Relationships between demographic variables and quality of life in a population of Dutch adult psychiatric outpatients

Quality of life for people with psychiatric disabilities employed in extended employment programs in two Arab towns in Israel: an exploratory study

Introduction

This study aims to examine the quality of life (QOL) for people with psychiatric disabilities who are engaged in extended employment programs (homogeneous versus heterogeneous) in the Arab-populated Triangle Area of Israel. The homogeneous program participants are exclusively Arab while the heterogeneous program includes both Arabs and Jews.

Methods

Quantitative research study of 104 adults with psychiatric disabilities engaged in two communal extended employment programs. Participants completed demographic (age (years), gender, marital status (married, widowed/separated, married, single), religion (Muslim, Jewish, Christian), dichotomous nationality variable (Jewish/Arab), and years of education) and employment questionnaires (length of time in the employment program, number of working days/h and salary satisfaction); SF 12 Scale; and The Personal Wellbeing Index questionnaire. Two-sample T-Test, exploratory factor analysis and multiple linear regressions were conducted for tracking the differences between participants in homogeneous and heterogeneous programs.

Results

A significant difference was found between the programs in two QOL components, insofar as satisfaction with the standard of living, together with health satisfaction were rated higher for participants in the heterogeneous program than for their homogeneous program counterparts. Furthermore, the results indicate that physical health and gender were the most important variables in explaining QOL in both programs, while the employment variables were not significant.

Discussion

Since the research findings show that the employment-related-items aren't significant in predicting the employees' QOL, the definition and suitability of extended employment environments as a mental health service must be reexamined. Cultural elements may also have an impact on QOL when the programs are located in a traditional town, with gender playing a key role. The family's role is pivotal in traditional societies, influencing an individual's ability to participate in employment programs and the support they receive. In patriarchal societies, there can be added pressure on men with psychiatric disabilities to conform to societal expectations. Given the general lack of health awareness in Arab communities, there is a need to develop additional projects or incorporate physical health improvement as a rehabilitation goal when working with individuals with psychiatric disabilities, regardless of the type of community rehabilitation program.

Predictors of Quality of Life Improvement with Escitalopram and Adjunctive Aripiprazole in Patients with Major Depressive Disorder: A CAN-BIND Study Report

BACKGROUND

Non-response to first-line treatment for major depressive disorder (MDD) is common; for such individuals, quality of life (QoL) impairments can be severe. Identifying predictors of QoL changes may support the management of cases with persistent depressive symptoms despite adequate initial pharmacological/psychological treatment.

OBJECTIVE

The present study aimed to explore predictors of domain-specific QoL improvement following adjunctive aripiprazole treatment for inadequate response to initial antidepressant therapy.

METHODS

We evaluated secondary QoL outcomes from a CAN-BIND (Canadian Biomarker Integration Network in Depression) study in patients with MDD who did not respond to an initial 8 weeks of escitalopram and received a further 8 weeks of adjunctive aripiprazole (n = 96). Physical, psychological, social, and environmental QoL domains were assessed using the World Health Organization QoL Scale Brief Version (WHOQOL-BREF). Clinician-rated depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS). Functioning was measured with the Sheehan Disability Scale (SDS). Satisfaction with medication was assessed with a single item from the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF). Exploratory t-tests were used to describe domain score changes. A hierarchical linear regression was used to explore demographic, clinical, and treatment-related predictors of improvement.

RESULTS

Across domains, QoL improved with adjunctive aripiprazole treatment. Satisfaction with medication and MADRS and SDS scores similarly improved. Symptom reduction was a predictor for positive change to physical and psychological QoL; functioning improvements were predictive of increases to all QoL domains. Satisfaction with medication predicted improvements to physical and psychological domains, whereas number of medication trials was a predictor of worsening QoL in the physical domain.

CONCLUSION

The final model explained the most variance in psychological (68%) and physical (67%) QoL. Less variance was explained for environmental (43%) and social QoL (33%), highlighting a need for further exploration of predictors in these domains. Strategies such as functional remediation may have potential to support QoL for individuals with persistent depressive symptoms.

CLINICAL TRIALS REGISTRY

ClinicalTrials.gov identifier: NCT016557.

Quality of life in patients with severe mental illness: a cross-sectional survey in an integrated outpatient health care model

PURPOSE

This study (a) assessed quality of life (QoL) in a patient sample with severe mental illness in an integrated psychiatric care (IC) programme in selected regions in Germany, (b) compared QoL among diagnostic groups and (c) identified socio-demographic, psychiatric anamnestic and clinical characteristics associated with QoL.

