Predictors of quality of life in patients with eating disorders.

BACKGROUND: The aims of this study were to analyse the quality of life (QoL) of a broad sample of patients with eating disorders (ED) and to identify potential factors that predict QoL. METHODS: This prospective cohort study involved 528 patients diagnosed with ED and treated over a 15-year period in the Eating Disorders Outpatient Clinic. Information on sociodemographic and clinical data were gathered. Patients completed five self-administered instruments: the Eating Attitudes Test-26 (EAT-26); the Eating Disorder Diagnostic Scale (EDDS); the Hospital Anxiety and Depression Scale (HADS); the Short-Form 12 (SF-12); and the Quality of Life in ED-short form (HeRQoLED-s). Descriptive, univariate analyses and multivariate linear regression models were applied to identify factors associated with QoL. RESULTS: Predictive variables for a low level of QoL in patients with anorexia nervosa (AN) included antidepressant treatment (P=0.009), substance abuse disorder, (P=0.03) and other organic comorbidities (P<0.0001). For patients with bulimia nervosa (BN), they included osteoporosis (P≤0.0001), obesity (P=0.0004) or being a student (P=0.04). For patients with eating disorders not otherwise specified (EDNOS), they included anxiolytic treatment (P=0.003), having circulatory disease (P=0.001), more years since start of ED treatment (P=0.03) and living alone (P<0.0001). CONCLUSIONS: We found a significant difference in QoL between the diagnostic ED groups. With regard to the variables predicting QoL in ED patients, the findings of this study suggest that organic or psychiatric comorbidities and some data of social normality might be more relevant to QoL in ED than age, type of compensatory behaviour, BMI or number of visits to hospital emergency department.

Impact of interdisciplinary treatment on physical and psychosocial parameters in patients with fibromyalgia: results of a randomised trial.

AIM: Fibromyalgia (FM) is a persistent disorder that can have a devastating effect on patients' lives. The purpose of the study was to assess the effects of an interdisciplinary treatment for FM on patients' physical and psychosocial parameters. METHODS: A randomised controlled clinical trial carried out among 153 patients. The control group (CG) received standard pharmacological therapy. The experimental group (EG) received an interdisciplinary treatment. At baseline and 6 months after the intervention, participants completed assessment for impact of FM in the quality of life, anxiety, depression, coping with pain, social support and satisfaction with the treatment. RESULTS: A total of 110 participants completed the trial. Six months after the intervention, statistically significant improvements in quality of life (p = 0.04), pain (p = 0.03), self-assertiveness (p = 0.01), mental self-control (p = 0.05), social support (p = 0.02) and satisfaction (p = 0.0001) were observed in the EG. Randomisation to the EG was identified as a predictor for improvement. CONCLUSION: An interdisciplinary intervention may be appropriate for patients referred to a hospital pain management unit.

Evaluation of the psychometric characteristics of the Spanish version of the Anorectic Behaviour Observation Scale.

AIMS: The Anorectic Behaviour Observation Scale (ABOS) was designed to obtain information from relatives about behaviours and attitudes of patients with eating disorders (ED). The aim of this study was to validate the ABOS into Spanish. METHODS: We evaluated the psychometric characteristics of the Spanish version of the ABOS in a clinical ED sample (239 caregivers of 143 ED patients). Instrument reliability (internal consistency), validity (construct, convergent and discriminant, known groups), responsiveness and goodness-of-fit were measured. RESULTS: Data from the Spanish population revealed a three-factor structure similar to that of the original ABOS, although the composition of subscales differed somewhat from the original. An ABOS cut-point of 21 was identified. The Cronbach's alpha coefficient for the total ABOS score was 0.81. Correlations with other instruments demonstrated convergent and divergent validity. Among caregivers, the total ABOS score and Factor scores significantly discriminated between anxiety, depression and health-related quality of life, while among ED patients they discriminated between diagnosis, severity and level of ED symptoms - evidence of known-groups validity. CONCLUSION: These findings suggest that the ABOS can be reliably and validly used in Spain in a number of different clinical contexts, by researchers and clinicians alike.

Assessment of the impact of eating disorders on quality of life using the disease-specific, Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire.

OBJECTIVE: To evaluate and compare the quality of life (QOL) in patients with eating disorders (ED) and general population, using the disease-specific Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire. METHODS: A total of 358 patients with ED completed the HeRQoLED questionnaire as well as the SF-12 and the Eating Attitudes Test (EAT-26) at baseline; 273 patients completed the same instruments after 1 year of multidisciplinary treatment. A total of 305 individuals recruited from the general population completed the HeRQoLED once. Comparison of means was used to assess change. Multivariate models were created to determine variables predictive of change in HeRQoLED scores. RESULTS: Patients with anorexia nervosa had higher baseline scores (indicating worse perception of QOL) on the HeRQoLED questionnaire and experienced smaller improvements than patients with other diagnoses after 1 year of treatment. After adjustment by relevant variables, body-mass index (BMI) and EAT-26 scores were associated with changes in QOL. SF-12 scores showed significant improvement in the physical health component but not in mental health. General population had lower baseline scores on the HeRQoLED. CONCLUSIONS: As measured by the disease-specific HeRQoLED and generic instruments, QOL in patients with ED improved after 1 year of treatment, though it did not reach the values of the general population.

