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Farah Fadilah Hasyim,1 Hari Setyowibowo,2 Fredrick Dermawan Purba2 1Psychology Study Program, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia; 2Department of Psychology, Faculty of Psychology, Universitas Padjadjaran, Bandung, IndonesiaCorrespondence: Farah Fadilah Hasyim, Psychology Study Program, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia, Tel +62895803776130, Email farah22009@mail.unpad.ac.idAbstract: In this review, the causes of the Quarter Life Crisis, a prevalent phenomenon in emerging adulthood, was evaluated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was used for this research’s systematic review. We browsed a variety of academic studies that had been published in English language, published in PubMed, Elsevier, Taylor & Francis, and Semantic Scholars that examine quarter life crisis. The literature search generated a total of 3100 publications. After removing duplicates and screening titles, abstracts, and full-text evaluation, there were 14 articles were included in the final analysis. The results were validated and examined. There were internal and external factors impacting quarter life crisis. The most powerful internal influences were commitment to purpose, spirituality, and anxiety. Meanwhile, social support, age, and gender were the most important external influences.Keywords: quarter life crisis, early adulthood, systematic literature review

Objectives: The EQ Health and Wellbeing (EQ-HWB) is a new generic measure that captures constructs beyond health-related quality of life, with a 25-item long form and a shorter 9-item version (EQ-HWB-S). This study aimed to assess the psychometric performance of both versions in breast cancer, which is the most prevalent cancer worldwide, and compare them with other instruments., Methods: A longitudinal survey in Indonesia (2023-2024) with 300 female patients used the EQ-HWB, 5-level EQ-5D (EQ-5D-5L), Functional Assessment of Cancer Therapy - General (from which Functional Assessment of Cancer Therapy Eight Dimension [FACT-8D] was derived), and Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS, from which the Short WEMWBS was derived). Distributional characteristics, convergent validity, known-group validity (Student's t test or analysis of variance), test-retest reliability, and responsiveness were assessed., Results: All patients reported problems in at least 1 EQ-HWB item. The EQ-HWB-S index (11%) had a lower ceiling than the EQ-5D-5L (35%) and the Short WEMWBS (15.3%), but not the FACT-8D (5%). EQ-HWB-S index values correlated strongly with EQ-5D-5L (r = 0.73) and FACT-8D index values (r = 0.70), whereas EQ-HWB level sum scores correlated strongly with Functional Assessment of Cancer Therapy - General (r = 0.69) and moderately with WEMWBS (r = 0.49). The EQ-HWB and EQ-HWB-S discriminated across known groups comparably with the EQ-5D-5L and FACT-8D with large effect sizes according to EuroQol visual analog scale groups, number of symptoms, and general health and exhibited excellent instrument-level test-retest reliability (intraclass correlations, 0.79-0.83) and acceptable responsiveness (standardized response means, |0.24| to |0.97|)., Conclusions: This study represents one of the first validations of the EQ-HWB and EQ-HWB-S in any clinical population. Both instrument versions demonstrate robust psychometric performance. The EQ-HWB-S can be recommended to inform resource allocation decisions of breast cancer treatments., Competing Interests: Author Disclosures Drs Purba, Mukuria, and Rencz are members of the EuroQol Group. Views expressed in the article are those of the authors and are not necessarily those of the EuroQol Research Foundation. Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2025. Published by Elsevier Inc.)

Purpose: There is a growing interest in Health Technology Assessment (HTA) in Morocco. A national EQ-5D-5L value set would allow for the computation of Quality Adjusted Life Years (QALYs) in economic evaluations of healthcare interventions to support decision-making. This study aimed to develop a Moroccan EQ-5D-5L value set based on data from a representative sample of the Moroccan adult general population., Methods: A Moroccan representative sample of adults was recruited using stratified quota sampling based on gender, age category, and place of residence. Data were collected between November 2022 and December 2023 using the international EuroQol valuation protocol, EQ-VT version 2.6.1. This protocol includes two elicitation techniques: the composite time trade-off (cTTO) and the discrete choice experiment (DCE). cTTO and DCE data were modeled using a heteroskedastic Tobit model and a conditional logit model, respectively. In addition, these models were combined using a hybrid model., Results: A total of 976 respondents were included in the final analysis. The hybrid heteroskedastic model was considered the preferred model. The predicted utility values ranged from -1.492 for the worst health state (55555) to 1 for full health (11111), where the two mildest impaired states (11211 and 21111) had a utility value of 0.979. Pain/discomfort had the largest effect on health utility values, followed by anxiety/depression, mobility, self-care and usual activities., Conclusion: Morocco is the third country in the Middle East and North Africa (MENA) region with an EQ-5D-5L value set. This study supports the use of EQ-5D-5L data for healthcare decision-making in the Moroccan context., Competing Interests: Declarations. Conflict of interest: F.D.P., F.R., E.A.S. and B.R. are members of the EuroQol Group. The views expressed in this article are those of the authors and do not necessarily reflect those of the EuroQol Research Foundation. Ethical approval: This study was approved by “the Ethics Committee for Biomedical Research from the Faculty of Medicine and Pharmacy of Rabat, Morocco (CERB O-22)”. Consent to participate: Informed consent was obtained from all individual participants included in the study., (© 2025. The Author(s).)

Objectives: Financial toxicity (FT) is the impairment of financial well-being experienced by patients with cancer, categorized into subjective (SFT) and objective (OFT) forms. This study aimed to investigate the associations between FT, health-related quality of life, and overall well-being in patients with breast cancer., Methods: We analyzed baseline data from a single-center longitudinal study in Indonesia. Patients completed the EQ-5D-5L, EQ Health and Wellbeing (EQ-HWB), COST: A FACIT Measure of Financial Toxicity (FACIT-COST, for measuring SFT), and OFT-related questions. Ordinal logistic regression was used to examine the associations between FT and selected EQ-5D-5L and EQ-HWB items. Multivariable linear regression was used to assess the associations of FT and EQ-5D-5L and EQ-HWB-S index values. The main regression models were adjusted for socio-demographic and clinical factors such as age, income, metastasis status, and symptoms., Results: The survey included 300 female patients with breast cancer undergoing treatment (mean age = 51). Overall, 21% experienced high SFT (FACIT-COST ≤ 17.5) and 51% reported any OFT (e.g., incurring debt). Adjusted for covariates, higher SFT was associated with more problems in EQ-5D-5L pain/discomfort and anxiety/depression, and in EQ-HWB exhaustion, anxiety, sadness/depression, frustration, pain, and discomfort. OFT was associated with more problems in exhaustion. Higher SFT was associated with lower EQ-5D-5L and EQ-HWB-S index values, with explained variances of 46.3% for EQ-HWB-S and 31.2% for EQ-5D-5L., Conclusions: This study is the first to explore the associations between financial toxicity, EQ-5D-5L, and EQ-HWB outcomes in breast cancer. Our findings provide insight into the cancer burden and its link to health and well-being., Competing Interests: Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Hasan Sadikin General Hospital (LB.02.01/X.6.5/284/2023). Informed consent: Informed consent was obtained from all participants included in the study. Conflict of interest: Fredrick Dermawan Purba, Clara Mukuria, and Fanni Rencz are active members of the EuroQol Group. Views expressed in the article are those of the authors and are not necessarily those of the EuroQol Research Foundation. Stevanus Pangestu and Hari Setyowibowo declare no competing interests., (© 2025. The Author(s).)

Introduction: The uptake of vaccines against COVID-19 remains low. Some barriers to childhood vaccination uptake persist, such as parents' assumption that children are at lower risk of severe COVID-19 and tend to be asymptomatic carriers. This study aims to develop guidance for in-depth interviews for a future qualitative study based on a cross-sectional quantitative study of parents with school-age children., Methods: This study adopted a cross-sectional design. The study population comprised parents of 6-11-year-old children in the Centra Java province who had received the COVID-19 vaccine or not. The data were collected from August 2023 by filling in an online questionnaire. The sample size was calculated using formulation in OpenEpi for 95% confidence levels, with a statistical power of 80%., Results: Our study finds that perceived benefit and perceived barriers are the two domains that most significantly influenced the parents' intention to vaccinate their children. In our study, there was no significant association between parent gender and the intention to vaccinate their children. Our study shows that parents' acceptance of vaccinating their children is high. We emphasized questions related to benefits and barriers in the interview. The questions on perceived benefits explored the advantages of COVID-19 vaccination. The content on perceived barriers examined the concerns of parents, the information influencing their decision to vaccinate their child, the procedure vaccination and the effect after vaccination., Discussion: The significant association between parents' intention to vaccinate their children and the perceived benefits and perceived barriers to vaccination generated guidance for in-depth interviews in the qualitative study. The health belief model should be further explored in Indonesia because of the potential external factors that may influence parents' intention to vaccinate their children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Handayani, Perwitasari and Purba.)

