The impact of chronic disease and accompanying bio-psycho-social factors on health-related quality of life

BACKGROUND: Most chronic illnesses lead to poor health outcomes. Bio-psycho-social sequelae and accompanying depression lead to further deterioration in health-related quality of life (HRQoL). This study explored the HRQoL of patients with major chronic diseases in a public tertiary health care institution in Trinidad and Tobago. METHODS: This cross-sectional study was conducted on a convenience sample of adult patients with chronic illnesses in a public health institute in Trinidad. Data were collected using face-to-face interviews and consenting patients’ records. A 43-item questionnaire comprising demographic, medical, and lifestyle questions, the nine-item patient health questionnaire (PHQ-9) on depression, and the EQ-5D-5L HRQoL questionnaire were used. Psychological and social variables were divided into six groups: Group 1 (community attachment variables), Group 2 (family and friends), Group 3 (life satisfaction), Group 4 (depression symptoms), Group 5 (social support), and Group 6 (lifestyle variables). The impact of these variables on HRQoL was investigated using regression and canonical correlation analysis. RESULTS: Patients were primarily female (70.3%), Indo-Trinidadian (63.9%), having diabetes mellitus (46.0%) or cancer (35.8%). The quality of life was lower than Trinidad and Tobago EQ-5D-5L population norms. Females and older patients had worse HRQoL than males and younger patients, respectively. Furthermore, kidney failure, all cancer patients, and middle-aged female cancer patients fared worse than other categories. Life satisfaction and exercise were significantly associated with better HRQoL. Depressive symptoms were consistently and significantly negatively associated with HRQoL. CONCLUSIONS: HRQoL was lower among participants with chronic disease than in the general population. Depressive symptoms led to worse HRQoL, whereas life satisfaction and exercise significantly improved HRQoL. The EQ-5D dimension most frequently affected was anxiety/depression.