Subjective Well-Being among Primary Health Care Patients

Received: June Subjective Well-Being among Primary Health Care Patients Alis Ozcakir * 0 Fatma Oflu Dogan 0 Yakup Tolga Cakir 0 Nuran Bayram 1 Nazan Bilgel 0 0 Uludag University Faculty of Medicine, Department of Family Medicine , Bursa , Turkey, 1 Uludag University Faculty of Economics and Administrative Sciences, Department of Econometrics , Bursa , Turkey - Over the past 40 years, researchers have tried to define subjective well-being and explain its correlations and consequences. Subjective well-being, which is synonymous with happiness, psychological well-being or mental well-being is attracting increasing attention in the field of positive psychology [1, 2, 3, 4]. Much of what we know about subjective well-being is based on the findings of a great number of representative surveys that have asked participants to report how happy and satisfied they are with their life as a whole and with various life domains. Happiness can be described as often being in a state of joy, or as a state of satisfaction. Being in a state of joy is an emotion and being satisfied is cognition. Measures of subjective well-being emphasize both emotions and cognitions. In previous studies, many variables have been shown to be related to subjective well-being. In respect of socio-demographic characteristics for example, education, wealth and being married have been determined to be positively related to happiness whereas age has been found to be related to satisfaction but not to happiness because older people experience emotions less intensely than younger people [3, 5]. Among the many factors which affect subjective well-being and happiness, being healthy is also important. On the other hand, many studies have shown that subjective well-being protects individuals from both physical and psychological disorders. Studies have shown that happiness appears to foster physical health and high optimism prevents cardio-vascular diseases and death [6, 7, 8, 9]. Optimism and positive emotions have also been linked to faster recovery rates and to a greater adherence to the medical regimen [10, 11]. Thus subjective well-being may act as a preventive factor [12, 13, 14, 15]. Happiness and life satisfaction predicted lower risk of all-cause mortality in healthy populations [16]. Furthermore life satisfaction, absence of negative emotions, optimism, and positive emotions have been reported to result in better health and longevity [17, 18, 19]. It is also well known that depressive and anxiety disorders have a negative effect on subjective well-being. Researchers have reported that the severity of anxiety is associated with significant impairments in psychological well-being and the presence of a depressive disorder comorbid with an anxiety disorder had a negative impact on quality of life and life satisfaction [20, 21, 22]. Positive psychological interventions have been seen to decrease depression and pain among primary health care patients [23]. Mood disorder and impaired emotional and social role functioning have been found to be associated with unhappiness [24]. In Turkey, the subjective well-being of the general population and of patients is a neglected issue and studies on this subject are rare. The studies available on life satisfaction and happiness for the general population in Turkey used the data sets of the World Values Survey and World Database of Happiness [25, 26]. In these studies which were conducted on the general population, the areas of happiness and life satisfaction were assessed with only one question of: Are you happy or Are you satisfied with your life? The results of these studies have shown discrepancies. One study found a significant negative effect of age on happiness and life satisfaction whereas the other study determined a positive significant effect [27, 28]. One study showed that being male has a significantly negative direct effect on happiness whereas the other study found that gender had no effect [27, 28]. Furthermore, one study found no significant effect of education whereas the other study revealed a significant positive relationship between education and happiness [27, 28]. Both of these studies showed a significant positive relationship between happiness, life satisfaction and higher levels of income. Compared to previous studies in Turkey, the current study is of importance because the data were collected directly from the participants. No previously collected data were used and the assessment of subjective well-being was made using validated scales. The purpose of this study was to assess the subjective well-being status of a group of patients who attended a primary healthcare unit in Turkey. Of the many factors which have been found to be related to subjective well-being evaluations were made to assess relationships between: 1. Some socio-demographic characteristics (age, sex, education, marital status and income) and subjective well-being; 2. Having a chronic disease and subjective well-being; 3. Experiencing any kind of loss (family member, money or job) and subjective well-being; 4. Mood status (depression, anxiety, stress) and subjective well-being. Materials and Methods Study design This was a cross-sectional, descriptive study which depended on self-reporting. Ethical Issues Approval for the study was granted by Uludag University Faculty of Medicine Ethics Committee (Date of approval: 31 July 2012; number: 2012-17/2). The study was conducted in accordance with the Declaration of Helsinki. Written informed consent forms were seen and approved by the Uludag University Faculty of Medicine Ethics Committee during the approval process of the study. All participants gave written informed consent before taking part and the informed consent forms were collected in a separate file. Place of the study This study was performed in a primary healthcare unit in Bursa, Turkey. This primary healthcare unit is affiliated to the medical faculty and serves as a training center for medical students and research assistants of the Family Medicine Department. Study participants During a period of two months, 378 adult patients (aged 18 years and over) attended this unit. All were asked to participate in the study after the neccessary information about the study was given. Written informed consent was obtained from 284 patients and 94 patients did not want to participate. The response rate to the study was 75.1%. Study materials All of the study materials were printed materials, which were distributed to the patients who then answered the questions anonymously. The printed materials used were as follows: 1. A questionnaire about the socio-demographic characteristics of the participants such as, sex, age, marital status, educational attainment and income. Two further questions were asked on this questionnaire: Have you been diagnosed or treated for clinical depression during the last year? Have you experienced any kind of loss (family member, money or job) during (...truncated)