Marianne Amir

The World Health Organization Quality of Life assessment (WHOQOL) : Development and general psychometric properties

This paper reports on the field testing, empirical derivation and psychometric properties of the World Health Organisation Quality of Life assessment (the WHOQOL). The steps are presented from the development of the initial pilot version of the instrument to the field trial version, the so-called WHOQOL-100. The instrument has been developed collaboratively in a number of centres in diverse cultural settings over several years; data are presented on the performance of the instrument in 15 different settings worldwide.

Autonomic dysfunction in patients with fibromyalgia: application of power spectral analysis of heart rate variability.

OBJECTIVES To assess the interaction between the sympathetic and parasympathetic systems in patients with fibromyalgia syndrome (FM), using power spectrum analysis (PSA) of heart rate variability (HRV). In addition, we explored the association between HRV, measures of tenderness, FM symptoms, physical function, psychological well being and quality of life. METHODS We studied 22 women with FM and 22 age-matched healthy women. Twenty-minute electrocardiogram recordings were obtained in a supine position during complete rest. Spectral analysis of R-R intervals was done by the fast-Fourier transform algorithm. RESULTS Heart rate was significantly higher in FM patients compared with controls (P < .006). FM patients had significantly lower HRV compared with controls (P= .001), and higher low-frequency (LF) and lower high-frequency (HF) components of PSA than controls (P < .001). Quality of life, physical function, anxiety, depression, and perceived stress were moderately to highly correlated with LF, HF (in normalized units), and LF/HF. No association was observed between HRV parameters and measures of tenderness and FM symptoms. CONCLUSIONS The basal autonomic state of patients with FM is characterized by increased sympathetic and decreased parasympathetic tones. Autonomic dysregulation may have implications regarding the symptomatology, physical and psychological aspects of health status.

Developing methods for assessing quality of life in different cultural settings. The history of the WHOQOL instruments.

Abstract.Background:This review traces the 12-year history of an international collaboration of researchers—the WHOQOL Group—who were brought together by the World Health Organisation to develop and produce a cross-cultural measure of quality of life for use in health and health care.Discussion:The theoretical and philosophical basis of the WHOQOL instrument is outlined as it evolved throughout the design and adjustment of a reflexive methodology that places an assessment of the users’ views at the centre of health care. The stages of research are further expanded and explained in recounting the scientific experience of this unique collaboration. The WHOQOL is available in 40 countries and most majority languages. Adaptations exist for assessing particular conditions, e. g. spirituality, religion and personal beliefs.

Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder

An emerging literature suggests that posttraumatic stress disorder (PTSD) patients are at an increased risk for suicide. The objective of this study was: a) to reexamine the relationship between PTSD and suicide by comparing suicide risks of persons with PTSD, to persons with anxiety disorder and to matched controls; and b) to examine the relationship between anger, impulsivity, social support and suicidality in PTSD and other anxiety disorders. Forty-six patients suffering from PTSD were compared with 42 non-PTSD anxiety disorder patients and with 50 healthy controls on measures of anger, impulsivity, social support, and suicide risk. Persons with PTSD had the highest scores on the measures of suicide risk, anger, and impulsivity and the lowest scores on social support. Multivariate analysis revealed that in the PTSD group, impulsivity was positively correlated with suicide risk and anger was not. PTSD symptoms of intrusion and avoidance were only mildly correlated with suicide risk at the bivariate level but not at the multivariate level. For the PTSD and anxiety disorder groups, the greater the social support, the lower the risk of suicide. For the controls, social support and impulsivity were not related to suicide risk, whereas anger was. These findings suggest that persons with PTSD are at higher risk for suicide and that in assessing suicide risk among persons with PTSD, careful attention should be paid to levels of impulsivity, which may increase suicide risk, and to social support, which may reduce the risk.

Self‐Efficacy and Social Support as Mediators in the Relation Between Disease Severity and Quality of Life in Patients with Epilepsy

Summary: Purpose: This study examined the influence of two psychosocial variables mediating between disease severity and quality of life (Qol) in epilepsy; social support and mastery (measured by locus of control and self‐efficacy). A model placing these two variables as mediators between disease severity and QoL was tested with structural equation modeling.

Post-traumatic symptoms, emotional distress and quality of life in long-term survivors of breast cancer: a preliminary research.