We examined the relationship between socioeconomic status (SES) and endorsement of honour. We studied the SES-honour link in 5 studies (N = 13,635) with participants recruited in different world regions (the Mediterranean and MENA, East Asian, South-East Asian, and Anglo-Western regions) using measures that tap into various different facets of honour. Findings from these studies revealed that individuals who subjectively perceived themselves as belonging to a higher (vs. lower) SES endorsed various facets of honour more strongly (i.e. defence of family honour values and concerns, self-promotion and retaliation values, masculine honour beliefs, emphasis on personal and family social image, the so-called street code). We discuss implications of these findings for the cultural dynamics linked to SES., (© 2025 British Psychological Society.)

Objectives: This study investigates the impact of coronavirus disease 2019 (COVID-19) pandemic on HTAsiaLink members at the organizational level and provides recommendations for mitigating similar challenges in the future., Methods: A survey was disseminated among HTAsiaLink members to assess the COVID-19 impact in three areas: (i) inputs, (ii) process, and (iii) outputs of the Health Technology Assessment organizations' (HTAOs) research operations and HTA process in general., Results: Survey results showed that most HTAOs hired more staff and secured similar or higher funding levels during COVID-19. Nevertheless, some organizations reported high staff turnover. COVID-19-relevant research was prioritized, and most of the organizations had to adapt their research design to meet the needs of policymakers. Time constraints in conducting research and inability to collect primary data were reported as impacts on the research process. Overall, the number of research projects and accessibility of respondents' publications increased during COVID-19., Conclusions: Research demand for HTAOs increased during COVID-19 and impacted their research process; however, they demonstrated resilience and adaptability to provide timely evidence for policymakers. With the growing reliance on HTA, HTAOs require adequate financial support, continuous capacity building, collaboration, and partnership, innovative HTA methods, and a pragmatic yet robust, evidence-to-policy process in preparation for future pandemics.

Background: Financial toxicity describes the impairment of financial wellbeing in patients due to the burden of cancer diagnosis and care. The COST: A Functional Assessment of Chronic Illness Therapy Measure of Financial Toxicity (FACIT-COST) is the most widely used cancer-specific measure of subjective financial toxicity, having been validated in multiple languages, but not in Indonesian. This study aimed to validate the Indonesian version of FACIT-COST in a breast cancer sample., Methods: A single-center prospective cohort study was performed in Indonesia. Female breast cancer patients aged ≥ 18 undergoing treatment at baseline were invited to participate and followed for up to six months. The survey included the official Indonesian version of FACIT-COST (v2) which was administered to the patients by interviewers. Clinical information (e.g., metastasis status, disease duration) was provided based on medical records. The following measurement properties of FACIT-COST were tested: distributional characteristics, structural validity (principal component [PCA] and confirmatory factor analyses [CFA]), internal consistency reliability (Cronbach's alpha and McDonald's omega), known-groups validity (Mann-Whitney U or Kruskal-Wallis H test), test-retest reliability, and responsiveness to change., Results: Overall, 300 female patients participated at baseline. No patients reported the best or worst possible FACIT-COST total scores. The PCA proposed a two-factor model structure for the instrument, which was confirmed by the CFA (RMSEA = 0.042, SRMR = 0.049, CFI = 0.99, TLI = 0.99). The internal consistency reliability of the two factors was considered adequate (Cronbach's alpha = 0.774-0.882, McDonald's omega = 0.786-0.888). The FACIT-COST total score significantly discriminated across the following known-groups: age, education, residential setting, income, employment, metastasis status, number of symptoms, and financial coping strategies. The FACIT-COST demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.96) and satisfactory responsiveness to change (standardized response mean and effect size ranges=|0.39| to |0.92|)., Conclusions: This is the first study to validate the FACIT-COST in patients with breast cancer and to present the measurement properties of the Indonesian version of FACIT-COST. The Indonesian FACIT-COST demonstrates acceptable psychometric performance and shows potential as a valid measure of subjective financial toxicity. The instrument may serve as a valuable tool for informing health policies that focus on providing resource support to improve cancer care in Indonesia., (© 2024. The Author(s).)

In the past decade, the concept of dyadic coping as a buffer against stress in romantic relationships has received much attention in Western countries, but it has rarely been studied in non-Western countries and among parents with school-aged children. The aim of the present study was to investigate the moderating effect of dyadic coping on the link between financial strain and marital satisfaction, as well as the mediating effect of marital satisfaction on the relationship between financial strain and quality of life. There were 751 heterosexual couples whose eldest child aged 7-12 years in West Java, Indonesia (mean age husband = 37.53 SD = 5.09; mean age wife = 34.42 SD = 4.85) fulfilled the paper and pencil questionnaires in the study. The moderated mediated model illustrated that (1) greater levels of dyadic coping weakened the negative association between financial strain and marital satisfaction for husbands and for wives (2) for both husbands and wives, there were no mediation effect (3) for both husbands and wives, financial strain was negatively associated with quality of life; and marital satisfaction was positively associated with quality of life. We discuss both the theoretical and practical implications of these findings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Novianti, Purba, Karremans and Agustiani.)

PURPOSE  : To assess gender differences in COVID-19 related changes in home and work responsibilities longitudinally, and determine whether these differences, together with other potential risk and protective factors, are associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptomatology., Method: Symptoms of depression, anxiety, and PTSD were measured using an online survey instrument, between May 2020 and April 2021, in four waves completed at 3-monthly intervals. Analyses were based on data from the COvid MEntal healTh (COMET) survey which investigated the mental health effects of the COVID-19 outbreak spanning 13 countries on five continents in N = 7,909 participants., Results: From the first to the last wave, women reported a greater increase in home and work responsibilities, and had higher depression, anxiety and PTSD scores compared to men. Women who reported a reduction in income due to the pandemic had higher depression scores. Working harder and experiencing a reduction in income were also associated with higher anxiety scores in women but not in men. Women were more likely to score above the cut-off for depression (32.5% vs 23.6%, p < .001), anxiety (21.2% vs 14.4%, p < .001) and PTSD (21.2% vs 14.4%, p < .001) than men during the first wave. Stronger reliance on socially supported coping mechanisms was a risk factor for depression, anxiety and PTSD in men and women., Conclusion: Women were more likely to report mental health problems which may be related to the gender disproportionate increase in home and work responsibilities but not necessarily due to COVID-19 stressors., (© 2024. The Author(s).)

Background: In Jordan, no national value set is available for any preference-accompanied health utility measure., Objective: This study aims to develop a value set for EQ-5D-3L based on the preferences of the Jordanian general population., Methods: A representative sample of the Jordanian general population was obtained through quota sampling involving age, gender, and region. Participants aged above 18 years were interviewed via videoconferencing using the EuroQol Valuation Technology 2.1 protocol. Participants completed ten composite time trade-offs (cTTO) and ten discrete choice experiments (DCE) tasks. cTTO and DCE data were analyzed using linear and logistic regression models, respectively, and hybrid models were applied to the combined DCE and cTTO data., Results: A total of 301 participants with complete data were included in the analysis. The sample was representative of the general population regarding region, age, and gender. All model types applied, that is, random intercept model, random intercept Tobit, linear model with correction for heteroskedasticity, Tobit with correction for heteroskedasticity, and all hybrid models, were statistically significant. They showed logical consistency in terms of higher utility decrements with more severe levels. The hybrid model corrected for heteroskedasticity was selected to construct the Jordanian EQ-5D-3L value set as it showed the best fit and lowest mean absolute error. The predicted value for the most severe health state (33333) was - 0.563. Utility decrements due to mobility had the largest weight, followed by anxiety/depression, while usual activities had the smallest weight., Conclusion: This study provides the first EQ-5D-3L value set in the Middle East. The Jordanian EQ-5D-3L value set can now be used in health technology assessments for health policy planning by the Jordanian health sector's decision-makers., (© 2024. The Author(s).)

