Caring for patients in the Covid era: Are the quality of life the same for doctors and nursing staff?

BACKGROUND: The Covid-19 pandemic has represented one of the most stressful events of recent times and has placed enormous psychological pressure on doctors and nurses. AIMS: The objective of this work is to evaluate the psychological impact of the Covid-19 outbreak on Spanish nurses and doctors, and to identify factors related to their mental health. METHODS: The study is a descriptive study and examined 812 doctors and 768 nurses. The dependent variables were health-related quality of life, anxiety, depression, perceived stress and insomnia. Participants completed the Health-related Quality of Life-Questionnaire, the Generalized Anxiety Disorder 7-item-Scale, the Patient Health Questionnaire-9, the Impact Event Scale-Revised, and the Insomnia Severity Index. Sociodemographic and Covid-related data were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were used. RESULTS: A greater proportion of nurses than doctors suffered clinical anxiety, depression and insomnia (56.84 % vs 45.81 p-value<0.0001, 64.67 % vs 53.39 p-value<0.0001, and 23.04 % vs 18.02 p-value 0.01, respectively). Although in our study nurses were more likely to suffer clinical anxiety, stress and insomnia than doctors, our results nevertheless showed that there were no differences in terms of quality of life. Different factors related to mental health were identified for doctors and nurses. Nurses working in care homes or geriatric services (OR = 4.13, IC95% 1.71-9.99, p-value 0.002), and in services with greatest contact with Covid-19 patients (OR = 1.71,IC95% 1.10-2.68, p-value 0.02) were more likely to suffer depression. CONCLUSIONS: Our study confirms that doctors and nurses are at high risk of clinical anxiety, depression, stress or insomnia during the Covid-19 pandemic.

Variables related to health-related quality of life among breast cancer survivors after participation in an interdisciplinary treatment combining mindfulness and physiotherapy.

BACKGROUND: Breast cancer diagnosis and treatment increase the potential psychological impact on breast cancer survivors (BCS). The objective of this study was to assess the effects of an interdisciplinary intervention during follow-up in BCS and identify variables related to improvements in HRQoL. MATERIALS AND METHODS: In a non-randomised quasi-experimental design performed on an outpatient basis in a hospital gynaecology and oncology unit, 60 BCS were assigned to an interdisciplinary experimental group (EG) or a usual care group (CG). The EG underwent 12 sessions of an interdisciplinary program which included Mindfulness and physiotherapy, for 120 min per day, once a week for 6 weeks. At baseline, at 6 weeks and at 3 months after the intervention, participants of EG and CG completed an assessment of HRQoL (EuroQol and EORTC-QLQ-C30) and symptomatology of anxiety and depression. Additionally, EG completed an assessment of satisfaction with the treatment. For data analysis, we used descriptive statistics, Wilcoxon test, Kruskal-Wallis test, Chi-square and Fisher tests and generalised linear models. RESULTS: After 6 weeks, statistically significant differences were apparent in global and cancer-related health symptoms such as fatigue and pain in the EORTC QLQ-C30 and in anxiety and depression, among the EG (n = 30) compared with the CG (n = 30). Patients receiving the intervention reported a high degree of satisfaction with the treatment. Three months after the intervention, patients in the EG continued to show statistically significant improvements compared with the CG. In addition, allocation to the EG was identified as a variable related to improvement of HRQoL (EORTC QLQ-C30) in the multivariable model. CONCLUSIONS: The results of our study suggest that a 6-week interdisciplinary intervention may improve HRQoL and symptomatology of anxiety and depression in BCS patients at 3 months. The study presents data that the intervention for BCS appears promising and warrants further study in a randomised controlled trial.

Evaluation of the mental health of health professionals in the COVID-19 era. What mental health conditions are our health care workers facing in the new wave of coronavirus?