METHODS

This cross-sectional study included severely mentally ill outpatients with substantial impairments in social functioning. Separate dimensions of QoL were assessed with the World Health Organisation's generic 26-item quality of life (WHOQOL-BREF) instrument. Descriptive analyses and analyses of variance (ANOVAs) were conducted for the overall sample as well as for diagnostic group.

RESULTS

A total of 953 patients fully completed the WHOQOL-BREF questionnaire. QoL in this sample was lower than in the general population (mean 34.1; 95% confidence interval (CI) 32.8 to 35.5), with the lowest QoL in unipolar depression patients (mean 30.5; 95% CI 28.9 to 32.2) and the highest in dementia patients (mean 53.0; 95% CI 47.5 to 58.5). Main psychiatric diagnosis, living situation (alone, partner/relatives, assisted), number of disease episodes, source of income, age and clinical global impression (CGI) scores were identified as potential predictors of QoL, but explained only a small part of the variation.

CONCLUSION

Aspects of health care that increase QoL despite the presence of a mental disorder are essential for severely mentally ill patients, as complete freedom from the disorder cannot be expected. QoL as a patient-centred outcome should be used as only one component among the recovery measures evaluating treatment outcomes in mental health care.

A Comparison of the Quality of Life of Arab Mothers of Children with and without Chronic Disabilities

AIM

To compare the quality of life (QoL) of Arab mothers in Kuwait who had children with chronic disabilities and those whose children had no disabilities and provide recommendations for how occupational therapists can assist in enhancing the mothers' QOL.

METHODS

The case group included 71 mothers of children with chronic disabilities and a control group of 86 mothers of children without disabilities. Mothers' QoL was assessed using the Arabic WHOQOL-BREF questionnaire and the support systems of mothers of children with disabilities using a support questionnaire.

RESULTS

The QoL of mothers of children with disabilities was significantly lower than that of mothers of healthy children (p < .001) in all four domains of WHOQOL-BREF (physical health, psychological wellbeing, social relationships, and environment). Mothers of children with disabilities reported that they received most support from their nuclear family. There was a lack of formal support systems in place in Kuwait.

CONCLUSION

Mothers of children with disabilities perceive their QoL as poor and they have limited support systems. Occupational therapists are encouraged to serve as a resource for families, sharing information including available services and community resources, and supporting mothers as competent caregivers.

Exploratory study on domain-specific determinants of opiate-dependent individuals' quality of life

BACKGROUND/AIMS

Studies on determinants of quality of life (QoL) among opiate-dependent individuals are scarce. Moreover, findings concerning the role of severity of drug use are inconsistent. This exploratory study investigates the association between domain-specific QoL and demographic, social, person, health and drug-related variables, and potential indirect effects of current heroin use on opiate-dependent individuals' QoL.

METHODS

A cohort of opiate-dependent individuals who started outpatient methadone treatment at least 5 years previously (n = 159) were interviewed about their current QoL, psychological distress, satisfaction with methadone treatment and the severity of drug-related problems using the Lancashire Quality of Life Profile, the Brief Symptom Inventory, the Verona Service Satisfaction Scale for Methadone Treatment and the EuropASI.

RESULTS

None of the QoL domains were defined by the same compilation of determinants. No direct effect of current heroin use on QoL was retained, but path analyses demonstrated its indirect effects on the domains of 'living situation', 'finances' and 'leisure and social participation'.

CONCLUSION

These findings illustrate the particularity of each QoL domain and the need for a multidimensional approach to the concept. The relationship between current heroin use and various domains of opiate-dependent individuals' QoL is complex, indirect and mediated by psychosocial and treatment-related variables.

[Research of the quality of life of schizophrenic patients in Belgrade]

First of all, it was pointed to the specificity of the quality of life of psychiatric patients, primarily to the fact that the very poor mental state significantly reduces the life satisfaction. Then, an overview of results of general research of quality of life among schizophrenic patients was presented, in relation to their conditions of treatment, cultural setting, influence of socio-demographic and other factors. The very research was conducted on the sample of 80 subjects treated under the diagnosis of schizophrenia at the Institute of Mental Health in Belgrade - treated as out-patients in the day-hospital. The controls were 80 healthy subjects employed with a Health-care centre in Belgrade. The statistical significance calculations of differences were related to replies to the instruments questions - the instrument being a combination of Lancashire and Manchester Questionnaire. The questions referred to 15 features, classified according to five dimensions of quality of life (physical and medical; psychological and psychopathological; economic; relational and social; and axiological and transcendental dimension), and we arrived at the following: In terms of statistical significance, schizophrenic patients, in comparison to healthy controls confirmed taking medicaments significantly more often, that is, confirmed feeling as being chronic patients, suffering due to their had disposition, fear and having hallucinations. The schizophrenic subjects, also confirmed something very interesting - that they were satisfied with their housing conditions and income. On the other hand, healthy controls, statistically speaking, replied significantly more often that they were satisfied with their sexual relations and relations with their friends, as well as that they were significantly more satisfied with their cultural and social activities. The results of our research were also commented on in relation to the social and other factors, and were compared to the results of similar researches.

