[Show abstract][Hide abstract] ABSTRACT: Background: The prevalence of mental disorders such as depression, schizophrenia and substance dependency, and neurological disorders such as dementia, migraine and epilepsy – together called brain disorders – is extremely high. Recently, evidence for the hypothesis of horizontal epidemiology, namely that impairments of mental functions, activity limitations and participation restrictions, and their determinants, experienced by persons with brain disorders in daily life are common across brain disorders, was shown in the EC-funded project Psychosocial fActors Relevant to BrAin DISorders in Europe (PARADISE). Objectives: To construct a metric scale of the impact of brain disorders on people’s lives and to identify a brief set of environmental and personal factors that are their shared determinants. Methods: Data from a cross-sectional study with a convenience sample of 722 persons with 9 different brain disorders interviewed in four European countries was used. Questions addressing 64 functioning domains were first reduced based on statistical considerations, patient’s perspective and clinical expertise. Rasch analyses for polytomous data were applied to construct a metric scale of functioning. Random forest regression and classical linear regression were used to identify a brief set of determinants with the highest impact on this metric. Results: A valid and reliable metric with 24 functioning items was created and ranges from zero (best level of functioning) to 100 (worst level of functioning). The brief set of determinants encompasses presence of comorbidities, stressful life events, self-esteem, self-worth, built environment and weather besides others.
WHO - Family of International Classifications Network Annual Meeting 2015, Manchester (UK); 10/2015
[Show abstract][Hide abstract] ABSTRACT: Objective:
To test the hypothesis of 'horizontal epidemiology', i.e. that psychosocial difficulties (PSDs), such as sleep disturbances, emotional instability and difficulties in personal interactions, and their environmental determinants are experienced in common across neurological and psychiatric disorders, together called brain disorders.
A multi-method study involving systematic literature reviews, content analysis of patient-reported outcomes and outcome instruments, clinical input and a qualitative study was carried out to generate a pool of PSD and environmental determinants relevant for nine different brain disorders, namely epilepsy, migraine, multiple sclerosis, Parkinson's disease, stroke, dementia, depression, schizophrenia and substance dependency. Information from these sources was harmonized and compiled, and after feedback from external experts, a data collection protocol including PSD and determinants common across these nine disorders was developed. This protocol was implemented as an interview in a cross-sectional study including a convenience sample of persons with one of the nine brain disorders. PSDs endorsed by at least 25% of patients with a brain disorder were considered associated with the disorder. PSD were considered common across disorders if associated to 5 out of the 9 brain disorders and if among the 5 both neurological and psychiatric conditions were represented.
The data collection protocol with 64 PSDs and 20 determinants was used to collect data from a convenience sample of 722 persons in four specialized health care facilities in Europe.
57 of the PSDs and 16 of the determinants included in the protocol were found to be experienced across brain disorders.
This is the first evidence that supports the hypothesis of horizontal epidemiology in brain disorders. This result challenges the brain disorder-specific or vertical approach in which clinical and epidemiological research about psychosocial difficulties experienced in daily life is commonly carried in neurology and psychiatry and the way in which the corresponding health care delivery is practiced in many countries of the world.
PLoS ONE 09/2015; 10(9):e0136271. DOI:10.1371/journal.pone.0136271 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Health conditions are associated with a variety of functional outcomes. Even though functional outcomes are diverse for different health conditions, they can have important commonalities. The aim of this study was to identify the most common problems in functioning across the wide range of health conditions using the International Classification of Functioning (ICF). Existing databases created for the 21 ICF Core Sets studies were descriptively analyzed. These included data collected in 44 countries on 9978 patients with one of 21 health conditions as the main diagnosis. A frequency cutoff of 50% was used to identify the most common problems in functioning when looking at single health conditions and across them. No category was identified as common to all health conditions included in the study. Fifteen most frequent categories were common in 10 to 13 health conditions out of 21. Eleven categories correspond to the list of activities and participation, and four to the list of body functions. These are related to mobility, daily routine, mental functions, intimate relations, employment, and leisure. Some health conditions have more commonalities between each other. The most common problems across health conditions are therefore related to mental functions, mobility, daily life, intimate relations, employment, and leisure. The results contribute toward the identification of the universal set of ICF categories that can be used in clinical practice for the general assessment of functioning.