BACKGROUND: The aims of this study were to analyse the mental health and health-related quality of life (HRQoL) of a broad sample of healthcare workers (HCWs) in Spain and to identify potential factors that have a significant effect on their mental health and HRQoL. METHOD: This prospective cohort study comprised 2089 HCWs who completed the Generalized Anxiety Disorder 7-item (GAD-7) Scale, the Patient Health Questionnaire-9 (PHQ-9), the Impact Event Scale-Revised (IES-R), the Insomnia Severity Index (ISI), and the health-related quality of life Questionnaire (EQ-5D). Sociodemographic and clinical data in relation to Covid-19 were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were applied to identify factors associated with mental health and HRQoL. RESULTS: 80.87% of participants were female and 19.13% male; 82.38% were aged under 55 years; 39.13% were physicians and 50.17% were nurses or auxiliaries; 80.42% of the health workers have directly treated patients with Covid-19 and 12.28% have themselves tested positive for Covid-19. 38.58% of HCWs had clinical depression; over half (51.75%) had clinical anxiety; 60.4% had clinical stress; and 21.57% had clinical insomnia. Older professionals (>55 years) reported lower rates of anxiety, depression, insomnia, and stress. Having worked directly with Covid-19 patients appears to be an explanatory variable of suffering greater anxiety, depression, stress and insomnia, and of having a worse HRQoL amongst our HCWs. The group of HCWs suffering the worst mental state were nursing home workers. CONCLUSIONS: Our study confirms that symptomatology of anxiety, depression, stress, insomnia, and HRQoL were affected amongst HCW during the Covid-19 pandemic.

Evaluation of the mental health of care home staff in the Covid-19 era. What price did care home workers pay for standing by their patients?

BACKGROUND: The characteristics of this pandemic increase the potential psychological impact on care homes workers (CHWs). The aims of this study were to analyse the mental health and health-related quality of life (HRQoL) of a broad sample of CHWs in Spain and to identify potential factors that have a significant effect on their mental health and HRQoL. METHOD: This descriptive study comprised 210 CHWs who completed the Generalized Anxiety Disorder 7-item Scale, the Patient Health Questionnaire-9, the Impact Event Scale-Revised, the Insomnia Severity Index, and the Health-related Quality of Life Questionnaire. Sociodemographic and clinical data in relation to COVID-19 were also recorded. Descriptive statistics, univariable analysis and multivariable linear regression models were applied to identify factors associated with mental health and HRQoL. RESULTS: Of total, 86.19% of participants were female; 86.67% were aged under 55 years; 11% were physicians and 64.19% were nurses or auxiliaries; 77.62% have themselves tested positive for Covid-19; and 67.94% of CHWs have directly treated patients with Covid-19. 49.28% had clinical depression; over half (58.57%) had clinical anxiety; 70.95% had clinical stress; and 28.57% had clinical insomnia. Increased use of tranquilizers/sedatives appears to be an explanatory variable of suffering greater anxiety, depression, stress and insomnia, and of having a worse HRQoL amongst our CHWs. CONCLUSIONS: Our study confirms that symptomatology of anxiety, depression, stress, insomnia and HRQoL were affected amongst CHWs during the Covid-19 pandemic.

Classification of subtypes of patients with eating disorders by correspondence analysis.

BACKGROUND: Grouping eating disorders (ED) patients into subtypes could help improve the establishment of more effective diagnostic and treatment strategies. AIM: To identify clinically meaningful subgroups among subjects with ED using multiple correspondence analysis (MCA). METHODS: A prospective cohort study was conducted of all outpatients diagnosed for an ED at an Eating Disorders Outpatient Clinic to characterize groups of patients with ED into subtypes according to sociodemographic and psychosocial impairment data, and to validate the results using several illustrative variables. In all, 176 (72.13%) patients completed five questionnaires (clinical impairment assessment, eating attitudes test-12, ED-short form health-related quality of life, metacognitions questionnaire, Penn State Worry Questionnaire) and sociodemographic data. ED patient groups were defined using MCA and cluster analysis. Results were validated using key outcomes of subtypes of ED. RESULTS: Four ED subgroups were identified based on the sociodemographic and psychosocial impairment data. CONCLUSION: ED patients were differentiated into well-defined outcome groups according to specific clusters of compensating behaviours.