Can sociodemographic and clinical variables predict the quality of life of outpatients with major depression?

Quality of life (QOL) in depression could be of great value as an outcome measure, especially in determining the effectiveness of treatment strategies. However, for this aim to be accomplished, it is important to clarify the relationship between QOL and a number of potentially mediating factors, such as sociodemographic and clinical variables. For this purpose, we assessed 140 depressed outpatients with the Mini International Neuropsychiatric Interview, the WHOQOL BREF, and the Beck Depression Inventory (BDI). After standard and stepwise multiple regression analyses, the following variables were found to be independent predictors of QOL: BDI score for the physical (adjusted R(2)=0.125) and psychological (adjusted R(2)=0.23) domains, and for the overall QOL estimate (adjusted R(2)=0.226); age, suicidality according to the MINI and BDI score for the social relations domain (adjusted R(2)=0.244); and ethnicity, psychiatric comorbidity, psychotic symptoms and BDI score for the environmental domain (adjusted R(2)=0.328). Limitations of the study include its cross-sectional design, relatively small sample size, and lack of objective measures of depressive symptomatology. Sociodemographic and clinical variables appear to explain less than 32.8% of the variance of QOL in subjects with depressive disorders. Clearly, further studies are needed to clarify which additional factors play a role in determining QOL in major depression.

Evaluation of schizophrenic patients quality of life

<zakljucak> I pored metodoloskih i epistemioloskih nedostataka istrazivanja kvaliteta zivota shizofrenih bolesnika (manjkavost jedinstvenog metodoloskog pristupa, sto povlaci za sobom neodredjenosti u definisanju problema istrazivanja i teskoce u operacionalizaciji) ova ispitivanja su se pokazala kao pouzdan indikator ishoda (outcome indicator) razlicitih oblika tretmana shizofrenih bolesnika, primene lekova, posebno. I ako rezultati ovih, u sustini multidimenzionih, istrazivanja zavise od depresivnog raspolozenja, crta licnosti i mehanizama prilagodjavanja koje shizofreni ispitanik koristi, istrazivanja kvaliteta zivota shizofrenih bolesnika ce ostati pouzdan, naucno verifikovan pokazatelj humanog statusa najbrojnijih medju teskim psihijatrijskim bolesnicima. Sto se instrumenata istrazivanja kvaliteta zivota tice, izdvojili bismo tri. Prvi od njih, Upitnik o kvalitetu zivota (QLS), najstariji je i dugo se, zbog dobrih metrickih svojstava, koristio u istrazivanjima ove vrste u svetu, ukljucujuci i domace autore 84. Sledeci, Mancesterski upitik o kvalitetu zivota (MANSA) relativno je kratak i primenjivan je u novijim istrazivanjima kvaliteta zivota psihijatrijskih bolesnika u svetu i kod nas. Najzad, izdvojili bismo onaj koji se najvise koristi. To je WHO-QOL-Brief, kraca verzija Upitnika o kvalitetu zivota shizofrenih bolesnika SZO. On se vrlo cesto pojavljuje u najnovijim istrazivanjima ove vrste (poslednjih pet godina) u svetu, a posebno u studijama sa transkulturnim obelezjima. Izbor ovog poslednjeg instrumenta omogucio bi nasim istrazivacima, ne samo brzo prikupljanje podataka, nego i validnije poredjenje sopstvenih rezultata istrazivanja sa slicnima u svetu. Istrazivanja kvaliteta zivota psihijatrijskih bolesnika, a shizofrenih bolesnika posebno, smatramo nezaobilaznim, ne samo u naucnim studijama vezanim za probleme najrasirenijeg psihoticnog poremecaja, nego i vaznim za planiranje i evaluaciju programa pomoci hronicnim psihoticnim bolesnicima uopste, posebno ako se imaju u vidu ambiciozne reforme institucijske psihijatrijske zastite zapocete kod nas.

Sociodemographic correlates of health-related quality of life in pediatric epilepsy

In most chronic conditions, better health-related quality of life (HRQOL) is associated with higher socioeconomic status (SES) and ethnic majority status, with disadvantaged groups typically reporting lower HRQOL. In 163 children with intractable epilepsy, we evaluated the relationship between HRQOL and a broad spectrum of demographic variables (SES, parental education, gender, age, marital status, family size, and ethnic and linguistic status), in relation to known neurological and behavioral correlates of HRQOL. No demographic variable was found to be related to child HRQOL, except for marital status, where children from divorced/separated parents had lower HRQOL. However, marital status was not uniquely predictive of HRQOL when neurological and behavioral variables were taken into account. Exploratory analyses indicated that children of separated/divorced parents were more likely to have early epilepsy onset, lower adaptive/developmental levels, and worse seizure frequency, suggesting that severe epilepsy may be a risk factor for marital stress. In sum, contrary to research in other chronic conditions, sociodemographic variables in pediatric epilepsy were weak predictors of HRQOL in comparison to neurological and behavioral variables. The results are discussed with respect to epilepsy-specific determinants of HRQOL.

