Objective: To assess the relationships between life satisfaction and disability after a severe traumatic brain injury (TBI).
Design: Cross-sectional study, including 75 patients 2 years or more after ...a severe TBI.
Methods: Life satisfaction was assessed with the Subjective Quality of Life Profile. Impairments, activities and participation were assessed with standardized tests.
Results: The satisfaction profile was flat, i.e. the majority of items obtained mean satisfaction scores close to 0, suggesting that participants felt indifferent to these items or in other words that they were neither satisfied nor unsatisfied. Patients were on average slightly dissatisfied with their cognitive functions, physical abilities and self-esteem. A factor analysis revealed three underlying factors. The main finding was that the relationships between life satisfaction and disability were not linear: the lowest satisfaction scores were reported by participants with moderate disability rated by the Glasgow Outcome Scale, while individuals with severe disability did not significantly differ from the good recovery group.
Conclusion: Life satisfaction is not linearly related to disability after severe TBI.
A questionnaire (Subjective Quality of Life Profile, or SQLP) was finalized at the end of the eighties by our team. It was endorsed and tested on more than 13,000 subjects recruited outside of any ...medical context, or suffering from any somatic or psychological pathologies. On a conceptual framework, the questionnaire takes into account the subject's history independent from the context of his/her personal objectives. It differentiates quality of life from health, and stresses its multi-factorial aspect. The questionnaire is made up of 28 "inevitable" items covering four domains: relational, somatic, contextual and psycho-affective, as well as a list of optional items. Two types of questions pertaining to history are applied to each item, as well as to the anticipated expectations. The results are of interest in the following domains: 1) To specify the demands and complaints of subjects afflicted with various illnesses, and comparing them with healthy subjects. 2) To demonstrate the impact of various factors on the quality of life. 3) To observe patients' development following long-term or difficult therapy. 4) To be able to compare (once the questionnaires are filled out by different contributors), the patient's responses to those of his family or caregiver. 5) To take into account the patients' illness in order to provide the most pertinent results. These illnesses are always higher in psychiatry (and in particular those suffering from addictions): and are an unfavorable prognoses. Once the patient improves clinically, their illness decreases. 6) Regarding associates whose illnesses are at a "normal" level, the illness does not prove to be more serious than in exposed situations (either medical or social). At the moment it seems that the evaluation of a patient's quality of life brings an enriching, clarification to the appreciation of traditional medicine. Avoiding a social "desirability" criteria, we believe the responses relative to the illnesses will provide the best indication of the subjects' quality of life.
The authors have validated three quality of life questionnaires designed to assess mostly subjective aspects of quality of life, in infants (QUALIN questionnaire, a parents' report), children (AUQUEI ...questionnaire, a pictured self-report for children aged 3-11 years old) and in adolescents (OK.ado questionnaire). Psychometric properties being satisfactory, these questionnaires were completed by different samples, in different health states. We were thus able to detect the influence of several factors on children or adolescents' quality of life: illness tends to alter quality of life, but this is also the case for several psychosociological conditions, especially when combined with the child's age. In adolescents, one has to be careful in interpretation of results, since the healthy adolescent tends to complain to adults.
As with adults, the quality of life of children is a multi-dimensional concept, therefore, in theory, evaluations cannot be carried out except by the subject, given the very subjective nature of this ...procedure. There are obstacles in pediatrics with this postulate, as one would prefer to implement a procedure of evaluation regarding the child's own characteristics in order to determine the cognitive limits of his/her development. We have attempted to summarize this subjective aspect by adapting tools for evaluation suitable for both the child and adolescent. 1) The AUQUEL questionnaire. Targeted to nursery school or primary school children, it consists of a closed scale comprised of thirty-one items: the phases of satisfaction are presented with the use of four aspects which express different emotional conditions. It also includes an open question. 894 French children so far have filled out this questionnaire: 491 from the general population, 403 were evaluated under specific contexts, either organic illnesses, psychological problems, or in the context of social personalities. Differences can be observed, depending on the contexts, in a closed scale or an open question. We will look at the example of a kidney transplant to illustrate our point. 2) The "OKadolescent" questionnaire Similar in structure to an adult questionnaire; it differs, however, by the themes that are adopted to the life and preoccupations of an adolescent. It is made up, as with the questionnaire for children, of a closed scale (26 items), and an open question. Here, 268 adolescents from the general population can be compared with adolescents evaluated in either a somatic or war-zone context. We will take as an example adolescents who have undergone kidney transplants or have suffered from hepatitis, to demonstrate the paradoxical characteristics of the evaluation of the adolescents quality of life. 3) Conclusion Our experience in this domain of the evaluation of a child's quality of life enables us to confirm its feasibility, on the condition of using specific tools, for the clinician (the best representation for the impact of pathology on a child's quality of life), and its relevance as an element for evaluating the needs linked with the health of the given population.