Anxiety and depressive symptoms are related to core symptoms, general health outcome, and medical comorbidities in eating disorders.

OBJECTIVE: The goal of this study is to identify potential factors that have a significant effect on anxiety and depression of patients with eating disorders (ED) using the beta-binomial regression (BBR) approach on a broad sample of patients. METHOD: This cross-sectional study involved 520 ED patients. The effect of sociodemographics, core symptoms, general health outcomes, and medical comorbidities in anxiety and depression were analysed jointly using the beta-binomial mixed-effects model. RESULTS: Two hundred fifty-five (49.4%) patients had anorexia nervosa, 173 (33.3%) patients had bulimia nervosa, and 92 (17.7%) had ED not otherwise specified. A high level of anxiety was associated, among other variables, with having a restrictive ED subtype as compared with purgative and binge ED subtypes (ß = -0.2, p < 0.001, OR = 0.82 and ß = -0.16, p < 0.03, OR = 0.85, respectively), with having a high level of ED symptomatology or with living not alone (ß = -0.23, p = 0.002, OR = 0.80). A high level of depression was associated, among other variables, with older age (ß = 0.74, p < 0.001, OR = 2.1). CONCLUSIONS: The results of our study suggest that depressive and anxiety symptoms are related to ED symptoms, health status, ED subtype, medical comorbitidy, and educational level. In addition, another interesting finding is the inverse association between symptomatology of anxiety and living alone. Finally, BBR may be a useful approach in interpreting patient-reported outcome as odds.

Predictors of mortality during hospitalization and 3 months after discharge in elderly people with and without dementia.

Objectives: The aims of this study were to assess mortality during hospitalization and 3 months after discharge in elderly people with and without dementia, and to identify variables that might predict mortality. Methods: A prospective matched cohort study was conducted involving 195 inpatients with dementia and 204 inpatients without dementia. Information on sociodemographic, and clinical data were gathered. Patients completed questionnaires on premorbid basic (Barthel, BI) and instrumental activities of daily living (Lawton and Brody), quality of life (EuroQoL5-D; Quality of Life in Alzheimer's Disease), burden of the caregiver (Zarit). Data were collected on admission and 3 months after discharge. Descriptive analyses, univariable analyses and multivariable logistic regression models were applied to identify risk factors associated with mortality at 90 days. Results: For patients with dementia the following variables were predictors of mortality: having complications during admission, age >84 years, myocardial infarction, >145 sodium and lower BI. For patients without dementia, having lower BI, adverse events during hospitalization, older patient age, sodium >145, no surgery during admission, and more than 2 classes of medication at admission were predictors of mortality. Conclusion: Adequate nutritional support should be initiated to optimize the clinical outcome of these patients.

Assessment of predictors of the impact of fibromyalgia on health-related quality of life 12 months after the end of an interdisciplinary treatment.

OBJECTIVE: Fibromyalgia is a chronic pain disorder with a range of comorbid symptoms, including anxiety. We aimed to prospectively identify predictors of the long-term impact of fibromyalgia on health-related quality of life after the end of an interdisciplinary intervention. METHODS: 138 patients with fibromyalgia, selected from a hospital pain management unit, participated in a 6-week interdisciplinary treatment that combined coordinated psychological, medical, educational, and physiotherapeutic interventions. Participants completed the Fibromyalgia Impact Questionnaire and the Hospital Anxiety and Depression Scale at baseline and 6 weeks, 6 months, and 12 months after the intervention. Multivariable generalized linear mixed models were developed, using the Fibromyalgia Impact Questionnaire score as a continuous variable. RESULTS: Variables that were significant predictors of the long-term impact of fibromyalgia on health-related quality of life in patients who completed a 6-week interdisciplinary treatment were marital status, the number of concurrent conditions, years since the onset of pain, and symptoms of anxiety. In the longitudinal analysis, patients with symptoms of anxiety had lower rates of improvement than those without symptoms of anxiety. DISCUSSION: Our results suggest that patients with lower level of anxiety have less impact on their HRQoL. The results also provide evidence that starting interventions as soon as possible is an important factor for improving health-related quality of life.

