Mental health disparities between German lesbian and bisexual women and a population-based sample.

Lesbians are at greater risk of mental health problems than heterosexual women, and bisexual individuals are even more likely to report mental health problems. No study has yet tested whether there are any mental health differences between German lesbians, bisexual women, and female controls. We tested for mental health differences between matched groups of 161 lesbian and bisexual women and 161 women in the general population, as well as between matched groups of 79 lesbians and 79 bisexual women. Lesbian and bisexual women reported more mental health problems than population-based women. In contrast, bisexual women did not differ in mental health from lesbians. Therefore, German lesbian and bisexual women constitute a risk group for mental health problems. To improve lesbian and bisexual women's mental health, attempts should be made to lower the frequency of minority stressors, and best-practice mental health interventions made available.

Psychometric Properties of the German Version of the Health Regulatory Focus Scale.

The Health Regulatory Focus Scale (HRFS) is a short scale which measures an individual's prevention and promotion focus in a health-specific context. The main objective of this study was to examine the psychometric properties of the newly translated German version of the HRFS. Reliability and item characteristics were found to be satisfactory. Validity of both subscales toward other psychological constructs including behavioral approach and avoidance, core self-evaluations, optimism, pessimism, neuroticism, as well as several measures of physical and mental health was shown. In addition, invariance of the measure across age and gender groups was shown. Exploratory as well as confirmatory factor analyses clearly indicated a two-factorial structure with a moderate correlation between the two latent constructs. Differences in health promotion and prevention focus between socio-demographic groups are discussed. The HRFS is found to be a valid and reliable instrument for the assessment of regulatory focus in health-related environments.

Mental health differences between German gay and bisexual men and population-based controls.

BACKGROUND: International studies have revealed that gay and bisexual men present more mental health problems than the general male population. Furthermore, there is evidence that minority stress predicts mental health problems in gay and bisexual men. The aim of the present study is to provide initial data on mental health differences in Germany and to analyze the effect of minority stress. METHODS: Mental health data on n = 1903 German gay and bisexual men and n = 958 men from a population-based sample were assessed using a shortened version of the SCL-90-S. The mental health of the two samples was compared. Furthermore, a linear regression was conducted for the gay and bisexual sample: mental health was used as the criterion and minority stressors as predictors. RESULTS: As compared to our population sample, gay and bisexual men demonstrated more mental health problems with a moderate effect size. In the regression, minority stress predicted mental health problems in the gay and bisexual sample. CONCLUSIONS: We observed pronounced mental health differences between gay and bisexual men versus the population sample. These differences could be at least partly due to the minority stress gay and bisexual men face. Research should focus on how to reduce and cope with minority stress.

Assessment of vision-related quality of life in patients with central retinal artery occlusion.

BACKGROUND: Central retinal artery occlusion (CRAO) is a major cause for severe visual impairment. Its effect on vision-related quality of life has not yet been determined. The purpose of the present study was thus to assess vision-related quality of life in patients with CRAO using the 39-item National Eye Institute Visual Function Questionnaire. METHODS: The case-control study comprised 26 patients with unilateral CRAO and a control group consisting of 26 control subjects, matched for age and sex. Vision-related quality of life was measured using the 39-item National Eye Institute Visual Function Questionnaire. RESULTS: After Bonferroni correction, the median 39-item National Eye Institute Visual Function Questionnaire composite score was significantly lower in patients with CRAO than in those in the control group (P(corr) < 0.001). Patients with CRAO showed significantly lower median scores in 9 of 12 subscales: general vision (P(corr) < 0.001), peripheral vision (P(corr) < 0.001), difficulties with near-vision activities (P(corr) < 0.001), difficulties with distance-vision activities (P(corr) < 0.001), role difficulties as a result of vision problems (P(corr) < 0.001), dependency on others because of vision problems (P(corr) < 0.001), limitations in social functioning because of vision problems (P(corr) < 0.001), mental health symptoms because of vision problems (P(corr) < 0.001), and general health (P(corr) = 0.008). CONCLUSION: Our data suggest that vision-related quality of life is reduced in patients with CRAO.

Psychological distress is associated with vision-related but not with generic quality of life in patients with visual field defects after cerebral lesions.