Translation and psychometric testing of the Basque version of the SF-36 health survey.

INTRODUCTION: The primary goals of this study were to adapt the Short Form-36 (SF-36) questionnaire to the Basque language and to assess the translated questionnaire's psychometric properties. METHODS: Two pilot studies and a field study were conducted in 1999. The pathologies selected were hypertension, eating disorders, back pain, and HIV infection; blood donors were also included. The analyses conducted at item-level were: item internal consistency, item discriminant validity, equal item variance, and equal item-scale correlation. Internal consistency was measured at the scale level. Reproducibility, convergent validity and discriminant validity were also examined. RESULTS: 285 individuals took part in the study; sufficient data were obtained for 265 (93%). All items correlated higher than 0.4 with their hypothesized scales. Within each scale, item standard deviations were similar. Item-scale correlations were also similar. Cronbach's alpha coefficients varied from 0.76 to 0.92. In the test-retest reliability study, which included 54 additional individuals, all scales were above 0.50. Regarding the inter-scale correlation, the majority exceeded the 0.40 coefficient. In the correlation of similar scales of the SF-36 and the Nottingham Health Profile, intraclass correlation coefficient results ranged from 0.29 to 0.62. CONCLUSIONS: These results confirm that this new version of the SF-36 has been translated and adapted correctly for the Basque language and that it fulfils, at least partially, the psychometric properties required for this instrument. Further studies, however, are needed to completely validate the Basque version of the SF-36.

Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale.

OBJECTIVE: To assess the psychometric properties of the Spanish version of the Hospital Anxiety and Depression Scale(HADS). METHOD: We administered HADS to 685 participants (256 controls and 429 patients with five different diagnoses). The reliability of the instrument was assessed by a test-retest study. Construct validity studies were carried out through item-subscale correlation and factor analysis for the whole group and by each of the five different diagnoses. Three instruments were used as external criteria to assess concurrent validity. RESULTS: HADS test-retest reliability presented correlation coefficients above 0.85. The internal consistency was high, with a Cronbach's alpha of 0.86 (anxiety) and 0.86 (depression). Factor analysis showed a clear two-factor structure for all groups. The results showed high concurrent validity with the Beck Depression Inventory and State-Trait Anxiety Inventory and with the mental domains of the Short-Form Health Survey. CONCLUSION: The Spanish version of the HADS demonstrated good reliability and validity when used in medical patients.

Changes in health related quality of life among patients treated for eating disorders.

OBJECTIVE: To prospectively investigate changes in the perception of health-related quality of life (HRQoL) among eating disorder patients after 2 years of treatment and follow-up and clinical predictors of change. METHOD: One hundred and thirty-one consecutive subjects were recruited from an eating disorder outpatient clinic. Subjects completed a generic HRQoL questionnaire, the Short Form-36 (SF-36), as well as the Eating Attitudes Test (EAT-40) to measure symptom severity and the Hospital Anxiety and Depression scale (HAD), at the first visit and after 24 months. RESULTS: Perception of HRQoL, measured by the SF-36, showed significant improvement in all but the role emotional domain after 2 years. The greatest improvements were observed in the physical function and social function domains, followed by mental health and vitality. Despite significant improvement in the summary mental health scale, scores after 2 years of treatment and follow-up were still below normative population values of women aged 18-34. Severity of eating disorder symptoms and presence of anxiety or depression at baseline significantly affected improvement in various SF-36 domains. CONCLUSIONS: Despite improvements in perception of HRQoL, eating disorder patients were more dysfunctional in all domains of the SF-36 even after 2 years of treatment and follow-up compared with women in the general population, and the severity of eating disorder symptoms was correlated with degree of dysfunction.

[Quality of life in patients with eating disorders]. / Calidad de vida de los pacientes afectados de trastornos de la alimentación.