Predictors of change in psychosocial impairment secondary to an eating disorder.

Eating disorders (ED) can significantly impair psychosocial health in patients. However, no published studies have so far used a standardized and specific instrument to evaluate predictive factors in ED-related psychosocial impairment. This prospective cohort study involved 177 patients receiving outpatient treatment for an ED at baseline and 115 patients at the 1-year follow-up. Patients completed three self-administered questionnaires: the Clinical Impairment Assessment (CIA), the Eating Attitudes Test-12 (EAT-12), and the Health-Related Quality of Life in ED-short form (HeRQoLED-s). Descriptive statistics, ANOVA, chi-square, and Fisher's exact test were applied to examine intervariable relationships. Multivariate linear regression was used to determine predictors of change in CIA scores. An improvement was reported by patients with restrictive anorexia nervosa (AN) compared to those with purgative AN. In the multivariate analysis, employment status, subtype of ED, and the bulimia and food preoccupation factor of the EAT-12 were significant predictors of change in the CIA scores.

Caregivers consequences of care among patients with eating disorders, depression or schizophrenia.

BACKGROUND: The consequences of caring for a person with a mental illness can impose a substantial burden. Few studies have compared this burden among caregivers of patients with eating disorders and other mental illnesses. The objective of this study was to compare caregiver consequences in eating disorders (ED) with caregiver consequences in depression and schizophrenia, assessed with the same instrument, the Involvement Evaluation Questionnaire (IEQ). Another aim was to identify factors that may predict these consequences. METHODS: We conducted a cross-sectional study involving 251 caregivers of ED patients; 252 caregivers of patients with depression; and 151 caregivers of patients with schizophrenia. Caregivers completed the Involvement Evaluation Questionnaire EU Version (IEQ-EU). Descriptive statistics, ANOVA, and Chi-square were applied to examine the inter-variable relationships. Consequences- indexes were also computed. RESULTS: In all samples, worrying was the most commonly reported consequence of caregiving. Predictive variables for a high level of caregiver burden included being a mother or partner of the person being cared for (p = <.01), and being a caregiver of a patient with ED. CONCLUSIONS: The burden of caregiving is higher among caregivers of patients with eating disorders patients than among caregivers of patients with depression or schizophrenia. Our findings suggest that caregivers of patients with an ED could benefit from providing adequate assessment and support.

Adaptation and validation of the Spanish version of the Clinical Impairment Assessment Questionnaire.

The Clinical Impairment Assessment (CIA) assesses psychosocial impairment secondary to an eating disorder. The aim of this study was to create and validate a Spanish-language version of the CIA. Using a forward-backward translation methodology, we translated the CIA into Spanish and evaluated its psychometric characteristics in a clinical sample of 178 ED patients. Cronbach's alpha values, confirmatory factor analysis (CFA), and correlations between the CIA and the Eating Attitudes Test-12 and the Health-Related Quality of Life in ED-short form questionnaires evaluated the reliability, construct validity, and convergent validity, respectively. Known-groups validity was also studied comparing the CIA according to different groups; responsiveness was assessed by means of effect sizes. Data revealed a three-factor structure similar to that of the original CIA. Cronbach alpha coefficient of 0.91 for the total CIA score supported its internal consistency and correlations with other instruments demonstrated convergent validity. The total CIA score and factor scores also significantly discriminated between employment status, evidencing known-groups validity. Responsiveness parameters showed moderate changes for patients with restrictive eating disorders. These findings suggest that the CIA can be reliably and validly used in Spain in a number of different clinical contexts, by researchers and clinicians alike.

Adaptation and validation of the Metacognition Questionnaire (MCQ-30) in Spanish clinical and nonclinical samples.