Objectives. The Brief Reason for Living Inventory for Adolescents (BRFL-A) is used to assess protective factors against suicide in non-clinical settings. This study aimed to validate the psychometric properties of BRFL-A in Bahasa Indonesia. Methods. A total of 728 high-school and university students filled BRFL-A questionnaire and the results were analyzed. The reliability, content, convergent, discriminant, and factorial or construct validity, were investigated using content validity index Cronbach's Alpha, while content validity index (CVI), confirmatory factor analysis, and Pearson product-moment correlation were assesed with MSPSS, SIS, INQ-15, and DASS-18. Results. The results showed that the Indonesian version of BRFL-A had good internal consistency, test-retest reliability, as well as content and concurrent validity, supporting both the 1-factor and the 5-factor model of factorial validity. Conclusions. The Indonesian version of the BRFL-A was valid and reliable to measure protective factors against suicide risk among adolescents and young adults in non-clinical settings., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objectives: To estimate a Saudi-specific value set for the EQ-5D-5L questionnaire using the EuroQol Valuation Technology program and the EuroQol Group's standard protocol., Methods: Participants were quota-sampled from the Saudi adult population based on residency location, age group, gender, education level, and employment status. The participants were guided through the completion of composite time trade-off (cTTO) and discrete choice experiment (DCE) tasks by trained interviewers using EuroQol Valuation Technology software. Quality control (QC) measures were used to ensure good data quality. Random intercept and Tobit models analyzed the cTTO data, as well as models correcting for heteroskedasticity. DCE data were analyzed using conditional logit models, whereas hybrid models were used to analyze the cTTO and DCE data jointly. To evaluate model performance, prediction accuracy, logical consistency, significance level, and goodness of fit were used., Results: The valuation study included a representative sample of the Saudi population (N = 1000). The hybrid heteroskedastic model without a constant was chosen as the preferred model for generating the value set. The predicted values ranged from -0.683 for the worst health state ("55555") to 1 for the full health state ("11111"). Pain and discomfort had the largest impact on health-state preference values, whereas usual activities had the least., Conclusion: The value set for the Kingdom of Saudi Arabia is the first value set for the EQ-5D-5L for any country in the Middle East. The value set can be used in Saudi health system economic evaluations and decision making., Competing Interests: Author Disclosures Author disclosure forms can be accessed in the Supplemental Material section., (Copyright © 2024. Published by Elsevier Inc.)

Objectives: A growing interest in healthcare costs and patients' health-related quality of life (HRQoL) exists in the context of the increasing importance of health technology assessment in countries with high numbers of the HIV and tuberculosis (TB) patient populations, such as Indonesia. This study aimed to analyze the HRQoL and out-of-pocket (OOP) costs of HIV, TB, and TB/HIV coinfected participants in a city in Indonesia with a high prevalence of HIV and TB., Methods: A cross-sectional survey was conducted in the voluntary counseling and testing and lung clinics of Bekasi City Public Hospital (Indonesia) from January to March 2018. Patients' HRQoL was measured using the EQ-5D-5L questionnaire, whereas OOP costs were extracted from a semistructured questionnaire., Results: Of the 460 eligible participants, 82% resided in the city, 48% of them were married, and their median age was 34 years. Less than half were insured, and more than half had no source of income. The median values of health utilities for participants with HIV, TB, and TB/HIV were perceived as potentially high (1.0, 0.9, and 0.8, respectively). The TB/HIV coinfected outpatients had the highest OOP costs (US$94.5), with the largest contribution coming from direct medical OOP expenditures. Taking loans from family members was adopted as a financial strategy to overcome inadequate household incomes and high treatment costs., Conclusion: This study suggests that TB/HIV coinfection potentially lowers HRQoL and increases healthcare costs and the need for economic analysis to underpin cost-effective treatment in such patients., Competing Interests: Author Disclosures Author disclosure forms can be accessed in the Supplemental Material section., (Copyright © 2023 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

The Indonesian government implemented a large-scale social restriction policy as part of the efforts to tackle the COVID-19 pandemic. This policy impacted the population, including mothers, and caused considerable psychological distress. Individual efforts to cope (avoidant and approach coping strategies) and support from significant persons might help handle the distress experienced by mothers. The purpose of this empirical study is to investigate the effect of individual coping strategies on psychological distress and the moderating role of social support among Indonesian mothers. An online survey was administered from 20th to 25th April 2020 to 1534 Indonesian mothers (Mean age 37.12 years; SD 6.63). Brief COPE (28 items), Depression Anxiety Stress Scale/DASS (18 items), and the Multidimensional Scale of Perceived Social Support/MSPSS (12 items) were used to measure coping strategies, psychological distress, and social support, respectively. IBM SPSS 24 software was used to analyze the data. The result showed that moderate and high levels of social support moderated the relationship between approach coping strategies and psychological distress (B = .041, CI .007-.075). When the mother uses approach coping, her psychological distress will decrease further whenever she receives moderate and high level social support. Any level of social support moderated the relationship between avoidant coping and psychological distress (B = -.100, CI -.138-.061). When mother used avoidant coping, her social support at any level served as buffer to her psychological distress. It can be concluded that mothers need to prioritize implementing approach coping strategies to lower their distress. Those who practiced avoidant coping strategies needed social support from their significant persons to decrease their distress., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lubis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Emotion dysregulation is a transdiagnostic marker for vulnerability and has high comorbidity rates across various range of disorders among adolescents and young adults, highlighting the crucial need for precise assessment tools to recognize its significant impact on well-being. The Difficulties in Emotion Regulation Scale Short Form (DERS-SF) is a comprehensive instrument designed to measure the ability to regulate emotion. This study aimed to investigate the psychometric properties of DERS-SF among the non-clinical population, particularly high school and university students in Indonesia., Methods: A total of 738 senior high school and university students completed the Indonesian version of DERS-SF and standard questionnaires to assess its validity, consisting of the Depression Anxiety Stress Scale (DASS), the Beck Depression Inventory-II (BDI-II) for young adults and the Children Depression Inventory (CDI) for adolescents. Three models were examined in factorial validity tests using confirmatory factor analysis., Results: The results showed that DERS-SF had an overall good internal consistency with Cronbach's alpha coefficient of.89 for the 18-item version,.90 for the 17-item version, and.91 for the 15-item version. Test-retest reliability was moderate with a value of.67. In addition, it had good satisfactory content as shown by item content validity index (I-CVI) = .96 and scale content validity index (S-CVI) = .83, as well as convergent validity. All subscales scores showed a positive and strong correlation with DASS, BDI-II, and CDI except awareness. Based on confirmatory factor analysis (CFA), the correlated 6-factor model excluding item number 6, and the 5-factor model excluding awareness were suitable to use in non-clinical populations., Conclusion: This study established the removal of the awareness subscale in the DERS-SF Indonesian version, resulting in better reliability and validity than the original version with complete subscales., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Danasasmita, Pandia, Fitriana, Afriandi, Purba, Ichsan, Pradana, Santoso, Mardhiyah and Engellia.)

Background: The EuroQol Group recently developed two new instruments, the EQ Health and Wellbeing (EQ-HWB) and the EQ Health and Wellbeing short version (EQ-HWB-S). The EQ-HWB and EQ-HWB-S are intended to capture a broad range of health and broader quality of life aspects, which may be relevant to general public members, patients, their families, social care users and informal carers. This study assesses the content validity of the Italian version of the two instruments in a sample of Italian patients, social care users and informal carers., Methods: Participants were recruited using a convenience sampling approach. One-on-one interviews were carried out using video-conferencing interviews. A semi-structured topic guide was used to guide the interview procedures, with open-ended questions supplemented by probes. Participants were asked to explain important aspects of their health and quality of life, to complete the questionnaires and verbalize their thoughts., Results: Twenty participants comprising of patients (n = 9), informal carers (n = 6), and members of the general public (n = 5) participated to the study. Content validity was summarized into six main themes: comprehension, interpretation, acceptability, relevance, response options and recall period. All participants found the instruments easy or quite easy to understand and to respond to. Items were relevant for all three groups of participants, and response options appropriate., Conclusions: The Italian version of the EQ-HWB showed content validity in measuring health and wellbeing in a mixed Italian population., (© 2024. The Author(s).)

Background: High infection rates of COVID-19 in Indonesia require attention, especially transmission and prevention behaviors. One way to lower infection rates is the use of face masks. However, people's adherence to its usage when in public is still low. This necessitates the exploration of predictors of the use of masks to increase community compliance. This study further aims to investigate the predictors of face mask use by applying the Health Belief Model, anxiety, stress, depression, and health motivation., Methods: A total of 255 respondents from Jakarta, Bandung, Tangerang, and Banten filled out an online questionnaire. Furthermore, hierarchical multiple regression was used to detect predictors associated with face mask use., Results: The results showed that the high perceived benefits and health motivation were higher in individuals who used a face mask when in public, while those who have high perceived barriers likely do not use masks. The respondent's level of psychological distress, including depression, anxiety, and stress were not associated with face mask use., Conclusions: These findings highlight the importance of personal appraisal regarding COVID-19 and its prevention behaviors. Comfortable mask design, and emphasizing the benefits of using masks in the community improve compliance., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Wulandari D et al.)

