Nikola Stenzel

What is “normal” disability? An investigation of disability in the general population

ABSTRACT Many studies have investigated the highly relevant association between pain and disability in clinical groups using the Pain Disability Index (PDI). To interpret these results, knowledge of disability in the general population is crucial. Moreover, to investigate criterion validity of the PDI, the influence on health care utilisation (HCU) is of special interest. In the present study, a broadened version of the PDI was psychometrically evaluated with a large representative sample of the general population. The independent impact of disability on HCU was also investigated. A representative sample of the German general population (N = 2510) was screened for disability, somatic complaints, mental health (PHQ) and HCU. Following a psychometric evaluation of the PDI, data are provided about the distribution of disability in the general population. For the prediction of HCU, stepwise linear regression analysis was calculated. The psychometric evaluation of the PDI revealed a one‐factor solution, high reliability, and satisfactory construct validity. Percentage scores for the distribution of disability are provided for those people reporting at least one pain/somatic symptom. These data allow a better description of disability in clinical samples. Somatic complaints, disability, unemployment or retirement, depression and anxiety explained 26% of the variance for HCU. The PDI is an economical, reliable and valid self‐rating instrument for assessing disability caused by physical symptoms. HCU in the general population is determined by the number and severity of somatic complaints and also by disability. Symptoms and disability play a crucial but somewhat independent role.

Emotion regulation is the essential skill for improving depressive symptoms

BACKGROUND For decades, research has shown that various skills (e.g., social skills) are associated with depressive symptoms. In recent years, much work has focused on skills for regulating emotion. Unfortunately, nearly all of these studies have investigated isolated skills. By contrast, the aim of the present study was the combined assessment of multiple skills in order to simultaneously analyze their relevance for depressive symptomatology. The authors wanted to identify skill domains that are essential for improving depressive symptoms. METHODS The sample consisted of N=124 inpatients assessed at admission and discharge. Seven different skills were measured using a structured multidimensional interview. In addition, the severity of depressive symptoms was assessed. RESULTS Correlations between the improvements in skills and depressive symptoms reached significance for every skill domain ranging from r=.21 to r=.54. A multiple hierarchical regression analysis was conducted with pre-treatment scores of skills. Compared to other domains, only emotion regulation significantly predicted the improvement of depressive symptomatology. Moreover, emotion regulation at pre-treatment turned out to be a moderator of the association between improvements in skills and the reduction of depressive symptoms. LIMITATIONS Because this study primarily focused on skills, no conclusions can be drawn regarding the relevance of these skills in relation to other predictors of therapy outcome. CONCLUSIONS Even when various skills are tested simultaneously, emotion regulation appears to be the essential skill influencing depressive symptom improvement. Therefore, a targeted enhancement of this skill may help to optimize the outcome regarding the treatment of depressive symptomatology.

The impact of chronic obstructive pulmonary disease-related fears on disease-specific disability

Anxiety is frequently observed in persons with chronic obstructive pulmonary disease (COPD). Although anxiety in persons with COPD is multifaceted, it is mostly assessed as a general psychopathological condition. Consequently, the objectives of this study were to revise an existing questionnaire assessing relevant anxieties for use in clinical practice and research, to examine the association between COPD-related fears and disability, and finally to develop norms for COPD-related fears. Disease severity (Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, use of long-term oxygen), sociodemographic characteristics, COPD-specific disability (COPD assessment test), and psychopathology (depression, general anxiety, somatoform symptoms, and disease-related fears) were obtained from a sample of 1025 individuals with COPD via the Internet. We used the COPD Anxiety Questionnaire (German: CAF) for the assessment of different fears that have been found to be relevant in COPD: fear of dyspnea, fear of physical activity, fear of progression, fear of social exclusion, and sleep-related worries. Mean COPD-specific disability was high (22.87). After explanatory and confirmatory factor analyses, a revised version of the CAF was constructed. The economical and user-friendly CAF-R showed adequate reliability and expected correlations with convergent and discriminant constructs. Gender-specific norms are provided for use in clinical practice and research. Even after controlling for GOLD stage, sociodemographic variables, and psychopathology, COPD-related fears contributed incrementally to disease-specific disability. The CAF-R is an economical and reliable tool to assess different specific fears in COPD. Results indicate that disease-specific fears have an impact on disability, supporting the assumption that detailed assessment of anxiety in COPD should be included in clinical practice.