Considerably diminished quality of life (QoL) is observed in patients with visual field defects after lesions affecting the visual pathway. But little is known to what extent vision-and health-related QoL impairments are associated with psychological distress. In 24 patients with chronic visual field defects (mean age=56.17±12.36) the National Eye Institute-visual functioning questionnaire (NEI-VFQ) for vision-related QoL, the Short Form Health Survey-36 (SF-36) for generic QoL and the revised Symptom-Checklist (SCL-90-R) were administered. Cases with clinically relevant SCL-90-R symptoms were defined. Demographic, QoL and visual field parameters were correlated with SCL-90-R scales. About 40% of the investigated patients met the criteria for the definition of psychiatric caseness. 8/12 NEI-VFQ scales correlated significantly with SCL-90-R phobic anxiety (r-range -0.41 to -0.64, P<0.05), 5/12 NEI-VFQ scales correlated with SCL-90-R interpersonal sensitivity (-0.43 to -0.50), and 3/12 with SCL-90-R depression (-0.51 to -0.57) and obsessive-compulsiveness (-0.41 to -0.43). In contrast, only 1/8 SF-36 scales correlated significantly with SCL-90-R depression, phobic anxiety and interpersonal sensitivity (-0.41 to -0.54). No substantial correlations were observed between visual field parameters and SCL-90-R scales. Significant correlations of SCL-90-R with NEI-VFQ but not with SF-36 suggest that self-rated psychological distress is the result of diminished vision-related QoL as a consequence of visual field loss. The extent of visual field loss itself did not influence the rating of psychological distress directly, since SCL-90-R symptoms were only reported when diminished vision-related QoL was present. Patients with reduced vision-related QoL due to persisting visual field defects should therefore be offered additional neuropsychological rehabilitation and supportive psychotherapeutic interventions even years after the lesion.

Vision-related quality of life in first stroke patients with homonymous visual field defects.

BACKGROUND: To evaluate vision-related and health-related quality of life (VRQoL, HRQoL) in first stroke patients with homonymous visual field defects (VFD) with respect to the extent of the lesion. Since VFD occur in approximately 10% of stroke patients the main purpose of the study was to investigate the additional impact of VFD in stroke patients hypothesizing that VFD causes diminished VRQoL. METHODS: In 177 first stroke patients with persisting VFD 2.5 years after posterior-parietal lesions VRQoL was assessed by the National-Eye-Institute-Visual-Functioning-Questionnaire (NEI-VFQ) and HRQoL by the Medical-Outcome-Study Short-Form-36 Health-Survey (SF-36). Questionnaire results of VFD-patients were compared with age- and sex-matched healthy controls and with general non-selected stroke samples as published elsewhere. VFD-type and visual acuity were partially correlated with questionnaire results. RESULTS: Compared to healthy controls VFD-patients had lower NEI-VFQ scores except ocular pain (Z-range -11.34 to -3.35) and lower SF-36 scores except emotional role limitations (Z-range -7.21 to -3.34). VFD-patients were less impaired in SF-36 scores than general stroke patients one month post lesion (6/8 subscales) but had lower SF-36 scores compared to stroke patients six months post lesion (5/8 subscales). Visual acuity significantly correlated with NEI-VFQ scores (r-range 0.27 to 0.48) and VFD-type with SF-36 mental subscales (r-range -0.26 to -0.36). CONCLUSIONS: VFD-patients showed substantial reductions of VRQoL and HRQoL compared to healthy normals, but better HRQoL compared to stroke patients one month post lesion. VFD-patients (although their lesion age was four times higher) had significantly lower HRQoL than a general stroke population at six months post-stroke. This indicates that the stroke-related subjective level of HRQoL impairment is significantly exacerbated by VFD. While VRQoL was primarily influenced by visual acuity, mental components of HRQoL were influenced by VFD-type with larger VFD being associated with more distress.

Parafoveal vision impairments and their influence on reading performance and self-evaluated reading abilities.