International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 09/2015; 38(3):253-262. DOI:10.1097/MRR.0000000000000124 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The usual approach in disability surveys is to screen persons with disability upfront and then ask questions about everyday problems. The objectives of this paper are to demonstrate the impact of screeners on disability rates, to challenge the usual exclusion of persons with mild and moderate disability from disability surveys and to demonstrate the advantage of using an a posteriori cut-off. Using data of a pilot study of the WHO Model Disability Survey (MDS) in Cambodia and the polytomous Rasch model, metric scales of disability were built. The conventional screener approach based on the short disability module of the Washington City Group and the a posteriori cut-off method described in the World Disability Report were compared regarding disability rates. The screener led to imprecise rates and classified persons with mild to moderate disability as non-disabled, although these respondents already experienced important problems in daily life. The a posteriori cut-off applied to the general population sample led to a more precise disability rate and allowed for a differentiation of the performance and needs of persons with mild, moderate and severe disability. This approach can be therefore considered as an inclusive approach suitable to monitor the Convention on the Rights of Persons with Disabilities.
International Journal of Environmental Research and Public Health 08/2015; 12(9):10329-10351. DOI:10.3390/ijerph120910329 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: To describe physical activity (PA) levels in persons with spinal cord injury (SCI) and to investigate
Methods: PA behavior of people with SCI in Switzerland was assessed in a community survey with four items from the Physical Activity Scale for individuals with physical disabilities (PA of light, moderate, and strenuous intensity and muscle-strengthening exercises). In addition to descriptive analyses, the odds of performing PA according to the WHO recommendations (at least 2.5 h/week of at least moderate intensity) were analyzed by multivariable logistic regression.
Results: Participants (n = 485; aged 52.9 ± 14.8; 73.6 % male) carried out PA a total of 6.0 h/week (median). 18.6 % were physically inactive, 50.3 % carried out musclestrengthening exercises, and 48.9 % fulfilled the WHO recommendations. Regression analyses showed that women, people aged 71+, and people with complete tetraplegia had significantly lower odds of fulfilling the WHO recommendations than participants in the respective reference category (men, ages 17–30, incomplete paraplegia).
Conclusions: PA levels of people with SCI in Switzerland are rather high. However, some subgroups need special consideration when planning interventions to increase PA levels.
International Journal of Public Health 08/2015; DOI:10.1007/s00038-015-0724-5 · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study is to determine whether persons with neuropsychiatric disorders experience a common set of psychosocial difficulties using qualitative data from focus groups and individual interviews.
The study was performed in five European countries (Finland, Italy, Germany, Poland and Spain) using the focus groups and individual interviews with persons with nine neuropsychiatric disorders (dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson's disease, schizophrenia, stroke and substance dependence). Digitally recorded sessions were analysed using a step-by-step qualitative and quantitative methodology resulting in the compilation of a common set of psychosocial difficulties using the International Classification of Functioning, Disability and Health (ICF) as a framework.
Sixty-seven persons participated in the study. Most persons with neuropsychiatric disorders experience difficulties in emotional functions, sleeping, carrying out daily routine, working and interpersonal relationships in common. Sixteen out of 33 psychosocial difficulties made up the common set. This set includes mental functions, pain and issues addressing activities and participation and provides first evidence for the hypothesis of horizontal epidemiology of psychosocial difficulties in neuropsychiatric disorders.
This study provides information about psychosocial difficulties that should be covered in the treatment and rehabilitation of persons with neuropsychiatric disorders regardless of clinical diagnoses. Implications for Rehabilitation Emotional problems, work and sleep problems should be addressed in all the treatments of neuropsychiatric disorders regardless of their specific diagnosis, etiology and severity. Personality issues should be targeted in the treatment for neurological disorders, whereas communication skill training may also be useful for mental disorders. The effects of medication and social environment on patient's daily life should be considered in all the neuropsychiatric conditions.
Disability and Rehabilitation 08/2015; DOI:10.3109/09638288.2015.1074729 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To construct a metric of the impact of brain disorders on people's lives, based on the psychosocial difficulties (PSDs) that are experienced in common across brain disorders.
