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This paper reports on the field testing, empirical derivation and psychometric properties of the World Health Organisation Quality of Life assessment (the WHOQOL). The steps are presented from the development of the initial pilot version of the instrument to the field trial version, the so-called WHOQOL-100. The instrument has been developed collaboratively in a number of centres in diverse cultural settings over several years ; data are presented on the performance of the instrument in 15 different settings worldwide.

Patient reported outcomes are important in understanding the impacts of medical conditions on the affected individuals, and in determining the effects of medical treatments. Since quality of life has been recognized as an important health outcome in chronic diseases, this paper aims to give an overview of studies that were carried out in Croatia in the health care field, and analyse them with respect to a contribution that subjective quality of life indicators may have in treating chronic conditions. We searched Medline and Scopus (2004 to the present) for studies on quality of life issues carried out in Croatia within the field of health sciences. The published articles were analysed with respect to 1. quality of life concept used in the published studies, 2. studied medical conditions, and 3. type of studies including quality of life measures. Results of some studies have been presented in order to demonstrate how quality of life assessments have contributed to patients' outcomes. The search findings are discussed in terms of methodological issues that might improve quality of life assessments in clinical care of people with chronic diseases.

Objective: The study was aimed at exploring a one-year course of depression in persons with type 2 diabetes and analysing demographic, disease-related and psychological variables that may predict depression persistence. Patients and methods: One hundred patients from a randomly selected sample of 470 outpatients were found to be suffering from severe depressive symptoms. They were followed and re-examined for depression after one year. Depression was assessed by the Center for Epidemiologic Studies-Depression scale, and a face-to-face diagnostic interview relying on the DSM-IV. Depression, health-related quality of life and diabetes-related distress were assessed at baseline. Non-parametric tests for between-group differences were used to compare patients who recovered from depression with those who still suffered from severe depressive symptoms. Multiple logistic regression was used to determine predictors of depression persistence. Results: Seventy-nine of 100 patients with baseline depression scores indicative of severe depression were reached at one-year follow-up. Among them, 53% were shown to have improved depressive symptoms, while 47% continued to suffer from severe depressive symptoms. Logistic regression analysis indicated that psychosocial variables were more strongly associated with persistent depression than demographic and diabetes-related ones. Baseline severity of depression, diabetes-related distress and subjectively perceived quality of life were shown to independently predict one-year depression outcomes (OR =3.5 /CI 1.17-10.71/ p=0.02 ; OR=3.5 /CI 1.2-10.5/ p=0.02 and OR=0.94 /CI 0.91-0.98/ respectively). Conclusions: Severity of baseline depression, a degree to which depression disrupted the affected patients' quality of life, and concomitant emotional problems related to diabetes were shown to be associated with persistent depresive disturbances.

The relationship between depression and blood glucose control in Type 2 diabetes is insufficiently understood. This study suggests that depression alone does not predict poorer glycaemic control than in the symptom-free individuals. Rather than mere depression, it is the interaction between depression and diabetes-related distress that compromises the ability of Type 2 diabetic patients to successfully control their diabetes.

Background and aims: Psychological well-being and diabetes self-management have been shown to be interdependent. However, associations between psychological symptoms and glycemic control are not quite consistent. This study was aimed at examining patterns of glycemic control in emotionally burdened subgroups versus symptom- free individuals with type 2 diabetes. Materials and Methods: A random sample of 470 type 2 diabetic patiens (aged 58± 8yrs, 52% female, with diabetes duration of 9± 6 yrs, 33% insulin treated) were assessed for depression and diabetes-related distress by using the Center for Epidemiologic Studies-Depression (CES-D) and the Problem Areas in Diabetes (PAID) scales. Relying on the standard cut offs (CES-D>16, PAID>40), four discrete subgroups were analysed: patients with severe depressive symptoms and high diabetes distress, patients with severe depressive symptoms only, patients with high diabetes-related distress only and symptom-free patients. The indicators of glycemic control, as determined by Hba1C values, were analysed at the point of psychological assessment and after one year. Pearson's correlation coefficients were used to determine univariate associations between glycemic control, disease-related and psychological variables. Analysis of covariance was used to compare glycemic control in the four groups while controlling for the disease-related variables. Results: Twelve percent of the examined patients suffered severe depressive symptoms combined with high diabetes-related distress, 10% reported severe depressive symptoms, 22% expressed high distress and 56% were symptom-free. The entire group's glycemic control was associated with diabetes duration (r=0, 14 p

Aims: To determine the prevalence rate of and risk factors for depression in Croatian Type 2 diabetic patients. Methods: Depressive mood was examined in 384 randomly selected outpatients with Type 2 diabetes. Center for Epidemiological Studies Depression Scale (CES-D) and Structured Clinical Interview for DSM-IV axis I disorders (SCID) were used to identify depressive disturbances. The groups with CES-D≥ 16 and

