Marion Freidl

What does the WHOQOL-Bref measure?

IntroductionQuality of life has become an important outcome criterion for psychiatric interventions. Especially in chronic disorders with no complete recovery, the improvement of quality of life is an important treatment goal. Nevertheless, there are methodological problems in assessing quality of life. There is a possible measurement overlap between quality of life and psychopathology, especially depression, which may invalidate research results. This study addresses the quality of life of patients with chronic somatoform pain and its relation to depressive symptoms.MethodOne hundred out-patients with somatoform pain disorder at the Behavioural Medicine Pain Clinic in the Department of Psychiatry of the Medical University of Vienna were diagnosed using the SCID for Diagnostic and Statistical Manual of Mental Disorder (DSM-IV). The patients filled out the World Health Organisation Quality of Life Assessment-Bref (WHOQOL-Bref) and the Beck Depression Inventory (BDI). Pain intensity (average pain, maximum pain, minimal pain) and disability (work, leisure and family life) were assessed using visual analogue scales.ResultsQuality of life in somatoform pain disorder was reduced compared to the norm population, especially in the physical and psychological domains. There were highly significant negative correlations between, on the one hand, depressive symptomatology (BDI) and, on the other hand, the physical quality of life domain (r=−0.655, p<0.01), the psychological domain (r=−0.735, p<0.01), the social domain (r=−0.511, p<0.01) and the environmental domain (r=−0.561, p<0.01). In all domains of the WHOQOL-Bref and in the global score, significant differences between the group of patients with severe or very severe depressive symptoms and the group with no or only mild depressive symptoms were found.DiscussionWhile the WHOQOL-Bref showed a poor quality of life of patients with chronic somatoform pain disorder in general and especially in the physical and in the psychological domains, the high correlation of physical and psychological quality of life scores with depressive symptomatology points to a measurement overlap. It is suggested that assessment of subjective quality of life should always be checked for the influence of depressive symptomatology on the quality of life score.

The "carers' needs assessment for Schizophrenia": an instrument to assess the needs of relatives caring for schizophrenia patients.

ObjectiveFor the purpose of service planning, an instrument was developed for the systematic assessment of interventions needed by the caregivers of schizophrenia patients.MethodThe development of this instrument was based on in-depth interviews and focus groups. It consists of 18 areas describing common problems of schizophrenia caregivers. For each of these problem areas several possible interventions are offered. Concurrent validity, inter-rater and retest reliability were tested among 50 caregivers.ResultsThe kappa values for the inter-rater reliability are predominantly excellent (kappa > 0.75). The values for the retest reliability show a wide range between excellent (kappa > 0.75) and fair agreement (kappa 0.40–0.60). The significant correlations found between summary scores of this new instrument and several sub-scales of the Family Problem Questionnaire support the assumption that the concurrent validity is satisfactory.ConclusionThese results suggest that this instrument is both valid and reliable.

How psychiatric patients perceive the public's stereotype of mental illness.

Abstract.Background: It is well established that the general public has devaluating attitudes towards psychiatric patients. In order to avoid rejection, many of these patients develop coping strategies, such as withdrawal and concealing their treatment history. These efforts are in themselves stressing, which might have negative consequences for the course of the disorder. It is not clear, however, how many and which patients do actually perceive the publics stereotype as threatening and, therefore, expect rejection. Method: Ninety psychiatric patients and a sample of 1042 persons of the Austrian general population were asked whether they agreed with five devaluating statements about mental patients contained in a questionnaire developed by Link et al. Matched pairs comparisons and multiple logistic regression were employed in order to find out whether patients agreed with these statements to the same extent as the general population did. Results: For the statements that most people believe that psychiatric patients are “less intelligent”, “less trustworthy” and “taken less seriously”, patients thought significantly less often than the general population that most people devalue mental patients. For two statements (“personal failure”, “think less of”) no difference was found. Conclusions: It seems that some psychiatric patients are less convinced than the general population that most people devalue psychiatric patients in specific respects; these patients might fear rejection less than other patients do. Those who actually fear rejection might need antistigma assistance more urgently than the first group.