Psychometric study using data from a cross-sectional study with a convenience sample of 722 persons with 9 different brain disorders interviewed in four European countries: Italy, Poland, Spain and Finland. Questions addressing 64 PSDs were first reduced based on statistical considerations, patient's perspective and clinical expertise. Rasch analyses for polytomous data were also applied.
In and outpatient settings.
A valid and reliable metric with 24 items was created. The infit of all questions ranged between 0.7 and 1.3. There were no disordered thresholds. The targeting between item thresholds and persons' abilities was good and the person-separation index was 0.92. Persons' abilities were linearly transformed into a more intuitive scale ranging from zero (no PSDs) to 100 (extreme PSDs).
The metric, called PARADISE 24, is based on the hypothesis of horizontal epidemiology, which affirms that people with brain disorders commonly experience PSDs. This metric is a useful tool to carry out cardinal comparisons over time of the magnitude of the psychosocial impact of brain disorders and between persons and groups in clinical practice and research.
PLoS ONE 07/2015; 10(7):e0132410. DOI:10.1371/journal.pone.0132410 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Lived health and biological health are two different perspectives of health introduced by the International Classification of Functioning, Disability and Health (ICF). Since in the concept of lived health the impact of the environment on biological health is inherently included, it seems intuitive that when identifying the environmental determinants of health, lived health is the appropriate outcome. The Multilevel Item Response Theory (MLIRT) model has proven to be a successful method when dealing with the relation between a latent variable and observed variables. The objective of this study was to identify environmental factors associated with lived health when controlling for biological health by using the MLIRT framework.
We performed a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data were collected from 17,303 adults living in 15,263 dwellings. The MLIRT model was used for each of the two steps of the analysis to: (1) calculate people’s biological health abilities and (2) estimate the association between lived health and environmental factors when controlling for biological health. The hierarchical structure of individuals in dwellings was considered in both models.
Social support, being able to maintain one’s job, the extent to which one’s health needs are addressed and being discriminated against due to one’s health problems were the environmental factors identified as associated with lived health. Biological health also had a strong positive association with lived health.
This study identified environmental factors associated with people’s lived health differences within and between dwellings according to the MLIRT-model approach. This study paves the way for the future implementation of the MLIRT model when analysing ICF-based data.
BMC Public Health 05/2015; 15(1). DOI:10.1186/s12889-015-1834-y · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this article is to compare the content of patient-reported outcome (PRO) burnout measures and to examine the degree of overlap between them and psychosocial difficulties (PSD) experienced by persons with burnout. The most frequently used PRO and qualitative studies were identified in two systematic literature reviews. Psychosocial difficulties identified in both sources were standardized and a qualitative content comparison was performed. Seven PROs and seven qualitative studies were selected. Energy and drive, emotional functions and work were key themes of both sources. Disparities were observed for problems in areas such as sleep, attention or family relationships, which were reported in several qualitative studies, but are seldom addressed in PROs. Several areas important to persons with burnout, such as family relationships, are seldom measured by currently used PROs. From a biopsychosocial perspective, these instruments cannot therefore be considered comprehensive enough to capture the whole experience of burnout and should be improved.
European Journal of Psychological Assessment 05/2015; 1(-1):1-9. DOI:10.1027/1015-5759/a000210 · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Comprehensive understanding of the determinants of health service use (HSU) by older people with depression is essential for health service planning for an ageing global population. This study aimed to determine the extent to which depressive symptom severity and functioning are associated with HSU by older people with depression in low and middle income countries (LMICs).
A cross-sectional analysis of the 10/66 Dementia Research Group population-based surveys dataset. Participants (n = 4590) were those aged 65 or older, in the clinical range for depressive symptoms (defined as scoring four or more on the EURO-D), living in 13 urban and/or rural catchment areas in nine LMICs. Associations were calculated using Poisson regression and random-effects meta-analysis.
After adjustment for confounding variables, (EURO-D) depressive symptom severity was significantly associated with "any community HSU" (Pooled Prevalence Ratios = 1.02; 95% CI = 1.01-1.03) but not hospital admission. Conversely, after adjustment, (WHODAS-II) functioning was significantly associated with hospital admission (Pooled PR = 1.14; 95% CI = 1.02-1.26) but not "any community HSU".