Drugo izdanje Psihologijskog rječnika sadrži mnogo novih natuknica, posebice u područjima psihologije koja su se u posljednje vrijeme najviše razvijala, poput biološke psihologije, kognitivne psihologije, kliničke psihologije kao i drugih područja u kojima se pojavio veći broj novih pojmova i teorija. Drugo, rječnik sada pokriva i područja koja su u prvom izdanju bila zanemarena, poput traumatske psihologije. Domovinski rat, a osobito uključenost psihologa u pružanje psihosocijalne pomoći, potakli su nas da se uputimo u područje traumatske psihologije, što se odrazilo i u nizu novih natuknica. Treće, u posljednjih desetak godina posebno je postala izražena uloga računalnog pristupa pojedinim problemima u znanosti općenito, pa tako i u psihologiji, te je i taj dio razvoja trebalo uključiti u Rječnik. Novo, nadopunjeno izdanje sadrži popis ljudi iz psihologije i drugih, srodnih struka koji su u nekom razdoblju razvoja psihologije doprinijeli tom razvoju ili u nekom od njezinih brojnih područja dali svoj značajan doprinos.

Prikazani su rezultati istraživanja depresivnosti u dijabetičkih bolesnika s tipom 2 šećerne bolesti. Oni su uspoređeni s rezultatima sličnih istraživanja.

Background and aims: Little is known about the course of depressive symtoms in type 2 diabetic patients. This study was aimed at exploring changes in depressive symptoms after one year follow-up, and determining factors that may predict them. Materials and methods: One hundred patients found to be at risk for depression by using CES-D scale in a random sample of 463 type patients, among them 30 diagnosed with clinical depression using structured clinical interview, were followed for one year. Problem areas in diabetes scale (PAID) and health-related quality of life measure (SF-12) were applied in addition to CES-D. Initially informed about their condition and treatment possibilities, the patients were contacted by phone at 3-month intervals, and re-assessed for depression after one year. They were aged 57&plusmn ; ; ; 7 yrs, with diabetes duration of 9&plusmn ; ; ; 6 yrs ; 66% were female and 44% were on insulin therapy. Changes in depressive symptoms were determined using t-test. A reduction in depressive symptoms from CES-D≥ 16 to CES-D< 16 was taken as being indicative of recovery, with multiple regression analysis used to determine its predictors. Results: Fifty-six percent of patients with baseline CES-D scores ≥ 16 improved their depressive symptoms after one year and were below this cut-off (CES-D=9.8&plusmn ; ; ; 3.6), while 44% remained in the category indicative of pervasive depression (CES-D=27.3&plusmn ; ; ; 8.4). Regression summary for CES-D group (

This study was aimed at exploring interaction of both clinical and subclinical depressive disorders with perceived well-being, diabetes self-management and glycemic control in type 2 patients. The examined sample (N=384) was randomly selected among patients attending their regular check-ups. Information on current life circumstances, family and economic status were collected by a semi-structured interview. Questionnaires assessing depressive symptoms (CES-D), diabetes-related distress (PAID), diabetes self-care (SCDA), quality of life (SF-12) and well-being (WHO-5) were used to gain insight into an individual s emotional state and experience in living with the disease. Patients with CES-D scores 16 were invited to psychiatric interview to assess clinical significance of depressive symptoms. One-way ANOVA was used to compare depression-free patients with those expressing clinically significant and subclinical depression. Chi-square tests were used to compare health-related indicators for the groups with and without depressive symptoms. Twenty-two percent of patients had CES-D scores 16 and among them 33% had clinical depression confirmed by psychiatric interview. Both clinically and subclinically depressed patients, when compared with symptom free patients, expressed more diabetes-related distress and poorer quality of life (F=15.27 p=0.0000 and F=52.19 p=0.0000 respectively). They had poorer adherence to diet (F=2.75 p=0.04), more frequent smoking status (chi =4.87 p=0.02) and higher rates of neuropathy and cardiopathy (chi =3.82 p=0.05 and chi =4.53 p=0.03 respectively). Glycemic control as assessed by HbA1C did not differ between symptom free and depressed patients, neither at the time of examination (F=0.24 p=0.856) nor previously (F=0.72 p=0.539). The collected data indicated that even subclinical depressive disorders in type 2 patients adversely interact with perceived health/well-being and might affect self-care. Both symptom free and depressed patients had comparable glycemic control.

