The structure of health-related quality of life (HRQOL) in HIV disease is examined in 205 symptomatic HIV+ individuals receiving care at two West Coast public hospitals. A 64-item HRQOL battery, tapping aspects of HRQOL of particular relevance to individuals with HIV disease, was administered and found to yield reliable self-report data. Confirmatory factor analysis provides support for a two-factor model of HRQOL: (a) a physical health dimension defined by physical function, role function, freedom from pain, disability days, and quality of sex life, and (b) a mental health dimension defined by overall quality of life, emotional well-being, hopefulness, lack of loneliness, will to function, quality of family life, quality of friendships, and cognitive function/distress. Correlations of HRQOL measures with social support, access to care, coping, and symptom measures are reported and discussed.
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References
1.
Beck, A. T.
, & Steer, R. A. (1988). Beck Hopelessness Scale. San Antonio: Harcourt Brace Jovanovich.
2.
Bentler, P. M.
(1986). Lagrange multiplier and Wald tests for EQS and EQS/PC. Los Angeles: BMDP Statistical Software.
3.
Bentler, P. M.
(1990a). Comparative fit indexes in structural models. Psychological Bulletin, 107, 238-246.
4.
Bentler, P. M.
(1990b). EQS Structural Equations program manual. Los Angeles: BMDP Statistical Software.
5.
Bentler, P. M.
, & Mooijaart, A. B. (1989). Choice of structural model parsimony: A rationale based on precision. Psychological Bulletin, 106, 315-317.
6.
Berry, S. H.
, Bozzette, S. A., Hays, R. D., Stewart, A., & Kanouse, D. E. (1994). Measuring patient-reported health status and experience in advanced HIV disease: HIV-PARSE survey instrument. Santa Monica, CA: RAND, MR-342.
7.
Billings, A. B.
, & Moos, R. H. (1981). The role of coping responses and social resources in attenuating the stress of life events. Journal of Behavioral Medicine, 4, 139-158.
8.
Bindman, A.
, Keane, D., & Lurie, N. (1990). Measuring health changes among severely ill patients: The floor phenomenon. Medical Care, 281142-1152.
9.
Bozzette, S. A.
, Hays, R. D., Berry, S. H., & Kanouse, D. E. (1994). A perceived health index for use in persons with advanced HIV disease: Derivation, reliability, and validity. Medical Care, 32, 716-731.
10.
Bozzette, S. A.
, Hays, R. D., Wu, A. W., Berry, S. H., & Kanouse, D. E. (1995). Derivation and psychometric properties of a brief health-related quality of life instrument for HIV disease. Journal of Acquired Immunodeficiency Syndromes and Human Retrovirology, 8, 253-265.
11.
Bozzette, S. A.
, Kanouse, D. E., Berry, S. H., Duan, N. (1995). Health status and function with zidovudine or zalcitabine as initial therapy for AIDS: A randomized controlled trial. Journal of the American Medical Association, 273, 295-301.
12.
Burgess, A.
, Dayer, M., Catalan, J., Hawkins, D., & Gazzard, B. (1993). The reliability and validity of two HIV-specific health-related quality-of-life measures: A preliminary analysis. AIDS, 7, 1001-1008.
13.
Cleary, P. D.
, Fowler, F. J., Weissman, J., Massagli, M. P., Wilson, I., Seage, G. R., Gatsonis, C., & Epstein, A. (1993). Health-related quality of life in persons with acquired immune deficiency syndrome. Medical Care, 31, 569-580.
14.
Cockrell, J. R.
, & Folstein, M. F. (1988). Mini-Mental State Examination (MMSE). Psychopharmacology Bulletin, 24, 689-692.
15.
Cronbach, L. J.
(1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297-334.
16.
Croog, S. H.
, Levine, S., Testa, M. A., Brown, B., Bulpitt, C. J., Jenkins, C. D., Klerman, G. L., & Williams, G. H. (1986). The effects of antihypertensive therapy on the quality of life. New England Journal of Medicine, 314, 1657-1664.
17.
Cudeck, R.
(1989). Analysis of correlation matrices using covariance structure models. Psychological Bulletin, 105, 317-327.
18.
Cunningham, W. E.
, Hays, R. D., Williams, K. W., Beck, C. K., Dixon, W. J., & Shapiro, M. F. (1995). Access to medical care and health-related quality of life for low-income persons with symptomatic Human Immunodeficiency virus. Medical Care, 33, 739-754.
19.
Fleishman, J. A.
, & Fogel, B. (1994). Coping and depressive symptoms among people with AIDS. Health Psychology, 13, 156-169.
20.
Folkman, S.
(1984). Personal control and stress and coping processes: A theoretical analysis. Journal of Personality and Social Psychology, 46, 839-852.
21.
Hays, R. D.
, & DiMatteo, M. R. (1987). A short-form measure of loneliness. Journal of Personality Assessment, 51, 69-81.
22.
Hays, R. D.