The stigma of mental illness: Anticipation and attitudes among patients with epileptic, dissociative or somatoform pain disorder

The aim of this study was to survey the attitudes of 101 consecutive in- and out-patients with epileptic, dissociative or somatoform pain disorders (mean age: 43 [±11] years; 58% female) from either the Department of Psychiatry or Neurology toward anticipated mental illness stigma. The patients were administered a modified 12-item version of Links Stigma Questionnaire. Nearly 60% of all 101 patients believe that “most people” would not allow a mental patient “to take care of their children”, “most young women” would be “reluctant to date a man” who has been treated for a mental illness and “most employers would pass over” the application of a psychiatric patient in favour of another applicant. Fifty five percent of the respondents assume that “most people think less of a person who has been in a mental hospital” and over a half of all patients interviewed assert that the general population thinks that psychiatric patients are “less intelligent, less trustworthy and that their opinion is taken less seriously by others”. Gender, age and education had no influence on the overall results. There is a high stigmatisation concerning psychiatry even in patients with epilepsy and somatoform/dissociative symptoms with psychiatric comorbidity. Fear of being stigmatized is more pronounced among somatoform pain patients as compared to patients suffering from epileptic or dissocative disorders, with particular reference to close personal relationships.

Gender aspects of parents' needs of schizophrenia patients.

BackgroundMost studies about the problems and needs of schizophrenia carers included only one care-giving relative, usually the patients’ mothers.Methods101 mothers and fathers of the same patients suffering from schizophrenia were included into this study. Their needs were assessed by means of the “Carers’ Needs Assessment for Schizophrenia”.ResultsMothers reported significantly more often problems than fathers concerning stress due to earlier life events and burn-out. Mothers needed interventions such as individual psychoeducation or family counselling more than twice as often as fathers. Overall, mothers reported higher numbers of problems and needs for intervention than fathers. The number of mothers’ problems was predicted by not living with a partner and by a shorter duration of the patients’ illness. The number of mothers’ needs was predicted by more psychiatric symptoms, not living with a partner and a shorter duration of the patients’ illness. Among fathers we could not identify any predictors, neither for the number of problems nor for the number of needs.ConclusionsFathers and mothers often report problems and frequently need professional support. Overall, mothers exhibited more problems and needs for interventions than fathers. The differences between mothers and fathers indicate the importance of considering the carer’s gender in clinical work.

How depressive symptoms correlate with stigma perception of mental illness

Introduction: The aim of this study was to survey the attitudes of 115 patients with the diagnosis of somatoform pain disorder, toward anticipated discrimination and mental illness stigma and how it is influenced by depressive symptoms. Method: 115 consecutive in- and outpatients with somatoform pain disorder (mean age: 50 ± 11 years; 62% female) from the Department of Psychiatry and Psychotherapy, Medical University of Vienna, were administered a modified 12-item version of Links Perceived Stigma Questionnaire and the Beck Depression Inventory. Results: With regard to close personal relationships, such as taking care of children or dating, somatoform pain patients showed a rather high perceived stigma score (over 70% for both items). Also nearly 70% think that ‘most employers’ would pass over the application of a psychiatric patient in favour of another applicant. The overall results show a significant correlation with depressive symptoms (r = 0.228 and p = 0.014). Conclusion: Fear of stigma increases with depressive symptoms and both are a risk for treatment delay. The goal of future research should be the question how to reduce subjective stigma experiences of the patients affected in order to help them enter psychiatric treatment early and gain self-confidence and mental health back again.

