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Hegde PR, Nirisha LP, Basavarajappa C, Suhas S, Kumar CN, Benegal V, Rao GN, Varghese M, Gururaj G. Schizophrenia spectrum disorders in India: A population-based study. Indian J Psychiatry 2023; 65:1223-1229. [PMID: 38298877 PMCID: PMC10826875 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_836_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Schizophrenia spectrum disorders represent a significant global health concern, contributing significantly to the global burden of disease. The National Mental Health Survey (NMHS) of India, conducted between 2015 and 2016, investigated the prevalence and epidemiological correlates of schizophrenia spectrum disorders in India. Materials and Methods The NMHS conducted a population-based cross-sectional study in 12 Indian states from 2015 to 2016, encompassing 34,802 adults. The overall study design of the NMHS was a multistage, stratified, random cluster sampling technique, incorporating random selection based on probability proportion to size at each stage. The Mini-International Neuropsychiatric Interview 6.0 was used for psychiatric diagnoses, disability was assessed using Sheehan's disability scale, and the illness-related socioeconomic impact was assessed using a questionnaire based on the World Health Organization Disability Assessment Schedule 2.0. Firth penalized logistic regression was employed to understand the correlates of current schizophrenia spectrum disorder. Results The study found a lifetime prevalence of schizophrenia spectrum disorders at 1.41%, with a current prevalence of 0.42%. A substantial treatment gap of 72% existed for current cases, rising to 83.3% in urban non-metro areas. The penalized logistic regression revealed that the age group category of 30-49 years, unemployed status, and lower education level had higher odds of association with schizophrenia spectrum disorders. Conclusion The primary finding of this study is a lifetime prevalence of 1.41%, a current prevalence of 0.42%, and a substantial treatment gap of 72%. Addressing this treatment gap and holistic intervention is crucial for reducing the socioeconomic impact of this disorder. Strengthening the National Mental Health Program and implementing community-based rehabilitation are essential first steps in this direction.
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Affiliation(s)
| | - Lakshmi P. Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Girish N. Rao
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gopalkrishna Gururaj
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Chen P, Zhang L, Sha S, Lam MI, Lok KI, Chow IHI, Si TL, Su Z, Cheung T, Feng Y, Jackson T, Xiang YT. Prevalence of insomnia and its association with quality of life among Macau residents shortly after the summer 2022 COVID-19 outbreak: A network analysis perspective. Front Psychiatry 2023; 14:1113122. [PMID: 36873201 PMCID: PMC9978518 DOI: 10.3389/fpsyt.2023.1113122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The latest wave of the coronavirus disease 2019 (COVID-19) pandemic in Macau began on 18 June 2022 and was more serious than previous waves. Ensuing disruption from the wave is likely to have had a variety of negative mental health consequences for Macau residents including increased risk for insomnia. This study investigated the prevalence and correlates of insomnia among Macau residents during this wave as well as its association with quality of life (QoL) from a network analysis perspective. METHODS A cross-sectional study was conducted between 26 July and 9 September 2022. Univariate and multivariate analyses explored correlates of insomnia. Analysis of covariance (ANCOVA) examined the relationship between insomnia and QoL. Network analysis assessed the structure of insomnia including "Expected influence" to identify central symptoms in the network, and the flow function to identify specific symptoms that were directly associated with QoL. Network stability was examined using a case-dropping bootstrap procedure. RESULTS A total of 1,008 Macau residents were included in this study. The overall prevalence of insomnia was 49.0% (n = 494; 95% CI = 45.9-52.1%). A binary logistic regression analysis indicated people with insomnia were more likely to report depression (OR = 1.237; P < 0.001) and anxiety symptoms (OR = 1.119; P < 0.001), as well as being quarantined during the COVID-19 pandemic (OR = 1.172; P = 0.034). An ANCOVA found people with insomnia had lower QoL (F(1,1,008) = 17.45, P < 0.001). "Sleep maintenance" (ISI2), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) were the most central symptoms in the insomnia network model, while "Sleep dissatisfaction" (ISI4), "Interference with daytime functioning" (ISI5), and "Distress caused by the sleep difficulties" (ISI7) had the strongest negative associations with QoL. CONCLUSION The high prevalence of insomnia among Macau residents during the COVID-19 pandemic warrants attention. Being quarantined during the pandemic and having psychiatric problems were correlates of insomnia. Future research should target central symptoms and symptoms linked to QoL observed in our network models to improve insomnia and QoL.