The aim of this international study is to examine the nature, correlates, and perceived determinants of development among professional psychotherapists from different countries and cultures at all ...career levels, trained in different professions and theoretical orientations. Psychotherapeutic development was conceptualized and assessed from several perspectives, including concurrent and retrospective reports by therapists and cross-sectional and longitudinal analyses of therapists' practices and experiences. This paper presents the main questions guiding the study, defines its core concepts, introduces the survey instrument, describes data collection procedures, and reports descriptive and scale development data from a multinational data base of nearly 3800 therapists. Analyses provide evidence for the reliability and validity of direct and indirect measures of retrospected career development and currently experienced development, and their applicability to diverse groups of psychotherapists. Diese inernationale Studie hat zum Ziel, die Inhalte, Korrelate und wahrgenommenen Determinanaten der Entwicklung von professionellen Psychotherapeut(inn)e in unterschiedlichem Berufsstadium zu analysieren. Die Psychotherapeut(inn)en kommen aus verschiedenen Ländern und Kulturen, gehören unterschiedlichen Berufen an und sind unterschiedlichen theoretischen Orientierungen verpfichtet. Psychotherapeutische Entwicklung wird aus unterschiedlichen Perspektiven konzeptualisiert und erfaßt: durch aktuelle und retrospektive Berichte der Therapeuten, Querschnitts-und Längschnittanalysen der therapeutischen Prazxis und therapeutische Erfahrungen. In diesem Beitrag werden die wesentlichen Fragen der Studie präsentiert, Kernkonzepte definiert und das Erhebungsinstrument vorgestellt. Außerdem werden die Datenerhebung beschrieben und deskriptive bzw. auf die Skalenentwicklung bezogene Ergebnisse vorgestellt, die sich auf eine multinationale Datenbasis von ungefähr 3800 Therapeut(inn)en bezieht. Die Analysen deuten auf die Reliabilitität and Validität direkter Messungen der rückblickend berichteten und aktuellen Kariereentwicklung hin und zeigen deren Eignung für unterschiedliche Gruppen von Psychotherapeut(inn)en. Cette étude internationale veut examiner la nature, les correspondances, et les défterminants perçus du développement des psychothérapeutes professionnels à tous les niveaux de carrière, provenant de pays et de cultures variées, et formés dans des orientations théoriques et professionnelles différentes. Le développement psychothérapeutique est conceptualisé et évalué à partir de plusieurs perspectives, y compris des rapports parallèles et rétrospectifs par les thérapeutes, et des analyses transversales et longitudinales des pratiques et expériences des thérapeutes. Cet article présente les questions essentielles sous-jacentes à l'étude, il définit ses concepts de base, introduit l'instrument de l'enquete, décrit le procédé de récolte des données, et rapporte les données descriptives et concernant le développement de l'échelle pour une base de données multinationale de presque 3800 thérapeutes. Les analyses confirment la fidélité et la validité des mesures diretes et indirectes du développement de la carrière du point de vue rétrospectif et actuel, ainsi que leur validitté d'application pour des groupes de psychothérapeutes divers. Este estudio intenta examinar la percepción que de la naturaleza, los correlatos y los determinantes de su formación tuvo un grupo de sicoterapeutas profesionales de todos los niveles de formación, de diferentes países y culturas, y entrenados en diferentes profesiones y orientaciones teóricas. El desarrollo del psicoterapeuta se conceptualiza y evalúa desde varias perspectivas, las que incluyen informes actuales y retrospectivos elaborados por los mismos terapeutas, así también como análisis cruzados y longitudinales de sus experiencias y prácticas. Este trabajo presenta los principales interrogantes que guiaron el estudio; define su núcleo conceptual; introduce el instrumento utilizado para el relevamiento; describe los procedimientos de recolección de información; e informa sobre los datos descriptivos y los correspondientes al desarrollo de escala de una base multinacional de datos de casi 3800 terapeutas. Los análisis dan evidencia de la confiabilidad y la validez de las medidas directas e indirectas tanto del desarrollo retrospectivo de sus carreras como de lo experienciado actualmente por ellos, así también como de su aplicabilidad a diversos grupos de psicoterapeutas.