, Marshall, G. N., Wang, E. Y. I., & Sherbourne, C. D. (1994). Four-year cross-lagged associations between physical and mental health in the Medical Outcomes Study. Journal of Consulting and Clinical Psychology, 62, 441-449.
23.
Hays, R. D.
, & Shapiro, M. F. (1992). An overview of generic health-related quality of life measures for HIV research. Quality of Life Research, 1, 91-97.
24.
Hays, R. D.
, Sherbourne, C. D., & Mazel, R. M. (1993). The RAND 36-Item Health Survey 1.0. Health Economics, 2, 217-227.
25.
Hays, R. D.
, & Stewart, A. L. (1990). The structure of self-reported health in chronic disease patients. Psychological Assessment, 2, 22-30.
26.
Hays, R. D.
, Stewart, A. L., Sherbourne, C. D., & Marshall, G. N. (1993). The "states versus weights" dilemma in quality of life measurement. Quality of Life Research, 2, 167-168.
27.
Hays, R. D.
, Wells, K. B., Sherboumne, C. D., Rogers, W. H., & Spritzer, K. (1995). Functioning and well-being outcomes of patients with depression compared to chronic medical illnesses. Archives of General Psychiatiy, 52, 11-19.
28.
Holmberg, S. D.
, & Byers, R. H. (1993). Does zidovudine delay development of AIDS? Analysis of data from observational cohorts. Lancet, 342 (8870), 558-559.
29.
Huba, G. J.
, & Harlow, L. L. (1987). Robust structural equation models: Implications for developmental psychology. Child Development, 58, 147-166.
30.
Kaplan, R. M.
, & Bush, T. W. (1982). Health-related quality of life measurement for evaluation research and policy analysis. Health Psychology, 1, 61-80.
31.
MacCallum, R. C.
(1986). Specification searches in covariance structure modeling. Psychological Bulletin, 100, 107-120.
32.
Marshall, G. N.
, Hays, R. D., Sherbourne, C., & Wells, K. B. (1993). The structure of patient ratings of outpatient medical care. Psychological Assessment, 5, 477-483.
33.
Mertz, H.
, Beck, C. K., Dixon, W., Esquivel, A., Hays, R.-D., & Shapiro, M. F. (in press). Validation of a new measure of diarrhea. Digestive Diseases and Sciences.
34.
Shapiro, M. F.
, Hays, R. D., Dixon, W. J., Visscher, B. R., Cunningham, W. E., George, W. L., Ettl, M. K., & Beck, C. K. (1995). Constitutional symptoms and quality of life in symptomatic HIV disease. Manuscript submitted for publication.
35.
Sherbourne, C. D.
, & Hays, R. D. (1990). Marital status, social support and health transitions in chronic disease patients. Journal of Health and Social Behavior, 31, 328-343.
36.
Sherbourne, C. D.
, & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32, 705-714.
37.
Siu, A. L.
(1991). Screening for dementia and investigating its causes. Annals of Internal Medicine, 115, 122-132.
38.
Stewart, A. L.
, Greenfield, S., Hays, R. D., Wells, K., Rogers, W. H., Berry S. D., McGlynn, E. A., & Ware, J. E. (1989). Functional status and well-being of patients with chronic conditions: Results from the Medical Outcomes Study. Journal of the American Medical Association, 262, 907-913.
39.
Vickrey, B. G.
, Hays, R. D., Graber, J., Rausch, R., Engel, J., & Brook, R. H. (1992). A health-related quality of life instrument for patients evaluated for epilepsy surgery. Medical Care, 30, 299-319.
40.
Vickrey, B. G.
, Perrine, K. R., Hays, R. D., Hermann, B. P., Cramer, J. A., Gordon, J., Meador, K. J., & Devinsky, O. (1993). Scoring manual for the QOLIE-89, Version 1.0. Santa Monica, CA: RAND.
41.
Wachtel, T.
, Piette, J., Mor, V., Stein, M., Fleishman, J., & Carpenter, C. (1992). Quality of life in persons with human immunodeficiency virus infection: Measurement by the Medical Outcomes Study instrument. Annals of Internal Medicine, 116, 129-137.
42.
Ware, J. E.
, Manning, W. G., Duan, N., Wells, K. B., & Newhouse, J. P. (1984). Health status and the use of outpatient mental health services. American Psychologist, 39, 1090-1100.
43.
Wolf, T. M.
, Balson, P. M., Morse, E. V., Simon, P. M., Gaumer, R. H., Dralle, P. W., & Williams, M. H. (1991). Relationship of coping style to affective state and perceived social support in asymptomatic and symptomatic HIV-infected persons. Journal of Clinical Psychiatry, 52, 171-173.
44.
Wu, A. W.
, Rubin, H. R., Mathews, W. C., Ware, J. E., Brysk, L. T., Hardy, W. D., Bozzette, S. A., Spector, S. A., & Richman, D. D. (1991). A health status questionnaire using 30 items from the Medical Outcomes Study: Preliminary validation in persons with early HIV infection. Medical Care, 29, 786-798.
