title: What are the determinants of quality of life in people with cervical dystonia?
abstract: BACKGROUND
  Little is known about the quality of life in patients with cervical dystonia, although pain and depression are relatively common.
  
  
  OBJECTIVE
  To test the hypothesis that an individual's ability to cope with the disease will modify the association of intrinsic, extrinsic, and disease related factors with quality of life.
  
  
  METHODS
  Patients with cervical dystonia diagnosed by a movement disorder specialist were recruited from seven European countries. Data on quality of life (SF-36), measures of coping, and intrinsic, extrinsic, and disease related factors were collected by a self completed postal questionnaire.
  
  
  RESULTS
  289 patients (101 men and 188 women), mean age 55 years, completed the questionnaire. Both physical and mental quality of life scores were predicted by self esteem and self deprecation, educational level, employment status, social support, response to botulinum toxin, disease severity, social participation, stigma, acceptance of illness, anxiety, and depression. In multivariable analyses, the strongest predictors were anxiety and depression. Severe depression was associated with a 19.1 point decrement in the physical summary score (95% confidence interval, -31.7 to -6.6; p = 0.003); however, disease duration and severity remained predictors.
  
  
  CONCLUSIONS
  Care for patients with cervical dystonia must not only focus on reducing the severity of the dystonia but also on the psychological wellbeing of the patient. Interventions aimed at treating depression or anxiety, especially of a cognitive nature, may have a large impact on improving quality of life.
authors.affiliation: Department of Social Medicine, MRC Health Services Collaboration, University of Bristol, Bristol, UK. y.ben-shlomo@bristol.ac.uk
authors.forename: Y
authors.initials: Y
authors.lastname: Ben-Shlomo
authors.forename: L
authors.initials: L
authors.lastname: Camfield
authors.forename: T
authors.initials: T
authors.lastname: Warner
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000209:etiology; D003071:Cognition; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index; D012944:Social Support; D014103:Torticollis / Q000150:complications* / Q000523:psychology*