High prevalence of restless legs syndrome in somatoform pain disorder

Patients with somatoform pain often complain of sleep disorders, but sleep disorders are not an integrated part of the diagnosis of this disorder. Restless legs syndrome is associated with painful symptoms and sleep disturbances. The aim of our study was to evaluate the prevalence of restless legs syndrome (RLS) in somatoform pain disorder. Method In this study 100 consecutive patients (mean age: 46.4; SD: 11.4; women: 58) diagnosed with somatoform pain disorder (SPD) were clinically investigated for the occurrence of RLS at the behavioral medicine clinic for pain outpatients in the department of psychiatry within the Medical University of Vienna. The pain parameters of SPD were assessed using a pain questionnaire and visual analogue scales (VAS). The severity of RLS was established using the questionnaire of the International Restless Legs Syndrome Study Group (IRLSSG). Results The prevalence of restless legs syndrome found in somatoform pain disorder was 42%. Interrupted sleep was found in 83.3% in somatoform pain disorder with comorbid RLS and in 64.1% in somatoform pain disorder without RLS. Patients with continuous somatoform pain had a significant higher occurrence of RLS (Sample: 55%; with RLS: 71.4% and without RLS: 43.1%). The pain parameters increased parallel to the severity of RLS. Additionally, RLS was associated with higher psychosocial disability in family life. Conclusions The prevalence of RLS is high in our sample of patients with somatoform pain disorder. There seems to be a difference in pain profile between patients with and without RLS. RLS may increase the pain level and prolong pain in somatoform pain disorder. RLS should be considered when a somatoform pain disorder is diagnosed.

Sleep Disturbances in Somatoform Pain Disorder

Patients with chronic somatoform pain often complain about sleep disorders. However, sleep disorder/disturbances are not an integrated part of the somatoform disorders in the DSM-IV and the ICD-10. Sleep is important for recreation. Deprivation of deep sleep stages is experimentally linked to muscle pain. Therefore, sleep disorder may play an important part in the persistence of somatoform pain disorder. The aim of the study was to evaluate the frequency of sleep disorder in patients with somatoform pain disorder and to correlate it with comorbid depression, pain parameters and psychosocial parameters. Method: In this study, 147 patients (mean age: 48.8 years; SD: 11.0) with the diagnosis of a somatoform pain disorder were studied with regard to affective comorbidity, pain duration (months), maximum pain within the last month, minimum pain within the last month and medium pain within the last month, psychosocial disability within the last month and the presence of a sleep disorder. Results: Eighty-four percent of the patients had a sleep disorder. The patients with a sleep disorder had significantly higher maximum and medium pain, a significantly higher level of psychosocial disability and a significantly lower overall subjective well-being. The medium pain and psychosocial disability in leisure and social activities are significant predictors for sleep disorder. Conclusions: The presence of a sleep disorder may be a hint for higher pain intensity and a higher level of psychosocial disability. Sleep disorder may be a factor in the persistence and aggravation of pain as well as psychosocial disability. Therefore, sleep disorder should be integrated in the therapeutic targets. It is suggested that sleep disorder should be a diagnostic criterion in somatoform pain disorder.

Effects of Clinical Decision Topic on Patients’ Involvement in and Satisfaction With Decisions and Their Subsequent Implementation

OBJECTIVE Clinical decision making is an important aspect of mental health care. Predictors of how patients experience decision making and whether decisions are implemented are underresearched. This study investigated the relationship between decision topic and involvement in the decision, satisfaction with it, and its subsequent implementation from both staff and patient perspectives. METHODS As part of the Clinical Decision Making and Outcome in Routine Care for People With Severe Mental Illness study, patients (N=588) and their providers (N=213) were recruited from community-based mental health services in six European countries. Both completed bimonthly assessments for one year using the Clinical Decision Making in Routine Care Scale to assess the decision topic and implementation; both also completed the Clinical Decision Making Involvement and Satisfaction Scale. RESULTS Three categories of decision topics were determined: treatment (most frequently cited), social, and financial. The topic identified as most important remained stable over the follow-up. Patients were more likely to rate their involvement as active rather than passive for social decisions (odds ratio [OR]=5.7, p<.001) and financial decisions (OR=9.5, p<.001). They were more likely to report higher levels of satisfaction rather than lower levels for social decisions (OR=1.5, p=.01) and financial decisions (OR=1.7, p=.01). Social decisions were more likely to be partly implemented (OR=3.0, p<.001) or fully implemented (OR=1.7, p=.03) than not implemented. CONCLUSIONS Patients reported poorer involvement, satisfaction, and implementation in regard to treatment-related decisions, compared with social and financial decisions. Clinicians may need to employ different interactional styles for different types of decisions to maximize satisfaction and decision implementation.