Background: Higher social support protects people from developing mental disorders. Limited evidence is available on the mechanism through which social support plays this protective role., Objective: To investigate the stress-buffering process of social support on depressive symptoms using a novel longitudinal dynamic symptom network approach., Methods: A total of 4242 adult participants who completed the first two waves (from May to October 2020) of the International Covid Mental Health Survey were included in the study. Cross-lagged panel network modelling was used to estimate a longitudinal network of self-reported social support, loneliness and depressive symptoms. Standardised regression coefficients from regularised cross-lagged regressions were estimated as edge weights of the network., Findings: The results support a unidirectional protective effect of social support on key depressive symptoms, partly mediated through loneliness: A higher number of close confidants and accessible practical help was associated with decreased anhedonia (weight=-0.033) and negative self-appraisal symptoms (weight=-0.038). Support from others was also negatively associated with loneliness, which in turn associated with decreased depressed mood (weight=0.086) and negative self-appraisal (weight=0.077). We identified a greater number of direct relationships from social support to depressive symptoms among men compared with women. Also, the edge weights from social support to depression were generally stronger in the men's network., Conclusions: Reductions in negative self-appraisal might function as a bridge between social support and other depressive symptoms, and, thus, it may have amplified the protective effect of social support. Men appear to benefit more from social support than women., Clinical Implications: Building community-based support networks to deliver practical support, and loneliness reduction components are critical for depression prevention interventions after stressful experiences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. Published by BMJ.)

Background: To utilize EQ-5D in economic evaluations, a societal-based value set is needed. To date, no value sets exist for any EQ-5D instrument in Pakistan. Previous EQ-5D studies conducted in Pakistan 'borrowed' health preferences developed in other countries. However, for a value set to be valid for Pakistani population, it should represent the preferences of the Pakistani population, and culture and living standards of Pakistan., Objective: The aim of this study was to derive a Pakistani EQ-5D-3L value set., Methods: A moderately representative sample aged 18 years and over was recruited from the Pakistani general population. A multi-stage stratified quota method with respect to ethnicity, gender, age and religion was utilized. Two elicitation techniques, the composite time trade-off (cTTO) and discrete choice experiments (DCE) were applied. Interviews were undertaken by trained interviewers using computer-assisted face-to-face interviews with the EuroQol Portable Valuation Technology (EQ-PVT) platform. To estimate the value set, a hybrid regression model combining cTTO and DCE data was used., Results: A total of 289 respondents who completed the interviews were included for the analysis. The hybrid model correcting for heteroskedasticity without a constant was selected as the final model for the value set. It is shown that being unable to do usual activities (level 3) was assigned the largest weight, followed by mobility level 3, self-care level 3, pain/discomfort level 3 and anxiety/depression level 3. The worst health state was assigned the value - 0.171 in the final model., Conclusions: A Pakistani country-specific EQ-5D-3L value set is now available. The availability of this value set may help promote and facilitate health economic evaluations and health-related quality-of-life (HRQoL) research in Pakistan., (© 2023. The Author(s).)

Introduction: Countries develop their EQ-5D-5L value sets using the EuroQol Valuation Technology (EQ-VT) protocol. This study aims to assess if extension in the conventional EQ-VT design can lead to development of value sets with improved precision., Methods: A cross-sectional survey was undertaken in a representative sample of 3,548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. A novel extended EQ-VT design was created that included 18 blocks of 10 health states, comprising 150 unique health states and 135 observations per health state. In addition to the standard EQ-VT design, which is based on 86 health states and 100 observations per health state, 3 extended designs were assessed for their predictive performance. The extended designs were created by 1) increasing the number of observations per health state in the design, 2) increasing the number of health states in the design, and 3) implementing both 1) and 2) at the same time. Subsamples of the data set were created for separate designs. The root mean squared error (RMSE) and mean absolute error (MAE) were used to measure the predictive accuracy of the conventional and extended designs., Results: The average RMSE and MAE for the standard EQ-VT design were 0.055 and 0.041, respectively, for the 150 health states. All 3 types of design extensions showed lower RMSE and MAE values as compared with the standard design and hence yielded better predictive performance. RMSE and MAE were lowest (0.051 and 0.039, respectively) for the designs that use a greater number of health states. Extending the design with inclusion of more health states was shown to improve the predictive performance even when the sample size was fixed at 1,000., Conclusion: Although the standard EQ-VT design performs well, its prediction accuracy can be further improved by extending its design. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state., Highlights: The EQ-5D-5L value sets are developed using the standardized EuroQol Valuation Technology (EQ-VT) protocol. This is the first study to empirically assess how much can be gained from extending the standard EQ-VT design in terms of sample size and/or health states. It not only presents useful insights into the performance of the standard design of the EQ-VT but also tests the potential extensions in the standard EQ-VT design in terms of increasing the health states to be directly valued as well as the number of observations recorded to predict the utility value of each of these health states.The study demonstrates that the standard EQ-VT design performs good, and an extension in the design of the standard EQ-VT can lead to further improvement in its performance. The addition of more health states in EQ-VT is more beneficial than increasing the number of observations per health state. Extending the design with inclusion of more health states marginally improves the predictive performance even when the sample size was fixed at 1,000.The findings of the study will streamline the systematic process for generating precise EQ-5D-5L value sets, thus facilitating the conduct of credible, transparent, and robust outcome valuation in health technology assessments.

Background: The availability of population norms from generic health-related quality of life (HRQoL) instruments can support the interpretation of health outcomes. This study aimed to provide Indonesian youth population norms for the generic HRQoL measures: EQ-5D-Y-3 L, EQ-5D-Y-5 L, and the PedsQL Generic Core Scales. In addition the opportunity arising from the generation of a large representative sample was taken to explore the relationships between HRQoL, health, and socio-economic factors., Methods: A representative sample of 1103 Indonesian children (aged 8-16 years) completed EQ-5D-Y-3 L, EQ-5D-Y-5 L, the PedsQL Generic Core Scales, and questions related to demographic data and self-reported health status. A stratified quota sampling design was used to represent Indonesian children in terms of residence, age, gender, and geographical area. Family expenses per capita per month were retrieved from parents to determine a child's economic status., Results: The total sample was representative of the Indonesian youth general population. The proportions of participants who reported problems were 43.35% (EQ-5D-Y-3 L), 44.10% (EQ-5D-Y-5 L), and 94.93% (PedsQL Generic), with 31.7% of children reporting health complaints. Older children (13-16 years) reported more problems than younger children (8-12 years). Children living in urban areas reported more problems than children living in rural areas. The lowest value health state reported was '12332' (valued at 0.54), and the minimum EQ VAS score was 60.00. Moderate correlations were found between EQ-5D-Y-3 L values to EQ VAS scores and to PedsQL Total Score. Hierarchical regression analysis showed that females, older age, and having health complaints contributed to a lower level of HRQoL as measured by EQ-5D-Y-3 L values, EQ VAS, and PedsQL Total Score. Remarkably, children with high economic status had lower EQ VAS and PedsQL Total Scores. Among symptoms, 'having stress' had the largest influence with respect to lower EQ-5D-Y-3L values, EQ VAS, and PedsQL Total Score., Conclusions: Population norms for children's HRQoL as measured by EQ-5D-Y-3 L, EQ-5D-Y-5 L, and the PedsQL Generic Scales are now available for Indonesia. Age, gender, economic status, and health complaints were related to children's HRQoL. These results provide a basis for health studies and health policy for the youth population of Indonesia., (© 2023. The Author(s).)

