Cancer and depression: A comparison of cancer victims with the general population, findings from the European Social Survey 2014.

Aims: An increasing number of people in Europe are living with cancer, either as an active disease or as a past experience. Depressive symptoms may impair quality of life in cancer patients and may constitute increased risks for disability, as well as being a risk factor for increased mortality. Our study compared self-reported symptoms of depression in people who currently or previously have experienced cancer with self-reported symptoms of depression in the general population. Methods: Our study was based on data from the European Social Survey 2014, with representative samples from 19 countries. Depression was measured by an eight-item CES-D Scale, with a cut-point of a mean score of 2 to indicate depression. Multilevel modelling was used to examine the relationship between cancer status and depression. Results: Respondents who at the time of the interview reported to have cancer were more likely to report symptoms above the cut-point on the depression scale than people who never had experienced cancer (unadjusted odds ratio (ORunadjusted)=2.59; 95% confidence interval (CI) 2.20-3.06; and ORadjusted=2.00; 95% CI 1.70-2.36). The difference was smaller comparing people who previously had experienced cancer to people who never had experienced cancer (ORunadjusted=1.46; 95% CI 1.19-1.79; and ORadjusted=1.28; 95% CI 1.05-1.55). The differences in depression by cancer status did not vary among the welfare state regimes. Conclusions: Respondents with a cancer disease showed a substantial elevated risk of depression after adjusting for a range of potential confounders. Respondents who had recovered also showed significantly higher adjusted risk of depression than respondents who had never experienced cancer.

Quality of life in primary school children: The Health Oriented Pedagogical Project (HOPP).

AIMS: The primary aim of the present study was to evaluate the association between parents' level of education, measurements of physical attributes, and quality of life in a general sample of primary school children. METHODS: The children's and the parents' versions of the Inventory of Life Quality in Children and Adolescents (ILC) were used to measure health-related quality of life (QOL) in 2140 school children (response rate 93%) and 1639 parents (response rate 71%) recruited from nine primary schools in Norway. A set of physical characteristics were also measured in the children: body mass index (BMI), waist circumference, average daily minutes of physical activity, aerobic fitness, and handgrip strength. RESULTS: The regression analysis showed stronger relationships between the covariates and QOL for the parents' assessments than for the children's. Parents' level of education was significantly related to children's QOL, with the strongest association for parental QOL assessment. Among the physical variables, aerobic fitness ( B = 0.01, p > .001 in both samples), and handgrip strength in the parents' sample ( B = 0.21, p < .05) were significantly related to the children's QOL. CONCLUSIONS: The present study replicated the well-known finding that parents' sociodemographic status is important for children's QOL. Our new contribution is to show that the physiological variables aerobic fitness and muscular strength also contributed significantly to explain variance in QOL. This opens up interesting perspectives on how to improve QOL among children through more emphasis on physical activity and physical fitness in schools.

Quality of life and living with cancer: findings from the European social survey (2014) special module on the social determinants of health.

Background: This study is a comparison of quality of life (QOL) of current and previous cancer victims with people who never had experienced cancer in samples from the general population from the 19 countries in the European Social Survey (ESS) 2014. Methods: The study was based on the ESS 2014 with representative samples from 19 countries. QOL was measured by combining two questions on happiness and life satisfaction into a QOL scale. Multilevel modelling was used to examine whether the relationship between cancer status and QOL varies between countries in general and by welfare state regimes in particular. Results: People with cancer at the time of the interview, showed lower general QOL than both people who previously have had cancer and people who never have experienced cancer. The unadjusted and the adjusted odds ratios (ORs) for poor QOL were respectively, OR = 2.38, (2.07, 2.74) and OR = 1.98, (1.71, 2.30). The difference between the 'Never' and the 'Previously' groups was minor but statistical significant. The welfare state classification was a strong predictor of country differences in QOL, but there was no significant statistical interaction effect between cancer status and the welfare state classification. The study also replicated well-documented findings on differences in QOL by education and social support. Conclusion: The QOL of people with a cancer disease is significantly impaired. People who previously have had cancer, scored only slightly lower on the QOL scale than people who never had experienced cancer. We found evidence indicating that these differences may vary between the countries, but this variation cannot be explained by the welfare state classification.

War Experiences and General Health Among People in Bosnia-Herzegovina and Kosovo.