BACKGROUND: The short form of the Metacognitions Questionnaire is a brief multidimensional measure of a range of metacognitive processes and metacognitive beliefs about worry and cognition relevant to vulnerability to and maintenance of emotional disorders. The aim of the study was adapt and validate a Spanish version of the short form of the Metacognitions Questionnaire (MCQ-30) and to evaluate its psychometric properties in clinical and nonclinical samples. METHOD: The MCQ-30 was administered to a sample of 316 patients with psychiatric disorders (anxiety, depression, and eating disorders) and to a sample of 169 individuals belonging to the general population. Instrument reliability (internal consistency), construct validity (confirmatory factor analysis [CFA], convergent validity, known groups) and responsiveness were measured. RESULTS: The clinical sample scored the highest on all factors when compared to nonclinical sample. The exploratory factor analysis supported the MCQ׳s original five-factor solution. The CFA suggested a good fit of the model. Correlation with measure of worry demonstrated convergent validity. Known-groups validity was supported by significant differences in the MCQ-30 mean scores according to certain variables, such as educational level and employment status. LIMITATIONS: This study did not assess the test-retest reliability. CONCLUSIONS: The MCQ-30 has good psychometric properties and can be used to evaluate several dimensions of metacognition in both clinical and nonclinical samples.

Evaluation of the interdisciplinary PSYMEPHY treatment on patients with fibromyalgia: a randomized control trial.

OBJECTIVE: Fibromyalgia (FM) is a chronic disorder that can have a devastating effect on patients' lives. This study assessed the efficacy of a 6-week interdisciplinary treatment that combines coordinated PSYchological, Medical, Educational, and PHYsiotherapeutic interventions (PSYMEPHY) compared with standard pharmacologic care. DESIGN: The study was a randomized controlled trial (54 participants in the PSYMEPHY group and 56 in the control group [CG] ) with follow-up at 6 months. PSYMEPHY patients were also assessed at 12 months. The main outcomes were changes in total Fibromyalgia Impact Questionnaire (FIQ) score, pain, fatigue, morning tiredness, anxiety, and use of pain coping strategies as measured by the FIQ, the visual analog scale, and the Coping with Chronic Pain Questionnaire. After the 6-month assessment, patients in the CG were offered the PSYMEPHY treatment, and completed all of the instruments immediately after treatment, and at 6- and 12-month follow-up visits (N = 93). SETTING: Subjects received therapy at two different outpatient clinical locations. PATIENTS: Fibromyalgia patients. RESULTS: Six months after the intervention, significant improvements in total FIQ score (P = 0.04), and pain (P = 0.03) were seen in the PSYMEPHY group compared with controls. Twelve months after the intervention, all patients in the PSYMEPHY group maintained statistically significant improvements in total FIQ score, and pain, and showed an improvement in fatigue, rested, anxiety, and current pain compared with baseline. Data from the control patients who underwent the PSYMEPHY intervention corroborated the initial results. CONCLUSIONS: This study highlights the beneficial effects of an interdisciplinary treatment for FM patients in a hospital pain management unit. A 6-week interdisciplinary intervention showed significant improvement in key domains of fibromyalgia, as quality of life, pain, fatigue, rested, and anxiety at 12 months.

Cross-validation study using item response theory: the health-related quality of life for eating disorders questionnaire-short version.

The Health-Related Quality of Life for Eating Disorder-Short questionnaire is one of the most suitable existing instruments for measuring quality of life in patients with eating disorders. The objective of the study was to evaluate its reliability, validity, and responsiveness in a cohort of 377 patients. A comprehensive validation process was performed, including confirmatory factor analysis and a graded response model, and assessments of reliability and responsiveness at 1 year of follow-up. The confirmatory factor analysis confirmed the two second-order latent traits, social maladjustment, and mental health and functionality. The graded response model results showed that all items were good for discriminating their respective latent traits. Cronbach's alpha coefficients were high, and responsiveness parameters showed moderate changes. In conclusion, this short questionnaire has good psychometric properties. Its simplicity and ease of application further enhance its acceptability and usefulness in clinical research and trials, as well as in routine practice.

Interdisciplinary treatment of patients with fibromyalgia: improvement of their health-related quality of life.