Objective: This study aims to develop a mapping algorithm for EORTC QLQ-C30 to EQ-5D-5L which can produce utility values in patients with cancer., Methods: We used a cross sectional study design with 300 cancer patients. The research instruments used were EORTC QLQ-C30 and EQ-5D-5L. Data were collected by interviewing cancer patients who were hospitalized in the Kasuari Installation of Dr Kariadi Hospital Semarang, Indonesia. The Ordinary Least Squares (OLS) regression method was used to predict the utility value of EQ-5D-5L. This study uses two models to predict utility values, namely model 1 with all domains, and model 2 with domains that affect the EQ-5D-5L. The predictive power of regression on the model is evaluated by calculating the mean absolute error (MAE) and root mean square error (RMSE) values., Result: The highest score in the functional domain is the 'emotional function' domain (mean: 85.89; SD: 16.04) and the highest symptom domain is 'weakness' (mean: 36.21; SD:21.69). The predicted utility values of models 1 and 2 are 0.683. The mean absolute error (MAE) and root mean square error (RMSE) values of model 1 are 0.128 and 0.173, while in model 2 the MAE and RMSE values obtained are 0.125 and 0.168., Conclusion: The development of the mapping algorithm from the EORTC QLQ-C30 to EQ-5D-5L instrument shows a predictive value of utility in a sample of patients with cancer at Dr. Kariadi Hospital, Semarang, Indonesia. The utility prediction in both model is similar, however model 2 involves fewer domains and symptoms., .

One of the important outcomes to define the success of cancer treatment is the health-related quality of life (HRQoL) that can be measured using generic and/or specific instruments. Our study aims to define the cancer patients' HRQoL in some hospitals in Indonesia as measured by the European Organization for Research and Treatment for Cancer (EORTC QLQ-C30) and the EQ-5D-5L, to define the differences of cancer patients' HRQoL referring to patients' characteristics, and to explore determinants of cancer patients' HRQoL. We recruited 451 cancer patients using a cross-sectional design in two referral hospitals in Central Java, Indonesia, using the purposive sampling technique. All subjects, recruited from July 2020 to October 2021, met the inclusion criteria, namely, adult patients diagnosed with cancers in all stages who willingly participated in the study. The Indonesian value set was used to obtain the EQ-5D-5L index score. We further analyzed the data based on cancer stages and compared two questionnaires using independent t test. We highlighted that most of the cancer patients are female (69.4%), young (86%), and at advanced stages of cancer (54.1%). The physical and role functions and global health status of the cancer patients are poor, and the most severe symptom is fatigue. Moreover, most of them experience severe pain and perform daily activities with difficulties. Some patients' characteristics show significant influences on the HRQoL domains in both questionnaires ( p < 0.05). Interestingly, both of the questionnaires have shown significant correlations between similar domains and revealed the poor HRQoL of advanced cancer patients ( p < 0.05). Our study finds that cancer patients still have poor HRQoL in some domains. We suggest to the health providers that they apply education and psychological intervention to increase their HRQoL., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2023 Dyah A. Perwitasari et al.)

Suicide remains one of the leading causes of death among youths and the commonly reported associated risk factor is interpersonal needs, which consists of perceived burdensomeness and thwarted belongingness. To date, there is no validated interpersonal needs questionnaire in Indonesia. Therefore, this research aims to validate and evaluate the psychometric properties of the Interpersonal Needs Questionnaire (INQ-15) among adolescents and young adults in the Indonesian language. Based on the results, the INQ-15 has high internal consistency and test-retest reliability. It was also found to have satisfactory content and concurrent validity, as well as support two factor model of factorial validity. This implies that The Indonesian version of the INQ-15 is a valid and reliable questionnaire to measure the interpersonal needs among adolescents and young adults, both in clinical and research applications., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Pandia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Objectives: Methods for estimating health values in adult populations are well developed, but lag behind in children. The EuroQol standard protocol to arrive at value sets for the youth version of the EQ-5D-Y-3L combines discrete choice experiments with ten composite time trade-off values. Whether ten composite time trade-off values are sufficient remains to be seen and this is one of the reasons the protocol allows for experimental expansion. In this study, 23 health states were administered for the composite time trade-off. This methodological research is embedded in a study aimed at generating a representative value set for EQ-5D-Y-3L in Indonesia., Methods: A representative sample of 1072 Indonesian adults each completed 15 discrete choice experiment choice pairs via face-to-face interviews. The discrete choice experiment responses were analysed using a mixed-logit model. To anchor the discrete choice experiment values onto the full health-dead quality-adjusted life-year scale, composite time trade-off values were separately obtained from 222 adults living in Java for 23 EQ-5D-Y-3L states. The derived latent discrete choice experiment values were mapped onto the mean observed composite time trade-off values to create a value set for the EQ-5D-Y-3L. Linear and non-linear mapping models were explored to estimate the most efficient and valid model for the value set., Results: Coefficients obtained from the choice model were consistent with the monotonic structure of the EQ-5D-Y-3L instrument. The composite time trade-off data showed non-linearity, as the values for the two worst states being evaluated were much lower than predicted by a standard linear model estimated over all composite time trade-off data. Thus, the non-linear mapping strategies with a power term outperformed the linear mapping in terms of mean absolute error. The final model gave a value range from 1.000 for full health (11111) to - 0.086 for the worst health state (33333). Values were most affected by pain/discomfort and least by self-care., Conclusions: This article presents the first EQ-5D-Y-3L value set for Indonesia based on the stated preferences of adults asked to consider their views about a 10-year-old child. Mapping the mixed-logit discrete choice experiment model with the inclusion of a power term (without a constant) allowed us to generate a consistent value set for Indonesian youth. Our findings support the expansion of the composite time trade-off part of the EQ-5D-Y valuation study design and show that it would be wise to account for possible non-linearities in updates of the design., (© 2022. The Author(s).)

Backgrounds: Individuals with chronic medical conditions are considered highly exposed to COVID-19 pandemic stress, but emerging evidence is demonstrating that resilience is common even among them. We aimed at identifying sustained resilient outcomes and their predictors in chronically ill people during the first year of the pandemic., Methods: This international 4-wave 1-year longitudinal online survey included items on socio-demographic characteristics, economic and living situation, lifestyle and habits, pandemic-related issues, and history of mental disorders. Adherence to and approval of imposed restrictions, trust in governments and in scientific community during the pandemic were also investigated. The following tools were administered: the Patient Health Questionnaire, the Generalized Anxiety Disorder scale, the PTSD Checklist DSM-5, the Oslo Social Support Scale, the Padua Inventory, and the Portrait Values Questionnaire., Results: One thousand fifty-two individuals reporting a chronic condition out of 8011 total participants from 13 countries were included in the study, and 965 had data available for the final model. The estimated probability of being "sustained-resilient" was 34%. Older male individuals, participants employed before and during the pandemic or with perceived social support were more likely to belong to the sustained-resilience group. Loneliness, a previous mental disorder, high hedonism, fear of COVID-19 contamination, concern for the health of loved ones, and non-approving pandemic restrictions were predictors of not-resilient outcomes in our sample., Conclusions: We found similarities and differences from established predictors of resilience and identified some new ones specific to pandemics. Further investigation is warranted and could inform the design of resilience-building interventions in people with chronic diseases., (© 2022. The Author(s).)

Background: The Philippines has recommended the use of Quality-Adjusted Life Years (QALYs) in government health technology assessments (HTA). We aimed to develop a value set for the EQ-5D-5L based on health preferences of the healthy general adult population in the Philippines., Methods: Healthy, literate adults were recruited from the Philippine general population with quota targets based on age, sex, administrative region, type of residence, education, income, and ethnolinguistic groups. Each participant's preference was elicited by completing Composite Time Trade-Off (C-TTO) and Discrete Choice Experiment (DCE) tasks. Tasks were computer-assisted using the EuroQol Valuation Technology 2.0. To estimate the value set, we explored 20- and 8-parameter models that either use c-TTO-only data or both c-TTO and DCE (also called hybrid models). Final model choice was guided by principles of monotonicity, out-of-sample likelihood, model fit, and parsimony., Results: We recruited 1000 respondents with demographic characteristics that approximate the general population such as 49.6% Female, 82% Roman Catholic, 40% in urban areas, and 55% finished high school. None of the 20-parameter models demonstrated monotonicity (logical worsening of coefficients with increasing severity). From the 8-parameter models, the homoscedastic TTO-only model exhibited the best fit. From this model, mobility and pain/ discomfort had the highest effect on utilities., Conclusion: The selected model for representing the Philippine general population preferences for EQ-5D-5L health states was an 8-parameter homoscedastic TTO-only model. This value set is recommended for use in QALY calculations in support of HTA-informed coverage decisions in the Philippines., (© 2022. The Author(s).)

