Oliver Toskovic

Psychometric evaluation of the Serbian version of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31)

PURPOSE To evaluate the psychometric properties of the Serbian-language version of the Quality of Life in Epilepsy Inventory-31 (QOLIE-31). METHODS After undergoing a translation and cultural adaptation of its items in order to create a Serbian-language version of QOLIE-31, we assessed its psychometric properties-reliability, construct validity and criterion validity. The sample consisted of 203 adults with epilepsy. Reliability was tested both by assessing the internal consistency and by the test-retest method. Construct validity was assessed by factor analysis, multitrait-scaling analysis and method of known-groups validation. This was achieved by assessing the relationship between scales and external measures (socio-demographic characteristics, seizure severity and etiology of epilepsy). Criterion validity was assessed by correlation analysis between QOLIE-31 and Short form 36 health survey (SF-36) and Neurotoxicity scale-II. RESULTS The domains showed high internal consistency (Cronbachs α 0.94). Test-retest reliability for Overall test score was 0.83 (Pearsons coefficient) indicating temporal stability. Seizure severity and etiology of epilepsy significantly influenced all QOLIE-31 domains except the Medication effect domain, with lowest scores in high seizure severity and symptomatic etiology groups. Employment status significantly influenced Overall quality of life, Emotional well-being, Social function and Overall score. Educational level was related to the Emotional well-being domain, with highest scores for students. The QOLIE-31 was highly positively correlated with SF-36 (rho=0.898) and strongly negatively correlated with Neurotoxicity scale-II (rho=-0.783). CONCLUSION Serbian adaptation of the QOLIE-31 questionnaire is reliable and valid for assessing the quality of life in patients with epilepsy.

Determinants of quality of life in people with epilepsy in Serbia

PURPOSE This study aimed at finding determinants of quality of life in people with epilepsy (PWE) living in Belgrade, Serbia. METHOD In this study, we recruited consecutive adults with epilepsy attending our outpatient department. Adult patients (age range: 18-65years) of normal intelligence and without any progressive neurological disease or psychiatric disorder were included in the study. They completed the following questionnaires: QOLIE-31 Inventory (Serbian version), Becks Depression Inventory-II, Becks Anxiety Inventory, Symptom Check List-90, and Neurotoxicity Scale-II. Hierarchical multiple regression analysis was performed to assess the predictive effects of some factors on QOLIE-31 Inventory. RESULTS The mean QOLIE-31 score of 203 patients who completed the questionnaires was 70.64±17.74. Sociodemographic factors (age, sex, education, and employment) did not significantly predict QOLIE-31 score. Significant determinants of quality of life were clinical characteristics - seizure severity and etiology of epilepsy - accounting for 30.9% of the variance, depressive and anxiety symptoms accounting for 42.8% of the variance, and cognitive effects of antiepileptic drugs, accounting for 1.5% above other variables. CONCLUSIONS The results suggest that seizure severity and etiology of epilepsy, depressive and anxiety symptoms, and cognitive adverse medication effects are main determinants of quality of life in this population of PWE.