Background and aimes: Depression is a prevalent co-morbid condition in diabetes. This study was aimed at determining the occurrence of depression in type 2 diabetic patients, as well as the degree to which depression was adequately treated. Materials and methods: A random sample of 405 type 2 diabetic outpatiens were screened for depression with the Center for Epidemiological Studies-Depression (CES-D) instrument. Patients with CES-D scores ≥ 16 were invited for a psychiatric interview relying on Axis I disorders of the DSM-IV (SCID) to establish the clinical significance of their symptoms. Psychological anamnestic data and data on current life circumstances were collected by a semi-structured interview. Adequate treatment of depression was defined as the use of either an antidepressant or a mood stabilizer for a minimum of 30 days, or at least 8 outpatient visits with any professional qualified in psychotherapy. Results: Of the examined patients 24 % had CES-D scores≥ 16 (66% female, aged 57&plusmn ; 8 yrs, educated for 10&plusmn ; 3 yrs, having diabetes for 9&plusmn ; 6 yrs, treated with insulin in 44% of cases, with BMI 29&plusmn ; 4 kg/m&sup2 ; and HbA1c 7.9&plusmn ; 1.6%), and in 36% of them clinical depression was confirmed by SCID (64% female, aged 55&plusmn ; 8 yrs, with 10&plusmn ; 3 yrs of education, having diabetes for 9&plusmn ; 6 yrs, 43% insulin treated, with BMI 29&plusmn ; 4 kg/m&sup2 ; and HbA1c 7.9&plusmn ; 2.2%). When compared with subjects free of severe depressive symptoms (CES-D16 but not confirmed by diagnosis of depression), clinically depressed patients were found to be taking psychotropic medication in a significantly greater proportion (71% vs. 47% in the group with mild depression and 27% in the group free of severe depressive symptoms χ &sup2 ; =27.72 ; p

This review traces the 12-year history of an international collaboration of researchers - the WHOQOL Group - who were brought together by the World Health Organisation to develop and produce a cross-cultural measure of quality of life for use in health and health care. The theoretical and philosophical basis of the WHOQOL instrument is outlined as it evolved throughout the design and adjustment of a reflexive methodology that places an assessment of the users' views at the centre of health care. The stages of research are further expanded and explained in recounting the scientific experience of this unique collaboration. The WHOQOL is available in 40 countries and most majority languages. Adaptations exist for assessing particular conditions, e. g. spirituality, religion and personal beliefs.

Background and aims: Knowing about patients’ quality of life (QoL) is becoming increasingly important in delivering diabetes care. This study was aimed to examine how particular life aspects contribute to the individuals’ ratings of their overall quality of life and general health. Patients and methods: 395 patients who attended a 5-day educational course were evaluated regarding their QoL at baseline, and after 3- and 18-month follow-up periods. The sample comprised 183 males and 212 females aged 39.2  15.1 years, with diabetes duration for 11.4  8.7 yrs, treated with insulin in 89% cases, with baseline HbA1C values 8.6%  2.3 having improved to 8.0%  1.8 and 7.8%  1.6 after 3 and 18 months respectively, educated at primary (10.4%), secondary (66.6%) and university level (23%), the majority (89.8%) living with families. The WHOQoL-BREF was used to assess the individual QoL. This 26-item generic instrument covered the respondent’ s overall QoL and general health, as well as four domains referring to physical health, psychological state, social relationships and environmental circumstances. Regression analysis was employed to determine the contribution of particular QoL domains to the patients’ ratings of their overall QoL and general health. Results: Psychological domain was shown to be the best predictor of overall QoL (Beta =.284 Sign .000), followed by Environment (Beta= .281 Sign .000) and Social relationships domain (Beta=.178 Sign .000). Physical and psychological domains were the best predictors of general health (Beta= .334 Sign .000 and Beta=.268 Sign .000). The predictive value of these domains were shown to be consistent at both follow-up assessments. Conclusion: The patients’ overall QoL seems to be primarily determined by psychological state, environmental factors and social relations, while their evaluation of general health is comparably associated with physical and psychological factors. Using these simple self-assessments might be helpful in clinical routine when more comprehensive measures are not available.