Objectives: This study aimed to develop the Indian 5-level version EQ-5D (EQ-5D-5L) value set, which is a key input in health technology assessment for resource allocation in healthcare., Methods: A cross-sectional survey using the EuroQol Group's Valuation Technology was undertaken in a representative sample of 3548 adult respondents, selected from 5 different states of India using a multistage stratified random sampling technique. The participants were interviewed using a computer-assisted personal interviewing technique. This study adopted a novel extended EuroQol Group's Valuation Technology design that included 18 blocks of 10 composite time trade-off (c-TTO) tasks, comprising 150 unique health states, and 36 blocks of 7 discrete choice experiment (DCE) tasks, comprising 252 DCE pairs. Different models were explored for their predictive performance. Hybrid modeling approach using both c-TTO and DCE data was used to estimate the value set., Results: A total of 2409 interviews were included in the analysis. The hybrid heteroscedastic model with censoring at -1 combining c-TTO and DCE data yielded the most consistent results and was used for the generation of the value set. The predicted values for all 3125 health states ranged from -0.923 to 1. The preference values were most affected by the pain/discomfort dimension., Conclusions: This is the largest EQ-5D-5L valuation study conducted so far in the world. The Indian EQ-5D-5L value set will promote the effective conduct of health technology assessment studies in India, thereby generating credible evidence for efficient resource use in healthcare., (Copyright © 2021 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to examine the feasibility of the 3-level-EQ-5D valuation methods and the impact of literacy, culture, and religion on the preferences of the Pakistani population., Methods: Respondents aged 18 to 65 years were recruited using quota sampling. The EuroQol Portable Valuation Technology was used, and data collection was done in Urdu. Graphical presentations were used to elicit responses from illiterate respondents. All interviews were audio recorded and transcribed. Odds ratios associated with the choice impact were assessed., Results: Usual activities showed highest impact on respondents' choice outcomes, followed by self-care and then anxiety/depression and mobility. Compared with "no problem," any problems in mobility had higher odds for a respondent to not to choose otherwise. The impact of health impairment on usual activities imposed the highest influences choices made. Most of the respondents reported that religion had no impact on their responses. Compared with literate respondents, illiterate respondents were more likely to be older, were unemployed, resided in rural, had lower self-reported health, had lower education/income, and had family members living in the same household with lower income. Although not significant, the number of nontraders was slightly higher in illiterate respondents. Literate respondents indicated cultural beliefs did not affects their responses whereas most of the illiterate respondents highlighted the impact of cultural norms on their responses, especially for self-care., Conclusions: Preference elicitation methods used in 3-level-EQ-5D valuation studies, namely, time trade-off and discrete choice experiments, are feasible in the Pakistani population. The use of graphical illustrations for illiterate respondents was successful., (Copyright © 2021 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc. All rights reserved.)

Introduction: Many countries have established their own EQ-5D value sets proceeding on the basis that health preferences differ among countries/populations. So far, published studies focused on comparing value set using TTO data. This study aims to compare the health preferences among 11 Asian populations using the DCE data collected in their EQ-5D-5L valuation studies., Methods: In the EQ-VT protocol, 196 pairs of EQ-5D-5L health states were valued by a general population sample using DCE method for all studies. DCE data were obtained from the study PI. To understand how the health preferences are different/similar with each other, the following analyses were done: (1) the statistical difference between the coefficients; (2) the relative importance of the five EQ-5D dimensions; (3) the relative importance of the response levels., Results: The number of statistically differed coefficients between two studies ranged from 2 to 16 (mean: 9.3), out of 20 main effects coefficients. For the relative importance, there is not a universal preference pattern that fits all studies, but with some common characteristics, e.g. mobility is considered the most important; the relative importance of levels are approximately 20% for level 2, 30% for level 3, 70% for level 4 for all studies., Discussion: Following a standardized study protocol, there are still considerable differences in the modeling and relative importance results in the EQ-5D-5L DCE data among 11 Asian studies. These findings advocate the use of local value set for calculating health state utility., (© 2022. The Author(s).)

Background: Self-report is the standard for measuring people's health-related quality of life (HRQoL), including children. However, in certain circumstances children cannot report their own health. For this reason, children's HRQoL measures often provide both a self-report and a proxy-report form. It is not clear whether the measurement properties will be the same for these two forms. We investigated whether it would be beneficial to extend the classification system of the EQ-5D-Y proxy questionnaire from 3 to 5 response levels. The agreement between self-report and proxy-report was assessed for both EQ-5D-Y measures., Methods: The study included 286 pediatric patients and their caregivers as proxies. At three consecutive measurements-baseline, test-retest and follow-up-the proxies assessed the child's HRQoL using the EQ-5D-Y-3L, EQ-5D-Y-5L, the PedsQL Generic, and matched disease-specific instruments. The proxy versions of EQ-5D-Y-3L and EQ-5D-Y-5L were compared in terms of feasibility, distribution properties, convergent validity, test-retest and responsiveness. Agreement between both EQ-5D-Y proxy versions to their respective self-report versions was assessed at baseline and follow-up., Results: The proportion of missing responses was 1% for the EQ-5D-Y-3L and 1.4% for the EQ-5D-Y-5L. The frequency of health state with no problems in all dimensions (11111) was slightly lower for the EQ-5D-Y-5L (21.3% vs 16.7%). Regarding the convergent validity with the PedsQL and disease-specific measures, the proxy versions of EQ-5D-Y-3L and EQ-5D-Y-5L had similar magnitudes of associations between similar dimensions. The means of test-retest coefficients between the two versions of the EQ-5D-Y proxy were comparable (0.83 vs. 0.84). Regarding reported improved conditions, responsiveness of the EQ-5D-Y-5L proxy (26.6-54.1%) was higher than that of the EQ-5D-Y-3L proxy (20.7-46.4%). Except for acutely ill patients, agreement between the EQ-5D-Y-5L proxy and self-reports was at least moderate., Conclusions: Extending the number of levels of the proxy version of EQ-5D-Y can improve the classification accuracy and the ability to detect health changes over time. The level structure of EQ-5D-Y-5L was associated with a closer agreement between proxy and self-report. The study findings support extending the EQ-5D-Y descriptive system from 3 to 5 levels when administered by a proxy, which is often the case in the pediatric population., (© 2022. The Author(s).)

Objectives: Healthcare workers (HCWs) are the front lines during the COVID-19 pandemic. They are more exposed to COVID-19 than other professions. Studies from other countries have shown that the mental health and health-related quality of life (HRQoL) of HCWs were affected during this pandemic. However, studies on mental health in Indonesia remain scarce and no study has evaluated the HRQoL among HCWs. Thus, this study was designed to explore the mental health status and HRQoL among HCWs in Indonesia., Design: This was a cross-sectional study., Setting: This was an open online survey in Indonesia conducted from December 2020 to February 2021., Participants: This study involved HCWs who worked during the COVID-19 pandemic. Of the 502 respondents who accessed the online questionnaire, 392 were included in the analysis., Outcomes: Mental health status was measured using the 21-item Depression, Anxiety and Stress Scale and HRQoL was measured using the second version of the 12-item Short-Form Health Survey (SF12v2)., Results: The prevalence of depression, anxiety and stress among HCWs was 29.4%, 44.9% and 31.8%, respectively. Using the SF12v2 questionnaire, 354 (90.3%) HCWs were found to have impaired physical component and 156 (39.8%) HCWs have impaired mental component., Conclusion: The prevalence of mental health problems among HCWs was high in Indonesia. HRQoL, particularly the physical component, was affected in most HCWs. Thus, policymakers should give more attention to the mental health and HRQoL of HCWs during the COVID-19 pandemic., Competing Interests: Competing interests: MP received grants and honoraria from various pharmaceutical companies, all fully unrelated to this research. Other authors have no conflict of interest to declare., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Suicide is one of the leading cause of mortality among adolescents and young adults, especially in low to middle-income countries. Research found that screening for suicidal ideation in non-clinical populations such as schools or communities is an important step toward preventing suicide. Despite so, not all screening tools have the capabilities to accurately detect suicidal ideation among adolescents and young adults in non-clinical populations. The Suicidal Ideation Scale (SIS) is one of the most used questionnaires to measure suicidal thoughts in non-clinical populations. This study aims to investigate the psychometric properties of SIS among adolescents and young adults in Indonesia, especially in non-clinical populations., Methods: After a series of language and cultural adaptations, 1254 senior high school and university students completed the Indonesian version of SIS using 3 standard questionnaires, namely Patient Health Questionnaire-9/PHQ-9, Beck Depression Inventory-II/BDI-II, and Children's Depression Inventory/CDI. The SIS content validity, internal consistency, test-retest reliability and concurrent, as well as internal structure validity, were investigated using content validity index (CVI), Cronbach's Alpha, Pearson product-moment correlation, and confirmatory factor analysis (CFA), respectively., Results: The result showed that SIS has good to excellent internal consistency and test-retest reliability. Based on the validity indicators, it has satisfactory content and convergent validity, and further support the one-factor and 2-factor model for factorial validity. Both one-factor and 2 factor model are suitable to use in non-clinical settings., Conclusions: SIS is a valid and reliable tool for suicide ideation screening in adolescents and young adults in non-clinical populations. This validated questionnaire can be used in the early detection of suicidal ideation among adolescents and young adults in non-clinical populations, thus contributing to developing strategies and policies to prevent suicide among Indonesian adolescents and young adults at group and institutional levels.