Nature based solution for improving mental health and well-being in urban areas

Abstract The general disproportion of urban development and the socio‐economical crisis in Serbia, followed by a number of acute and chronic stressors, as well as years of accumulated trauma, prevented the parallel physical, mental and social adaptation of society as a whole. These trends certainly affected the quality of mental health and well‐being, particularly on the vulnerable urban population, increasing the absolute number of people with depression, stress and psychosomatic disorders. This study was pioneering in Serbia and was conducted in collaboration with the Faculty of Forestry, the Institute of Mental Health and the Botanical Garden in Belgrade, in order to understand how spending time and performing horticulture therapy in specially designed urban green environments can improve mental health. The participants were psychiatric patients (n=30), users of the day hospital of the Institute who were randomly selected for the study, and the control group, assessed for depression, anxiety and stress before and after the intervention, using a DASS21 scale. During the intervention period the study group stayed in the Botanical garden and participated in a special programme of horticulture therapy. In order to exclude any possible “special treatment” or “placebo effect”, the control group was included in occupational art therapy while it continued to receive conventional therapy. The test results indicated that nature based therapy had a positive influence on the mental health and well‐being of the participants. Furthermore, the difference in the test results of the subscale stress before and after the intervention for the study group was F1.28 = 5.442 and p<;.05. According to socio demographic and clinical variables, the interesting trend was recorded on the subscale of anxiety showing that the male participants in the study group were more anxious, with the most pronounced inflection noted on this scale after treatment. The results of this study have shown that recuperation from stress, depression and anxiety was possible and much more complete when participants were involved in horticulture therapy as a nature‐based solution for improving mental health. HighlightsThe patients with stress‐related mental disorders were included in pioneering HT study in Serbia.The horticulture therapy was associated with reduction of the self‐rated levels of stress.We identify an interesting trend on anxiety subscale among male participants in the study group.Nature‐based therapy is recommended to psychiatric patients as a form of occupational or supportive therapy.The Jevremovac Botanical Garden was recognized as a setting for mental health promotion in Belgrade.

Posttraumatic stress disorder in a Serbian community: seven years after trauma exposure.

Abstract Posttraumatic stress disorder (PTSD) may develop as a serious long-term consequence of traumatic experiences, even many years after trauma exposure. The objectives of this study were to examine the prevalence of lifetime and current PTSD as well as to detect the most stressful life events and sociodemographic risk factors of PTSD in a general adult Serbian population. The sample consisted of 640 subjects chosen by random walk technique in five regions of the country. The Mini International Neuropsychiatric Interview 5 revealed an 18.8% prevalence rate of current PTSD and a 32.3% prevalence rate of lifetime PTSD. According to the Life Stressor Checklist–Revised, the bombardment, being expelled from home, siege, and participation in combat were the stressful events most likely to be associated with PTSD. The prevalence of PTSD increased among widows and widowers, divorced persons, unemployed persons, and retired persons. The high level of PTSD a few years after the trauma exposure classifies as a significant health problem that can cause serious consequences for families and the community as a whole.

Comparative study of experienced and anticipated stigma in Serbia and the world

Aim: The presented study is part of the International Study of Discrimination and Stigma Outcomes (INDIGO) conducted in 28 countries. The aim of this study was to compare the degree of experienced and anticipated stigma of patients with schizophrenia in Serbia with world results. Method: The Discrimination and Stigma Scale (DISC) was applied in individual interviews. The sample comprised 732 subjects of the main study and 50 subjects from Serbia. Results: The amount of negative experienced discrimination in Serbia is the same as in other participating countries. The Serbian sample shows more negative discrimination in intimate relationships, personal safety and general harm due to the diagnosis, but more positive discrimination within the family, privileges during treatment of somatic illnesses, and benefits enjoyed in social and retirement insurance. The Serbian sample shows less anticipated discrimination in looking for a close relationship and in stopping self from applying for work. The results show that socio-demographic variables could not predict negative experienced and anticipated discrimination, while those same variables enable the prediction of 34% of positive discrimination. Conclusion: Compared to other investigated countries, stigmatization processes for persons with schizophrenia do not differ considerably in Serbia, which justifies the implementation of unique anti-stigma programmes and joint upgrading of legal regulations.

Experienced and anticipated discrimination among people with major depressive disorder in Serbia

Background: Experiences of discrimination have significant impact on the lives of people with mental illness. Aim: This study investigates the nature and severity of experienced and anticipated discrimination reported by persons with a depressive disorder in Serbia. Methods: Patients were recruited from two psychiatric day hospitals and a primary mental health service with a diagnosis of major depressive disorder. Interviews were conducted using a socio-demographic questionnaire and the Discrimination and Stigma Scale. Results: The respondents experienced discrimination mostly in the field of family relationships, making and keeping friends and keeping a job. In domains of making close personal relationships or applying for education, anticipated discrimination was higher than experienced. The need to conceal mental health problems was stronger than experiences of being avoided. The need to hide mental health problems was higher than the overall score for experienced discrimination. Participants who were hospitalized in some period of life reported higher experienced discrimination. Compared to younger participants, older participants experienced more negative as well as positive discrimination. Married participants experienced more negative discrimination than unmarried. Conclusion: It is important to design interventions to overcome discrimination toward persons with depression at all levels.