This article describes early results of a new instrument for measuring quality of life--the French Subjective Quality of Life Profile (SQLP) questionnaire. This 36-item, self-administered ...questionnaire has been previously validated in a large sample population with somatic disorders. It is characterized by its multidimensional pattern and subjective approach (i.e., the degree of satisfaction with various domains of life, the degree of change anticipated and the importance attributed to these domains). The SQLP was tested with three psychiatric patient samples: people with depression, psychosis or substance abuse. Preliminary findings indicate that the questionnaire is useful in describing psychiatric patients, their characteristics, and explaining some of their changes.
The initial severity of the patients' psychiatric difficulties, as well as the quality of their therapeutic relationships, are important predictors of treatment outcome. However, the influence of the ...patient's commitment to therapy, within specific therapeutic approaches, is also a potential predictor of outcome. Therefore, the aim of this study was to evaluate the clinical status of adult psychiatry patients (N = 121) at admission and discharge from a psychiatric day-treatment unit in order to identify factors predictive of change, and to assess the therapeutic outcomes of the treatments employed by using validated translations of the Health-Sickness Rating Scale (Luborsky, 1975), the Helping Alliance Questionnaire (Luborsky, Crits-Christoph, Alexander, Margolis, & Cohen, 1983), the Clinical Evaluation Profile (Gerin, Dazord, & Sali, 1991), and the Commitment Scale developed and validated for this study. Relative to four ICD-9 homogeneous diagnostic subgroups (schizophrenia, 29%; personality disorders, 25%; dysthymic psychoses, 20%), and neurotic disorders (11%), the primary findings of the study concerned factors predictive of change and where therapeutic approaches interacted with diagnoses in predicting outcome. Patients with personality disorders benefitted the most from group therapy, whereas the reverse situation was observed for patients with neurotic disorders. For schizophrenic patients, the most important factor of change was their commitment to the environment of the hospital. With respect to the "outcome equivalence paradox" (i.e., the interaction between treatment approach and diagnosis), it was revealed that therapeutic approach (i.e., objective measure) was not predictive of outcome, whereas commitment to therapy (i.e., subjective measure) was significantly predictive and further differentiated the therapeutic approaches.ZusammenfassungDer anfängliche Schweregrad der Störung bei Patienten mit psychiatrischen Problemen und die Qualität der therapeutischen Beziehung sind wichtige Prädiktoren des Behandlungsergebnisses. Auch die Bedeutung des persönlichen Einsatzes eines Patienten in der Therapie, im Rahmen spezifischer therapeutischer Angebote, dürfte ein potentieller Pradiktor des Ergebnisses sein. Ziel dieser Studie war es, den klinischen Zustand erwachsener psychiatrischer Patienten (N = 121) bei Aufnahme und Entlassung aus einer psychiatrischen Tagesklinik zu evaluieren, um jene Faktoren zu identifizieren, die Veränderungen vorhersagen können. Der Behandlungserfolg sollte unter Venwendung validierter Übersetzungen der Health and Sickness Rating Scale (Luborsky, 1975), des Helping Alliance Fragebogens (Luborsky, Crits-Cristoph, Alexander, Margolis, & Cohen, 1983), eines klinischen Evaluationsprofils (Gerin, Dazord, & Sali, 1991) sowie einer Skala erfolgen, die das Engagement de Patienten erfasst. Diese Skala wurde eigens für diese Studie entwickelt und validiert. Bezogen auf vier homogene diagnostische Subgruppen (gebildet auf der Basis des ICD-9: Schizophrene, 29% Pat. mit Persönlichkeitsstörungen, 25% affektiven Psychosen, 20% und neurotischen Störungen, 11%) basieren die Hauptbefunde der Studie auf wesentlichen Prognosefaktoren und auf der Interaktion therapeutischer Angebote mit den Diagnosen. Patienten mit Persönlichkeitsstörungen profitierten am meisten von Gruppentherapien, nicht so die neurotischen Patienten. Für die schizophrenen Patienten enwies sich ihr persönlicher Bezug zum Stationsmilieu als bester Prädiktor für das Therapieergebnis. Im Zusammenhang mit dem Äquivalenzparadoxon (d.h. die Interaktion zwischen dem Behandlungsansatz und der Diagnose) zeigte sich, dass das konkrete Behandlungsangebot (also ein objektives Mass) das Ergebnis der Behandlung nicht vorhersagen konnte, wohl aber die persönliche Bewertung der Behandlung (also ein subjektives Mass). (Dazord et al.)RésuméLa gravité initiale des difficultés psychiatriques des patients, tout comme la qualité de leurs relations thérapeutiques, sont d'importants prédicateurs pour les résultats du traitement. Cependant, l'influence le l'engagement du patient dans la thérapie, à l'intérieur d'approches thérapeutiques spécifiques, est également un prédicateur potentiel pour les résultats. Ainsi, l'objectif de cette étude est d'tvaluer le statut clinique des patients psychiatriques adultes (N = 121) à l'entrée et à la sortie d'une unité de traitement journalier psychiatrique afin d'identifier des facteurs prédicateurs de changement et afin d'évaluer les résultats d'un traitement en utilisant la version validée de l'Echelle de santé et de maladie (Luborsky, 1975), le Questionnaire des alliances de soutien (Luborsky, Crits-Cristoph, Alexander, Margolis, & Cohen, 1983), le Profile d'évaluation clinique (Gerin, Dazord, & Sali, 1991), et l'Echelle d'engagement développée et validée par cette étude. Nous nous référons à quatre subgroupes diagnostiques homogènes de l'ICD-9 (schizophrénie, 29%; troubles de la personnalité, 25%; psychoses dysthymiques, 20%; troubles névrotiques, 18%). Les résultats principaux de cette étude concernent les facteurs prédicateurs de changement alors que les approches thérapeutiques interagissent avec les diagnoses en prédisant le résultats. Ce sont les patients avec des troubles de la personnalité qui bénéficient le plus de la thérapie de groupe, alors que la situation inverse est observée avec les patients névrotiques. En ce qui concerne les patients schizophréniques, le changement le plus important c'est fait au niveau de leur engagement dans l'environnement hospitalier. Tout en respectant "le paradoxe du résultat d'équivalence" (ex. L'interaction entre l'approche du traitement et le diagnostic), nous constatons que l'approche thérapeutique (ex. Mesures objectives) n'est pas prédicateur des résultats, alors que l'engagement dans la thérapie (ex. Mesures subjectives) est significativement prédictive et de plus différencie les approches thérapeutiques. (Dazord et al.)
We compared the relationships between response to a crisis intervention program and long-term outcome in 31 depressed outpatients with and without DSM-III-R personality disorders (PD). The presence ...of PD predicted a poorer 2-year outcome. PD subjects with better working alliance and increased insight at termination of crisis intervention had increased compliance with long-term psychiatric treatment (p < .005) and better 2-year outcome (p < .005). Increased compliance with long-term psychiatric treatment predicted better long-term outcome in PD patients (p < .005). None of these significant relationships was observed in the comparison group without PD, suggesting that establishing an effective treatment process may be especially important for outcome in PD patients.
