J.Th.M. van Eijk

The role of coping resources and coping style in quality of life of patients with asthma or COPD

Objective: Sufficient psychosocial coping resources and an adequate coping style may have a beneficial influence on quality of life in patients with a chronic disease. Until now little research has been directed at these associations and particularly not among patients with asthma or chronic obstructive pulmonary disease (COPD). The objective of this study is to examine the association between psychosocial coping resources and coping style with HRQoL, for asthma and COPD separately. Methods: Fourteen general practitioners in the Netherlands recruited 273 adult patients with asthma (n = 220) or COPD (n = 53). Data were collected by a pulmonary function assessment, a face-to-face interview and validated questionnaires about psychosocial coping resources (self-efficacy, mastery, self-esteem, and social support), coping style (avoidant, rational and emotional), and health related quality of life (HRQoL). Results: A more emotional coping style (p < 0.01) was independently associated with poor HRQoL in both asthma and COPD patients. Furthermore, in asthma patients, less self-efficacy feelings (p < 0.01), less mastery feelings (p = 0.05), a more avoidant coping style (p = 0.04) and poor pulmonary function (p < 0.01) were independently associated with poor HRQoL. In COPD patients, a more rational coping style (p = 0.02) was independently associated with poor HRQoL. Conclusion: Our findings suggest that psychosocial coping resources and coping style are independently associated with HRQoL in patients with asthma or COPD. Further research should explore the possibilities of intervening on these factors, aiming to improve HRQoL in patients with asthma or COPD.

Quality of care for patients with Type 2 diabetes mellitus—a long‐term comparison of two quality improvement programmes in the Netherlands

Aim  To compare two intervention programmes, aimed at improving the quality of care provided for patients with Type 2 diabetes in the longer term.

Cognitive hostility predicts all-cause mortality irrespective of behavioural risk at late middle and older age

BACKGROUND Most but not all evidence supports hostility-related attributes to increase mortality risk. However, studies usually include single attributes, their effects have been studied predominantly in younger populations, and behavioural pathways explaining the mortality effect seem to differ by age. We examined the relationship between all-cause mortality and cognitive hostility, anger, aggression and rebelliousness, and their independence of health behaviours in a late middle-aged and older population. METHODS Data were derived from the longitudinal Dutch Study of Medical Information and Lifestyles in the city of Eindhoven, in the Southeast of the Netherlands study among 2679 late middle-aged and older Dutch people. Psychological characteristics were self-reported in 2004/2005, and mortality was monitored from 2005 to 2010. Cox regression analyses were used to calculate the mortality risk by each unique psychological variable with additional adjustments for the other psychological variables and for health behaviours. Baseline adjustments included age, sex, educational level and prevalent morbidity. RESULTS Cognitive hostility was associated with all-cause mortality, independent of health behaviours (on a scale ranging from 6 to 30, the hazard ratio (HR) was 1.05; 95% confidence interval [95% CI): 1.01-1.09]. Anger, aggression and rebelliousness were not associated with mortality risk. CONCLUSIONS In diminishing excess mortality risks, hostile cognitions might be acknowledged separately and additionally to the risk posed by unhealthy lifestyles.

Measuring rebelliousness and predicting health behaviour and outcomes: an investigation of the construct validity of the Social Reactivity Scale.

The Social Reactivity Scale is a questionnaire measure of individual differences in rebelliousness. The associations between rebelliousness, health behaviours and health outcomes were examined in two Dutch samples by means of cross-sectional survey data. We found moderate support for the reliability and construct validity of the scale. Findings were suggestive of rebelliousness, first, being associated with low control beliefs, second, being related to hostility and, third, also heightening the risk of engaging in unhealthy behaviours and that of poor health (perhaps through deliberately rejecting health education messages). Findings thus contribute to the ongoing emergence of an empirically viable theoretical construct.