Do Austerity Measures Harm International Trade

The aim of this study was to explore extensity (regarding various life domains in which it appears) and intensity of experienced and anticipated discrimination of persons with physical disabilities; (2) to investigate how experienced and anticipated discrimination relate to each other; (3) to explore relations between experienced and anticipated discrimination and certain socio demographic variables (gender, marriage, residence, family type, employment and age). The levels of experienced and anticipated stigmatization were evaluated by Discrimination and Stigma Scale (DISC – 12). The results showed that persons with physical disability experience discrimination in family life (63. 3%), (starting a family (65. 5%), marriage (45. 4%), role as a parent (45. 3%), in the experience of being avoided or shunned (42. 1%), in relation to professional staff (40. 3%), etc. They anticipate discrimination in making close relationships (46. 3%), in employment (30. 2%) and in education (24. 3%). Multiple regression analysis showed that experienced discrimination is a predictor of anticipated discrimination. Discrimination is more anticipated by unmarried participants, younger, participants living in extended families and by participants not living in their own apartments. It is necessary to design an anti-stigma campaign, which will lead to the reduction of experienced and anticipated discrimination. Keywords: stigma, experienced discrimination, anticipated discrimination, persons with physical disability.

Experienced and anticipated discrimination against people with schizophrenia

Aim of this research was to describe the nature, direction and severity of anticipated and experienced discrimination reported by people with schizophrenia. We applied interview to 50 patients with diagnosis of schizophrenia in two psychiatric hospitals in Belgrade. Discrimination was measured with discrimination and stigma scale (DISC) which produce 3 subscores, positive experienced discrimination, negative experienced discrimination and anticipated discrimination. The same scale was used in cross-cultural research in 27 european countries. Results have shown that participants from Serbia do not recognize discrimination in all areas of life equally. The discrimination recognized is more frequentlly negative then positive and is associated with existentially important realms of life. Due to anticipated discrimination participants in our study prevent themselves from looking for a close relationship. Anticipated discrimination could not be predicted on the grounds of experienced, positive or negative discrimination.

Assessment of grammar comprehension: Adaptation of TROG for Serbian language

In this study we present our adaptation and preliminary standardization of Test for Reception of Grammar TROG (Bishop, 1989) for Serbian language. TROG is a receptive test of grammatical structures, constructed primarily for an assessment of grammatical development and detection of children with Specific Language Impairment (SLI). Due to the lack of standardized tests for language development in our clinical community, TROG is selected for adaptation as a test which includes two components relevant for discrimination of children with language difficulties: a) measure of receptive abilities and b) distinguishing knowledge of grammar from semantic aspect of comprehension. Preliminary standardization was done on a sample of 335 participants between 4 and 7 years of age, divided into 8 age subsamples. Since dynamic of language change at early ages is faster, age samples covered range of 3 months at the ages 4;0-4;2, 4;3-4;5, 4;6-4;8, 4;9-4;11, and range of 6 months at the ages 5;0-5;5, 5;6-5;11, 6;00-6;05, 6;06-6;11. Analyses have revealed that the first version of Serbian TROG is discriminative for the differences between age samples, but discrimination is smaller then it was expected. The test discriminates three age-samples (4;0-4;8, 4;9-5;5, and 5;6-6;11). It is easier for the children older then 5 years, which causes statistical significance of discrimination to tilt within a narrow margin around 0,05. Reliability of the whole instrument is estimated very high - between 0,86 and 0,91, depending on the method of estimation. However, reliability estimated for particular blocks (grammatical structure) revealed that internal consistency of blocks is not homogeneous. This finding prevents reliable estimation of competence for particular structures, and makes difficult to define which contrast is understood by a child and which is not. Furthermore, internal inconsistency of blocks may also be additional source of low discrimination of test for children older then 5. Further improvement of test, balancing of items and inclusion of additional grammatical structures in order to get a wider range of age discrimination is required. This will be done in future research.