Background: As one of the strategies to mitigate the COVID-19 pandemic, social distancing (SD) measures are recommended to control disease spread and reduce the attack rate. Therefore, this study aims to estimate the costs and effects of SD measures through school closures, workforce, and community contact reductions for mitigating the COVID-19 pandemic in Indonesia., Methods: Two mitigation scenarios of SD for 1 month and continuous SD were compared with the baseline (no intervention). A modified Susceptible-Exposed-Infected-Recovered (SEIR) compartmental model accounting for disease spread during the latent period was applied by considering a 1-year time horizon. The costs of healthcare, school closures, and productivity loss due to disease as well as intervention were considered to estimate the total pandemic cost among all scenarios., Results: In a comparison with the baseline, the result showed that total savings in scenarios of SD for 1 month and continuous SD was approximately $415 billion and $699 billion, respectively, while the averted deaths were 4.6 million and 8.5 million, respectively. Sensitivity analysis showed that basic reproduction number, infectious period, daily wage, incubation period, daily ICU admission cost, and case fatality rate were the most influential parameters affecting the savings and the number of averted deaths., Conclusions: SD measures through school closures, workforce, and community contact reductions were concluded to be cost-saving. Increasing the duration of social distancing tends to increase both the savings and the number of averted deaths., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The adult versions EQ-5D-3L and EQ-5D-5L have been extensive compared. This is not the case for the EQ-5D youth versions. The study aim was to compare the measurement properties and responsiveness of EQ-5D-Y-3L and EQ-5D-Y-5L in paediatric patients., Methods: A sample of patients 8-16 years old with different diseases and a wide range of disease severity was asked to complete EQ-5D-Y-3L, EQ-5D-Y-5L, PedsQL Generic Core Scale, and selected, appropriate disease-specific instruments, three times. EQ-5D-Y-3L and EQ-5D-Y-5L were compared in terms of: feasibility, (re-)distribution properties, discriminatory power, convergent validity, test-retest reliability, and responsiveness., Results: 286 participating patients suffered from one of the following diseases: major beta-thalassemia, haemophilia, acute lymphoblastic leukaemia, acute illness. Missing responses were comparable between versions of the EQ-5D-Y, suggesting comparable feasibility. The number of patients in the best health state (level profile 11111) was equal in both EQ-5D-Y versions. The projection of EQ-5D-Y-3L scores onto EQ-5D-Y-5L for all dimensions showed that the two additional levels in EQ-5D-Y-5L slightly improved the accuracy of patients in reporting their problems, especially if severe. Convergent validity with PedsQL and disease-specific measures showed that the two EQ-5D-Y versions performed about equally. Test-retest reliability (EQ-5D-Y-3L 0.78 vs EQ-5D-Y-5L 0.84), and sensitivity for detecting health changes, were both better in EQ-5D-Y-5L., Conclusions: Extending the number of levels did not give clear superiority to EQ-5D-Y-5L over EQ-5D-Y-3L based on the criteria assessed in this study. However, increasing the number of levels benefitted EQ-5D-Y performance in the measurement of moderate to severe problems and especially in longitudinal study designs., (© 2021. The Author(s).)

Purpose: To examine the differences between patient-reports and proxy-reports by nurses of EQ-5D-5L responses among patients with schizophrenia., Methods: This study was conducted in June-September 2019 in Duren Sawit Regional Public Hospital in Jakarta, Indonesia. The self-report data were obtained by interviewing the patients and the proxy-report data were obtained from the psychiatric nurses. The patients' Positive and Negative Syndrome Scale (PANSS) scores were obtained from their medical records. The data were collected in two time points: (1) when the patients moved from the acute to the quiet rooms (first-test) and (2) when they were discharged from the hospital (second-test). The self and proxy report scores were analysed by the Wilcoxon matched-pairs signed-ranks test and their relationship with the PANSS scores using Spearman's rank correlation coefficient., Results: There were 206 patients in the final sample. The majority are male (56.8%) with a mean age of 37.5 years (SD = 12.05). Significant differences between the two reports were found in three domains (i.e., self-care, usual activities, and pain/discomfort) in the first-test and two domains (i.e., usual activities and pain/discomfort) in the second-test. Concerning the relationship with the PANSS scores, only three significant correlations were found, all in the proxy-version and in the second-test: mobility (r = 0.139), anxiety/depression (r = 0.2523), and utility scores (r = - 0.176)., Conclusions: The poor-to-fair agreement between patients and nurses reports and the poor correlation with the PANSS scores suggested that it is difficult to decide which report best represents the patients' health status., (© 2021. The Author(s).)

COVID-19 pandemic has impacted people around the globe. Countries, including Indonesia, implemented large-scale social restrictions. Since marriage is found to be beneficial to people's quality of life (QoL), the study aimed to examine the QoL of married people in Indonesia during a large-scale social restriction of the COVID-19 pandemic. An online cross-sectional survey using Qualtrics was conducted in June 2020. Respondents' sociodemographic data, spouse data (as reported by the respondents), and pandemic-related data were collected, followed by QoL data, measured by WHQOOL-BREF. WHOQL-BREF consists of 26 questions grouped into four domains: physical, psychological, social relationships, and environmental. Mann-Whitney U, Kruskal-Wallis H and Spearman correlation analyses were employed to compare QoL between groups of sociodemographic characteristics. In total, 603 respondents were recruited. The respondents' mean age is 35.3 years (SD = 7.61), most are females (82%), bachelor degree graduate (95%), Islam (78%), employed (69%), and assigned to work from home during the pandemic (76%). Married men reported better QoL in almost all domains than women; employed respondents reported higher QoL scores than unemployed; higher educated respondents reported higher QoL than those with lower education; respondents with higher income reported higher QoL than those with lower income. We found significant positive correlations between the QoL scores and age, spouse's age, and marriage length, although they were considered small. Compared to Indonesian population normative scores pre-pandemic, our sample reported no difference in physical and social domains, lower in the psychological domain, but higher in the environmental domain. Indonesian married people, especially women, those with low level of education, currently out of work, and below-average financial condition are the ones who reported worse quality of life during the lockdown. These results can help direct the Indonesian government efforts in dealing with psychosocial problems during the COVID-19 pandemic, especially for married couples., Competing Interests: The authors have declared that no competing interests exist.

Purpose: The most widely used generic questionnaire to estimate the quality of life for yielding quality-adjusted life years in economic evaluations is EQ-5D. Country-specific population value sets are required to use EQ-5D in economic evaluations. The aim of this study was to establish an EQ-5D-3L value set for Russia., Methods: A representative sample aged 18+ years was recruited from the Russia`s general population. Computer-assisted face-to-face interviews were conducted based on the standardized valuation protocol using EQ-Portable Valuation Technology. Population preferences were elicited utilizing both composite time trade-off (cTTO) and discrete choice experiment (DCE) techniques. To estimate the value set, a hybrid regression model combining cTTO and DCE data was used., Results: A total of 300 respondents who successfully completed the interview were included in the primary analysis. 120 (40.0%) respondents reported no health problems of any dimension, and 56 (18.7%) reported moderate health problems in one dimension of the EQ-5D-3L. Median self-rated health using EQ-VAS was 80 with IQR 70-90. Comparing cTTO and DCE-predicted values for 243 health states resulted in a similar pattern. This supports the use of hybrid models. The predicted value based on the preferred model for the worst health state "33333" was -0.503. Mobility dimension had the most significant impact on the utility decrement, and anxiety/depression had the lowest decrement., Conclusion: Determining a Russian national value set may be considered the first step towards promoting cost-utility analysis use to increase comparability among studies and improve the transferability of healthcare decision-making in Russia.