War experiences may have an extensive impact on the health status of the exposed populations. This population-based study aimed to examine the relationship between war experiences and self-reported general health in representative sample surveys from Bosnia-Herzegovina (n = 3,313) and Kosovo (n = 1,000). Data were collected with face-to-face interviews fielded in the winter of 2003-2004. Logistic regression analysis was used to compute unadjusted and adjusted odds ratios (ORs). The adjusted effects of the extensiveness of war experiences on poor health were positive in both countries, but they were statistically significant only for Bosnia-Herzegovina: OR = 1.04, 95% CI [1.00, 1.08] for Bosnia-Herzegovina and OR = 1.03, 95% CI [0.98, 1.09] for Kosovo. The strongest observed effect was found for Kosovo only: The extensiveness of war experiences was relatively strongly related to longstanding health problems, OR = 1.09, 95% CI [1.03, 1.15]. We found that war experiences may contribute to increased poorer health in the exposed populations; however, the effects 4-9 years after the war ended were modest. Hence, war experiences seemed to be more strongly related to war-related distress and posttraumatic stress disorder than to self-reported general health.

Socioeconomic inequalities in mortality and repeated measurement of explanatory risk factors in a 25 years follow-up.

BACKGROUND: Socioeconomic inequalities in mortality can be explained by different groups of risk factors. However, little is known whether repeated measurement of risk factors can provide better explanation of socioeconomic inequalities in health. Our study examines the extent to which relative educational and income inequalities in mortality might be explained by explanatory risk factors (behavioral, psychosocial, biomedical risk factors and employment) measured at two points in time, as compared to one measurement at baseline. METHODS AND FINDINGS: From the Norwegian total county population-based HUNT Study (years 1984-86 and 1995-1997, respectively) 61 513 men and women aged 25-80 (82.5% of all enrolled) were followed-up for mortality in 25 years until 2009, employing a discrete time survival analysis. Socioeconomic inequalities in mortality were observed. As compared to their highest socioeconomic counterparts, the lowest educated men had an OR (odds ratio) of 1.41 (95% CI 1.29-1.55) and for the lowest income quartile OR = 1.59 (1.48-1.571), for women OR = 1.35 (1.17-1.55), and OR = 1.40 (1.28-1.52), respectively. Baseline explanatory variables attenuated the association between education and income with mortality by 54% and 54% in men, respectively, and by 69% and 18% in women. After entering time-varying variables, this attainment increased to 63% and 59% in men, respectively, and to 25% (income) in women, with no improvement in regard to education in women. Change in biomedical factors and employment did not amend the explanation. CONCLUSIONS: Addition of a second measurement for risk factors provided only a modest improvement in explaining educational and income inequalities in mortality in Norwegian men and women. Accounting for change in behavior provided the largest improvement in explained inequalities in mortality for both men and women, as compared to measurement at baseline. Psychosocial factors explained the largest share of income inequalities in mortality for men, but repeated measurement of these factors contributed only to modest improvement in explanation. Further comparative research on the relative importance of explanatory pathways assessed over time is needed.

Educational health inequalities in former Yugoslavia: evidence from the South-East European Social Survey Project.

BACKGROUND: An important gap in our knowledge of social inequalities in health is the former Yugoslavia, a region of culturally and historically diverse countries, with recent conflict. The aim of the present paper is to investigate relative and absolute inequalities in self-assessed health in former Yugoslavia (Bosnia-Herzegovina, Croatia, Kosovo, Macedonia, Montenegro, Slovenia and Serbia) by sex and education. METHODS: The data source is the South-East European Social Survey Project fielded in December 2003 to Winter 2004, covering the former Yugoslavia with a total sample of 18 481 respondents. Data from Slovenia were obtained from the 2004-wave of the European Social Survey. The health outcome variables were self-reported general health (SRH) and limiting longstanding illness (LLI). RESULTS: Both absolute and relative educational health inequalities were present throughout the former Yugoslavia to a larger or lesser extent, although odds ratios (ORs) for LLI and SRH were not significant for Montenegrin women [LLI OR = 1.12, 95% confidence interval (CI): 0.92-1.37; SRH OR = 1.16, 95% CI: 0.96-1.40] and with respect to the reporting of LLI among Slovenian men (OR = 1.16, 95% CI: 0.96-1.44). Overall, Montenegro held the best position. CONCLUSIONS: The prevalence of poor health and the degree of relative inequality in self-assessed health in the former Yugoslavian countries were similar in order to one another, and to other East European countries during the same period. Influences on subjective health require further elucidation. Further research should study a wider range of health outcomes using larger survey samples and a wider range of cultural and other predictor variables.

Welfare state regimes and differences in self-perceived health in Europe: a multilevel analysis.

The aim of this study was to determine the degree to which welfare state regime characteristics explained the proportional variation of self-perceived health between European countries, when individual and regional variation was accounted for, by undertaking a multilevel analysis of the European Social Survey (2002 and 2004). A total of 65,065 individuals, from 218 regions and 21 countries, aged 25 years and above were included in the analysis. The health outcomes related to people's own mental and physical health, in general. The study showed that almost 90% of the variation in health was attributable to the individual-level, while approximately 10% was associated with national welfare state characteristics. The variation across regions within countries was not significant. Type of welfare state regime appeared to account for approximately half of the national-level variation of health inequalities between European countries. People in countries with Scandinavian and Anglo-Saxon welfare regimes were observed to have better self-perceived general health in comparison to Southern and East European welfare regimes.