OBJECTIVE: To evaluate the quality of life of ambulatory patients with eating disorders in relation to the severity of their symptomatology and in comparison with other psychiatric disorders and general population values. METHODS: Cross-sectional descriptive study of the quality of life of 180 patients recruited at an eating disorders unit. In order to study different aspects of their Health Related Quality of Life, the SF-36, the EAT and the HAD questionnaires were used. The results of the SF-36 were compared to population values of the same gender and age, and to other studies of psychiatric disorders where the SF-36 questionnaire was used. RESULTS: Patients with eating disorders presented worse quality of life than the general population of the same gender and age, and similar to patients with other psychiatric diagnoses, as schizophrenia, depression or panic disorder. No significant differences were found between patients with diagnoses of restrictive anorexia, purgative anorexia and bulimia. Mental health, rol emotional and vitality were the most affected areas of the SF-36. CONCLUSIONS: This study shows the severity of these disorders, which have a special incidence in young active women. This fact is becoming an important public health problem and raises the need of specialised assistance.

[Assessment of quality of life in lung cancer patients]. / Evaluación de la calidad de vida en pacientes con cáncer de pulmón.

OBJETIVES: The aim of this study was to describe lung cancer patients' quality of life, measuring physical, psychological and social parameters, and general and specific symptoms of the disease using different questionnaires. METHODS: 103 primary lung cancer patients who were between 20 and 80 years old and recruited during one year were included. All patients fulfilled the generic health related quality of life (HRQoL) questionnaire SF-36 and the specific EORTC-C30. Also sociodemographic and clinical important data were collected. Differences in aspects of perceived quality of life by diagnostic group and stage were analysed. RESULTS: The results indicate that the patients with a higher disease stage had worse perception of their quality of life in comparison with patients in a lower stage of the disease. Likewise, small cell lung cancer patients, overall, showed a worse perception of their quality of life than non-small cell lung cancer patients. These differences were shown either by generic and the specific questionnaire scores. CONCLUSIONS: The results obtained in the study show that the SF-36 and EORTC capture the differences in the perceived quality of life in patients by diagnosis and evolution stage of the disease. All quality of life areas were already affected at the moment of the diagnosis of the disease. The scores of both questionnaires are coherent with clinical evaluation, based on the clinical stage, which support the discriminative validity of those instruments.

Calidad de vida de los pacientes afectados de trastornos de la alimentación / Quality of life in patients with eating disorders

Objetivo: Analizar la calidad de vida percibida de pacientes ambulatorios con trastornos de la alimentación en relación a la gravedad de su sintomatología y en comparación a otros trastornos psiquiátricos y con la población general. Métodos: Estudio descriptivo transversal de la calidad de vida de 180 pacientes reclutados en una unidad de trastornos de la alimentación. Para estudiar diferentes aspectos de la calidad de vida relacionada con la salud, se utilizaron los cuestionarios SF-36, EAT y HAD. Los resultados del SF-36 fueron comparados con los de una muestra de la población general del mismo sexo y edad, así como con otros estudios de trastornos psiquiátricos en los que se utilizó el SF-36.Resultados: Los pacientes con trastornos de la alimentación presentaron peor calidad de vida que la población general de su mismo sexo y edad y similar a la de pacientes con otros trastornos psiquiátricos, como esquizofrenia, depresión y trastornos de pánico. No se apreciaron diferencias significativas entre los pacientes con diagnóstico de anorexia restrictiva, anorexia purgativa y bulimia. Las áreas del SF-36 más afectadas fueron salud mental, rol emocional y vitalidad. Conclusiones: Este estudio muestra la gravedad de estos trastornos, que tienen una gran incidencia entre mujeres jóvenes en edad escolar y laboral. Esto supone un grave problema de salud pública y plantea la necesidad de una asistencia especializada (AU)

Objective: To evaluate the quality of life of ambulatory patients with eating disorders in relation to the severity of their symptomatology and in comparison with other psychiatric disorders and general population values. Methods: Cross-sectional descriptive study of the quality of life of 180 patients recruited at an eating disorders unit. In order to study different aspects of their Health Related Quality of Life, the SF-36, the EAT and the HAD questionnaires were used. The results of the SF-36 were compared to population values of the same gender and age, and to other studies of psychiatric disorders where the SF-36 questionnaire was used. Results: Patients with eating disorders presented worse quality of life than the general population of the same gender and age, and similar to patients with other psychiatric diagnoses, as schizophrenia, depression or panic disorder. No significant differences were found between patients with diagnoses of restrictive anorexia, purgative anorexia and bulimia. Mental health, rol emotional and vitality were the most affected areas of the SF-36.Conclusions: This study shows the severity of these disorders, which have a special incidence in young active women. This fact is becoming an important public health problem and raises the need of specialized assistance (AU)

Evaluación de la calidad de vida en pacientes con cáncer de pulmón / Assessment of quality of life in lung cancer patients)