Psychiatric illness and length of stay in general hospitals: do case finding methods matter?

SummaryObjectiveSeveral prior studies have investigated whether patients with “non-cognitive” mental disorders (i.e., organic disorders, substance abuse, delirium, and psychotic disorders excluded) have longer Length Of Stay (LOS) than mentally healthy individuals in nonpsychiatric hospital settings. These studies yielded contrasting results. The present paper aims to examine whether methods of psychiatric case finding can explain these differences.MethodsUsing the Clinical Interview Schedule (CIS) and the General Health Questionnaire (GHQ), 462 in-patients of medical, surgical, gynecological, and rehabilitation departments were assessed for the presence of psychiatric disorders.ResultsIn multiple regression analysis, all CIS-cases together did not show an association with LOS. Of the diagnostic groups assessed by CIS only major depression showed a significantly prolonged LOS. Using the GHQ sum-score as a continuous variable, LOS was significantly increased while using the GHQ as a dichotomous variable did not show such an association. After removing those suffering from multiple psychiatric diagnoses (such as major depression co-morbid with organic mental illness), none of the case definitions showed a significant association with LOS.ConclusionsIt seems that different case finding methods yield different results concerning the association of psychiatric disorders with LOS. When interpreting these results the small size of some subsamples must be taken into consideration.ZusammenfassungZielDie Frage, ob Patienten von nicht-psychiatrischen Krankenhausabteilungen, die unter “nicht-kognitiven” psychischen Erkrankungen leiden, einen längeren Krankenhausaufenthalt als psychisch Gesunde haben, wurde mehrfach untersucht. Die Studien lieferten aber widersprüchliche Ergebnisse. Die vorliegende Auswertung geht der Frage nach, ob verschiedene Methoden der Fallfindung die unterschiedlichen Ergebnisse verursachen.MethodikDie Clinical Interview Schedule (CIS) und der General Health Questionnaire (GHQ) wurden bei 462 stationären Patienten von internen, chirurgischen, gynäkologischen und somatisch-rehabilitativen Abteilungen verwendet, um das Vorhandensein von psychischen Krankheiten zu erfassen.ErgebnisseAlle CIS-Fälle zusammen zeigten in multiplen Regressionsanalysen keinen signifikanten Zusammenhang mit der Aufenthaltsdauer. Von allen diagnostischen Kategorien, die mittels CIS erfasst wurden, zeigte ausschließlich die Major Depression eine signifikant verlängerte Aufenthaltsdauer. Wenn der GHQ-Summenscore als kontinuierliche Variable verwendet wurde, zeigte sich ein signifikant positiver Zusammenhang mit der Aufenthaltsdauer. Wenn der GHQ aber dichotomisiert verwendet wurde, konnte ein solcher Zusammenhang nicht gefunden werden. Wenn Patienten mit multiplen psychiatrischen Diagnosen (beispielweise Depression plus psycho-organische Erkrankung) ausgeschlossen wurden, verschwanden alle Zusammenhänge mit der Aufenthaltsdauer, unabhängig von der verwendeten Falldefinition.SchlussfolgerungenDie vorliegenden Ergebnisse bestätigen die Vermutung, dass unterschiedliche Methoden der psychiatrischen Fallfindung die statistischen Zusammenhänge mit der Aufenthaltsdauer beeinflussen. Allerdings muss berücksichtigt werden, dass manche Teilstichproben in den vorliegenden Auswertungen relativ klein waren.