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Posttraumatic stress disorder (PTSD) and depression are strong predictors of poor health-related quality of life (HRQOL) among injured U.S. military service members (SMs). Patterns of HRQOL between injury categories and injury categories stratified by mental health (MH) symptoms have not been examined. Among deployment-injured SMs and veterans (n = 4353), we examined HRQOL and screening data for PTSD and/or depression within specific injury categories. Participants included those enrolled in the Wounded Warrior Recovery Project with complete data for HRQOL (SF-36) from June 2017 to May 2020. Injuries were categorized using the Barell Injury Diagnosis Matrix (Barell Matrix). Mean physical component summary (PCS) and mental component summary (MCS) scores were calculated for each injury category and stratified by the presence or absence of probable PTSD and/or depression. The average follow-up time that participants were surveyed after injury was 10.7 years. Most participants were male, non-Hispanic White, served in the Army, and enlisted rank. Mechanism of injury for 77% was blast-related. Mean PCS and MCS scores across the entire sample were 43.6 (SD = 10.3) and 39.5 (SD = 13.3), respectively; 50% screened positive for depression and/or PTSD. PCS and MCS scores were significantly lower within each injury category among individuals with probable PTSD and/or depression than those without. Among deployment-injured SMs, those with probable PTSD and/or depression reported significantly lower HRQOL within injury categories and HRQOL component (i.e., physical or mental) than those without. Findings are consistent with prior reports showing mental health symptoms to be strongly associated with lower HRQOL and suggest integration of mental health treatment into standard care practices to improve long-term HRQOL.

We examined whether established associations between HIV disease and HIV disease progression on worse health-related quality of life (HQOL) were applicable to women with severe trauma histories, in this case Rwandan women genocide survivors, the majority of whom were HIV-infected. Additionally, this study attempted to clarify whether post-traumatic stress symptoms were uniquely associated with HQOL or confounded with depression. The Rwandan Women’s Interassociation Study and Assessment was a longitudinal prospective study of HIV-infected and uninfected women. At study entry, 922 women (705 HIV+ and 217 HIV−) completed measures of symptoms of post-traumatic stress and HQOL as well as other demographic, clinical, and behavioral characteristics. Even after controlling for potential confounders and mediators, HIV+ women, in particular those with the lowest CD4 counts, scored significantly worse on HQOL and overall quality of life (QOL) than did HIV− women. Even after controlling for depression and HIV disease progression, women with more post-traumatic stress symptoms scored worse on HQOL and overall QOL than women with fewer post-traumatic stress symptoms. This study demonstrated that post-traumatic stress symptoms were independently associated with HQOL and overall QOL, independent of depression and other confounders or potential mediators. Future research should examine whether the long-term impact of treatment on physical and psychological symptoms of HIV and post-traumatic stress symptoms would generate improvement in HQOL.

This report describes the reliability and validity of a French version of the Functional Assessment of Cancer Therapy – General (FACT-G) with a French sample of 493 cancer patients. The FACT-G consists of 27 items and four subscales: Physical (PWB), Functional (FWB), Social/Family (SFWB) and Emotional well-being (EWB). The study sample includes 64% with localized disease, 26% with metastases, 11% in remission, and 71% receiving radiation/chemotherapy. Internal consistency Cronbach alphas of the global FACT-G scale (0.90) and subscales (>0.75) are satisfactory (n =126). Test-retest reproducibility is satisfactory for all subscales and the global scale (n =87 to 93, r=0.74 to 0.90). ANOVA models show that PWB differentiated between the three disease stages; the global FACT-G and FWB discriminated between patients with metastases and others with localized disease or in remission; EWB only discriminated between metastases and localized disease; while SFWB did not discriminate between groups at different stages of cancer. Only the PWB subscale discriminated between patients with no history from those receiving chemotherapy (p ≤ 0.05). None of the scales discriminated between groups based on radiotherapy. These results may be useful in the design and interpretation of clinical trials involving French patients when the FACT-G is the outcome measure.

Most breast cancer (BC) survivorship research focuses on the general population of survivors. Scant research investigates the potentially unique experiences of minorities, especially during and after the difficult transition from primary treatment to post-treatment. This qualitative study explored African American BC survivors’ and caregivers’ quality-of-life in the post-treatment period with a focus on social and spiritual well-being. Participants included a convenience sample of African American women with stage I–III BC (N = 23) who completed treatment 6–24 months before enrollment. Primary caregivers (N = 22) included friends, spouses and other family members (21 complete dyads). Participants completed separate semi-structured telephone interviews. Template analysis was used to evaluate themes related to religiousness and spirituality, both across and within dyads. After treatment, religiousness and spirituality played a major role in both survivors’ and caregivers’ lives by: (1) providing global guidance, (2) guiding illness management efforts and (3) facilitating recovery. Participants described a spiritual connectedness with God and others in their social networks. Dyad members shared the goal of keeping a positive attitude and described positive growth from cancer. Few future concerns were expressed due to the belief that survivors were healed and “done” with cancer. Beyond practical and emotional support, provision of spiritual assistance was common. Results highlight the principal, positive role of religiousness and spirituality for African American BC survivors and caregivers after treatment. Findings emphasize the need to assess the importance of religious and spiritual beliefs and practices, and if appropriate, to provide resources that promote spiritual well-being.