Cost-effectiveness of an intervention to reduce fear of falling

OBJECTIVES The aim of this study was to assess whether a multicomponent cognitive behavioral group intervention is preferable to usual care in terms of (healthcare) costs and effects on fear of falling and activity avoidance. METHODS This economic evaluation was embedded in a randomized controlled trial among 540 community-living adults in the Netherlands, aged 70 years and older who reported fear of falling and fear-induced activity avoidance. The participants allocated to the intervention group received a multicomponent cognitive behavioral group intervention consisting of eight weekly sessions and a booster session. The sessions were aimed at instilling realistic views of falls, reducing fall risk, and increasing activity and safe behavior. Participants in the control group received usual care. Cost outcome measures were healthcare costs, and patient and family costs. Clinical outcomes were fear of falling and activity avoidance. All outcomes were assessed at baseline and at 2, 8, and 14 months by means of registration forms, self-administered questionnaires, and interviews by telephone. RESULTS Participants were randomly allocated to intervention (n = 280) and control groups (n = 260). Costs for the intervention program were on average €276 per person. Total costs per person were comparable (€4,925 in intervention group and €4,828 in control group). Furthermore, favorable effects of the program were observed for fear of falling and activity avoidance. CONCLUSIONS This study showed that the intervention program is preferable to usual care in terms of costs and effects. The program had comparable costs and significantly reduced fear of falling and associated activity avoidance among older community-living persons.

Personality and health as predictors of income decrease in old age: Findings from the longitudinal SMILE study

BACKGROUND There is much evidence for the influence of low socio-economic status on poor health. It is, however, also important to study the ways in which people attain and retain their socio-economic status and the factors that predict changes in socio-economic status, such as a decrease in income. Such mobility also occurs in older populations, in which financial and health-related changes are very common, especially after retirement. METHODS Three years of follow-up data from 1443 Dutch men and women aged 55 years and older who participated in the Study on Medical Information and Lifestyles Eindhoven (SMILE) were gathered. Logistic regression analyses were used to study the independent effects of physical and mental dysfunction and severity of chronic diseases and adverse personality factors on decrease in income. RESULTS Social anxiety (OR = 1.62, 95% CI: 1.09-2.40), physical dysfunction (OR = 1.71, 95% CI: 1.07-2.74) and severe diseases (OR = 1.37, 95% CI: 1.05-1.78) were significant predictors of decrease in income. These contributions were independent of each other, and remained robust after controlling for other confounding factors, such as gender, age and educational level and change in employment status. Mental dysfunction and other personality characteristics, such as hostility and mastery, did not contribute to decrease in income. CONCLUSION Social anxiety and poor physical health are relevant factors associated with decrease in income in old age. The findings suggest that these factors are important in retaining ones socio-economic status. Future longitudinal research is necessary to further disentangle the mechanisms and pathways related to socio-economic health inequalities along the life-course.

The educational patterning of health-related adversities in individuals with major depression

BACKGROUND Major depressive disorder and depression severity are socially patterned, disfavouring individuals from lower socioeconomic groups. Depressive disorders are associated with several adverse health-related outcomes. We examined the educational patterning of somatic health, lifestyles, psychological function and treatment modalities in individuals suffering from major depressive disorder. METHODS We used cross-sectional medical and psychiatric data from 992 participants of The Netherlands Study of Depression and Anxiety (NESDA) with a diagnosed current major depressive disorder. Associations of education with somatic, lifestyle-related, and psychological outcomes, and with treatment modalities, adjusted for depression severity, were examined by means of (multinomial and binary) logistic and linear regression analyses. RESULTS In addition to and independent of major depressions being more severe in the less educated patients, metabolic syndrome, current smoking, low alcohol consumption, hopelessness and low control were more prevalent in a group of less educated individuals suffering from major depression, compared with their more highly educated peers. The less educated persons were more likely to be treated with antidepressant medication and less likely to receive psychotherapy treatment. None of these observations were explained by a higher depression severity in the less educated group. LIMITATIONS The cross-sectional design does not allow us to make direct causal inferences regarding the mutual influences of the different health-related outcomes. CONCLUSIONS Further research should explore the necessity and feasibility of routine screening for additional health risk, particularly among less educated depressed individuals.