The present study is a preliminary study assessing long-term psychological effects in survivors of breast cancer. Thirty-nine long-term female survivors of breast cancer were compared with 39 matched women who had not been exposed to any chronic disease regarding post-traumatic stress disorder (PTSD), quality of life (QoL), emotional distress and coping styles. Survivors revealed significantly higher rates of full and partial PTSD, scored significantly higher on emotional distress, scored significantly lower on physical and psychological QoL and exhibited coping styles significantly different from those of the control group. PTSD was associated with the coping style of suppression. Multiple regression analysis showed that receiving chemotherapy and disease stage, as well as the interaction between chemotherapy and disease stage, were significant predictors of hyperarousal. The findings show that post-traumatic symptoms are a common sequel after recovery from cancer. Furthermore, finding suggest a conceptual distinction between PTSD symptoms and QoL in the study of long-term effects of cancer.

POSTTRAUMATIC STRESS DISORDER, TENDERNESS AND FIBROMYALGIA

The aims of the present study were to inquire into the prevalence of fibromyalgia syndrome, to assess nonarticular tenderness, to measure fibromyalgia syndrome-related symptoms, quality of life, and functional impairment among posttraumatic stress disorder (PTSD) patients as compared with control subjects. Furthermore, the differences between the PTSD patients with and without fibromyalgia syndrome were studied. Twenty-nine PTSD patients and 37 control subjects were assessed as to the diagnosis of fibromyalgia syndrome according to the American College of Rheumatology. Tenderness was assessed manually and with a dolorimeter. Fibromyalgia syndrome-related symptoms, quality of life, physical functioning, PTSD symptomatology, and psychiatric features were assessed by valid and reliable self-report inventories. Results showed that the prevalence of fibromyalgia syndrome in the PTSD group was 21% vs. 0% in the control group. Furthermore, the PTSD group was more tender than the control group. PTSD subjects suffering from fibromyalgia syndrome were more tender, reported more pain, lower quality of life, higher functional impairment and suffered more psychological distress than the PTSD patients not having fibromyalgia syndrome. It is suggested that previous reports on diffuse pain in PTSD in fact described undiagnosed fibromyalgia syndrome. The link between psychological stress and pain syndromes is emphasized.

POSTTRAUMATIC GROWTH AMONG HOLOCAUST CHILD SURVIVORS

The objective of this study was to examine the relationship between posttraumatic stress disorder (PTSD) symptomatology, personal resources, and posttraumatic growth (PTG) in Holocaust child survivors. Ninety-seven nonclinical Holocaust child survivors who were born after 1930 were administered self-report questionnaires with regard to PTG, psychological distress, potency, and perceived social support. Results indicated that arousal, a PTSD category, and PTG coexist. Personal resources were negatively correlated with PTSD symptomatology, and only social support from friends contributed positively to PTG.

Effect of transcranial magnetic stimulation in posttraumatic stress disorder: a preliminary study

BACKGROUND Transcranial magnetic stimulation (TMS) has become, over the last few years, a promising avenue for new research in affective disorders. In this study we have evaluated the clinical effect of slow TMS on posttraumatic stress disorder (PTSD) symptoms. METHODS Ten PTSD patients were given one session of slow TMS with 30 pulses of 1 m/sec each, 15 to each side of the motor cortex. RESULTS Symptoms of PTSD were assessed by using three psychological assessment scales, at four different time points. In this first, pilot, open study, TMS was found to be effective in lowering the core symptoms of PTSD: avoidance (as measured by the Impact of Event Scale), anxiety, and somatization (as measured by the Symptom Check List-90). A general clinical improvement was found (as measured by the Clinical Global Impression scale); however, the effect was rather short and transient. CONCLUSIONS The present study showed TMS to be a safe and tolerable intervention with possibly indications of therapeutic efficacy for PTSD patients.

Time does not heal all wounds: Quality of life and psychological distress of people who survived the Holocaust as children 55 years later

The present study assessed posttraumatic stress disorder (PTSD) symptoms, psychological distress, and subjective quality of life (QoL) in a group of 43 child Holocaust survivors and a community sample of 44 persons who had not personally experienced the Holocaust. The participants were administered the PTSD-Scale, the SCL-90, and the WHOQOL-Bref. Results showed that the child survivors had higher PTSD symptom scores, higher depression, anxiety, somatization, and anger–hostility scores; and lower physical, psychological, and social QoL than did the comparison group. The findings suggest that the psychological consequences of being a child during the Holocaust can be long lasting.