Depressive symptom severity does not explain a large proportion of the variance in HSU by older people with depression in LMICs. The association of functioning with this HSU is worthy of further investigation. In LMICs, variables related to accessibility may be more important correlates of HSU than variables directly related to health problems.
International Journal of Environmental Research and Public Health 04/2015; 12(4):3774-3792. DOI:10.3390/ijerph120403774 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The poster briefly outlines a methodology proposed to give impetus to a collaborative effort involving integral stakeholders to determine whether Web accessibility facilitation measures must be adapted for people with depression and anxiety, and if so, in what way(s). The methodology has three-phases: (1) identification of Web accessibility barriers using two data sources: a systematic review of pertinent literature and focus group interviews with people with depression and anxiety; (2) validation of current Web accessibility facilitation measures for this population using experimental user-testing; (3) provision of expertise-based recommendations for the improvement of Web accessibility facilitation measures using a delphi method. If adopted, the study’s findings are expected to make a significant contribution towards ensuring full and effective participation and inclusion in society, and equality of opportunity for people with mental disorders by improving their access to the Web.
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury is a sudden and unexpected condition that gives rise to different impairments in body functions and structures leading to dramatic life changes, not only to the patient but also to his or her family and ultimately in the wider society. As a health strategy, rehabilitation aims to reduce disability and increasing the quality of life of those people that suffer from TBI but also to reduce the social burden associated with it. Functioning is the starting point of rehabilitation and the use of measurement instruments and classifications are commonly used tools for its definition. Within the endorsement of the ICF by WHO, there is now a classification and a conceptual framework for the description of functioning providing an opportunity of a full understanding of the experience of TBI.
This paper aims to identify the utility of ICF in TBI as well as bringing new challenges for further clinical practice and research.
ICF has shown itself to be useful in the content comparison of measurement instruments. It has also been used to describe the functional profile of individuals with TBI in both acute and chronic phases making it possible to draw comparisons across other health conditions. Furthermore, the development of the TBI ICF Core Sets provided an item bank to describe not only functional status but also to set goals and plan interventions. Overall, we now have a potentially useful tool in rehabilitation of TBI that allows us to understand the full burden of traumatic brain injury.
[Show abstract][Hide abstract] ABSTRACT: Background
Major depression and alcohol use disorders are risk factors for incidence of disability. However, it is still unclear whether a chronic course of these health conditions is also prospectively associated with incidence of disability. The aim of the present study was, first, to confirm whether chronic major depression (MD) and alcohol use disorders (AUD) are, respectively, risk factors for persistence and incidence of disability in the general population; and then to analyze the role of help-seeking behavior in the course of disability among respondents with chronic MD and chronic AUD.Method
Data from two assessments in the National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. Disability was measured by eight domains of the Short Form 12 Health Survey version 2 (SF-12). Generalized estimating equations and logistic regression models were run to estimate risk factors for persistence and incidence of disability, respectively.ResultsAnalyses conducted on data from the US general population showed that chronic MD was the strongest risk factor for incidence and persistence of disability in the social functioning, emotional role and mental health domains. Chronic AUD were risk factors for incidence and persistence of disability in the vitality, social functioning, and emotional role domains. Within the group of chronic MD, physical comorbidity and help-seeking were associated with persistent disability in most of the SF-12 domains. Help-seeking behavior was also associated with incidence of problems in the mental health domain for the depression group. Regarding the AUD group, comorbidity with physical health problems was a strong risk factor for persistence of disability in all SF-12 domains. Help-seeking behavior was not related to either persistence or incidence of disability in the chronic alcohol group.Conclusions
Chronic MD and chronic AUDs are independent risk factors for persistence and incidence of disability in the US general population. People with chronic MD seek help for their problems when they experience persistent disability, whereas people with chronic AUD might not seek any help even if they are suffering from persistent disability.
Health and Quality of Life Outcomes 12/2014; 12(1):186. DOI:10.1186/s12955-014-0186-0 · 2.12 Impact Factor