To assess the reliability, validity, and factor structure of the Persian Brief Quality of Life in Bipolar Disorder (QoL.BD) in Iranian patients with bipolar disorder (BD). After translation and cross-cultural adaptation of the Brief QoL.BD, we administered the questionnaire to 184 patients diagnosed with BD. To determine factor structure, we performed both exploratory and confirmatory factor analyses. To investigate the reliability, we assessed internal consistency, reproducibility and agreement. Construct validity was assessed by calculating correlations between the Brief QoL.BD and the Short Form-36 (SF-36), Positive And Negative Affect Schedule (PANAS), Hamilton Depression Rating Scale, Young Mania Rating Scale (YMRS) and Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). We also investigated gender differences in interpretations of QoL.BD items. The results obtained from reliability analysis confirmed internal consistency (Cronbach’s alpha was 0.87 and 0.89 for two assessments) and reproducibility and agreement (the intraclass correlation coefficient ranged between 0.74 and 0.94). Validity analyses showed that the items loaded on a single-factor structure. The inter-item correlations varied from 0.31 to 0.68. Significantly lower scores on the Brief QoL.BD were observed in people diagnosed with BD I compared to BD II. Significant correlations were observed between the Brief QoL.BD and SF-36 summary measures, HAMD, YMRS, Q-LES-Q-SF and PANAS subscales. Items in the Brief QoL.BD were interpreted similarly by men and women. The Brief Persian QoL.BD is a psychometrically sound measure with acceptable validity and reliability and provides a rapid assessment tool for measuring QoL in patients with BD.

To assess the association between children’s sleep quality and life satisfaction; and to evaluate the underlying mechanisms of this relationship. Three pediatric cohorts in the National Institutes of Health (NIH) Environmental influences on Child Health (ECHO) Research Program administered Patient-Reported Outcome Measurement Information System (PROMIS®) parent-proxy measures to caregivers (n = 1111) who reported on their 5- to 9-year-old children’s (n = 1251) sleep quality, psychological stress, general health, and life satisfaction; extant sociodemographic data were harmonized across cohorts. Bootstrapped path modeling of individual patient data meta-analysis was used to determine whether and to what extent stress and general health mediate the relationship between children’s sleep quality and life satisfaction. Nonparametric bootstrapped path analyses with 1000 replications suggested children’s sleep quality was associated with lower levels of stress and better general health, which, in turn, predicted higher levels of life satisfaction. Family environmental factors (i.e., income and maternal mental health) moderated these relationships. Children who sleep well have happier lives than those with more disturbed sleep. Given the modifiable nature of children’s sleep quality, this study offers evidence to inform future interventional studies on specific mechanisms to improve children’s well-being.

Thyroid diseases are common and often affect quality of life (QoL). No cross-culturally validated patient-reported outcome measuring thyroid-related QoL is available. The purpose of the present study was to test the cross-cultural validity of the newly developed thyroid-related patient-reported outcome ThyPRO, using tests for differential item functioning (DIF) according to language version. The ThyPRO consists of 85 items summarized in 13 multi-item scales and one single item. Scales cover physical and mental symptoms, well-being and function as well as social and daily function and cosmetic concerns. Translation applied standard forward–backward methodology with subsequent cognitive interviews and reviews. Responses (N = 1,810) to the ThyPRO were collected in seven countries: UK (n = 166), The Netherlands (n = 147), Serbia (n = 150), Italy (n = 110), India (n = 148), Denmark (n = 902) and Sweden (n = 187). Translated versions were compared pairwise to the English version by examining uniform and nonuniform DIF, i.e., whether patients from different countries respond differently to a particular item, although they have identical level of the concept measured by the item. Analyses were controlled for thyroid diagnosis. DIF was investigated by ordinal logistic regression, testing for both statistical significance and magnitude (ΔR 2 > 0.02). Scale level was estimated by the sum score, after purification. For twelve of the 84 tested items, DIF was identified in more than one language. Eight of these were small, but four were indicative of possible low translatability. Twenty-one instances of DIF in single languages were identified, indicating potential problems with the particular translation. However, only seven were of a magnitude which could affect scale scores, most of which could be explained by sample differences not controlled for. The ThyPRO has good cross-cultural validity with only minor cross-cultural invariance and is recommended for use in international multicenter studies.

The purpose of the current study was to examine the association between social cohesion and two domains of quality of life (QOL) among individuals affected by Hurricane Ike, which made landfall on September 13, 2008. Psychosocial and physical QOL were measured using the Short form of the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF; Endicottn et al. in Psychopharmacol Bull 29: 321–326, 1993). The participants were 658 survivors who participated in the Galveston Bay Recovery Study (GBRS; National Center for Disaster Mental Health Research, Galea, and Norris in Galveston Bay Recovery Study, 2008–2010, Inter-university Consortium for Political and Social Research [distributor], Ann Arbor, MI, https://doi.org/10.3886/ICPSR34801.v1 , 2016). Assessments were conducted at approximately 3, 6, and 15 months after the disaster. Longitudinal structural equation modeling was conducted to examine the association between social cohesion and both psychosocial and physical QOL at 6 and 15 months after the hurricane. The results revealed no significant association between social cohesion and physical QOL at either 6 or 15 months. Furthermore, no association was found between social cohesion and psychosocial QOL at 6 months. However, there was a significant positive association between social cohesion and psychosocial QOL at 15 months, even after controlling for the previous levels of posttraumatic stress and demographic variables. The current study highlights a potential effect of social cohesion on QOL, specifically the psychosocial domain, which may manifest after 6 months among survivors of a hurricane. The current results also suggest the importance of long-term programs and interventions to help survivors adjust after experiences of disaster.