War experiences and war-related distress in Bosnia and Herzegovina eight years after war.

AIM: To examine the relationship between war experiences and war-related distress in Bosnia and Herzegovina. METHODS: The survey was performed in the late 2003 on a representative sample of 3313 respondents. The face-to-face interviews included 15 items on war-related distress and 24 items on war experiences. From these items we developed the War-related Distress Scale, the Direct War Experiences Scale, and the Indirect War Experiences Scale. Regression analysis was used to examine the relationship between war-related distress symptoms and war experiences variables, controlling for a range of other variables. RESULTS: Almost half of the respondents did not report any war-related distress symptoms, while about 13% reported 7 or more symptoms. Direct war experiences had a significant effect on war-related distress even eight years after the war, while indirect war experiences showed no significant effect on war-related distress. We found that marital status weakly decreased war-related distress, while household size increased it. CONCLUSION: Direct war experiences seem to have a long-lasting traumatic effect on a substantial number of residents of Bosnia and Herzegovina.

Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer?

OBJECTIVE: To examine the relationship between social support and emotional functioning and stress reactions. Our hypothesis is that patients who reported a high degree of social support will experience better emotional functioning and less serious stress reactions than patients with a low degree of social support. METHOD: The sample was comprised of 434 patients at the Palliative Medicine Unit (PMU), University Hospital of Trondheim in Norway. The patients completed a questionnaire monthly including questions about social support from the MacAdam's Scale, subjective stress measured by the Impact of Event Scale (IES), and emotional functioning measured by the subscale in the EORTC QLQ-30. RESULTS: Although our hypothesis was not supported at the baseline assessment, it was supported at the second assessment, 2 months later. Patients with high social support reported better emotional functioning and less serious stress reactions, in terms of lower scores on the IES avoidance subscale, than patients with a low degree of social support. SIGNIFICANCE OF THE RESULTS: The mixed findings may indicate that social support has only small effects on emotional functioning and stress reactions. Our results on the second assessment indicate, however, that social support might work as a buffer against reactions toward external stressful events such as terminal cancer.

Health-related quality of life (HRQOL) in family members of cancer victims: results from a longitudinal intervention study in Norway and Sweden.

This study compared the health-related quality of life (HRQOL) of family members of patients who participated in a program of palliative care (intervention family members) with those in conventional care (control family members). The HRQOL was measured by the short-form (SF-36) health survey questionnaire, including eight subscales. The longitudinal intervention study includes two sites: Trondheim, Norway and Malmø, Sweden. Our first hypothesis was that the HRQOL of the family members would deteriorate over time in the terminal phase and reach a low point a few months after the death of the patients, and thereafter gradually increase. This hypothesis was fully supported by the trajectories for the five scales, role limitation due to physical problems, vitality, social functioning, role limitation due to emotional problems, and mental health; but only partially so for the remaining three scales, physical functioning, bodily pain, and general health perception. From a second hypothesis, we expected the trajectories of the HRQOL scale scores for the two groups to show an increasing difference over time in quality of life in favor of the intervention group. This was the case for two of the scales: role limitation due to emotional problems and mental health. Before we may reach a definitive conclusion on the effects of palliative care programs for the HRQOL of family members, we need further longitudinal intervention studies with large samples.

[Do physicians experience spousal support in their medical career?]. / Opplever legene at partnerne er gode støttespillere i yrkeskarrieren?

BACKGROUND: The professional life of physicians is characterised by long working days and pressure for efficiency. Family life represents an arena for developing other aspects of life. It is not well known to what extent physicians' spouses are supportive of the physician's total situation, or how gender, age, family or professional aspects influence this perception. MATERIAL AND METHODS: In a nation-wide survey of the medical profession, 1594 male and 512 female physicians answered 12 attitude statements relating to work and family life. The responses were grouped by factor analysis into three dimensions: emotional support, instrumental support, and conflict. The statistical analysis for associations between social support and age, family and professional factors was performed separately for men and women in multivariate models. RESULTS: Physicians were generally satisfied with the support given by their spouses. Female physicians reported more emotional support; male physicians perceived or reported more practical support as well as more conflict. The experience of conflict was most pronounced among physicians aged 35-44 and among those reporting long working hours. The strongest positive association between social support and spouse's profession was found for spouses who were physicians themselves. INTERPRETATION: Experienced spousal support among Norwegian physicians is influenced by gender and various aspects of work and family life. Physicians with same-profession spouses expressed the greatest satisfaction with the support they received.