultant scale structure "good" and "bad" sleepers are distinguished in order to provide validity. The results indicate that the theoretical dimensions proposed by Morin (1993) do not present an adequate homogeneity, as presented in the moderate, low, and even nonexistent total item correlation values. Therefore, reflecting a low internal consistency in three of the five supposed dimensions. The exploratory factorial analysis only obtained one factor of the 15 items with adequate psychometric guarantees (DBAS-15), from which we can differentiate "bad sleeper" from "good sleeper" subjects.

Existe evidencia acerca de la asociación entre pensamientos disfuncionales sobre el sueño y el mantenimiento del insomnio. En la detección de estos pensamientos se suele utilizar la Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS) que según su autor incluye cinco dimensiones: Consecuencias del insomnio, Control y predicción del sueño, Expectativas no realistas sobre el sueño, Atribuciones causales del insomnio y Creencias sobre las prácticas que promueven el sueño. En este estudio se presentan los primeros datos psicométricos de la versión española de la DBAS, en donde se incluye un análisis de ítem, un análisis factorial, un estudio de la fiabilidad y, con la estructura resultante de la escala, se diferencia entre "buenos" y "malos" dormidores, con el fin de darle validez. Los resultados indican que las dimensiones teóricas propuestas por Morin (1993), no presentan una homogeneidad adecuada, encontrándose valores de correlación ítem-total moderados, bajos o incluso inexistentes, lo que se refleja en una consistencia interna baja en tres de las cinco supuestas dimensiones. El análisis factorial exploratorio permite obtener solamente un factor de 15 ítems con unas adecuadas garantías psicométricas (DBAS-15), a partir del cual podemos diferenciar a sujetos "malos dormidores" de "buenos dormidores".

Evaluación de la relación entre rasgos psicopatológicos de la personalidad y la calidad del sueño