OBJECTIVE: To assess whether an interdisciplinary intervention is more effective than usual care for improving the health-related quality of life (HRQoL) among patients with fibromyalgia (FM), and to identify variables that were predictors of improvement in HRQoL. METHODS: In a randomized controlled clinical trial carried out on an outpatient basis in a hospital pain management unit, 153 patients with FM were randomly allocated to an experimental group (EG) or a control group (CG). Participants completed the Fibromyalgia Impact Questionnaire (FIQ) at baseline and 6 months after the intervention. The EG received an interdisciplinary treatment (12 sessions for 6 weeks) which consisted of coordinated psychological, medical, educational, and physiotherapeutic interventions while the CG received standard-of-care pharmacologic treatment. Descriptive statistics, ANOVA, Chi square and Fisher tests and generalized linear models were used for data analysis. RESULTS: Six months after the intervention, statistically significant improvements in HRQoL were observed in physical functioning (P = 0.01), pain (P = 0.03) and total FIQ score (P = 0.04) in the EG compared to the CG. The number of physical illnesses was identified as a predictor for improvement. CONCLUSIONS: This interdisciplinary intervention has shown effectiveness in improving the HRQoL of this sample of patients with FM. The number of physical illnesses was identified as a predictor of that improvement.

Predictors of quality of life and caregiver burden among maternal and paternal caregivers of patients with eating disorders.

This prospective study investigated quality of life and caregiver burden of 244 parent caregivers of 113 Spanish patients with Eating Disorders (ED). One hundred eleven mothers and 70 fathers fulfilled the inclusion criteria. ED patients completed the Hospital Anxiety and Depression Scale (HADS) and the Eating Attitudes Test-26. Caregivers completed the HADS, the Short Form-12 (SF-12), the Involvement Evaluation Questionnaire-EU version, and the Anorectic Behaviour Observation Scale. Descriptive statistics, ANOVA, Chi-square and Fisher's exact test were applied. Among mothers, anxiety and depression and patient age contributed to poorer quality of life. Caregiver variables that affected the burden for mothers were marital status, the mental subscale of the SF-12, and the mother's perception of the severity of her child's illness. Caregiver variables that affected the burden for fathers were the caregiver's anxiety and the physical domain of the SF-12. Among mothers but not fathers, being married was a protective factor of caregiver burden. Our findings suggest that mothers and fathers have different perceptions of their quality of life and caregiver burden, and that mothers of patients with ED may be in considerable need for extra psychosocial support.

Anxiety and depression among caregivers of patients with eating disorders and their change over 1 year.

PURPOSE: Limited data are available on the difficulties experienced over time by caregivers of patients with eating disorders (CPED). The aim of this study was to describe changes in anxiety and depression among such caregivers over 1 year and to identify factors predicting any change in both. METHODS: At recruitment, 145 ED patients and their 246 caregivers completed sociodemographic and clinical instruments, including the hospital anxiety and depression scale (HADS), and the Short-Form 12 (SF-12). Patients also completed the Eating Attitudes Test-26 (EAT-26), and their psychiatrists assessed clinical variables. Patients and caregivers completed the same instruments 1 year later. RESULTS: At baseline, prevalence of anxiety and depression among caregivers was 56 and 32%, respectively. Scores were essentially the same 1 year later. Factors associated with the changes in anxiety were higher anxiety level at baseline and caring for a patient with a restrictive ED. Factors associated with changes in depression included higher depression at baseline and caring for a patient with a restrictive ED. Neither health-related quality of life among patients and caregivers nor patients' eating attitudes was related to caregiver anxiety or depression. CONCLUSIONS: These findings confirm the presence of substantial and continuing emotional distress among caregivers of patients with ED, highlighting the importance of offering them more extended follow-up and treatment.

Burden of caregiving amongst family caregivers of patients with eating disorders.