Therapieplanung mithilfe des Interviews zur operationalisierten Fertigkeitsdiagnostik (OFD)

Hintergrund: In der Verhaltenstherapie wird sowohl mit stÖrungsspezifischen als auch mit diagnoseÜbergreifenden Interventionen gearbeitet. Letztere dienen oft dem Aufbau spezieller Fertigkeiten wie sozialer Kompetenz oder Emotionsregulation. Mit dem Interview «Operationalisierte Fertigkeitsdiagnostik zur Therapieplanung» (OFD) lassen sich sieben Fertigkeiten in vier Lebensbereichen erfassen: ProblemlÖsen, soziale Kompetenz, StressbewÄltigung, Emotionsregulation, EntspannungsfÄhigkeit, Selbstwirksamkeit, Selbstwert. Patienten und Methoden: In der vorliegenden Studie wurde die psychometrische QualitÄt des Interviews an einer klinischen Stichprobe (N = 111) ÜberprÜft. Ergebnisse: Die Ergebnisse einer frÜheren, nichtklinischen Studie ließen sich weitgehend bestÄtigen. Es ergaben sich gute ReliabilitÄten. Konfirmatorische Faktorenanalysen bestÄtigten grÖßtenteils die Struktur des Interviews. Etablierte FragebÖgen belegen weitgehend dessen ValiditÄt. ZusÄtzlich erwiesen sich die BeurteilerÜbereinstimmung und die ÄnderungssensitivitÄt als gut. Schlussfolgerung: Das OFD ist ein valides Instrument zur differenzierten Erfassung von Fertigkeiten, das zur Indikationsstellung eingesetzt werden kann.

For better or for worse: a longitudinal study on dyadic coping and quality of life among couples with a partner suffering from COPD

In chronic obstructive pulmonary disease, impairments of dyadic coping are associated with reduced quality of life. However, existing studies have a cross-sectional design. The present study explores changes in dyadic coping over time and its long-term effects on quality of life of both patients suffering from COPD and their partners. Dyadic coping, psychological distress, health-related quality of life, and exercise capacity were assessed in 63 patients suffering from COPD with their partners, at baseline and 3-year-follow-up. Correlation analyses and actor-partner interdependence models (APIMs) were conducted. Patients’ delegated dyadic coping (taking over tasks) and common dyadic coping (mutual coping efforts when both partners are stressed) rated by the spouses decreased. Correlation analyses showed that patients’ quality of life at follow-up was positively influenced by partners’ stress communication (signaling stress). Partners’ quality of life at follow-up was negatively influenced by patients’ negative dyadic coping (reacting superficially, ambivalently or hostilely) and positively influenced by partners’ delegated dyadic coping rated by patients (taking over tasks). APIMs mostly supported these results. It seems important that both partners communicate about stress and provide appropriate instrumental and emotional support to maintain quality of life.

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

Objective: Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal’s common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status. Methods: Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the ‘KKG questionnaire for the assessment of control beliefs about illness and health’. Multiple linear regressions were calculated. Results: The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life. Conclusion: Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.

Illness perceptions and coping with disease in chronic obstructive pulmonary disease: Effects on health-related quality of life

This study investigated the effects of illness perceptions and coping with disease on health-related quality of life in chronic obstructive pulmonary disease. Therefore, participants (N = 444) completed online questionnaires assessing illness severity (chronic obstructive pulmonary disease stage), Illness Perceptions Questionnaire, coping with disease (Essener Coping Questionnaire), and health-related quality of life (short form-12). Hierarchical regression and moderation analyses were conducted. The results showed that health-related quality of life was predicted by illness perceptions and several aspects of coping with disease. The association between illness perceptions and health-related quality of life was mediated by the corresponding coping with disease subscales. It is concluded that in order to prevent decreasing health-related quality of life in chronic obstructive pulmonary disease, treatment may be adjusted by promoting coping with disease and functional illness perceptions.

