Health-Related Quality of Life in Adolescents and Adults With Cystic Fibrosis: Physical and Mental Health Predictors

Abstract

BACKGROUND: People with cystic fibrosis face substantial physical, psychological, and social challenges as they move into adolescence and adulthood, which are likely to impact on their health-related quality of life. This study sought to examine the relative importance of physical and mental health variables associated with health-related quality of life in this group. METHODS: Adults and adolescents (N ‫؍‬ 174; >14 y old) from across 11 adult or pediatric cystic fibrosis clinics in the Republic of Ireland, completed a background questionnaire that contained self-reported physical health variables, pulmonary function (ie, FEV 1 %) and body mass index. Questionnaire packs also contained the Hospital Anxiety and Depression Scale (HADS) and the Cystic Fibrosis Questionnaire-Revised, which has been specifically designed to assess health-related quality of life in patients with cystic fibrosis. RESULTS: HADS depression and/or anxiety scores were negatively associated with 11 of the 12 Cystic Fibrosis Questionnaire-Revised domain scores. FEV 1 % was positively associated with 8 domains when controlling for HADS anxiety but only 4 domains when controlling for HADS depression. HADS anxiety and depression scores demonstrated larger effect sizes and explained a greater proportion of the variance than pulmonary function in 8 of the 12 Cystic Fibrosis Questionnaire-Revised domain scores. CONCLUSIONS: Mental health variables, depression and anxiety, were strongly associated with health-related quality of life in subjects with cystic fibrosis and demonstrated greater effect sizes and explained a higher proportion of the variance overall than the physical health indicators, FEV 1 % and body mass index, which highlighted the importance of screening for, and treating, depression and anxiety symptoms.

Characterizing medication management and the role of pharmacists in caring for people living with cystic fibrosis: A work system approach

“…19 Anxiety, depression, and psychosocial factors have been correlated to healthrelated quality-of-life measures in the literature. 9,13 This study identifies the prevalent adherence tools and strategies used by PwCF. Adherence is crucial for PwCF because higher adherence is correlated with reduced hospitalizations, CF exacerbations, and health care costs.…”

“…1,6,7 Challenges with medication and other therapies for PwCF are well documented in the current medical literature. 3,4,[8][9][10][11][12][13] Regimens often include complex administration directions at multiple occasions, totaling 2-3 hours daily. 11,12 The complex therapies cited include inhaled nebulized medications, physiotherapy, and pancreatic enzymes.…”

“…Managing CF is burdensome, and a low health-related quality-of-life is associated with anxiety, depression, and poor adherence to therapies. 2,4,8,13 Contributors to poor medication and therapy compliance currently noted in the literature include lack of time, forgetfulness, emerging adulthood in persons aged 18 to 25 years, depression, low socioeconomic status, and adverse effects. 12 Social transitions in life, such as those during adolescence, also negatively affect adherence.…”

“…12 Social transitions in life, such as those during adolescence, also negatively affect adherence. 12,13 Nonadherence is associated with increased hospitalization, work or school absence, and poor disease prognosis. 3,10 Establishing care within a multidisciplinary CF care team is recommended to promote healthy medication-taking behaviors, encourage wellness, and prevent disease burden in PwCF.…”

Coping with Cystic Fibrosis in the Republic of Macedonia–Parent Perspective

“…Psychosocial factors may impact the course of chronic conditions, such as CF. Previous research demonstrated that health-related quality of life domains may predict the survival in children and adults with CF [1].…”