Objetivo: El objetivo de este estudio ha sido describir la calidad de vida de los pacientes afectados de cáncer de pulmón, midiendo parámetros físicos, psíquicos, sociales, y síntomas generales y específicos de la enfermedad, por medio de cuestionarios, e investigar si existen diferencias en aspectos de la percepción de su calidad de vida según diagnóstico. Métodos: Se incluyeron 103 pacientes con cáncer de pulmón primario con diagnóstico citohistológico de seguridad, con edades comprendidas entre 20 y 80 años, que fueron diagnosticados a lo largo de un año. Todos los pacientes rellenaron el cuestionario de calidad de vida genérico SF-36 y el cuestionario específico EORTC-C30, y se recogió información sobrevariables sociodemográficas y clínicas relevantes. Se analizan los resultados según grupo diagnóstico y estadificación. Resultados: Los resultados obtenidos indican que los pacientes con un estadio de la enfermedad más elevado muestran una peor calidad de vida en comparación con los pacientes que se encuentran en estadios más bajos de la enfermedad. Así mismo, los pacientes con células pequeñas en su conjunto muestran peor calidad de vida que los pacientes con diagnóstico de células no pequeñas. Estas diferencias pueden observarse tanto en las puntuaciones del cuestionario genérico como en las del cuestionario específico. Conclusiones: En conclusión, los resultados obtenidos en el estudio muestran que el SF-36 y el EORTC captan las diferencias existentes en la percepción de la calidad de vida de los pacientes según el diagnóstico y el estadio de evolución de la enfermedad. Todas las áreas de la calidad de vida están afectadas ya en el momento del diagnóstico. Las puntuaciones resultantes de estos 2 cuestionarios son coherentes con la valoración clínica según la estadificación, lo que apoya su validez discriminativa (AU)

Objetives: The aim of this study was to describe lung cancer patients’ quality of life, measuring physical, psychological and social parameters, and general and specific symptoms of the disease using different questionnaires.Methods: 103 primary lung cancer patients who were between 20 and 80 years old and recruited during one year were included. All patients fulfilled the generic health related qualityof life (HRQoL) questionnaire SF-36 and the specificEORTC-C30. Also sociodemographic and clinical important data were collected. Differences in aspects of perceived quality of life by diagnostic group and stage were analysed. Results: The results indicate that the patients with a higher disease stage had worse perception of their quality of life incomparison with patients in a lower stage of the disease. Likewise, small cell lung cancer patients, overall, showed a worse perception of their quality of life than non-small cell lung cancer patients. These differences were shown either by generic and the specific questionnaire scores. Conclusions: The results obtained in the study show that theSF-36 and EORTC capture the differences in the perceived quality of life in patients by diagnosis and evolution stage of the disease. All quality of life areas were already affected at the moment of the diagnosis of the disease. The scores of both questionnaires are coherent with clinical evaluation, based on the clinical stage, which support the discriminative validity of those instruments (AU)

Evolución clínica y percepción de bienestar en los trastornos alimentarios / Clinical outcome and well-being perception in eating disorders

Se analiza la evolución clínica y la percepción de calidad de vida relacionada con la salud de una muestra de 131 pacientes con trastornos alimentarios tras un periodo de dos años de seguimiento ambulatorio. El 52 por ciento de los sujetos alcanzaban puntuaciones inferiores a 30 puntos en el cuestionario EAT; el 51 por ciento presentaban un probable trastorno de ansiedad y el 24 por ciento un probable trastorno depresivo de modo comórbido. La evolución de la percepción de calidad de vida muestra mejorías significativas en todas las áreas con excepción del Rol Emocional, con mayores incrementos en el Rol Físico y en el Funcionamiento Social. Los pacientes con puntuaciones iniciales en el EAT superiores a 30, tras el seguimiento y a pesar de las mejorías parciales descritas, mostraban en todas las áreas del cuestionario de calidad de vida, puntuaciones inferiores a los valores normalizados de la población general de mujeres españolas (AU)

The health-related quality of life in eating disorders.

OBJECTIVE: This study investigated the perception of health-related quality of life (HRQoL) in ambulatory patients with eating disorders in relation to the severity of eating symptomatology and psychological comorbidity. METHODS: One hundred ninety-seven study patients were consecutively recruited at the Eating Disorders Outpatient Clinic. Short Form-36 items (SF-36), a generic HRQoL questionnaire, the Eating Attitudes Test (EAT-40), and the Hospital Anxiety and Depression Scale (HAD) were used to measure different aspects of HRQoL. The results of the SF-36 were compared with the norms of the Spanish general population for women 18-34 years of age. RESULTS: Patients with eating disorders were more dysfunctional in all areas of the SF-36 compared with women in the general population. There were no differences among the eating disorder diagnostic groups. Higher scores on the EAT-40 and the HAD were associated with a perception of greater impairment on all SF-36 subscales. CONCLUSION: The evaluation of HRQoL in these patients confirms the impact of these disorders on daily life in areas not directly related to eating disorders. The SF-36 is useful for discriminating among different levels of severity of eating disorders and other psychological comorbidities of these patients.