Prediction of end-of-life fears in COPD – hoping for the best but preparing for the worst

Objective: The diagnosis of a life-threatening illness can trigger end-of-life fears. Early studies show that end-of-life fears play an important role in chronic obstructive pulmonary disease (COPD). However, predictors of these fears have not yet been identified. This study investigated the relevance of socio-demographic variables, illness severity, psychological distress and disease-specific anxieties as predictors of end-of-life fears in COPD. Design: A total of 131 COPD patients participated at two time points. Regression and mediation analyses, as well as cross-lagged panel analyses were conducted. Main outcome measures: The participants completed questionnaires assessing end-of-life fears (Multidimensional Orientation toward Dying and Death Inventory), psychological distress (Hospital Anxiety and Depression Scale), and disease-specific anxieties (COPD Anxiety Questionnaire). Pulmonary function and a 6-min walk test served as measures of illness severity. Results: Illness severity was not predictive of end-of-life fears. However, gender and psychological distress explained incremental variance. When disease-specific anxieties were included as additional predictors, psychological distress was no longer significant. Cross-lagged panel analyses mostly supported these results. Moreover, disease-specific anxieties mediated the association between psychological distress and end-of-life fears. Conclusion: Administration and intensity of end-of-life care (especially concerning end-of-life fears) in COPD patients should be based not only on illness severity, but rather on psychological distress and disease-specific anxieties.

With the strength to carry on: The role of sense of coherence and resilience for anxiety, depression and disability in chronic obstructive pulmonary disease.

People with chronic obstructive pulmonary disease (COPD) are affected by somatic as well as psychological symptoms such as anxiety and depression and reduced quality of life. Protective psychological factors exist which enable people to adapt successfully to disease, but research about these factors in COPD is sparse. The aim of this study was to investigate whether sense of coherence (SOC), resilience and social support are potential protective factors and thus associated with reduced levels of symptoms of anxiety and depression and lower perceived disability in people with COPD. An online study was conducted in which n = 531 participants with COPD completed questionnaires assessing protective psychological factors, anxiety and depressive symptoms (Hospital Anxiety and Depression Scale) and disease-specific disability (COPD Disability Index). Regression analyses were conducted. SOC and resilience contributed significantly to reduced levels of symptoms of anxiety and depression and to lower disease-specific disability after controlling for confounding variables and disease severity. Symptoms of anxiety and depression were most strongly predicted by SOC. This study’s results indicated that SOC and resilience could represent helpful individual resources due to their protective potential helping people adjust to COPD. Limitations and implications of this study are discussed.

The Relationship Between Skill Deficits and Disability–A Transdiagnostic Study

OBJECTIVE Transdiagnostic skills (e.g., emotion regulation, stress management) and related self-concepts (e.g., self-esteem) are associated with the pathogenesis and course of different mental disorders. Evidence suggests that skill deficits coincide with not only specific psychopathology but also psychological strain and disability. So far, studies examining the relevance of several skills for a patients disability are lacking. The aim of the present study was the combined assessment of 7 skills and self-concept variables to simultaneously analyze their relevance for disability. METHOD We interviewed inpatients (N = 183) both on admission and discharge to assess 7 specific skills, 7 areas of daily living disability, and psychopathological distress. RESULTS Results support a relationship between several skills and disability (especially stress management), even while controlling for psychopathology. The improvement of skills and related self-concepts during therapy contributed substantially to the improvement of disability ratings. CONCLUSION This study highlights the transdiagnostic importance of skills as well as the improvement of skills and related self-concepts as major determinants of disability. Parts of these effects are robust, even while controlling for psychopathology.