The subjective well-being of people caring for a family member with a severe disability at home: a review

This review concerns the life quality of people caring for a relative with a severe disability within their family. It involves the balance between the advantages such care brings to the care recipient and the costs borne by the family. A brief history indicates that the forces that encourage family care are minimally concerned with family welfare. Moreover, an analysis of both qualitative and quantitative data indicates that primary caregivers are at considerable risk of high stress, clinical depression, and abnormally low subjective quality of life. It is concluded that increased public expenditure directed to the care of people with severe disability is urgently required.

Subjective quality of life, perceived control and dispositional optimism among older people

Objectives: To examine whether the subjective quality of life (QOL) of elderly people is held under homeostatic control, and to investigate the role of perceived control and dispositional optimism in the maintenance of subjective QOL.
Method: 100 older people (M=75.6 years) and a control group of 107 younger people (M=20.1 years) completed a self-report survey.
Results: Both groups had a level of subjective QOL within the normal range. The older group reported higher levels of secondary control and optimism, but similar levels of primary control, as the younger group. Primary control and optimism predicted subjective QOL for both groups. Secondary control was a significant predictor (or the younger group, however it was only marginally significant for the older group. Optimism accounted for the most subjective QOL variance for both groups.
Conclusions: The finding that the subjective QOL of the older group lay within the normative range supports the proposal that their subjective QOL is being successfully maintained under bomeostatic control. However, they appear to have an increased reliance on secondary control. The fact that dispositional optimism captures the predictive variance of perceived control, is an important finding adding to the understanding of subjective QOL maintenance.

Developing a national index of subjective wellbeing: the Australian unity wellbeing index

The Australian Unity Wellbeing Index has been designed as a new barometer of Australians' satisfaction with their lives, and life in Australia. It is based on, and develops, the theoretical model of subjective wellbeing homeostasis. The Index comprises two sub-scales of Personal and National Wellbeing. Data were collected through a nationally representative sample of 2,000 people in April/May 2001.Factor analysis confirmed the integrity of the two sub-scales and, confirming empirical expectation, the average level of life satisfaction was 75.5 percent of the scale maximum score. Group comparisons revealed that all age groups maintained their Personal Index score within the normal range. In addition,people in country areas were more satisfied with their personal lives than city-dwellers,but less satisfied about the national situation, and people who had recently experienced a strong positive event evidenced arise in wellbeing, whereas those who had experienced a strong negative event evidenced wellbeing in the low-normal range. It is argued that these data generally support homeostatic theory. However, an unusual result was that females were more satisfied with their own lives than males. A tentative argument is advanced that this may represent a constitutional difference. It is concluded that the Australian Unity Wellbeing Index has potential as a valid, reliable and sensitive instrument to monitor national wellbeing.

The management of subjective quality of life by short-stay hospital patients: an exploratory study

Background: This study tested the homeostatic model of subjective quality of life in a group of 47 short stay patients as they progressed through the stages of hospitalization for surgery.
Method: Participants completed a questionnaire measuring subjective quality of life, positive and negative affect, self-esteem, optimism and cognitive flexibility, the day prior to admission (T1), two days post-operation (T2) and one week after discharge (T3). Neuroticism and Extroversion were measured at Time 1.
Results: All variables remained stable across the three times, apart from positive affect, which dropped significantly post-operation but returned to its previous level post discharge.
Conclusion: Although the homeostatic model of subjective quality of life was supported at Time 1, the analyses raise doubts about the stability of personality. This finding is consistent with recent discussions of personality.

HRQOL and subjective well-being: noncomplementary forms of outcome measurement

This review considers some of the broad principles that concern quality of life assessment. These are discussed in relation to health-related quality of life (HRQOL) and the measurement of subjective well-being. It is argued that there are serious logical and methodological issues concerning HRQOL measurement, to the extent that the instruments may not be regarded as valid measures of life quality as this term is generally understood. It is recommended that HRQOL measurement be abandoned in favor of three separate forms of measurement as medical symptoms, subjective well-being and specific dimensions of psychological ill-being.

Subjective quality of life and self-esteem in children: the role of primary and secondary control in coping with everyday stress

Two major predictors of subjective quality oflife (SQOL) in adults are known to beself-esteem and a sense of primary control.Moreover, secondary control is known to be animportant defence strategy when primary controlfails. This study aimed to determine whetherthese relationships also apply to children. Asample of 66 children aged from 5 to 12 yearswere compared on their use of primary andsecondary control and on their ratings of SQOLand self-esteem. SQOL was measured using theComprehensive Quality of Life Scale,self-esteem by using the CoopersmithSelf-Esteem Inventory, and primary andsecondary control were measured by codingchildren's responses to three short video clipsof children in stressful situations. It wasfound that younger children use more primarycontrol and less secondary control than olderchildren. However, five year olds were foundcapable of producing secondary controlstrategies. Contrary to expectation, primaryand secondary control did not predict eitherself-esteem or SQOL. However, self-esteempredicted SQOL as expected and no sexdifferences were found. These findingsemphasise important differences from the adultliterature and the reasons for this arediscussed.

Caregivers as managers of subjective wellbeing: a homeostatic perspective

Background: This paper proposes that the adequacy of service delivery and caregiving to people who are disabled should be assessed using two criteria. One is the objective circumstance of living, which should be at a standard acceptable to the community at large. The other is a level of subjective wellbeing (SWB) within the normal range. Method: This latter criterion is a novel conception based on an understanding that SWB is homeostatically managed to lie normally within a narrow range of values. Results: People who have a disability are more likely than usual to have a fragile homeostatic system because of the additional life challenges imposed by their disability. Conclusions: The role of a caregiver is to provide resources and protection against strong threats to homeostasis, thereby ensuring that the person in their care has a normal-range level of SWB.

Economic deprivation and its effects on subjective wellbeing in families of people with multiple sclerosis

Background: There has been limited research on the role of financial strain on the adjustment of people with multiple sclerosis.

Aims: This study examined the financial costs of MS and the impact of financial strain on the quality of life and adjustment of people with MS and their families.

Methods: Interviews were conducted with 16 health professionals, 26 people with MS and 11 family members of people who have MS.

Results: Economic deprivation impacted on the subjective well being of many families living with MS. Concerns included adjustment to a lower income if the person with MS reduced or ceased work, and meeting the costs of home alterations, mobility equipment, and special transport. The additional cost of living with MS is a stress factor, especially for people dependent on disability support pensions.

Conclusions: It is anticipated that the findings from this study will raise the awareness of health professionals and politicians regarding the potential impact of financial stress on people with MS and their families.