Two diagnoses and more: stress's association with quality of life was twice as strong

In Finnish residents with two or more chronic diseases, stress was more strongly associated with a low assessment of quality of life than in people without such diseases. With a comparable difference in stress levels, the difference in health scores was about twice as large. Participants who found it easier to use medical information reported less stress on average. About how scientists measured the daily workload and why patients with multiple diagnoses need coordination of care, see the Izvestia article.

Who was interviewed and what was considered stressful

The authors used data from the Finnish online survey PROM 2024. It was completed by 4,003 people aged 19 to 79 years. The sample was formed taking into account age, gender, and region of residence. In the model, where scientists compared the relationship between stress and quality of life in different groups, they used the complete responses of 3,716 participants.

Participants were asked to identify which of the 21 chronic conditions they had. The list included, for example, high blood pressure, high cholesterol, migraines, and back problems. After adjusting for the age and gender composition of the sample, the proportion of those who reported at least one such condition was 74.3%, two or more — 48.7%. These estimates are based on the participants' responses and depend on which states were included in the questionnaire.

By perceived stress, the researchers understood how unpredictable and difficult people found their lives to control in the previous month. The ten-question questionnaire assessed, in particular, how often a person felt that too much was piling on them. This is how scientists have assessed the overall stress experienced.

Separately, they asked how easy it was for a person to move around, take care of themselves, perform routine tasks, and how much pain, discomfort, anxiety, or depression bothered them. The answers were combined into a single index of health-related quality of life.

Just not to go to school: how school bullying is related to PTSD symptoms

How did the answers differ in the three groups?

With higher stress levels, participants in all three groups received lower scores on the quality of life index on average. The relationship persisted after age, gender, education, employment, and financial difficulties were taken into account. It was most pronounced in people with several chronic conditions. For those who reported one such condition, the result was intermediate.

A one-point difference on the stress scale corresponded to a lower quality of life index. In people without chronic diseases, it was lower by an average of 0.006 points, in participants with two or more conditions — by 0.012. The comparison concerns the responses of different people at one point in time. To assess how a particular person's well-being changes with increasing or decreasing stress, repeated surveys would be required.

The authors also take into account the features of the scale itself. Almost half of the participants without chronic diseases received the maximum score on the quality of life index. In people with multiple conditions, such assessments were much less common. The accumulation of responses at the upper end of the scale could partially affect the difference between the groups.

What role did medical literacy play?

Medical literacy in this work meant the ability to find, understand, evaluate, and apply health information. The participants themselves assessed how easy it was for them to cope with such tasks. In everyday life, this can mean, for example, the ability to figure out where to get the right service, or to understand what to do after an examination. The availability of information depends, among other things, on how it is provided by medical organizations.

Scientists talked about the impact of pandemic stress on biological aging

Participants who found it easier to use health information reported less stress on average. This relationship was comparable in the three groups. In the statistical model, the main part of the relationship between health literacy and quality of life was accounted for by differences in perceived stress. The sequence of events has yet to be determined. For example, constant pain and limitations in routine activities can increase stress, and stress can make it more difficult for a person to process information.

How can treatment coordination help?

A patient with multiple diagnoses may need to keep multiple examination schedules and coordinate appointments with different specialists. Tomi Miaki-Opas, a professor at the University of Eastern Finland and co-author of the work, believes that the available explanations should be combined with help in organizing treatment. If the patient understands the medical instructions, this in itself does not solve the question of how to complete all the appointments at the same time.

The British National Institute for Health and Care Excellence recommends discussing with patients how much time and effort visits and treatment take, and individually indicating who is responsible for coordinating care. This approach allows us to take into account what is important for the patient in everyday life, for example, to keep the opportunity to work or independently cope with household chores.