BackgroundDespite the existing evidence of a long lasting effect of disaster related experiences on physical and psychological health, few studies have evaluated long-term quality of life (QOL) outcomes of disaster survivors and the factors associated with such outcomes.Methods23 years after the 1988 Spitak earthquake in Armenia, the associations of demographic characteristics, trauma exposure and psychosocial variables on QOL were explored among a cohort of 725 exposed individuals. The EQ-5D-5 L instrument was applied to measure QOL of participants. Multivariate linear and ordinal logistic regressions were applied to evaluate the determinants of QOL and its underlying five domains (mobility, self-care, usual activity, pain/discomfort, and anxiety/depression).ResultsOlder age, current depression, post-traumatic stress disorder and anxiety symptoms were negatively associated with QOL. Additionally, those with severe losses (who did not receive any financial/material aid) had significantly poorer QOL outcomes, with higher odds of mobility difficulties (OR = 1.86, p < 0.05), self-care difficulties (OR = 2.85, p < 0.05), and mood problems (OR = 2.69, p < 0.05). However, those with severe earthquake related losses who received financial/material aid reported less self-care difficulties (OR = 0.21, p < 0.05) usual activity difficulties (OR = 0.40, p < 0.05), and mood problems (OR = 0.44, p < 0.05). Finally, each unit increase in current social support score was found to be significantly associated with a better QOL outcome and better self-reported outcomes across all underlying domains of QOL.ConclusionsThese findings suggest that earthquake related loss and concurrent psychopathology symptoms can have adverse impact on the QOL of survivors. They also indicate that well-targeted post-disaster financial/material aid and social support should be considered as means for improving the long-term QOL outcomes of disaster survivors.

IntroductionSelf-rated health is a widely used health outcome measure that strongly correlates with physical and mental health status and predicts mortality. This study identified the set of predictors of fair/poor self-rated health in adult female and male populations of Armenia during a period of long-lasting socio-economic transition to a market economy.MethodsDifferences in self-rated health were analyzed along three dimensions: socioeconomic, behavioral/attitudinal, and psychosocial. The study utilized data from a 2006 nationwide household health survey that used a multi-stage probability proportional to size cluster sampling with a combination of interviewer-administered and self-administered surveys. Both female and male representatives of a household aged 18 and over completed the self-administered survey. Multivariate odds ratios (OR) for fair/poor self-rated health were calculated for different sets of variables and logistic regression models fitted separately for women and men to identify the determinants of fair/poor self-rated health.ResultsOverall, 2310 women and 462 men participated in the survey. The rate of fair/poor self-rated health was 61.8% among women and 59.7% among men. For women, the set of independent predictors of fair/poor self-rated health included age, unemployment, poverty, low affordability of healthcare, depression, and weak social support. For men, the set included age, lower education, depression, weak social support, and drinking alcohol less than once a week. For both genders, depression and weak social support demonstrated the strongest independent association with fair/poor self-rated health.ConclusionsThe prevalence of fair/poor self-rated health was similar among men and women in this study, but the sets of independent predictors of perceived health differed somewhat, possibly, reflecting lifestyle differences between men and women in Armenia. Nevertheless, psychosocial variables were the strongest predictors of fair/poor self-rated health for both genders, indicating the importance of improving the country’s psychosocial environment through social reforms and poverty reduction.

BackgroundMultimorbidity, presence of two or more health conditions, is a widespread phenomenon affecting populations’ health all over the world. It becomes a serious public health concern due to its negative consequences on quality of life, mortality, and cost of healthcare services utilization. Studies exploring determinants of multimorbidity are limited, particularly those looking at vulnerable populations prospectively over time. This study aimed at identifying short and long term socioeconomic, psychosocial, and health behavioral determinants of incident multimorbidity among a cohort of the 1988 Armenian earthquake survivors.MethodsThe study included a representative subsample of 725 from a larger initial cohort of the earthquake survivors. Data on this subsample were collected via four phases of this cohort study during the period 1990–2012. The final logistic regression analysis eliminated all those cases with baseline multimorbidity to investigate short and long term determinants of incident multimorbidity; this subsample included 600 participants.ResultsMore than 75% of the studied sample had multimorbidity. Perceived low affordability of healthcare services, poor living standards during the post-earthquake decade, and lower education were independent predictors of incident multimorbidity developed during the period 1990–2012. Stressful life events and poor social support were among psychosocial determinants of incident multimorbidity. Participants’ baseline BMI reported in 1990 was independently associated with incident multimorbidity.ConclusionsMost of the identified determinants of incident multimorbidity in our study population were markers of social inequities, indicating that inequities pose a serious threat to both individual and public health-related outcomes. Strategies targeting to decrease such inequities along with promotion of healthy lifestyle and strengthening of social networks may considerably reduce multimorbidity among population groups with similar socioeconomic and cultural profiles.