BACKGROUND AND PURPOSE: Patients with homonymous hemianopic field defects (HFD) after postchiasmatic cerebral brain injuries often complain about impairments in daily life activities, particularly problems in reading, and show considerable reductions of vision-related quality of life (QoL). This study aimed to assess the relation of "objective" reading performance and self-reported "subjective" reading abilities; it was further investigated whether parafoveal HFD characteristics have an impact on both parameters. METHODS: In postchiasmatic-lesioned subjects with HFD (n = 43), "objective" reading performance was measured with Radner-Reading-Charts (reading speed, reading acuity). Vision-related QoL was assessed by the National-Eye-Institute-Visual-Function-Questionnaire (NEI-VFQ). Four reading-relevant NEI-VFQ items that assessed "subjective" reading abilities were separately analyzed. Macular sparing measures were derived from campimetry (+/-16 degrees vertical, +/-21.5 degrees horizontal); i.e., the vertical HFD border between +/-2 degrees and the proportion of intact parafoveal visual field within the "reading window". Since macular sparing may be a perimetric artefact, eye movements during campimetry were recorded in 26 subjects. RESULTS: Mean reading speed of the total sample (90.72 +/- 33.96 words per minute) was considerably reduced, as was the patients' vision-related QoL, which was revealed by diminished NEI-VFQ scores. Reading acuity was 0.12 +/- 0.13 LogRAD (0.81 +/- 0.26 according to the decimal system). There were significant but weak correlations between reading acuity and speed with all reading-relevant NEI-VFQ-items (r-range, reading acuity: -0.57 to -0.38, reading speed: 0.33 to 0.43) and 7/12 NEI-VFQ-subscales (r-range, reading acuity: -0.47 to -0.33, reading speed: 0.31 to 0.40). The intact parafoveal visual field correlated significantly with 2/4 reading-related NEI-VFQ-items and with 4/12 NEI-VFQ-subscales (r-range 0.31 to 0.52). Reading acuity and mean reading speed were both correlated with fixation accuracy during campimetry (r = -0.38 and 0.45). Correlations of spared areas between +2 degrees to -2 degrees and the relative and absolute defect HFD border with reading speed, but not reading acuity, tended to significance. Subjects deviated from the campimetric fixation mark in a SD-range of +/-5.2 degrees vertically and +/-6.5 degrees horizontally but eye movement ranges were not correlated with macular sparing measures. CONCLUSIONS: Patients with HFD showed severely reduced reading speed, which was reflected in subjectively diminished reading performance, and reduced reading-related QoL parameters. Larger areas of functionally intact parafoveal vision were associated with better reading performance. Although eye movements occurred during campimetry, these did not seem to constitute an artificially enlarged area of parafoveal intact vision.

Vision- and health-related quality of life in patients with visual field loss after postchiasmatic lesions.

PURPOSE: The purpose of the study was to assess vision-related quality of life (QoL) in patients with visual field loss (VFL) after lesions of the postchiasmatic visual pathway and to investigate the influence of VFL and reduced visual acuity (VA) on vision-related QoL. METHODS: In 312 patients with postchiasmatic damage, VFL was measured by automated computer campimetry, and vision-related QoL was assessed by the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ). Health-related QoL was obtained by the SF-36 Health Survey in 272 patients. In addition, 90 degrees visual fields and VA data were obtained. NEI-VFQ and SF-36 scores were compared with those of healthy subjects and poststroke, brain-injured patients in general. Multiple analyses of covariance and multiple linear regression models for QoL results were performed with VA and VFL as independent variables. RESULTS: Patients with postchiasmatic lesions who had VFL had markedly lower NEI-VFQ scores than did healthy subjects and also lower SF-36 scores than did poststroke, brain-injured patients, particularly in the domain of role functioning. VFL and VA correlated significantly with vision-related but not with health-related QoL estimates when age was considered as confounding variable. Most scales of NEI-VFQ (9/12) were sensitive to differences in VFL. CONCLUSIONS: VFL and VA had a coordinate influence on vision-related QoL in brain-injured patients with postchiasmatic lesions. Diminished health-related QoL was not associated with VFL and VA. Both VFL and VA should be considered when trying to explain variance of NEI-VFQ results in patients with postchiasmatic lesions of the visual pathway.

Vision- and health-related quality of life before and after vision restoration training in cerebrally damaged patients.

