Subjective Health-Related Quality of Life in Homeless and Vulnerably Housed Individuals and Its Relationship with Self-Reported Physical and Mental Health Status

Although the association between homelessness and objective indicators of poor health is well-established, little research has focused on the subjective health-related quality of life of homeless and vulnerably housed (HVH) individuals. This study examined the subjective health-related quality of life of HVH individuals, using the Multiple Discrepancies Theory (MDT) Scale for Health of the Quality of Life for Homeless and Hard-to-House Individuals (QoLHHI) Inventory, and its association with self-reported functional health status, as measured by the SF-12, and self-reported physical and mental health conditions in a sample of 100 HVH individuals recruited in Vancouver, Toronto and Ottawa. Our findings indicate that physical and mental health conditions are highly prevalent among HVH individuals and that the SF-12 Physical and Mental Component Summary scores are substantially lower compared to US population norms. The MDT Health items were not statistically significantly associated with physical or mental health conditions and only showed correlations of small to moderate magnitude with the SF-12 Component Summary Scales. These findings suggest that the QoLHHI MDT Scale for Health can provide information about HVH individuals’ subjective health experiences that is different from, and can serve as a valuable complement to, health status information for use in research and evaluation studies, as well as for policy purposes to make informed decisions based on subjective health-related quality of life data from HVH individuals.     

Lessons from a project to create performance measures for public health

This paper uses a specific example to illustrate complications that arise in formulating and implementing performance measures. The context of this demonstration is a Centers for Disease Control and Prevention (CDC)-funded project to explore the feasibility of performance measures developed at the national level for local sexually transmitted disease (STD) prevention and control programs. Grantees provided local data and reported on their experience in eliciting the data and using the results for program development. The experience of this project suggests that measures can be made operationally feasible and programmatically useful only if terminologies are subjected to extensive definition and clarification activities. These activities must include development of common language, mapping of workflows, and clarification of spheres of influence. Finally, performance measures must be used with some caution, as they often unintentionally capture extraneous program elements.     

An investigation of predictors of mental health in single men and women experiencing homelessness in three Canadian cities

Homelessness is related to poorer mental health, yet, there is limited understanding of the predictors of mental health of men and women experiencing homelessness. To support service providers in identifying individuals who might be at particular risk of poor mental health, this study investigated the predictors of mental health in 501 single men and women experiencing homelessness in Vancouver, Toronto, and Ottawa, Canada. Data were obtained via in-person, structured interviews. In order to identify whether predictors differ by gender, multiple linear regressions were conducted separately for men and women. Mental health status was measured by the Mental Component Summary score of the 12-item Short-Form Health Survey. Better mental health for men and women was associated with the presence of fewer chronic health conditions and a higher level of social support. An older age, not having experienced a recent physical attack, and absence of a mental health diagnosis were related to better mental health for women. The absence of unmet mental health needs within the past 12 months was associated with better mental health for men. The study highlights differences in factors associated with mental health for men and women. Service providers should be aware of the association of these factors with mental health to guide assessment and service planning.     

Health and the Quality of Life

The aim of this investigation was to explain theimpact of peoples self-reported health on theirlevels of satisfaction with their health, and theimpact of these things plus satisfaction with otherspecific domains of their lives on the perceivedquality of their lives. The latter was operationalized as general happiness, satisfactionwith life as a whole and overall satisfaction with thequality of life. Seven hundred and twenty-three (723)usable questionnaires returned from a mailout randomsample of 2500 households of Prince George, BritishColumbia in November 1998 formed the working data-setfor our analyses. Among other things, mean respondentscores on the SF-36 health profile were found to belower than published norms from the UK, USA,Netherlands and Sweden, but higher than scores fromAberdeen, Scotland. Mean scores on the CES-Ddepression scale also indicated that our respondentstended to have more depressive symptoms thancomparison groups in Winnipeg and the USA. A review oftrends in mean scores on 17 quality of life items(e.g., satisfaction with family life, financialsecurity, recreation, etc.) from 1994, 1997 and 1998revealed that there were only 7 statisticallysignificant changes across the four year period andthey were all negative. Multivariate regressionanalysis showed that health status measured with avariety of indicators could explain 56% of thevariation in respondents reported satisfaction withtheir health. A combination of health status plusdomain satisfaction indicators could explain 53% ofthe variation in respondents reported happiness, 68%of reported life satisfaction and 63% of reportedsatisfaction with the overall quality of life. Sixtypercent of the explained variation in happiness scoreswas attributable to self-reported health scores, whileonly 18% of the explained variation in satisfactionwith life and with the overall quality of life scoreswas attributable self-reported health scores.     

Does Weighting Capture What’s Important? Revisiting Subjective Importance Weighting with a Quality of Life Measure

The present study evaluated subjective importance weighting using data collected with the Injection Drug User Quality of Life Scale (IDUQOL). Weighted and unweighted IDUQOL scores from 241 adults were correlated with convergent, discriminant, and criterion measures. Regression analysis was used to examine the contribution of importance ratings to scores on a global measure of life satisfaction and the corrected weighted IDUQOL total scores. Overall, the results showed that weighted scores did not perform better than unweighted scores in measuring quality of life. However, the mean satisfaction ratings for important domains correlated significantly higher with convergent measures than did the mean satisfaction ratings for unimportant domains. This finding suggests further attention needs to be paid to the meaning and measurement of subjective importance and how it may be incorporated more effectively into measures of quality of life.     

