Jan Olof Hörnquist

The concept of quality of life.

Despite the fact that, in the current debate, quality of life is depicted as something very desirable, its concept is seldom specified. With regard to previous research into welfare and quality of life, a model of an overall concept of quality of life is presented here. The theoretical analysis ends in and is woven into an empirical application. The application consists of a prospective longitudinal investigation of alcoholics who receive disability pensions. This report is the first in a planned series from the research project “Abuse of alcohol — Disability pension — Quality of life”.

Quality of life: concept and assessment

To understand and assess the concept “quality of life”, it must be analyzed. In this report it is postulated that quality of life covers life as a whole as well as different subdomains of life. Life quality is defined as perceived global satisfaction and satisfaction within a number of key domains with special emphasis on well-being. A comprehensive chart of relevant life domains is presented and a flexible package of tested rating techniques outlined. In order to obtain valid and sensitive assessments, pincer operations with various types of ratings are recommended.

Loneliness and alcohol abuse: A review of evidences of an interplay

This report contains a review of the literature about the interplay between loneliness and the abuse of alcohol. A theoretical discussion based on clinical observations can be dated back to the 1950s. Systematic empirical studies, however, appear sparsely and have mainly been performed during the last decade. Thus, knowledge is still incomplete, but the review indicates that loneliness may be significant at all stages in the course of alcoholism: as a contributing and maintaining factor in the growth of abuse and as an encumbrance in attempts to give it up. Concordant reports demonstrate that alcoholics do feel more lonely than members of most other groups do. In advanced abusers, loneliness is obviously connected with a number of negative characteristics and, together with several of those, directly linked to a poor prognosis. There are, however, no obvious relations to the external social situation (i.e. network) or amount of drinking. Instead, the feeling of loneliness appears to be more connected with a general negative perception about oneself and ones relations to other people and also with a general dissatisfaction with most things in life. The lonely abuser seems likewise resigned and unable to bring himself to change his/her situation. There are also associations with a broad array of psychopathology. In comparison to people with other health problems, the supportive value of the social network of alcoholics appears to be more wavering.

Self-assessed Quality of Life and Metabolic Control in Persons with Insulin-Dependent Diabetes Mellitus (IDDM)

The aim of the study was to analyse the association between satisfaction with life and glycosylated haemoglobulin (MbAl). A quality of life questionnaire was administered to 247 persons with IDDM at a Diabetic Clinic in Bergen, Norway. The material was divided into two groups depending on their level of HbAl; HbAl > 0.09 was labelled poorly regulated and a level of HbAl ≥ 0.09 was labelled well regulated. The groups were compared with regard to different life domains and well-being scales. The statistical analysis showed that the well-regulated group had significantly higher average scores considering the somatic and activity/behavioural life domain ratings, the latter being only significantly different among people with higher education. The well-gegulated group had lower average scores in the psychological and social life domain ratings, but these differences were not statistically significant. Among the well-being scales we found a statistically significant difference between poor and well-regulated persons only regarding sociability and loneliness. Well-regulated persons felt on average less sociable and more lonely than poorly-regulated persons.

Rheumatoid arthritis, coping and well-being Cross-sectional sub-group comparisons and correlational analyses

A study was performed on 169 women and 53 men with a clinical diagnosis of rheumatoid arthritis (RA). This is a chronic disabling disease with no known cure and therefore the outcome of treatment has increasingly become focused upon assessment of well-being rather than more clinical parameters. We studied the relationship between clinical manifestation, self assessed functional disability and coping, on one hand, and well-being, on the other. Severity of RA disease was hypothesised to be negatively related while utilisation of various coping strategies, was deemed positively to well-being. The most mentioned coping strategies in the study group were problem oriented. With increasing severity of the RA disease we observed less acceptance and control. Well-being consistently decreased with increasing severity of RA, both with regard to clinical severity and functional disability status. Significant trends were seen with regard to security, future orientation, endurance, indolence and loneliness. Bivariate analysis between coping strategies and well-being revealed generally low correlations. Individuals accepting the illness displayed less guilt and tension and more endurance. Those who had decided to live an active life showed a more positive belief in the future and less indolence. The study outcome underscores the significance of well-being and coping (psychosocial factors) in RA, which should be considered and not neglected in clinical practice.

Precursors of repeated short-term sick-leave : an empirical review of some background, job and well-being characteristics

The aim of the study was to search for bivariate associations between on the one hand samples of background, job-related and well-being characteristics, and on the other hand longitudinally recorded sick-leave in individuals with repeated short-term sick-leave. Out of altogether 123 subjects included, 113 self-rated their well-being at the onset of, and 88 also after, a supportive programme. The well-being rating covered experience of treatment by other people, reservation, loneliness, inferiority, tension, vulnerability, guilt, security and indolence. Socio-demographic and job-related characteristics and attitudes were registered and declared at the initial contact. Correlations between these separate sets of independent variables, and sick-leave occasions and days in each of the two years following the contact were computed. There was an almost complete lack of covariation between background variables and sick-leave. Neither did job-related characteristics correlate. Only an expressed wish for a job change was vaguely associated with more absence days, but not with more spells. In striking contrast, a convincing consistent longitudinal pattern between self-rated well-being and sick-leave behaviour emerged. The poorer the well-being, the greater the subsequent sick-leave. Yet, a major part of the sick-leave variance remained unexplained. Accordingly, other etiological factors may still interact with well-being in the comprehensive setting behind the sick-leave behaviour. In conclusion, it is to be noticed that, the way the subject looks upon and describes himself as an independent individual and the interaction with his social environment, seems to have a certain bearing upon his future sick-leave behaviour in this context. The outcome of the study is corroborated by similar predictive correlations between well-being and working capacity previously found in alcohol abusers.