[Applicability of the abbreviated version of the World Health Organization's quality of life questionnaire in Hungary]

INTRODUCTION

Quality of life, as a subjective parameter of the general condition, is suitable for characterization of the health status of populations or patient groups, and for studying the effects of therapeutic or preventive interventions.

AIMS

To test the applicability and reliability in Hungary of the abbreviated form of the quality of life questionnaire developed by WHO, one of several ways to measure the quality of life.

METHODS

Questionnaire-based cross-sectional investigation was performed among altogether 814 persons, in small settlements of population under 1000 and 2000, and in a small town for control, in Csongrád county, Hungary. The reliability and validity of the quality of life questionnaire was tested, within each group of questions, by means of Cronbach's alpha, ANOVA and Kruskal-Wallis tests, and by Spearman's rho correlation coefficient.

RESULTS

The mean values of the four domains of quality of life - physical, psychological, social and environmental - showed no noteworthy differences. The Cronbach's alpha figures of the internal consistency test on separate groups of questions and on all questions were in all cases above the expected minimum of 0.7. The means calculated for each domain of quality of life were decreasing with increasing age. Healthy people estimated each aspect of quality of life as significantly better, compared to the sick. Correlation tests showed that all dimensions of the quality of life were in close positive correlation with the general quality of life, with the level of satisfaction with the own health, with the self-assessed health, and with the responses given on other questions related to the social or health situation of the questioned.

CONCLUSION

The variation of the questionnaire, adapted to Hungarian conditions, proved to be suitable for testing the quality of life of persons with various demographical, social and health conditions, and for distinction between the healthy and the sick. The sheet, which can be filled in quickly and easily, enables the measurement of quality of life in the Hungarian population, and the comparison of that with international data.

Quality of life in unaffected twins discordant for affective disorder

BACKGROUND

The disability and hardship associated with affective disorder is shared by the family members of affective patients and might affect the family member's quality of life.

METHOD

In a cross-sectional, high-risk, case-control study, monozygotic (MZ) and dizygotic (DZ) twins with (High-Risk twins) and without (the control group/Low-Risk twins) a co-twin history of affective disorder were identified through nationwide registers. The aim of the present study was to investigate the hypothesis that a genetic liability to affective disorder is associated with a lower perception of quality of life.

RESULTS

Univariate analyses showed that quality of life in all domains was impaired for the 121 High-Risk twins compared to the 84 Low-Risk twins. In multiple regression analyses, the differences remained significant after adjustment for sex, age, marital status and years of education. Adjusted for the effect of subclinical anxiety and depressive symptoms, the differences were significant on the domain environment and total WHOQoL-BREF and marginally significant on the domain physical health and overall quality of life.

LIMITATIONS

It is not possible from the cross-sectional analyses to distinguish between subsyndromal state and trait scores.

CONCLUSIONS

Perceived health related quality of life might share common familial vulnerability with affective disorders. Having a co-twin with affective disorder seem to have a negative influence on quality of life of the healthy co-twin and this influence might be due to the genetic liability to affective disorder. These findings need to be replicated in future family studies.

Predictors of quality of life: a model based study

In this study, predictors of quality of life (QOL) in psychiatric outpatients (n = 410) were investigated using the psychological stress model developed by Taylor and Aspinwall (Psychosocial Stress. Perspective on Structures, Theory, Life-Course and Methods. San Diego, CA: Academic Press, 1996; pp. 71-110). External resources, personal resources, stressors, appraisal of stressors, social support, coping, and QOL were assessed with several questionnaires. The complete original Taylor and Aspinwall model was tested with SEM analyses. These analyses were not able to explain the data adequately. Therefore, initially a more exploratory data analytic strategy was followed using a series of multiple regression analyses. These analyses only partially supported the Taylor and Aspinwall model. In fact, QOL was not predicted by coping, while all other antecedents affected QOL directly, explaining considerable amounts of QOL variance. As a next step, taking the outcomes of the regression analyses as point of departure, new SEM analyses were carried out, testing a modified model. This model, without coping, had an excellent fit. Consequently, modifications of the model are recommended concerning psychiatric outpatients when QOL is the psychosocial outcome measure.