Screening for depression after cardiac events using the Beck Depression Inventory-II and the Geriatric Depression Scale

Despite findings that depression is a risk factor for heart disease and for death following cardiac events and that depressed cardiac patients experience significantly reduced quality of life and are less likely to follow treatment regimens, depression is neither adequately identified nor treated in cardiac patients. Recent calls in the literature for the use of standardized screening measures and sensitivity/specificity studies to identify useful measures compelled us to examine the sensitivity and specificity of the Beck Depression Inventory-II (BDI-II) and Geriatric Depression Scale (GDS) and recommend appropriate cut-scores for identifying depression in post-myocardial infarction or unstable angina patients. A total of 119 patients who met criteria for either acute myocardial infarction or unstable angina pectoris were recruited from coronary care units at three hospitals and interviewed in their homes approximately 2 weeks post-admission. The criterion used in the study was the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I/NP). Administration of the SCID-I/NP, BDI-II, and GDS was counterbalanced using a digram-balanced approach and blinded comparison was used. Alphas were .89 for BDI-II and .88 for GDS. For major depression, a BDI-II cut-score of 10 produced a sensitivity = 100%, specificity = 75%, and PPV = 18% whereas a GDS cut-score of 14 produced sensitivity = 100%, specificity = 94%, and PPV = 50%. For major/double depression, a BDI-II cut-score of 10 produced sensitivity = 100%, specificity = 75%, and PPV = 21% whereas a GDS cut-score of 13 produced sensitivity = 100%, specificity = 91%, and PPV = 41%. Although both measures demonstrated excellent reliability and sensitivity, the GDS showed better specificity and PPV and is recommended as the better screen for major depression or double depression with cardiac patients.     

Subjective Quality of Life Among Individuals who are Homeless: A Review of Current Knowledge

The purpose of this article was to review the current literature on subjective quality of life (SQOL) in individuals who are homeless, with a focus on differences in SQOL (a) between homeless individuals and the general population, (b) based on housing situation, and (c) associated with demographic characteristics (such as age and gender), physical and mental health, and external variables such as service program type. A literature search was conducted of the online databases PubMed and PsycInfo for relevant studies published from January 1981 to August 2011. Although this review showed that individuals who are homeless tended to have lower levels of SQOL compared to the general population or housed individuals, it was also evident that our current understanding of the relationships between SQOL and various demographic, health, and other variables is based on very limited information. More information about the relationships between various characteristics and experiences of individuals who are homeless and SQOL is clearly needed to aid researchers, service providers, and policy-makers in addressing the needs of this population and examining the effectiveness of interventions to end homelessness and improve health among homeless individuals.     

Using Alternate Forms of the Multidimensional Health Locus of Control Scale: Caveat Emptor

This study examined whether Forms A and B ofthe Multidimensional Health Locus of ControlScale (MHLCS) are parallel by comparing (a)mean performance on the internal, powerfulothers, and chance subscales, (b) the internalconsistency and one-week test-retestreliability estimates for each of thesubscales, (c) the intercorrelations among thesubscales, (d) the relationship betweenself-rated health status and each of thesubscales, and (e) the fit of the three-factorstructure for the MHLCS proposed by Wallston etal. (1978) using confirmatory factor analysis(CFA). A non-clinical sample (N = 245) wasused. Overall, the results of the study do notsupport treating Forms A and B of the MHLCS asparallel or exchangeable forms. Directions forfurther revisions to the MHLCS are proposedbased on both the present study as well asfindings from the literature.     

Health and Other Aspects of the Quality of Life of Older People

Celebrating the United Nations' International Year of Older Persons, in September 1999 a survey research project was undertaken throughout the Northern Interior Health Region (NIHR) of British Columbia. A total of 875 people completed 23-page questionnaires, the average age of the respondents was 69 and the range ran from 55 to 95 years. Responses to the SF-36 questionnaire indicated that for male respondents aged 55–64, the mean score for the 8 dimensions was 74.4. This mean was practically identical to that of the United States norm for such people (74.5) and lower than that for the United Kingdom (77.4). For male respondents aged 65 and older, the mean was 68.3. This was numerically higher but again practically the same as that of the norm for the United States (68.1). For females aged 55–64, the mean score for 8 dimensions was 73. This was superior to that of the United States norm of (70.6) for such people and lower than that for the United Kingdom (74.6). For female respondents aged 65 and older, the mean score was 65.4. This was practically identical to that of the United States (65.5).Comparing 18 average figures for our respondents on satisfaction with specific domains of life (e.g., financial security, health, friendships) and life as a whole with those of average adults in Prince George in November 1999, we found that in all but two cases the older people's scores were higher. Only in the cases of satisfaction with health and overall happiness were older people's scores lower, and the differences were not statistically significant.Eleven percent of our respondents reported that they had been a victim of a crime in the last year, compared to 38% in our 1997 adult victimization survey. Older people had a more benign view than ordinary adults of the growth of crime in their neighbourhood and city, although exactly 64% of both groups thought that crime had increased in Canada. Although older people had a more optimistic view than other adults of the increase in crime in their neighbourhoods, fewer of the former than the latter felt safe out at night. Nevertheless, compared to adults surveyed in 1997, the behaviour of respondents in our survey of older people was not as constrained by concerns of criminal victimization.Two or three of the 8 SF-36 health dimensions explained 37% of the variation in life satisfaction scores, 34% of variation in happiness scores, 34% in satisfaction with the overall quality of life scores and 22% in satisfaction with one's overall standard of living. In every case, Mental Health was the dimension that had the greatest impact on our four dependent variables.When all of our potential predictors were entered into a regression equation simultaneously, we found that they could explain 60% of the variance in life satisfaction scores, 44% in happiness scores, 58% in satisfaction with the overall quality of life scores and 59% in satisfaction with one's overall standard of living scores.     

Index of Authors Volume 51

Authors Index

Index of Authors Volume 51