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Quality of Life Research
Published in: Quality of Life Research 8/2011

Open Access 01-10-2011

Clinical correlates of health-related quality of life among opioid-dependent patients

Authors: Kevin C. Heslin, Judith A. Stein, Keith G. Heinzerling, Deyu Pan, Christine Magladry, Ron D. Hays

Published in: Quality of Life Research | Issue 8/2011

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Abstract

Purpose

Previous work suggests that opioid users have lower health-related quality of life (HRQOL) than patients with more prevalent chronic illnesses such as hypertension or diabetes. Although comparisons with population norms are informative, studies of the correlates of HRQOL for opioid users are needed to plan clinical services.

Methods

We tested a conceptual model of the pathways between physiologic factors and symptoms in relation to HRQOL among 344 opioid users in a clinical trial. Physical and mental HRQOL were measured by the Short-Form (SF)-36; withdrawal signs, symptoms, and functioning were also measured with validated instruments. Using structural equation modeling, we tested hypotheses that medical history directly predicts withdrawal signs and symptoms, and that medical history, withdrawal signs and symptoms, and functioning predict the physical and mental HRQOL latent variables of the SF-36.

Results

Most hypothesized relationships were significant, and model fit was good. The model explained 36% of the variance in mental HRQOL and 34% of the variance in physical HRQOL.