Background: The EuroQoL five-dimensional instrument (EQ-5D) is the favoured preference-based instrument to measure health-related quality of life (HRQoL) in several countries. Two versions of the EQ-5D are available: the 3-level version (EQ-5D-3 L) and the 5-level version (EQ-5D-5 L). This study aims to compare specific measurement properties and scoring of the EQ-5D-3 L (3 L) and EQ-5D-5 L (5 L) in Indonesian type 2 diabetes mellitus (T2DM) outpatients., Methods: A survey was conducted in a hospital and two primary healthcare centres on Sulawesi Island. Participants were asked to complete the two versions of the EQ-5D instruments. The 3 L and 5 L were compared in terms of distribution and ceiling, discriminative power and test-retest reliability. To determine the consistency of the participants' answers, we checked the redistribution pattern, i.e., the consistency of a participant's scores in both versions., Results: A total of 198 T2DM outpatients (mean age 59.90 ± 11.06) completed the 3 L and 5 L surveys. A total of 46 health states for 3 L and 90 health states for 5 L were reported. The '11121' health state was reported most often: 17% in the 3 L and 13% in the 5 L. The results suggested a lower ceiling effect for 5 L (11%) than for 3 L (15%). Regarding redistribution, only 6.1% of responses were found to be inconsistent in this study. The 5 L had higher discriminative power than the 3 L version. Reliability as reflected by the index score was 0.64 for 3 L and 0.74 for 5 L. Pain/discomfort was the dimension mostly affected, whereas the self-care dimension was the least affected., Conclusions: This study suggests that the 5 L-version of the EQ-5D instrument performs better than the 3 L-version in T2DM outpatients in Indonesia, regarding measurement and scoring properties. As such, our study supports the use of the 5 L as the preferred health-related quality of life measurement tool. We did not do a trial but this study was approved by the Medical Ethics Committee of Universitas Gadjah Mada Yogyakarta, Indonesia (document number KE/FK/1188/EC, 12 November 2014, amended 16 March 2015).

Objectives : To compare the time trade-off (TTO) utility values of EQ-5D-5L health states elicited from different general populations in Asia. Methods : We analyzed the TTO data from seven Asian EQ-5D-5L valuation studies in which utility values of 86 EQ-5D-5L health states were elicited from general population samples. An eight-parameter multiplicative regression model including five dimension parameters (mobility [MO], self-care, usual activities [UA], pain/discomfort, anxiety/depression) and three level parameters (level 2 [L2], level 3 [L3], and level 4 [L4]) was used to model the data from each of the populations. The model coefficients were compared to understand how the valuations of EQ-5D-5L health states differ. Results : For dimension parameters, Korea and Indonesia generally had the highest and lowest values among the populations, respectively; UA and MO commonly had the highest and lowest values among the parameters, respectively. For level parameters, Singapore and Korea generally had the highest and lowest values, respectively; L2 showed less variance compared to L3 and L4. Koreans, Indonesians, and Singaporeans appeared to have different health preferences compared with other populations. Conclusion : Utility values of EQ-5D-5L health states differ among Asian populations, suggesting that each health system should establish and use its own value set.

Objectives: To present EuroQol-5D (EQ-5D) index scores in Indonesian type 2 diabetes mellitus (T2DM) outpatients and to investigate the associations between EQ-5D and socio-demographic characteristics and clinical condition., Methods: Socio-demographic data were collected by interviewing participants, clinical data were obtained from treating physicians and self-reporting. Participants originated from primary and secondary care facilities in the Java and Sulawesi regions. Ordinal regression analysis was conducted with the quintiles of the EQ-5D index scores as the dependent variable to investigate the multivariate association with the participants' socio-demographic characteristics and clinical condition., Results: 907 participants completed the five-level Indonesian version of the EQ-5D. The mean age of the participants was 59.3 (SD 9.7), and 57% were female. The overall EQ-5D index score was 0.77 (0.75-0.79). Male participants had a higher EQ-5D index score compared to females, and the highest percentage of self-reported health problems was in the pain/discomfort dimension (61%). Factors identified as being significantly associated with lower EQ-5D index scores were: (i) treatment in secondary care, (ii) lower educational level, (iii) dependency on caregivers, (iv) not undergoing T2DM therapy, and (v) being a housewife., Conclusion: This study provides estimates of EQ-5D index scores that can be used in health economic evaluations. As housewives were found to experience more T2DM-related pain/discomfort and anxiety/depression, targeted approaches to reduce these problems should be aimed specifically at this group of patients. Potential approaches could involve disease-specific-counselors (health literacy partners) who provide routine monitoring of T2DM therapy as well as improved health promotion among T2DM communities.

Objectives: To explore the test-retest reliability of the composite time trade-off (C-TTO) and discrete choice experiment (DCE) used in the Indonesian five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) valuation study., Methods: A representative sample aged 17 years and older was recruited from the Indonesian general population by stratified quota sampling with respect to residence, sex, and age. Trained interviewers conducted computer-assisted face-to-face interviews using the EuroQol valuation technology. Each respondent valued 10 health states using C-TTO and 7 pairs of health states in a DCE exercise. The retest interview was conducted after 2 weeks by the same interviewer. The Wilcoxon matched-pairs signed-rank test, intraclass correlation coefficient, and multilevel regression were applied in comparing the C-TTO test and retest data. For DCE, the analysis of proportions was used., Results: A total of 226 respondents with characteristics similar to the Indonesian population completed the retest interview. For C-TTO, 82 (95.3%) of 86 health states had no significant mean value differences between test and retest. The mean value of the second test was statistically significantly higher than that of the first test by 0.042. For DCE, 72.5% of responses were identical. DCE retest showed a different pattern concerning the relative importance of the dimensions, whereas the C-TTO remained the same., Conclusions: C-TTO is stable over time, whereas in DCE the relative values of the dimensions shift. The results support the use of the C-TTO, in particular the Indonesian EQ-5D-5L value set, and suggest a critical examination of the reliability of DCE results over time., (Copyright © 2018 ISPOR--The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Objectives: Breast cancer (BC) is prevalent in low and middle-income countries (LMICs) where the majority of cases are diagnosed in late stages. The aims of this study were: (1) to assess quality of life (QOL) and health status of Indonesian women with BC symptoms before definitive diagnosis; (2) to compare QOL and health status between women with BC symptoms before definitive diagnosis and Indonesian women in general; (3) to evaluate the association between demographic variables (age, residence, social economic status and education level) and QOL within the Indonesian women with BC symptoms before definitive diagnosis., Methods: We used WHOQOL-BREF to measure QOL and EQ-5D-5L for health status. Multivariate analysis of covariance (MANCOVA) was used to compare QOL and health status between women with BC symptoms and women from the general Indonesian population in order to control for confounders. Regression analyses were used for testing the association between the demographic variables, QOL, and health status., Results: In comparison with the data from the women from the general population (n = 471), the women with BC symptoms (n = 132) reported lower QOL, especially in physical and psychological domains. They also reported more problems in all dimensions of health status. Higher education and monthly income were positively associated with QOL and health status among the women with BC symptoms., Conclusion: Before receiving a definitive diagnosis, women who visit hospitals with symptoms of BC, report a lower QOL and health status than women in general. Our results suggest that healthcare providers should provide targeted strategies for women with BC symptoms to improve their QOL., Competing Interests: The authors have declared that no competing interests exist.

Background: People living on the banks of polluted rivers with yearly flooding lived in impoverished and physically unhealthy circumstances. However, they were reluctant to move or be relocated to other locations where better living conditions were available. This study aimed to investigate the health status, quality of life (QoL), happiness, and life satisfaction of the people who were living on the banks of one of the main rivers in Jakarta, Indonesia, the Ciliwung., Methods: Respondents were 17 years and older and recruited from the Bukit Duri community (n = 204). Three comparison samples comprised: i) a socio-demographically matched control group, not living on the river bank (n = 204); ii) inhabitants of Jakarta (n = 305), and iii) the Indonesian general population (n = 1041). Health status and QoL were measured utilizing EQ-5D-5L, WHOQOL-BREF, the Happiness Scale, and the Life Satisfaction Index. A visual analogue scale question concerning respondents' financial situations was added. MANOVA and multivariate regression analysis were used to analyze the differences between the Ciliwung respondents and the three comparison groups., Results: The Ciliwung respondents reported lower physical QoL on WHOQOL-BREF and less personal happiness than the matched controls but rated their health (EQ-5D-5L) and life satisfaction better than the matched controls. Similar results were obtained by comparison with the Jakarta inhabitants and the general population. Bukit Duri inhabitants also perceived themselves as being in a better financial situation than the three comparison groups even though their incomes were lower., Conclusions: The recent relocation to a better environment with better housing might improve the former Ciliwung inhabitants' quality of life and happiness, but not necessarily their perceived health, satisfaction with life, and financial situations.