Background and aims: Quality of life (QoL) is an important outcome measure in diabetes care. This study was aimed to examine the long-term effects of a team educational intervention on the patients&#8217 ; QoL. Patients and methods: 395 patients (212 females, aged 39.2&#61617 ; 15.1 yrs, suffering from diabetes for 11.4&#61617 ; 8.7 yrs, treated with insulin in 89%, having baseline HbA1C values 8.6% &#61617 ; 2.3, educated at primary level in 10.4%, secondary in 66.6% and university in 23%, were included in a 5-day educational course, structured as a small-group educational and psychological workshop. The groups were invited for medical check-ups and educational refreshments at 3- month periods, and assessed regarding their QoL prior to the course, and after follow-up periods of 3 and 18 months. The WHOQoL-BREF, a 26-item generic quality of life instrument was used. The instrument covers four QoL domains: Physical, Psychological, Social relations and Environment. Paired t-tests and correlations were employed to compare the QoL indicators at different assessment points. Results: When compared with baseline indicators, the patients&#8217 ; QoL improved after 3 months with regard to their overall QoL (t=-4.3 p=.000), satisfaction with health (t=-8.5 p=.000), Physical domain (t=-6.44 p=.000), Psychological domain (t=-4.29 p=.000), Social domain (t=-3.25 p=.001) and Environment (t=-4.69 p=.000). The improved QoL remained stable after 15 months for all the four domains, while the subjective evaluations of overall QoL and general health further improved. The indicators of metabolic control were improved after 3 months to 8.0%&#61617 ; 1.8, and 7.8%&#61617 ; 1.6 after 18 months. The associations between glycemic control as measured by HbA1C values and QoL were shown to be significant for physical and psychological domains at baseline (r=-.13 r=-.11), for physical, psychological and social domains at the 3-month follow-up period ( r=-.11 r=-.17 r=-.12) and for physical domain after a 18-month follow-up period (r=-.29).Conclusion: A team educational intervention followed by regular check-ups has long-term positive effects on the patients&#8217 ; quality of life.

Sixty-five diabetic persons were compared with 185 otherwise ill and 50 healthy persons in order to highlight quality of life issuess. The samples were balanced with respect to gender, education and family status, while age was lower in the healthy persons group (diabetic: 46.6 yrs +/-15.6 ; otherwise ill: 45.4 years +/-15.5 ; healthy persons 38.8 yrs +/-14.6 p=0.014). The World Health Quality of Life questionnaire (WHOQOL-100) was applied to assess the individual quality of life. The WHOQOL inquires into the respondent's perception and subjective evaluation of overall quality of life and general health, as well as 6 quality of life domains: physical, psychological, level of independence, social relationships, environment and spirituality/religion/personal beliefs domain. Analysis of variance was used to compare diabetic versus otherwise ill and healthy subjects. The group variability was statistically significant with regard to physical domain (F=18.98 p=0.0001), and level of independence (F=26.83 p=0.0001). The Scheffe test revealed that healthy persons gave significantly higher ratings, indicating better quality of life, than both unwell groups. Diabetic persons gave higher ratings for the physical domain than other unwell persons. F ratio significance remained unchanged with age as covariate. The results in particular facets indicate that diabetic persons are mostly disturbed with regard to their energy level, mobility, activities of daily living and working capacity, but do not differ from the healthy persons in positive feelings, negative feelings, self-esteem, body image, cognitive abilities and social relationships.

The aim of the study was to analyse psychometric properties of the WHOQOL –100, a multidimensionally conceptualised, generic, 100-item quality of life instrument in a pilot sample of 63 NIDDM patients (mean age 60.4 yrs (10.1); 55% women; mean disease duration 10.2 yrs (6.2); mean education 10 yrs (5.2); 78% married. While covering the subjective perception and evaluation of overall QOL and general health, as well as 4 broad domains (physical health, psychological state, social relationships, environment), the instrument may be useful in integrating the individual QOL perception. The properties tested referred to reliability, validity in discriminating patients with different disease characteristics, and responsiveness to change. Methods: Reliability was determined by Chronbach’s alpha coefficients of internal consistency. Discriminant validity was determined by comparing the groups of patients with poor and satisfactory glycemic control, the first of them being switched to insulin therapy (intervention group – I vs. comparison group –C, consisting of 35 and 28 patients respectively). Responsiveness to change was determined by comparing the two groups after a two-month follow-up period. Results: The obtained alpha coefficients were 0.95 for the Physical domain, 0.89 for the Psychological domain, 0.76 for the Social relationships domain, and 0.92 for the domain referring to Environment. The groups characterized by different disease characteristics (I test vs. C test) rated their QOL differently, primarily in the physical and psychological domain (p

Sixty-five diabetic subjects were compared with 185 otherwise ill and 50 healthy subjects in order to highlight the quality of life issuess. The samples were matched according to gender, education and family status, while age was slightly lower in the group of healthy subjects. The World Health Organization Quality of Life Questionnaire (WHOQOL) was used to assess the individual quality of life. WHOQOL inquires into the respondent's perception and subjective evaluation of life position including physical health, psychological state, level of independence, social relationships, personal beliefs and relationships to salient features of the environment. Analysis of variance was used to compare diabetic versus other ill and healthy subjects. The group variability was statistically significant with regard to physical domain (F=18.98, p=.0001) and level of independence (F=26.83, p=.0001). Scheffe tests revealed that healthy subjects gave significantly higher ratings, indicating better quality of life than either patient group. Diabetic subjects gave higher ratings for the physical domain than other ill subjects. The level of F ratio significance remained unchanged with age as a covariate. The results indicating psychological state, social relationships, personal beliefs and environmental factors did not differ between the groups.