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Affiliation(s)
- Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Ling Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Mei Ieng Lam
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Kiang Wu Nursing College of Macau, Macao, Macao SAR, China
| | - Ka-In Lok
- Kiang Wu Nursing College of Macau, Macao, Macao SAR, China
| | - Ines Hang Iao Chow
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
| | - Tong Leong Si
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Yuan Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao, Macao SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
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3
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Tiderington E, Henwood BF, Padgett DK, Tran Smith B. Employment experiences of formerly homeless adults with serious mental illness in Housing First versus treatment first supportive housing programs. Psychiatr Rehabil J 2020; 43:253-260. [PMID: 31621352 PMCID: PMC7162698 DOI: 10.1037/prj0000391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This paper examines how formerly homeless adults with serious mental illness living in Housing First (HF) and "treatment first" (TF) supportive housing programs experience employment. Research questions include: How do these individuals experience employment in the context of their mental health recovery? What do they perceive as the benefits of and obstacles to attaining employment? Are there programmatic differences in their employment experiences? METHOD Case study analyses of data from a federally funded qualitative study were conducted of 40 individuals purposively sampled from HF and TF programs. Data were independently analyzed and consensually discussed to develop cross-case themes. RESULTS Three themes emerged: (a) the meaning of work, (b) working within the system, and (c) balancing treatment requirements and work. While none of the study participants had full-time jobs, more HF program clients had part-time employment than their TF counterparts. Of the 12 employed participants, all but 2 worked within their respective programs. Participants in both groups described similar benefits of obtaining employment, but TF program requirements inhibited job-seeking. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These findings provide insight into the challenges of obtaining employment for formerly homeless individuals with serious mental illness residing in supportive housing. Despite the motivation to work, individual, structural, and organizational factors impeded employment. To address this problem, factors at each of these levels will need to be considered. Interventions such as supported employment offer promise to supportive housing programs committed to employment as a contributor to recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Emmy Tiderington
- School of Social Work, Rutgers, The State University of New Jersey
| | - Benjamin F Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California
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Harrison M, Singh Roy A, Hultqvist J, Pan AW, McCartney D, McGuire N, Irvine Fitzpatrick L, Forsyth K. Quality of life outcomes for people with serious mental illness living in supported accommodation: systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:977-988. [PMID: 32448927 PMCID: PMC7395041 DOI: 10.1007/s00127-020-01885-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis of quality of life (QoL) outcomes for people with serious mental illness living in three types of supported accommodation. METHODS Studies were identified that described QoL outcomes for people with serious mental illness living in supported accommodation in six electronic databases. We applied a random-effects model to derive the meta-analytic results. RESULTS 13 studies from 7 countries were included, with 3276 participants receiving high support (457), supported housing (1576) and floating outreach (1243). QoL outcomes related to wellbeing, living conditions and social functioning were compared between different supported accommodation types. Living condition outcomes were better for people living in supported housing ([Formula: see text]= - 0.31; CI = [- 0.47; - 0.16]) and floating outreach ([Formula: see text]= - 0.95; CI = [- 1.30; - 0.61]) compared to high-support accommodation, with a medium effect size for living condition outcomes between supported housing and floating outreach ([Formula: see text]= - 0.40; CI = [- 0.82; 0.03]), indicating that living conditions are better for people living in floating outreach. Social functioning outcomes were significant for people living in supported housing compared to high support ([Formula: see text] = - 0.37; CI = [- 0.65; - 0.09]), with wellbeing outcomes not significant between the three types of supported accommodation. CONCLUSION There is evidence that satisfaction with living conditions differs across supported accommodation types. The results suggest there is a need to focus on improving social functioning and wellbeing outcomes for people with serious mental illness across supported accommodation types.