Conclusions

The conceptual framework appears valid for explaining variation in the physical and mental HRQOL of opioid users undergoing medically managed withdrawal. Analysis of longitudinal data would help to evaluate more rigorously the adequacy of the model for explaining HRQOL in opioid withdrawal.
Literature
1.
Strain, E. C., & Stitzer, M. L. (2006). The treatment of opioid dependence (1st ed.). Baltimore: Johns Hopkins University Press.
2.
Miller, P. G., & Miller, W. R. (2009). What should we be aiming for in the treatment of addiction? Addiction, 104(5), 685–686.PubMedCrossRef
3.
Stewart, A. L., Sherbourne, C. D., Hays, R. D., Wells, K. B., Nelson, E. C., Kamberg, C. J., et al. (1992). Summary and discussion of MOS measures. In A. L. Stewart & J. E. Ware (Eds.), Measuring functioning and well-being: The medical outcomes study approach (pp. 345–371). Durham, NC: Duke University Press.
4.
Bjorner, J., Fayers, P., & Idler, E. (2004). Self-rated health. In P. Fayers & R. D. Hays (Eds.), Assessing quality of life in clinical trials (pp. 309–324). New York: Oxford University Press.
5.
McDowell, I. (2006). Measuring health: A guide to rating scales and questionnaires. New York: Oxford University Press.
6.
Baker, S. R., Pankhurst, C. L., & Robinson, P. G. (2007). Testing relationships between clinical and non-clinical variables in xerostomia: A structural equation model of oral health-related quality of life. Quality of Life Research, 16, 297–308.PubMedCrossRef
7.
Sousa, K. H., & Kwok, O. M. (2006). Putting Wilson and Cleary to the test: Analysis of a HRQOL conceptual model using structural equation modeling. Quality of Life Research, 15, 725–737.PubMedCrossRef
8.
Vidrine, D. J., Amick, B. C., Gritz, E. R., & Arduino, R. C. (2005). Assessing a conceptual framework of health-related quality of life in a HIV/AIDS population. Quality of Life Research, 14, 923–933.PubMedCrossRef
9.
Janz, N. K., Janevic, M. R., Didge, J. A., et al. (2001). Factors influencing quality of life in older women with heart disease. Medical Care, 39, 588–598.PubMedCrossRef
10.
Heo, S., Moser, D. K., Riegel, B., Hall, L. A., & Christman, N. (2005). Testing a published model of health-related quality of life in heart failure. Cardiac Failure, 11, 372–379.PubMedCrossRef
11.
Wettergren, L., Björkholm, M., Axdorph, U., & Langius-Eklöf, A. (2004). Determinants of health-related quality of life in long-term survivors of Hodgkin’s lymphoma. Quality of Life Research, 13, 1369–1379.PubMedCrossRef
12.
Baker, S. R., Pankhurst, C. L., & Robinson, P. G. (2007). Testing relationships between clinical and non-clinical variables in xerostomia: A structural equation model of oral health-related quality of life. Quality of Life Research, 16, 297–308.PubMedCrossRef
13.
Ryan, C. F., & White, J. M. (1996). Health status at entry to methadone maintenance treatment using the SF-36 health survey questionnaire. Addiction, 91, 39–45.PubMedCrossRef
14.
Neale, J. (2004). Measuring the health of Scottish drug users. Health and Social Care in the Community, 12, 202–211.PubMedCrossRef
15.
Perneger, T. V., Giner, F., del Rio, M., & Mino, A. (1998). Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments. BMJ, 317, 13–18.PubMed
16.
Richter, D., Eikelmann, B., & Berger, K. (2004). Use of the SF-36 in the evaluation of a drug detoxification program. Quality of Life Research, 13, 907–914.PubMedCrossRef
17.
Freeman, K. (2003). Health and well-being outcomes for drug-dependent offenders on the NSW Drug Court programme. Drug and Alcohol Review, 22, 409–416.PubMedCrossRef
18.
Deering, D. E., Frampton, C. M. A., Horn, J., Sellman, J. D., Adamson, S. J., & Potiki, T. L. (2004). Health status of clients receiving methadone maintenance treatment using the SF-36 health survey instrument. Drug and Alcohol Review, 23, 273–280.PubMedCrossRef
19.
Dalgard, O., Egeland, A., Skaug, K., Vilimas, K., & Steen, T. (2004). Health-related quality of life in active injecting drug users with and without chronic hepatitis C virus infection. Hepatology, 39, 74–80.PubMedCrossRef
20.
Kertesz, S. G., Larson, M. J., Horton, N. J., Winter, M., Saitz, R., & Samet, J. H. (2005). Homeless chronicity and health-related quality of life trajectories among adults with addictions. Medical Care, 43, 574–585.PubMedCrossRef
21.
McGregor, C., Machin, A., & White, J. M. (2003). In-patient benzodiazepine withdrawal: Comparison of fixed and symptom-triggered taper methods. Drug and Alcohol Review, 22, 175–180.PubMedCrossRef
22.
Millson, P. E., Challacombe, L., Villeneuve, P. J., Fischer, B., Strike, C. J., Myers, T., et al. (2004). Self-perceived health among Canadian opiate users: A comparison to the general population and to other chronic disease populations. Canadian Journal of Public Health, 95, 99–103.
23.
Costenbader, E. C., Zule, W. A., & Coomes, C. M. (2007). The impact of illicit drug use and harmful drinking on quality of life among injection drug users at high risk for hepatitis C infection. Drug and Alcohol Dependence, 89, 251–258.PubMedCrossRef
24.
Ling, W., Amass, L., Shoptaw, S., et al. (2005). A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxication: Findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction, 100, 1090–1100.PubMedCrossRef
25.
Wilson, I. B., & Cleary, P. D. (1995). Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA, 273, 59–65.PubMedCrossRef
26.
Bentler, P. M., & Stein, J. A. (1992). Structural equation models in medical research. Statistical Methods in Medical Research, 1, 159–181.PubMedCrossRef
27.
Ware, J. E., Kosinski, M., & Dewey, J. E. (2000). How to score version two of the SF-36 health survey (Vol. 1). Lincoln, RI: QualityMetric, Incorporated.
28.
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.PubMedCrossRef
29.
Amass, L., Kamien, J. B., & Mikulich, L. K. (2000). Efficacy of daily and alternate-day dosing regimens with the combination buprenorphine-naloxone tablet. Drug and Alcohol Dependence, 58, 143–152.PubMedCrossRef
30.
Little, T. D., Cunningham, W. A., Shahar, G., & Widaman, K. F. (2002). To parcel or not to parcel: Exploring the question, weighing the merits. Structural Equation Modeling, 9, 151–173.CrossRef
31.
Yuan, K.-H., Bentler, P. M., & Kano, Y. (1997). On averaging variables in a confirmatory factor analysis model. Behaviormetrika, 24, 71–83.CrossRef
32.
Bandalos, D. L., & Finney, S. J. (2001). Item parceling issues in structural equation modeling. In G. A. Marcoulides (Ed.), New developments and techniques in structural equation modeling (pp. 269–296). Mahwah, NJ: Lawrence Erlbaum & Associates.
33.
Wesson, D. R., & Ling, W. (2003). The clinical opiate withdrawal scale (COWS). Journal of Psychoactive Drugs, 35, 253–259.PubMedCrossRef
34.
McGahan, P. L., Griffith, J. A., Parente, R., & McLellan, A. T. (1986). Addiction severity index composite scores manual. Philadelphia, PA: Treatment Research Institute.
35.
Søltoft, F., Hammer, M., & Kragh, N. (2009). The association of body mass index and health-related quality of life in the general population: Data from the 2003 Health Survey of England. Quality of Life Research, 18, 1293–1299.PubMedCrossRef
36.
Bentler, P. M. (2006). EQS 6 structural equations program manual. Encino, CA: Multivariate Software, Inc.
37.
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structural analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRef
38.
Yuan, K.-H., & Bentler, P. M. (1998). Robust mean and covariance structure analysis. British Journal of Mathematical and Statistical Psychology, 51, 63–88.PubMedCrossRef
39.
Yuan, K.-H., & Bentler, P. M. (1999). On asymptotic distributions of normal theory MLE in covariance structure analysis under some nonnormal distributions. Statistics & Probability Letters, 42, 107–113.CrossRef
40.
Chou, C., & Bentler, P. M. (1990). Model modification in covariance structure modeling: A comparison among likelihood ratio, Lagrange multiplier, and Wald tests. Multivariate Behavioral Research, 25, 115–136.CrossRef
41.
Sobel, M. E. (1987). Direct and indirect effects in linear structural equation models. Sociological Methods & Research, 16, 155–176.CrossRef
42.
Ware, J. E., Gandek, B., Kosinski, M., Aaronson, N. K., Apolone, G., Brazier, J., et al. (1998). The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: Results from the IQOLA Project. Journal of Clinical Epidemiology, 51, 1167–1170.PubMedCrossRef
43.
Gowing, L., Ali, R., & White, J. M. (2009). Buprenorphine for the management of opioid withdrawal. Cochrane Database Systematic Review; CD002025.
44.
Amato, L., Davoli, M., Minozzi, S., Ali, R., & Ferri, M. (2005). Methadone at tapered doses for the management of opioid withdrawal. Cochrane Database Systematic Review; CD003409.
45.
Center for Substance Abuse Treatment. Protracted Withdrawal. Substance Abuse Treatment Advisory, Volume 9, Issue 1.
46.
Velikova, G., & Wright, P. (2005). Individual patient monitoring. In Fayer P, Hays R, (Eds.) Assessing quality of life in clinical trials. Oxford University Press.
47.
Keller, S. D., Bayliss, M. S., Ware, J. E., Hsu, M. A., Damiano, A. M., & Goss, T. F. (1997). Comparison of responses to SF-36 health survey questions with one-week and four-week recall periods. Health Services Research, 32, 367–384.PubMed
48.
Bandalos, D. L. (2002). The effects of item parceling on goodness-of-fit and parameter estimate bias in structural equation modeling. Structural Equation Modeling, 9, 78–102.CrossRef
49.
Trivedi, M. H., Rush, A. J., Wisniewski, S. R., et al. (2006). Evaluation of outcomes with Citalopram for depression using measurement-based care in STAR*D: Implications for clinical practice. American Journal of Psychiatry, 163, 28–40.PubMedCrossRef
50.
Reiser, S. J. (1993). The era of the patient: Using the experience of illness in shaping the missions of health care. JAMA, 269, 1012–1018.PubMedCrossRef
Metadata
Title
Clinical correlates of health-related quality of life among opioid-dependent patients
Authors
Kevin C. Heslin
Judith A. Stein
Keith G. Heinzerling
Deyu Pan
Christine Magladry
Ron D. Hays
Publication date
01-10-2011
Publisher
Springer Netherlands
Published in
Quality of Life Research / Issue 8/2011
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-011-9858-y

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