Assessment of quality of life in rheumatoid arthritis: methods and implications.

SummaryDuring the last decade, self-report of health status and quality of life has gained increasing credibility and acceptance in studies of individuals with rheumatoid arthritis (RA). According to a number of reports. the new self-assessment instruments offer an excellent complement to the more traditional clinical outcome measurements.In the absence of a cure for RA and the use of potentially toxic drugs, quality-of-life assessment seems to have an important place in clinical drug trials. The most commonly used quality of life or health Status instruments in studies of RA seem 10 perform well and give reliable and valid information. A common concern. however, with these instruments is that there appears to be a lack of questionnaires which allow satisfaction with various aspects of quality o f life to be expressed. Many instruments focus on negative aspects of quality of life, although quality of life for most individuals is related to something positive.There is no perfect instrument applicable for all situations, but the selection of an instrument depends on the specific purpose of a particular study. Psychological interventions are more likely to affect people’s emotions and well-being, whereas a drug intervention might more dramatically affect physical function. It appears, however, reasonable to assume that effects of drug intervention on quality of life should be measured with a longer perspective, such as after at least 6 months’ observation. The field is still in a phase of methodological and theoretical development which is also reflected in the few numbers of published studies concerning the effect of drug interventions on quality of life of patients with RA.

Repeated Short-Term Sick-Leave and Quality of Life An Evaluation of a Clinical Socio-Medical Intervention

The primary aim of this study was to evaluate a clinical socio-medical supportive program for repeated short-term sickleavers who exhibited no evident reason for their prolonged absence. Attention was drawn to changes in the quality of life of the participants. Ninety-nine persons took part in the full program. The sex distribution was even and the mean age was 32 years. The average number of days of sick-leave during the year preceding the entrance into the program was 28. The most common self-stated diagnosis was upper respiratory infection or gastro-intestinal problems. The evaluation showed a significant change for the better in the quality of life and well-being of the patients, although more than every other patient did not explicitly attribute any personal benefit to the intervention itself. The results coincide irrespective of measuring method and, are by and large, consistent over most areas of life and components of well-being assessed. Thus the design and the results of the evalution look very promising concerning reliability, validity and especially sensitivity. A corresponding model may be applicable more generally when evaluating health- and medical care.

Loneliness correlates in advanced alcohol abusers. I. Social factors and needs

A previous report on 34 alcohol abusers undergoing rehabilitation revealed that, among 86 medical, social and psychological variables, “feelings of loneliness” were most important for the prognosis. The current analysis was performed in order to illuminate the less satisfactory prerequisites regarding external social factors and needs of the lonely alcohol abuser. Ninety-five abusers, the previously mentioned sample included, were examined twice with an approximate interval of two years. The results indicated that there were no simple or obvious correlations to the external social situation (the amount of contacts, social network, etc). Feelings of loneliness were more closely associated with dissatisfaction with the quality of existing relationships, independent of quantity. Furthermore, even in relation to work and activities, the lonely abusers showed a general dissatisfaction with the existing situation, independent of its nature. In addition, the lonely abusers felt dissatisfied in a number of need domains, although they were only inclined to stress the priority of some social needs. To sum up, the lonely abuser showed a recurrent pattern characterized by discontentment and dissatisfaction, in combination with some traces of passivity in essential life-spheres.

Grounds for disability pension. The younger abuser as compared with older abusers of alcohol.

Current social legislation in Sweden prescribes a great degree of restrictivity in the granting of disability pensions to young abusers of alcohol. In order to test whether his prescription is really applied, a comparison between 29 abuser applicants up to age 46 and 32 over the age of 6 years was carried out. The total of 61 abusers represented all 78 first-time applicants with an abuse over a period of 1 1/2 years who were living in a geographically defined, mixed urban–rural region in the Swedish county of Östergötland. The period lasted from 1st January 978 until 1st July 1979. The participants quality of life was examined in a multidisciplinary fashion. In line with the prescribed restrictivity, the younger group proved to the fundamentally worse, primarily in socio-psychological and psychiatric respects. In addition, they also demontrated a greater degree of alcohol injury. Besides the legislative situation, even situational conditions were proposed as explanatory factors for the empirical findings. This is the fourth report from the research project “Abuse of alcohol – Disability pension – Quality of life”.