Psychometric properties of the Armenian-language posttraumatic stress disorder (PTSD) Checklist-Civilian version (PCL-C) and the DSM-5 PTSD symptom set were examined in a long-term cohort of earthquake survivors. In 2012, 725 survivors completed the instruments. Item-/scale-level analysis and confirmatory factor analysis (CFA) were performed for both scales. In addition, exploratory factor analysis (EFA) was conducted for DSM-5 symptoms. Also, the differential internal versus external specificity of PTSD symptom clusters taken from the most supported PTSD structural models was examined. Both scales had Cronbach's alpha greater than .9. CFA of PCL-C structure demonstrated an excellent fit by a four-factor (reexperiencing, avoidance, numbing, and hyperarousal) model known as numbing model; however, a superior fit was achieved by a five-factor model (Elhai et al.). EFA yielded a five-factor structure for DSM-5 symptoms with the aforementioned four domains plus a negative state domain. This model achieved an acceptable fit during CFA, whereas the DSM-5 criteria-based model did not. The Armenian-language PCL-C was recommended as a valid PTSD screening tool. The study findings provided support to the proposed new classification of common mental disorders, where PTSD, depression, and generalized anxiety are grouped together as a subclass of distress disorders. Recommendations were made to further improve the PTSD diagnostic criteria.

Abstract

Background

The former soviet Republic of Armenia entered a turbulent and long-lasting economic transition when it declared its independence in 1991. This analysis sought to identify the determinants of poor self-rated health as an indirect measure of health status and mortality prognosis in an adult female population during a period of socio-economic transition in Armenia.

Methods

Differences in self-rated health in women respondents were analyzed along three main dimensions: social, behavioral/attitudinal, and psychological. The data used were generated from cross-sectional household health surveys conducted in Armavir marz in 2001 and 2004. The surveys utilized the same instruments and study design (probability proportional to size, multistage cluster sampling with a combination of interviewer-administered and self-administered surveys) and generated two independent samples of households representative of Armavir marz. Binary logistic regression models with self-rated health as the outcome were fitted to the 2001 and 2004 datasets and a combined 2001/2004 dataset.

Results

Overall, 2 038 women aged 18 and over participated in the two surveys (1 019 in each). The rate of perceived "poor" health was relatively high in both surveys: 38.1% in 2001 and 27.0% in 2004. The sets of independent predictors of poor self-rated health were similar in all three models and included severe and moderate material deprivation, probable and possible depression, low level of education, and having ever smoked. These predictors mediated the effect of women's economic activity (including unemployment), ethnicity, low access to/utilization of healthcare services, and living alone on self-rated health.

Conclusion

Material deprivation was the most influential predictor of self-rated health. Thus, social reforms to decrease the gap between the rich and poor are recommended as a powerful tool for reducing health inequalities and improving the health status of the population.

The study evaluated rates and determinants of hospital morbidity, serious morbid events, and prolonged intensive care unit stay associated with isolated coronary artery bypass. The medical records of 391 patients undergoing isolated coronary artery bypass at our center during 2003 were reviewed. The observed crude hospital mortality rate was 2.05%, similar to the EuroSCORE predicted mortality rate of 2.34%. Arrhythmia was the most frequent postoperative complication (17.6%). The serious hospital morbidity rate was 5.9%. The final logistic regression model of serious morbid events identified the following predictors: drug allergy, diabetes, and EuroSCORE. Prolonged intensive care unit stay (>/= 3 days) was observed in 9.5% of patients. Multivariable logistic regression analysis revealed age, preoperative rhythm disturbances, previous cardiac operation, and hypertension as independent predictors of prolonged intensive care unit stay. The rates of hospital mortality, morbidity, and prolonged intensive care unit stay were comparable to those of other major international cardiac surgery centers. These data can be used as a benchmark for further self- and peer-assessment quality improvement activities.

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The study assessed the level of patient satisfaction at selected primary health-care facilities in Lori and Shirak provinces of Armenia. Self-administered questionnaires were distributed to 684 recent clients at primary health-care facilities. The majority of patients were satisfied with their provider (mean satisfaction score of 1.75 out of maximum 2). Most patients (89.0%) would visit the same provider again, and would recommend the provider to friends (85.6%). Satisfaction with other aspects of care, including waiting time, accessibility of services, confidentiality and cleanliness of the facility, was also high (mean score of 1.70 out of 2). Seventy-eight percent of respondents considered the care they received to be 'excellent' or 'good'. The less educated and those in rural areas were more likely to be satisfied with the provider's quality. Despite the fundamental problems now challenging the Armenian primary health-care sector, patient satisfaction remains high. Given the high level of reported satisfaction, more focused satisfaction research tools and alternative approaches to patient assessments of care are needed to inform quality improvement in the Armenian setting.