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Affiliation(s)
- Michele Harrison
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
| | - Anusua Singh Roy
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
| | - Jenny Hultqvist
- Mental Health, Activity and Participation (MAP), Department of Health Sciences, Lund University, Lund, Sweden
| | - Ay-Woan Pan
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Deborah McCartney
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
- Present Address: Adult Learning Disability Service, Lynebank Hospital, Dunfermline, UK
| | - Nicola McGuire
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
- Present Address: Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Linda Irvine Fitzpatrick
- Mental Health and Wellbeing, City of Edinburgh Health and Social Care Partnership, Edinburgh, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU UK
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Identifying social participation subgroups of individuals with severe mental illnesses: a latent class analysis. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1067-1077. [PMID: 31127349 DOI: 10.1007/s00127-019-01704-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate factors that influence participation in and needs for work and other daytime activities among individuals with severe mental illnesses (SMI). METHODS A latent class analysis using routine outcome monitoring data from 1069 patients was conducted to investigate whether subgroups of individuals with SMI can be distinguished based on participation in work or other daytime activities, needs for care in these areas, and the differences between these subgroups. RESULTS Four subgroups could be distinguished: (1) an inactive group without daytime activities or paid employment and many needs for care in these areas; (2) a moderately active group with some daytime activities, no paid employment, and few needs for care; (3) an active group with more daytime activities, no paid employment, and mainly met needs for care; and (4) a group engaged in paid employment without needs for care in this area. Groups differed significantly from each other in age, duration in MHC, living situation, educational level, having a life partner or not, needs for care regarding social contacts, quality of life, psychosocial functioning, and psychiatric symptoms. Differences were not found for clinical diagnosis or gender. CONCLUSIONS Among individuals with SMI, different subgroups can be distinguished based on employment situation, daytime activities, and needs for care in these areas. Subgroups differ from each other on patient characteristics and each subgroup poses specific challenges, underlining the need for tailored rehabilitation interventions. Special attention is needed for individuals who are involuntarily inactive, with severe psychiatric symptoms and problems in psychosocial functioning.
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Ang MS, Nurjono M, Lee J. The effects of clinical illness severity and physical activity on health-related quality of life in schizophrenia. Qual Life Res 2019; 28:1509-1520. [PMID: 30805880 DOI: 10.1007/s11136-019-02126-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Quality of life is an important clinical outcome in individuals with schizophrenia. Illness severity and physical activity (PA) were independently reported to influence health-related quality of life (HRQoL) in people with schizophrenia. This study attempts to examine the intensity and types of PA and their impact on HRQoL, as well as the relative contributions of illness severity, PA, and sedentary behavior (SB) to HRQoL in people with schizophrenia. METHODS Demographic information was collected from 297 community-dwelling individuals with schizophrenia. Severity of illness was assessed on the Clinical Global Impression-Severity (CGI-S); PA and SB were assessed on the Global Physical Activity Questionnaire (GPAQ); HRQoL was assessed on the RAND-36. Regression analyses were conducted to examine the impact of different types and intensities of PA on HRQoL, and the relative impact of CGI-S, GPAQ-PA, and GPAQ-SB on HRQoL. RESULTS Most participants had low PA level, and travel is the main type of PA adopted. Leisure time, travel-related, work-related, moderate-, and vigorous-intensity PA were all not associated with HRQoL. Lower severity of illness was significantly associated with better physical (PHC), mental (MHC) and global (GHC) health composites of the RAND-36 (GHC: t = - 5.628, p < 0.001, PHC: t = - 4.026, p < 0.001, MHC: t = - 5.534, p < 0.001). Both PA and SB were not significantly associated with PHC, MHC, and GHC. CONCLUSION Severity of illness has a significant impact on HRQoL in people with schizophrenia. However, we found no evidence to support the association between physical activity and sedentary behavior with HRQoL.
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Affiliation(s)
- Mei San Ang
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore. .,North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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7
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O'Connell M, Sint K, Rosenheck R. How do Housing Subsidies Improve Quality of Life Among Homeless Adults? A Mediation Analysis. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 61:433-444. [PMID: 29493811 DOI: 10.1002/ajcp.12229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Supported housing, combining rent subsidies with intensive case management, is associated with improvements in quality of life of homeless adults, but factors mediating their impact on quality of life have not been studied. Twelve-month outcome data from a randomized trial of the Housing and Urban Development- Veterans Affairs Supported Housing program (HUD-VASH) showed that access to a housing rent subsidy plus intensive case management (ICM) was associated with greater improvement in subjective quality of life than ICM alone. Multiple mediation analyses were applied to identify variables that significantly mediated the relationship between receipt of housing voucher and improvements in quality of life. Significant mediating covariates were those whose 95% bias-corrected confidence intervals, when added to the model predicting improvement in quality of life, did not overlap zero. Increases in the number of days housed, size of social network, and availability of emotional support appear to mediate improvement in quality of life and account for 71% of the benefit attributable to having a rent subsidy. Improvement in subjective quality of life though housing subsidies is mediated by gains in both material and psychosocial factors. Mediating factors deserve special attention in supported housing services.