BACKGROUND: Eating disorders (EDs) in a close relative can be particularly stressful for family members. AIMS: To assess the perceived burden of caregivers of patients with EDs and to identify demographic and clinical variables that could predict this burden. METHOD: We conducted a cross-sectional study involving 145 ED patients and 246 related caregivers. ED patients completed the Health-Related Quality of Life in ED-short form, the Hospital Anxiety and Depression Scale, and the Short Form-12. Caregivers completed the Involvement Evaluation Questionnaire-EU version, the Short Form-12, the Hospital Anxiety and Depression Scale, and the Anorectic Behaviour Observation Scale. Descriptive statistics, ANOVA, Chi-square, and Fisher's exact test were applied to examine the inter-variable relationships. RESULTS: A high burden of caregiving was associated with being divorced (ß = 14.23, SE = 3.88; p = 0.001), having a low level of education (ß = 4.70, SE = 1.96; p = 0.02), having high levels of anxiety (ß = 5.45, SE = 2.13; p = 0.01) or depression (ß = 5.74, SE = 2.80; p = 0.04), and caring for a relative with a low physical quality of life (ß = 5.91, SE = 1.78; p = 0.002). CONCLUSIONS: Evaluating family caregivers of patients with ED for risk factors for increased caregiver burden and offering them assistance could reduce their perceived burden of caregiving.

Six-and 12-month follow-up of an interdisciplinary fibromyalgia treatment programme: results of a randomised trial.

OBJECTIVES: To assess the efficacy of a 6-week interdisciplinary treatment that combines coordinated psychological, medical, educational, and physiotherapeutic components (PSYMEPHY) over time compared to standard pharmacologic care. METHODS: Randomised controlled trial with follow-up at 6 months for the PSYMEPHY and control groups and 12 months for the PSYMEPHY group. Participants were 153 outpatients with FM recruited from a hospital pain management unit. Patients randomly allocated to the control group (CG) received standard pharmacologic therapy. The experimental group (EG) received an interdisciplinary treatment (12 sessions). The main outcome was changes in quality of life, and secondary outcomes were pain, physical function, anxiety, depression, use of pain coping strategies, and satisfaction with treatment as measured by the Fibromyalgia Impact Questionnaire, the Hospital Anxiety and Depression Scale, the Coping with Chronic Pain Questionnaire, and a question regarding satisfaction with the treatment. RESULTS: Six months after the intervention, significant improvements in quality of life (p=0.04), physical function (p=0.01), and pain (p=0.03) were seen in the PSYMEPHY group (n=54) compared with controls (n=56). Patients receiving the intervention reported greater satisfaction with treatment. Twelve months after the intervention, patients in the PSYMEPHY group (n=58) maintained statistically significant improvements in quality of life, physical functioning, pain, and symptoms of anxiety and depression, and were less likely to use maladaptive passive coping strategies compared to baseline. CONCLUSIONS: An interdisciplinary treatment for FM was associated with improvements in quality of life, pain, physical function, anxiety and depression, and pain coping strategies up to 12 months after the intervention.

Validity and reliability of the Spanish version of the Involvement Evaluation Questionnaire among caregivers of patients with eating disorders.

The Involvement Evaluation Questionnaire (IEQ) was developed to evaluate burden among caregivers of patients with schizophrenia. We aimed to examine its psychometric properties among caregivers of patients with eating disorders (ED). A prospective study was carried out, recruiting caregivers of patients with an ED attending two outpatient clinics in Bizkaia, Spain. Caregivers provided sociodemographic information and completed the Involvement Evaluation Questionnaire (IEQ), the Hospital Anxiety and Depression Scale (HADS), the Short-Form 12 (SF-12) and the Anorectic Behaviour Observation Scale (ABOS). The same information was requested one year later. The confirmatory factor analysis (CFA) provided satisfactory fit indexes. Almost all of the factor loadings were above 0.40. Cronbach's alpha coefficients were mostly superior to 0.70. The correlation coefficients between the IEQ domains and the other questionnaires were lower than the Cronbach's alpha coefficients. Known-groups validity was supported by significant differences in the IEQ mean scores according to certain variables, as contact hours, living with the patient, type of caregiver and gender. The indexes employed for the evaluation of responsiveness were between 0.13 and 0.99. The IEQ has good psychometric properties and can be used to evaluate burden among caregivers of patients with ED.