The aim of this study was to examine the validity and reliability of the Polish WHOQOL - Bref in a sample of 908 respondents. The Bref is a generic quality of life (QoL) instrument designed for cross - cultural use. Correlational and multivariate analyses confirmed the relevancy of individual items and domains supporting the construct validity of the scale. Multiple regression analyses of the domain scores with two overall questions (dependent variable) showed that all four domains made a significant contribution in explaining the variance in overall QoL. The psychological domain made the strongest contribution (unstandardized B coefficient = 0.10, r2 = 0.41), followed by the social, environmental and physical domains. When overall health satisfaction was considered as the dependent variable, the physical domain contributed most strongly (unstandardized B coefficient = 0.21, r2= 0.43) followed by the psychological and environmental domains. Exploratory factor analyses resulted in a four factors solution with 24 items explaining 49.6% of the cumulative variance. Confirmatory factor analyses lended marginal support for the goodness of fit of the four-domain model. The physical domain was found to be strongest in differentiating between unhealthy and healthy subjects, followed by psychological and social domains. Acceptable internal consistency was shown with Cronbach's alpha coefficients being greater than 0.70 for all domains with the exception of the social domain. Further exploration of the scales validity and conceptual clarity need further testing in Polish and international samples.

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Strengthening of family support, treatment of depression and reduction of physical dependence may be the decisive factors in improving post-stroke QOL.

Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.

Because psychopathology seems to have the greatest impact on the QoL, there is a need to develop community psychosocial treatment to reduce these symptoms and to support patients in the early phase of the disease.