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Abstract: Introduction. Diverse studies llave demonstrated the relationship between psychopathology and sleep alterations. Data proceeding from the ambulatory psychiatric field show that 70-75% of the patients experience sleep problems. The most frequent complaints refer to nighttime sleep alterations, excessive daytime sleep, difficulty with morning waking, and disturbances in the circadian rhythm of the sleep-wake cycle. Many studies, most of which use patient samples, have associated psychopathological personality traits and sleep disorders. All of these studies reveal that subjects with sleep disorder tend to be characterized by psychopathological traits (anxiety, psychasthenia, depression, etc.). There is some evidence that the structure of some dream dysfunctions (such as insomnia) is similar among general population and psychiatric samples; differences are more quantitative than qualitative. In samples of university students, the percentage of individuals who report bad sleep quality has been similar to the percentage of insomniacs in general population. With the aim to delve more deeply into the analogy between the sleep quality of normal subjects and clinical samples, and given the shortage of studies relating psychopathological traits of personality and sleep quality in normal population, this study intends to explore the relationship between the psychopathological personality variables included in the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the sleep quality evaluated with the Pittsburg Sleep Quality Index in a sample ofsubjects who have no diagnosed sleep disorder. The psychopathological variables included in the MMPI-2 which predict sleep quality in a non-clinical sample are also determined. Methodology. A sample of 222 individuals (186 women and 36 men) with a mean age of 21.65 years (SD=2.81) completes the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Pittsburg Sleep Quality Index (PSQI), which provide an overall sleep quality measure and seven partial scores for different dimensions: Subjective sleep quality, Sleep latency, Sleep duration, Sleep habit efficiency, Sleep alterations, the use of hypnotic medication, and daytime dysfunction. Results. Some psychopathological traits (hypochondria, anxiety, and depression) correlate positively with almost all of the sleep quality dimensions comprising the PSQI. From a logistic regression model developed to predict the probability of being a good or bad sleeper, hypochondria and anxiety are the only statistically significant predictors. Discussion and conclusions. Human sleep, from a behavioral perspective, would be explained from four different dimensions: Circadian time (sleep-wake cycle situation on the nictemero), Organism (intrinsic factors such as age, sleep patterns, emotional states, etc.), Behavior (facilitating or inhibiting behaviors), and Environment (temperature, light, noise, etc.). Psychopathological personality traits, the main objective of this study, can also be included within the second component (organism). Previous studies using the MMPI have associated insomnia to high anxiety levels, depression, hypochondria, hysteria, and psychasthenia. The MMPI has also been considered to be a useful instrument in identifying different personality profiles ininsomnia subjects. There are, however, only a few studies focusing on the relationship between these personality traits and sleep quality in normal subjects. The results indicate that this study sample the subjects do not present serious sleep disorders. All of the components pertaining to the Pittsburg Sleep Quality Index present mean scores below the middle response range, situated in 1.5. However, if we consider the total score and bear in mind that a score of five is the cut-off point used to differentiate good sleepers from bad sleepers, we can classify 45.94% of the sample as bad sleepers. In considering the scores for the different MMPI-2 clinical scales, we should mention that none of them reached the typical score of 60; therefore no trait was found to be clinically significant. Some psychopathological traits are linked to almost all of the sleep quality dimensions. Hypochondria, anxiety, and depression are present in the associations with subjective sleep quality, disturbances, or daytime sleepiness. Though no stronger relations between use of hypnotic medication and psychopathological traits have been found (none of them above 0.30), a similar trend on patients dependent on benzodiazepines (predominating traits as depression, psychasthenia and schizophrenia) has been showed. It is also important to point out the relationship between daily dysfunction and the WRK scale (work interferences), which reveals the negative effects of daytime sleepiness, even in subjects who do not present important sleep disorders, as in this sample. On the other hand, the relationship between daily dysfunction and hypochondria, depression, and schizophrenia found in this study has previously been verified in patients with excessive daytime sleepiness. When considering the global score, we can clearly inform that health concerns (reflected in the Hs, HEA, and Hy scales) and the negative emotional states (D, ANX, and DEP scales) are related to sleep quality. These two factors (health concerns and anxiety) are part of the regression model, revealing that an increase in hypochondria and anxiety scores significantly increases the probability of being a bad sleeper, that is to say, of having a poor sleep quality. This explicative model presents a good predictive capacity which allows us to correctly classify 68.50% of the sample. We can correctly predict 78.30% of the good sleepers and 53.90% ofthe bad sleepers (scores higher than 5 on the Pittsburg global index), which grants the model an adequate specificity and sensibility. It is, however, necessary to consider that data used for the estimation respond to a range of restricted scores, causing any effect to be much less important than if we had worked with a more heterogeneous group of subjects. For example, global sleep quality scores can oscillate between 0 and 21, but in our sample they are comprised between 0 and 15. It is possible that, in including subjects who present high scores on the scales used in this study, a greater number of significant sleep quality predictors with greater magnitudes would be emphasized. Nevertheless, our interest resides in exploring the relationship between health concerns, anxiety and depression levels, and sleep quality in a non-clinical sample. So far, this relationship has not been explored in depth. One common limitation of these non-randomized studies is the difficulty to generalize findings to the normal population. Nevertheless, we assume higher possibilities to generalize findings if our study results are similar to those obtained from other non-clinical samples. In conclusion, health concerns and anxiety levels are the psychopathological traits most related to sleep quality and which hold a certain capacity to determine this quality in a sample of normal subjects. Both variables are clearly related to insomnia, as has been revealed in many insomnia patient studies. Therefore, we can verify that the pattern followed in the relationship between psychopathological traits and sleep quality in a non-clinical sample is similar to that found in sleep disorder patient samples, supporting that relationship between psychopathological traits and sleep quality in normal subjects opposite to patients with dream disorders can be drawn more easily from a quantitative than a qualitative approach.

Impacto del apoyo social y la morbilidad psíquica en la calidad de vida en pacientes tratados con antirretrovirales / The impact of the social support and the psychic morbidity on the quality of life of patients with antiretroviral therapy

El objeto de este estudio es analizar la relación existente entre la morbilidad psíquica y el apoyo social con la calidad de vida. Por otro, el papel que realiza el apoyo social como amortiguador de la morbilidad psíquica en estos pacientes. Se estudiaron a 320 pacientes VIH positivos en tratamiento con antirretrovirales, que acudieron a las consultas externas del servicio de infecciosos de cuatro hospitales de la comunidad autónoma andaluza. Así, una mejor calidad de vida se asoció a una ausencia de morbilidad psíquica y a la presencia de apoyo social, a la vez que se observa el papel fundamental que juega el apoyo social como amortiguador de la morbilidad psíquica en este tipo de pacientes. Estos resultados ponen de relieve la importancia que los factores psicosociales tienen durante el transcurso de enfermedades de carácter crónico

The aim of this study is to analyse the existing relation between the psychic morbidity and social support and the quality of life. Besides this, the paper analyses the buffer roll that social support plays on the psychic morbidity in these patients. We studied 320 HIV+ patients in treatment with antiretrovirals, who attended the infectious disease services of four hospitals of the Autonomous Andalusian Community. Being associated a better quality of life to an absence of psychic morbidity and to the presence of social support, it is observed the relevant buffer role that the social support like shock absorber of the psychic morbidity in this one type of patients. These results show the importance that the psycho-social factors have during the course of chronic diseases