PURPOSE: The aim of the study was to examine if improvements of stimulus detection performance in visual field tests after intensive visual training of the visual field border zone in patients with visual field defects are associated with changes in self-reported vision- and health-related quality of life (QoL). METHODS: We studied a clinical sample of 85 patients suffering from visual field loss after brain damage that underwent repetitive, daily light stimulation (vision restoration training, VRT) of the visual field border and the blind visual field for up to 75 hrs (N=16) or 150 hrs (N=69). Stimulus detection was quantified in the central visual field with a campimetric method before and after intervention. Health-related QoL was assessed by the Health-Survey SF-36 and vision-related QoL by the 39-item National Eye Institute Visual Function Questionnaire (NEI-VFQ). RESULTS: Both vision- and health-related QoL measures improved after VRT. Significant increases were found in 8 out of 12 NEI-VFQ and 3 out of 8 SF-36 subscales. Of the 85 participants 6% showed a decrease in stimulus detection performance, 42% showed an increase of less than 5% detected stimuli, 24% showed an increase of 5-10% detected stimuli and 28% of more than 10% detected stimuli. Changes in campimetric stimulus detection rates were related to NEI-VFQ subscales point differences general vision (3 points), difficulty with near vision activities (4 points), limitations in social functioning due to vision (4 points) and driving problems (12 points). There was no relation of visual field changes to changes in SF-36 component and subscale scores. CONCLUSIONS: The NEI-VFQ is a valuable measure of self-reported visual impairment in patients with visual field defects. Stimulation of the visual field by training may lead to improvements of vision-related QoL which were correlated with the extent of visual field enlargements.

Living-related liver transplantation from the view of the donor: a 1-year follow-up survey.

BACKGROUND: In the past, follow-up surveys for living-related liver transplantation (LRLT) mainly focused on the medical outcome of recipients and donors. In this survey the prevalence of personal, familial, or economic problems of the donors and changes of quality of life after donation were studied. METHODS: Questionnaires were sent to 24 donors after right hepatectomy for LRLT (response 92%). The modified EUROTOLD (European Multicenter Study of Transplantation Using Living Donors) questionnaire was used to inquire about the decision-making process, family problems, and economic problems related to the donation. Global quality of life was measured with the SF-36 Health Survey. RESULTS: For most donors the decision to donate was easy or not very difficult (21/22) and was made spontaneously (17/22). The amount of information about the risks of LRLT was limited at the time of decision but increased remarkably immediately before the operation. In 28%, family conflicts occurred (5/22). Retrospectively, all but two donors (91%) would donate again. On average, donors started working after 9 (+/-3.7) weeks and felt fully recovered after 13 (+/-7.3) weeks. Adverse financial affects were experienced by 41% of the donors (9/22) because of the donation, and four of those received a compensation. Importantly, quality of life did not differ between donors and nondonors. CONCLUSION: Donors viewed LRLT positively. Quality of life after donation did not change. However, donors had a prolonged period of physical rehabilitation, and 41% experienced financial disadvantages.

Quality of life in kidney recipients: comparison of tacrolimus and cyclosporine-microemulsion.

Treatment of end-stage renal disease (ESRD) is evaluated by survival, quality of life (QOL) and cost-effectiveness. Little is known about the influence of immunosuppressive agents on global and disease-specific QOL in kidney recipients. In winter 1997/98 (t0) as well as in winter 1998/99 (t1), all kidney recipients of our University were asked to participate in a QOL study. The psychodiagnostic approach combined a global QOL-measure (SF-36 Health Survey) and a disease-specific questionnaire (ESRD-SCL, Nephron 1999). Inclusion criteria for the final analysis were (a) participation in both surveys and (b) eligibility after the matching procedure: patients with tacrolimus-based immunosuppressive regimen were matched to patients with cyclosporin-microemulsion (CsA-ME)-based immunosuppressive-regimen as to age, gender and duration of graft function. Group data were compared by performing a two-variate ('immunosuppression', 'time') analysis of variance. Both groups consisted of 63 patients. Analysis of QOL revealed statistically significant advantages for the tacrolimus treated patients concerning global (SF-36 'Physical Component Summary') as well as disease-specific QOL (ESRD-SCLTM 'Global Severity Index'; both p < 0.05). In detail, these results were due to statistically significant better QOL in tacrolimus treated patients as to the SF-36 subscales 'Physical Functioning' and 'General Health' (p < 0.05) and the ESRD-SCL subscales 'Limited Physical Capacity' (p < 0.05), 'Cardial and Renal Dysfunction' (p < 0.01) and 'Increased Growth of Gum and Hair' (p < 0.001). The factor 'time' did not contribute statistically significant to explanation of variance. In terms of QOL in kidney recipients, tacrolimus is superior to CsA-ME. Tacrolimus improves disease-specific QOL and also shows slight advantages concerning global QOL compared with CsA-ME. To record differentiated aspects of QOL in kidney recipients, the diagnostic approach should include a global QOL measure completed by a sensitive disease-specific instrument.