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Affiliation(s)
- Maria O'Connell
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Kyaw Sint
- School of Public Health, Yale University, New Haven, CT, USA
- Department of Veterans Affairs, New England Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, CT, USA
| | - Robert Rosenheck
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- School of Public Health, Yale University, New Haven, CT, USA
- Department of Veterans Affairs, New England Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, CT, USA
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O’ Flynn P, O’ Regan R, O’ Reilly K, G Kennedy H. Predictors of quality of life among inpatients in forensic mental health: implications for occupational therapists. BMC Psychiatry 2018; 18:16. [PMID: 29351784 PMCID: PMC5775562 DOI: 10.1186/s12888-018-1605-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 01/11/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Padraic O’ Flynn
- 0000 0004 0616 8533grid.459431.eNational Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Roisin O’ Regan
- 0000 0004 0616 8533grid.459431.eNational Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Ken O’ Reilly
- 0000 0004 0616 8533grid.459431.eNational Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland ,0000 0004 1936 9705grid.8217.cDepartment of Psychiatry, Trinity College, Dublin, Ireland
| | - Harry G Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland. .,Department of Psychiatry, Trinity College, Dublin, Ireland.
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Elisabeth A, Carina T, Mona E. Quality of Life Among People with Psychiatric Disabilities: Does Day Centre Attendance Make a Difference? Community Ment Health J 2017; 53:984-990. [PMID: 28105574 DOI: 10.1007/s10597-017-0084-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
The purpose was to investigate (i) how people with psychiatric disabilities who attend day centres experience their quality of life (QoL) compared to non-attendees, (ii) differences in QoL between those who attend meeting place-oriented centres and those who attend work-oriented centres, (iii) possible correlates of QoL among day centre attendees. Ninety-three day centre attendees and 82 non-attendees completed questionnaires addressing QoL and selected correlates. No group difference was found regarding QoL. Factors related with a good QoL were high levels of self-mastery and motivation. Thus, promoting day centre attendees' self-mastery and motivation might enhance their QoL.
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Affiliation(s)
- Argentzell Elisabeth
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Box 157, Lund, SE 221 00, Sweden.
| | - Tjörnstrand Carina
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Box 157, Lund, SE 221 00, Sweden
| | - Eklund Mona
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Box 157, Lund, SE 221 00, Sweden
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Martini LC, Barbosa Neto JB, Petreche B, Fonseca AO, Santos FVD, Magalhães L, Marques AG, Soares C, Cordeiro Q, Attux C, Bressan RA. Schizophrenia and work: aspects related to job acquisition in a follow-up study. ACTA ACUST UNITED AC 2017; 40:35-40. [PMID: 28832749 PMCID: PMC6899422 DOI: 10.1590/1516-4446-2016-2128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/03/2017] [Indexed: 11/27/2022]
Abstract
Objective: Work is considered one of the main forms of social organization; however, few individuals with schizophrenia find work opportunities. The purpose of this study was to evaluate the relationship between schizophrenia symptoms and job acquisition. Method: Fifty-three individuals diagnosed with schizophrenia from an outpatient treatment facility were included in an 18-month follow-up study. After enrollment, they participated in a prevocational training group. At the end of training (baseline) and 18 months later, sociodemographic, clinical data and occupational history were collected. Positive and negative symptoms (Positive and Negative Syndrome Scale – PANSS), depression (Calgary Depression Scale), disease severity (Clinical Global Impression – CGI), functionality (Global Assessment of Functioning – GAF), personal and social performance (Personal and Social Performance – PSP) and cognitive functions (Measurement and Treatment Research to Improve Cognition in Schizophrenia – MATRICS battery) were applied at baseline and at the end of the study. Results: Those with some previous work experience (n=19) presented lower scores on the PANSS, Calgary, GAF, CGI and PSP scales (p < 0.05) than those who did not work. Among those who worked, there was a slight worsening in positive symptoms (positive PANSS). Conclusions: Individuals with less severe symptoms were more able to find employment. Positive symptom changes do not seem to affect participation at work; however, this calls for discussion about the importance of employment support.
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Affiliation(s)
- Larissa C Martini
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Jair B Barbosa Neto
- Departamento de Medicina, Universidade Federal de São Carlos (UFSCar), São Carlos, SP, Brazil
| | - Beatriz Petreche
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ana O Fonseca
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernanda V Dos Santos
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lílian Magalhães
- Departamento de Terapia Ocupacional, UFSCar, São Carlos, SP, Brazil
| | - Alessandra G Marques
- Departamento de Psiquiatria, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Camila Soares
- Departamento de Psiquiatria, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Quirino Cordeiro
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.,Departamento de Psiquiatria, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Cecília Attux
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Rodrigo A Bressan
- Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Gardsjord ES, Romm KL, Friis S, Barder HE, Evensen J, Haahr U, ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T, Melle I, Røssberg JI. Subjective quality of life in first-episode psychosis. A ten year follow-up study. Schizophr Res 2016; 172:23-8. [PMID: 26947210 DOI: 10.1016/j.schres.2016.02.034] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/19/2016] [Accepted: 02/22/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Subjective quality of life (S-QoL) is an important outcome measure in first episode psychosis (FEP). The aims of this study were to describe S-QoL-development the first 10-years in FEP patients and to identify predictors of this development. METHODS A representative sample of 272 patients with a first episode psychotic disorder was included from 1997 through 2000. At 10 year follow-up 186 patients participated. QoL was measured by the Lehman's Quality of Life Interview. Linear mixed model analyses were performed to investigate longitudinal effects of baseline psychiatric symptoms and socio-economic variables and the effects of changes in the same variables on S-QoL-development. RESULTS S-QoL improved significantly over the follow-up period. More contact with family and a better financial situation at baseline had a positive and longstanding effect on S-QoL-development, but changes in these variables were not associated with S-QoL-development. Higher depressive symptoms and less daily activities at baseline both had a negative independent effect, but a positive interaction effect with time on S-QoL-development indicating that the independent negative effect diminished over time. In the change analysis, increased daily activities and a decrease in depressive symptoms were associated with a positive S-QoL-development. CONCLUSIONS Treatment of depressive symptoms and measures aimed at increasing daily activities seem important to improve S-QoL in patients with psychosis. More contact with family and a better financial situation at baseline have a long-standing effect on S-QoL-development in FEP patients.
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Affiliation(s)
| | - Kristin Lie Romm
- Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | | | - Julie Evensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Adult Psychiatric Department Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Ulrik Haahr
- Early Psychosis Intervention Center, Psychiatry East-Region Zealand, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Wenche ten Velden Hegelstad
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Inge Joa
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Langeveld
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Tor Ketil Larsen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, Section Psychiatry, University of Bergen, 5021 Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094, Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark; Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, 0318 Oslo, Norway
| | - Thomas McGlashan
- Department of Social and Behavioural Health, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Ingrid Melle
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
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Karow A, Wittmann L, Schöttle D, Schäfer I, Lambert M. The assessment of quality of life in clinical practice in patients with schizophrenia. DIALOGUES IN CLINICAL NEUROSCIENCE 2015. [PMID: 25152657 PMCID: PMC4140512 DOI: 10.31887/dcns.2014.16.2/akarow] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the present article is to review QoL scales used in studies investigating patients with schizophrenia over the past 5 years, and to summarize the results of QoL assessment in clinical practice in these patients. Literature available from January 2009 to December 2013 was identified in a PubMed search using the key words "quality of life" and "schizophrenia" and in a cross-reference search for articles that were particularly relevant. A total of n=432 studies used 35 different standardized generic and specific QoL scales in patients with schizophrenia. Affective symptoms were major obstacles for QoL improvement in patients with schizophrenia. Though positive symptoms, negative symptoms, and cognitive functioning may be seen as largely independent parameters from subjective QoL, especially in cross-sectional trials, long-term studies confirmed a critical impact of early QoL improvement on long-term symptomatic and functional remission, as well as of early symptomatic response on long-term QoL. Results of the present review suggest that QoL is a valid and useful outcome criterion in patients with schizophrenia. As such, it should be consistently applied in clinical trials. Understanding the relationship between symptoms and functioning with QoL is important because interventions that focus on symptoms of psychosis or functioning alone may fail to improve subjective QoL to the same level. However, the lack of consensus on QoL scales hampers research on its predictive validity. Future research needs to find a consensus on the concept and measures of QoL and to test whether QoL predicts better outcomes with respect to remission and recovery under consideration of different treatment approaches in patients with schizophrenia.
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Affiliation(s)
- Anne Karow
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linus Wittmann
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Schöttle
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Eklund M, Bäckström M, Eakman AM. Psychometric properties and factor structure of the 13-item satisfaction with daily occupations scale when used with people with mental health problems. Health Qual Life Outcomes 2014; 12:191. [PMID: 25539859 PMCID: PMC4302612 DOI: 10.1186/s12955-014-0191-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 12/12/2014] [Indexed: 11/23/2022] Open
Abstract
Background In mental health care practice and research it is increasingly recognized that clients’ subjective perceptions of everyday occupations, such as satisfaction, are important in recovery from mental illness. Instruments thus need to be developed to assess satisfaction with everyday occupations. The aim of the present study was to assess psychometric properties of the 13-item Satisfaction with Daily Occupation (SDO-13) when used with people with mental health problems, including its internal consistency, factor structure, construct validity and whether the scale produced ceiling or floor effects. An additional question concerned if the factor structure varied whether the participants were, or were not, presently engaged in the activity they rated. Methods The interview-based SDO-13 includes items pertaining to work/studies, leisure, home maintenance, and self-care occupations. Whether the person currently performs an occupation or not, he/she is asked to indicate his/her satisfaction with that occupation. The SDO-13 was completed with 184 persons with mental illness. Residual variables were created to remove the variation linked with currently performing the targeted occupation or not and to assess the factor structure of the SDO-13. The indicators of general satisfaction with daily occupations, self-esteem and global functioning were used to assess construct validity. The statistical methods included tests of homogeneity, confirmatory factor analysis and Pearson correlations. Results The internal consistency was satisfactory at 0.79. A three-factor solution indicated that the construct behind the SDO-13 was composed of three facets; Taking care of oneself and the home, Work and studies, and Leisure and relaxation. The same factor structure was valid for both original scores and the residuals. An expected pattern of correlations with the indicators was mainly found, suggesting basic construct validity. No ceiling or floor effects were found. Conclusions Taken together, the findings suggest the SDO-13 is a reliable and robust instrument that may be used to get an overview of the satisfaction people living with mental illness derive from their daily occupations.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Occupational Therapy and Occupational Science, Lund University, PO Box 157, SE-221 00, Lund, Sweden.
| | | | - Aaron M Eakman
- Department of Occupational Therapy Program, Colorado State University, Fort Collins, CO, USA.
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14
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Quality of life after housing first for adults with serious mental illness who have experienced chronic homelessness. Psychiatry Res 2014; 220:549-55. [PMID: 25129560 DOI: 10.1016/j.psychres.2014.07.072] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 07/24/2014] [Accepted: 07/28/2014] [Indexed: 11/23/2022]
Abstract
This 1-year longitudinal study of adults who have recently transitioned from homelessness to Permanent Supportive Housing (PSH) focuses on quality of life as a primary outcome of interest. Eighty of 103 new tenants participated in structured interviews at the time of entry into their new home and at 12-months post-housing. t-tests assessed differences in community participation and quality of life measures at the 2 time points. Mixed effects models examined the impact of community participation on quality of life. Results show that time in independent housing was significantly associated with several domains of quality of life. Symptom severity was also significantly and negatively related to quality of life domains. Community participation was significantly related to frequency of social contacts only. These findings suggest that community participation is not critical to improving quality of life, and that despite concerns that individuals may feel isolated and lonely when living independently, satisfaction with one׳s living situation and family relationships nevertheless improves with housing tenure.
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Hui C, Morcillo C, Russo DA, Stochl J, Shelley GF, Painter M, Jones PB, Perez J. Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis. Schizophr Res 2013; 148:175-80. [PMID: 23773297 PMCID: PMC3744805 DOI: 10.1016/j.schres.2013.05.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/29/2013] [Accepted: 05/23/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent studies suggest that psychotic-like experiences may also act as markers for non-psychotic psychiatric disorders, which may indicate that the focus of research in individuals at high risk (HR) for psychosis needs updating. In this study we thoroughly examined the clinical and functional characteristics of a consecutive cohort of young people at HR for psychosis and compared them to a matched sample of healthy volunteers. METHOD Between February 2010 and September 2012 60 help-seeking HR individuals, aged 16-35, were recruited from CAMEO Early Intervention in Psychosis Service, Cambridgeshire, UK. Forty-five age- and gender-matched healthy volunteers were randomly recruited from the same geographical area. Sociodemographic, psychiatric morbidity, functioning and quality of life measures were compared between both groups. RESULTS HR individuals suffered a wide range of DSM-IV psychiatric disorders, mainly within the affective and anxiety diagnostic spectra. In comparison to healthy volunteers, young people at HR reported more suicidal ideation/intention, depressive and anxiety symptoms and presented with remarkably poor functioning and quality of life. CONCLUSION The presence of co-morbid moderate or severe depressive and anxiety symptoms was common in our sample of young people at enhanced risk for psychosis. A HR mental state may be associated not only with an increased risk for psychosis, but also other psychiatric disorders. Our findings may have implications for the future implementation of therapeutic interventions that this population could benefit from.
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Affiliation(s)
- Christy Hui
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Carmen Morcillo
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Debra A. Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Gillian F. Shelley
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Michelle Painter
- CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK,NIHR Collaboration for Leadership in Applied Health Research & Care, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, UK,CAMEO Early Intervention in Psychosis Service, Cambridgeshire and Peterborough NHS Foundation Trust, UK,Corresponding author at: Block 7, Ida Darwin Site, Fulbourn Hospital, Fulbourn, Cambridge CB21 5EE, UK. Tel.: + 44 1223884360; fax: + 44 1223884362.
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Eklund M, Tjörnstrand C. Psychiatric rehabilitation in community-based day centres: motivation and satisfaction. Scand J Occup Ther 2013; 20:438-45. [PMID: 23721255 DOI: 10.3109/11038128.2013.805428] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study investigated attendees' motivation and motives for participation in day centres and their satisfaction with the rehabilitation, while also addressing the influence of day centre orientation (work- or meeting-place orientation), gender and age. METHODS Ninety-three Swedish day centre attendees participated in a cross-sectional study and completed questionnaires about motivation, motives, and satisfaction with the rehabilitation. Data were analysed with non-parametric statistics. RESULTS The participants were highly motivated for going to the day centre and set clear goals for their rehabilitation. Female gender, but not age, was associated with stronger motivation. The strongest motives for going to the day centre were getting structure to the day and socializing. Attendees at work-oriented day centres more often expressed that they went there to get structure to the day and gain social status. Satisfaction with the rehabilitation was high, and the most common wishes for further opportunities concerned earning money and learning new things. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The rehabilitation largely seemed to meet the attendees' needs, but the findings indicated that further developments were desired, such as participation in work on the open market and more work-like occupations in the day centre, accompanied by some kind of remuneration.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Occupational Therapy and Occupational Science, Lund University , Sweden
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Nygren U, Markström U, Svensson B, Hansson L, Sandlund M. Individual placement and support - a model to get employed for people with mental illness - the first Swedish report of outcomes. Scand J Caring Sci 2011; 25:591-8. [DOI: 10.1111/j.1471-6712.2011.00869.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Money management, mental health, and psychiatric disability: a recovery-oriented model for improving financial skills. Psychiatr Rehabil J 2011; 34:223-31. [PMID: 21208861 DOI: 10.2975/34.3.2011.223.231] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
TOPIC Although money management skills are essential for independent functioning in the community, when viewed from the framework of psychosocial rehabilitation, there have been few systematic models for teaching money management skills to consumers with psychiatric disabilities based on a recovery orientation. PURPOSE For those diagnosed with psychiatric disabilities, better money management has consistently been shown to be associated with superior quality of life, fewer hospitalizations, and greater self-efficacy. Consumers frequently indicate that learning how to budget and staying out of debt are among their top goals for recovery with mental illness. The current paper reviews the issues of money management and mental health among people with psychiatric disabilities and proposes a recovery-oriented approach to increasing money management skills to increase community functioning among consumers. SOURCES USED Published literature, clinical cases, and financial literacy resources. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Improving money management can lead to a number of benefits by helping consumers with psychiatric disabilities: 1) gain more knowledge about disability benefits, 2) improve basic financial skills, and 3) reduce vulnerability to financial exploitation. Future work on incorporating this model into psychiatric rehabilitation programs would address skills consumers can use in living, working, and social environments in a way that enhances consumer choice and promotes recovery.
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Argentzell E, