Skip to main content
Top
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship

Authors: Steffi Weidt, Annette B Bruehl, Dominik Straumann, Stefan CA Hegemann, Gerhard Krautstrunk, Michael Rufer

Published in: BMC Health Services Research | Issue 1/2014

Login to get access

Abstract

Background

Dizziness is frequently encountered in medical practice, often takes a chronic course and can impair the health related quality of life (HRQoL). However results on the extent of this impairment of HRQoL are mixed. Furthermore, the relationship between dizziness and the HRQoL is only partially understood. The role of clinical symptoms of dizziness and psychosocial factors such as emotional distress on this relationship is for the most part unknown.

Methods

The cross-sectional study evaluated the HRQoL in 203 patients suffering from dizziness, using the Medical Outcomes Studies 36-Item Short-Form Health-Survey (SF-36). The results were correlated with the severity of dizziness, using the Dizziness Handicap-Inventory (DHI), with emotional distress, using the Hospital Anxiety and Depression-Scale (HADS) and with further clinical symptoms and psychosocial parameters. In a multivariate hierarchical regression analysis associated variables which explain significant variance of the mental and physical HRQoL (MCS-36, PCS-36) were identified.

Results

Patients suffering from dizziness showed a markedly reduced mental and physical HRQoL. Higher DHI and HADS scores were correlated with lower MCS-36 and PCS-36 scores. Taken together DHI and vertigo characteristics of dizziness explained 38% of the variance of PCS-36. Overall explained variance of PCS-36 was 45%. HADS and living with a significant other explained 66% of the variance of MCS-36 (overall variance explained: 69%).

Conclusion

Both the physical and mental HRQoL are significantly impaired in patients with dizziness. While the impairment in PCS-36 can be explained by clinical symptoms of the dizziness, MCS-36 impairment is largely associated with psychosocial factors. To improve the patient’s overall well-being significantly and permanently doctors have to keep in mind both, the clinical symptoms and the psychosocial factors. Therefore, in addition to the physical examination doctors should integrate a basic psychological examination into the daily routine with dizziness patients.
Appendix
Available only for authorised users
Literature
1.
go back to reference Bird JC, Beynon GJ, Prevost AT, Baguley DM: An analysis of referral patterns for dizziness in the primary care setting. Br J Gen Pract. 1998, 48 (437): 1828-1832.PubMedPubMedCentral Bird JC, Beynon GJ, Prevost AT, Baguley DM: An analysis of referral patterns for dizziness in the primary care setting. Br J Gen Pract. 1998, 48 (437): 1828-1832.PubMedPubMedCentral
2.
go back to reference Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T: Burden of dizziness and vertigo in the community. Arch Intern Med. 2008, 168 (19): 2118-2124.CrossRefPubMed Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T: Burden of dizziness and vertigo in the community. Arch Intern Med. 2008, 168 (19): 2118-2124.CrossRefPubMed
3.
go back to reference Yardley L, Owen N, Nazareth I, Luxon L: Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract. 1998, 48 (429): 1131-1135.PubMedPubMedCentral Yardley L, Owen N, Nazareth I, Luxon L: Prevalence and presentation of dizziness in a general practice community sample of working age people. Br J Gen Pract. 1998, 48 (429): 1131-1135.PubMedPubMedCentral
4.
go back to reference Karatas M: Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008, 14 (6): 355-364.CrossRefPubMed Karatas M: Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008, 14 (6): 355-364.CrossRefPubMed
5.
go back to reference Sloane PD, Coeytaux RR, Beck RS, Dallara J: Dizziness: state of the science. Ann Intern Med. 2001, 134 (9 Pt 2): 823-832.CrossRefPubMed Sloane PD, Coeytaux RR, Beck RS, Dallara J: Dizziness: state of the science. Ann Intern Med. 2001, 134 (9 Pt 2): 823-832.CrossRefPubMed
6.
go back to reference Sloane PD: Dizziness in primary care. Results from the National Ambulatory Medical Care Survey. J Fam Pract. 1989, 29 (1): 33-38.PubMed Sloane PD: Dizziness in primary care. Results from the National Ambulatory Medical Care Survey. J Fam Pract. 1989, 29 (1): 33-38.PubMed
7.
go back to reference Colledge NR, Barr-Hamilton RM, Lewis SJ, Sellar RJ, Wilson JA: Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996, 313 (7060): 788-792.CrossRefPubMedPubMedCentral Colledge NR, Barr-Hamilton RM, Lewis SJ, Sellar RJ, Wilson JA: Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996, 313 (7060): 788-792.CrossRefPubMedPubMedCentral
8.
go back to reference Branch WT, Barton JJ: Approach to the patient with dizziness. 2014, UpToDate® Branch WT, Barton JJ: Approach to the patient with dizziness. 2014, UpToDate®
9.
go back to reference Ten Voorde M, Zaag-Loonen HJ, Leeuwen RB: Dizziness impairs health-related quality of life. Qual Life Res. 2012, 21 (6): 961-966.CrossRefPubMed Ten Voorde M, Zaag-Loonen HJ, Leeuwen RB: Dizziness impairs health-related quality of life. Qual Life Res. 2012, 21 (6): 961-966.CrossRefPubMed
10.
go back to reference Best C, Eckhardt-Henn A, Diener G, Bense S, Breuer P, Dieterich M: Interaction of somatoform and vestibular disorders. J Neurol Neurosurg Psychiatry. 2006, 77 (5): 658-664.CrossRefPubMedPubMedCentral Best C, Eckhardt-Henn A, Diener G, Bense S, Breuer P, Dieterich M: Interaction of somatoform and vestibular disorders. J Neurol Neurosurg Psychiatry. 2006, 77 (5): 658-664.CrossRefPubMedPubMedCentral
11.
go back to reference Eckhardt-Henn A, Tschan R, Best C, Dieterich M: Somatoform vertigo syndrome. Nervenarzt. 2009, 80 (8): 909-917.CrossRefPubMed Eckhardt-Henn A, Tschan R, Best C, Dieterich M: Somatoform vertigo syndrome. Nervenarzt. 2009, 80 (8): 909-917.CrossRefPubMed
12.
go back to reference Ronel J, Lahmann C: Vertigo und Psyche. Nervenheilkunde. 2008, 27 (9): 846-852. Ronel J, Lahmann C: Vertigo und Psyche. Nervenheilkunde. 2008, 27 (9): 846-852.
13.
go back to reference Yardley L, Putman J: Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study. Clin Otolaryngol Allied Sci. 1992, 17 (3): 231-236.CrossRefPubMed Yardley L, Putman J: Quantitative analysis of factors contributing to handicap and distress in vertiginous patients: a questionnaire study. Clin Otolaryngol Allied Sci. 1992, 17 (3): 231-236.CrossRefPubMed
14.
go back to reference Hannaford PC, Simpson JA, Bisset AF, Davis A, McKerrow W, Mills R: The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland. Fam Pract. 2005, 22 (3): 227-233.CrossRefPubMed Hannaford PC, Simpson JA, Bisset AF, Davis A, McKerrow W, Mills R: The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland. Fam Pract. 2005, 22 (3): 227-233.CrossRefPubMed
15.
go back to reference Fallowfield L: What is quality of life. What is? Volume 2. 2009, Hayward Medical Communications Fallowfield L: What is quality of life. What is? Volume 2. 2009, Hayward Medical Communications
16.
go back to reference George LK: Perceived quality of life. Handbook of Aging and the Social Science. 2006, Burlington: Academic Press, 320-336. 6CrossRef George LK: Perceived quality of life. Handbook of Aging and the Social Science. 2006, Burlington: Academic Press, 320-336. 6CrossRef
17.
go back to reference Ware JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992, 30 (6): 473-483.CrossRefPubMed Ware JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992, 30 (6): 473-483.CrossRefPubMed
18.
go back to reference Enloe LJ, Shields RK: Evaluation of Health-Related Quality of Life in Individuals With Vestibular Disease Using Disease-Specific and General Outcome Measures. Phys Ther. 1997, 77 (9): 890-903.PubMed Enloe LJ, Shields RK: Evaluation of Health-Related Quality of Life in Individuals With Vestibular Disease Using Disease-Specific and General Outcome Measures. Phys Ther. 1997, 77 (9): 890-903.PubMed
19.
go back to reference Yardley L, Dibb B, Osborne G: Factors associated with quality of life in Menière's disease. Clin Otolaryngol Allied Sci. 2003, 28 (5): 436-441.CrossRefPubMed Yardley L, Dibb B, Osborne G: Factors associated with quality of life in Menière's disease. Clin Otolaryngol Allied Sci. 2003, 28 (5): 436-441.CrossRefPubMed
20.
go back to reference Hsu L-c H, H-h WW-j, S-j W, Y-o L, C-m C: Quality of life in elderly patients with dizziness: analysis of the short-form health survey in 197 patients. Acta Oto-laryngologica. 2005, 125 (1): 55-59.CrossRefPubMed Hsu L-c H, H-h WW-j, S-j W, Y-o L, C-m C: Quality of life in elderly patients with dizziness: analysis of the short-form health survey in 197 patients. Acta Oto-laryngologica. 2005, 125 (1): 55-59.CrossRefPubMed
21.
go back to reference Fielder H, Denholm SW, Lyons RA, Fielder CP: Measurement of health status in patients with vertigo. Clin Otolaryngol Allied Sci. 1996, 21 (2): 124-126.CrossRefPubMed Fielder H, Denholm SW, Lyons RA, Fielder CP: Measurement of health status in patients with vertigo. Clin Otolaryngol Allied Sci. 1996, 21 (2): 124-126.CrossRefPubMed
22.
go back to reference Gámiz MJ, Lopez-Escamez JA: Health-Related Quality of Life in Patients over Sixty Years Old with Benign Paroxysmal Positional Vertigo. Gerontology. 2004, 50 (2): 82-86.CrossRefPubMed Gámiz MJ, Lopez-Escamez JA: Health-Related Quality of Life in Patients over Sixty Years Old with Benign Paroxysmal Positional Vertigo. Gerontology. 2004, 50 (2): 82-86.CrossRefPubMed
23.
go back to reference Herrmann C, Brand-Driehorst S, Buss U, Ruger U: Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing. J Psychosom Res. 2000, 48 (4–5): 455-462.CrossRefPubMed Herrmann C, Brand-Driehorst S, Buss U, Ruger U: Effects of anxiety and depression on 5-year mortality in 5,057 patients referred for exercise testing. J Psychosom Res. 2000, 48 (4–5): 455-462.CrossRefPubMed
24.
go back to reference Hallam RS, Stephens SDG: Vestibular disorder and emotional distress. J Psychosom Res. 1985, 29 (4): 407-413.CrossRefPubMed Hallam RS, Stephens SDG: Vestibular disorder and emotional distress. J Psychosom Res. 1985, 29 (4): 407-413.CrossRefPubMed
25.
go back to reference Tschan R, Best C, Beutel M, Knebel A, Wiltink J, Dieterich M, Eckhardt-Henn A: Patients’ psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease. J Neurol. 2011, 258 (1): 104-112.CrossRefPubMed Tschan R, Best C, Beutel M, Knebel A, Wiltink J, Dieterich M, Eckhardt-Henn A: Patients’ psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease. J Neurol. 2011, 258 (1): 104-112.CrossRefPubMed
26.
go back to reference Bullinger M: German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med. 1995, 41 (10): 1359-1366.CrossRefPubMed Bullinger M: German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med. 1995, 41 (10): 1359-1366.CrossRefPubMed
27.
go back to reference Bullinger M: SF-Fragebogen zum Gesundheitszustand. 1998, Göttingen: Hogrefe Bullinger M: SF-Fragebogen zum Gesundheitszustand. 1998, Göttingen: Hogrefe
28.
go back to reference Jacobson GP, Newman CW: The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1990, 116 (4): 424-427.CrossRefPubMed Jacobson GP, Newman CW: The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1990, 116 (4): 424-427.CrossRefPubMed
29.
go back to reference Kurre A, van Gool CJ, Bastiaenen CH, Gloor-Juzi T, Straumann D, de Bruin ED: Translation, cross-cultural adaptation and reliability of the german version of the dizziness handicap inventory. Otol Neurotol. 2009, 30 (3): 359-367.CrossRefPubMed Kurre A, van Gool CJ, Bastiaenen CH, Gloor-Juzi T, Straumann D, de Bruin ED: Translation, cross-cultural adaptation and reliability of the german version of the dizziness handicap inventory. Otol Neurotol. 2009, 30 (3): 359-367.CrossRefPubMed
30.
go back to reference Hermann C, Buss U: Vorstellung und Validierung einer deutschen Version der "Hospital Anxiety and Depression Scale" (HAD-Skala): Ein Fragebogen zur Erfassung des psychischen Befindens bei Patienten mit körperlichen Beschwerden. Diagnostica. 1994, 40: 143-154. Hermann C, Buss U: Vorstellung und Validierung einer deutschen Version der "Hospital Anxiety and Depression Scale" (HAD-Skala): Ein Fragebogen zur Erfassung des psychischen Befindens bei Patienten mit körperlichen Beschwerden. Diagnostica. 1994, 40: 143-154.
31.
go back to reference Herrmann C: International experiences with the Hospital Anxiety and Depression Scale–a review of validation data and clinical results. J Psychosom Res. 1997, 42 (1): 17-41.CrossRefPubMed Herrmann C: International experiences with the Hospital Anxiety and Depression Scale–a review of validation data and clinical results. J Psychosom Res. 1997, 42 (1): 17-41.CrossRefPubMed
32.
go back to reference Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983, 67 (6): 361-370.CrossRefPubMed Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983, 67 (6): 361-370.CrossRefPubMed
33.
go back to reference Cosco TD, Doyle F, Ward M, McGee H: Latent structure of the Hospital Anxiety And Depression Scale: a 10-year systematic review. J Psychosom Res. 2012, 72 (3): 180-184.CrossRefPubMed Cosco TD, Doyle F, Ward M, McGee H: Latent structure of the Hospital Anxiety And Depression Scale: a 10-year systematic review. J Psychosom Res. 2012, 72 (3): 180-184.CrossRefPubMed
34.
go back to reference Kammerlind A-S, Bergquist Larsson P, Ledin T, Skargren E, ouml, rn: Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium. Adv Physiother. 2005, 7 (3): 96-107.CrossRef Kammerlind A-S, Bergquist Larsson P, Ledin T, Skargren E, ouml, rn: Reliability of clinical balance tests and subjective ratings in dizziness and disequilibrium. Adv Physiother. 2005, 7 (3): 96-107.CrossRef
35.
go back to reference Durbin J, Watson GS: Testing for Serial Correlation in Least Squares Regression. II. Biometrika. 1951, 38 (1/2): 159-177.CrossRefPubMed Durbin J, Watson GS: Testing for Serial Correlation in Least Squares Regression. II. Biometrika. 1951, 38 (1/2): 159-177.CrossRefPubMed
36.
go back to reference Myers R: Classical and modern regression with applications. 1990, Boston: Brooks/Cole, 2 Myers R: Classical and modern regression with applications. 1990, Boston: Brooks/Cole, 2
37.
go back to reference Bowerman BL, Connell RT O: Linear statistical models: an applied approach. 1990, Belmont: PWS-Kent Pub, 2 Bowerman BL, Connell RT O: Linear statistical models: an applied approach. 1990, Belmont: PWS-Kent Pub, 2
38.
go back to reference Menard S: Applied logistic regression analysis. 1995, Thousand Oaks: SAGE Publications Menard S: Applied logistic regression analysis. 1995, Thousand Oaks: SAGE Publications
39.
go back to reference Downey RG, King C: Missing data in Likert ratings: A comparison of replacement methods. J Gen Psychol. 1998, 125 (2): 175-191.CrossRefPubMed Downey RG, King C: Missing data in Likert ratings: A comparison of replacement methods. J Gen Psychol. 1998, 125 (2): 175-191.CrossRefPubMed
40.
go back to reference Fox-Wasylyshyn SM, El-Masri MM: Handling missing data in self-report measures. Res Nurs Health. 2005, 28 (6): 488-495.CrossRefPubMed Fox-Wasylyshyn SM, El-Masri MM: Handling missing data in self-report measures. Res Nurs Health. 2005, 28 (6): 488-495.CrossRefPubMed
41.
go back to reference Grauvogel J, Kaminsky J, Rosahl SK: The impact of tinnitus and vertigo on patient-perceived quality of life after cerebellopontine angle surgery. Neurosurgery. 2010, 67 (3): 601-609. discussion 609–610CrossRefPubMed Grauvogel J, Kaminsky J, Rosahl SK: The impact of tinnitus and vertigo on patient-perceived quality of life after cerebellopontine angle surgery. Neurosurgery. 2010, 67 (3): 601-609. discussion 609–610CrossRefPubMed
42.
go back to reference Pratt RTC, McKenzie W: Anxiety states following vestibular disorders. The Lancet. 1958, 272 (7042): 347-349.CrossRef Pratt RTC, McKenzie W: Anxiety states following vestibular disorders. The Lancet. 1958, 272 (7042): 347-349.CrossRef
43.
44.
go back to reference Soderman AC, Bagger-Sjoback D, Bergenius J, Langius A: Factors influencing quality of life in patients with Meniere's disease, identified by a multidimensional approach. Otol Neurotol. 2002, 23 (6): 941-948.CrossRefPubMed Soderman AC, Bagger-Sjoback D, Bergenius J, Langius A: Factors influencing quality of life in patients with Meniere's disease, identified by a multidimensional approach. Otol Neurotol. 2002, 23 (6): 941-948.CrossRefPubMed
45.
go back to reference Santos EM, Gazzola JM, Gananca CF, Caovilla HH, Gananca FF: Impact of dizziness on the life quality of elderly with chronic vestibulopathy. Pro Fono. 2010, 22 (4): 427-432.CrossRefPubMed Santos EM, Gazzola JM, Gananca CF, Caovilla HH, Gananca FF: Impact of dizziness on the life quality of elderly with chronic vestibulopathy. Pro Fono. 2010, 22 (4): 427-432.CrossRefPubMed
46.
go back to reference Kirby SE, Yardley L: Cognitions associated with anxiety in Meniere's disease. J Psychosom Res. 2009, 66 (2): 111-118.CrossRefPubMed Kirby SE, Yardley L: Cognitions associated with anxiety in Meniere's disease. J Psychosom Res. 2009, 66 (2): 111-118.CrossRefPubMed
47.
go back to reference Yardley L, Beech S, Weinman J: Influence of beliefs about the consequences of dizziness on handicap in people with dizziness, and the effect of therapy on beliefs. J Psychosom Res. 2001, 50 (1): 1-6.CrossRefPubMed Yardley L, Beech S, Weinman J: Influence of beliefs about the consequences of dizziness on handicap in people with dizziness, and the effect of therapy on beliefs. J Psychosom Res. 2001, 50 (1): 1-6.CrossRefPubMed
48.
go back to reference Furman JM, Jacob RG: A clinical taxonomy of dizziness and anxiety in the otoneurological setting. J Anxiety Disord. 2001, 15 (1–2): 9-26.CrossRefPubMed Furman JM, Jacob RG: A clinical taxonomy of dizziness and anxiety in the otoneurological setting. J Anxiety Disord. 2001, 15 (1–2): 9-26.CrossRefPubMed
49.
go back to reference Loughran S, Gatehouse S, Kishore A, Swan IR: Does patient-perceived handicap correspond to the modified clinical test for the sensory interaction on balance?. Otol Neurotol. 2006, 27 (1): 86-91.CrossRefPubMed Loughran S, Gatehouse S, Kishore A, Swan IR: Does patient-perceived handicap correspond to the modified clinical test for the sensory interaction on balance?. Otol Neurotol. 2006, 27 (1): 86-91.CrossRefPubMed
51.
go back to reference Pérez N, Martin E, Garcia-Tapia R: Dizziness: Relating the Severity of Vertigo to the Degree of Handicap by Measuring Vestibular Impairment. Otolaryngol Head Neck Surg. 2003, 128 (3): 372-381.CrossRefPubMed Pérez N, Martin E, Garcia-Tapia R: Dizziness: Relating the Severity of Vertigo to the Degree of Handicap by Measuring Vestibular Impairment. Otolaryngol Head Neck Surg. 2003, 128 (3): 372-381.CrossRefPubMed
Metadata
Title
Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship
Authors
Steffi Weidt
Annette B Bruehl
Dominik Straumann
Stefan CA Hegemann
Gerhard Krautstrunk
Michael Rufer
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-317

Other articles of this Issue 1/2014

BMC Health Services Research 1/2014 Go to the issue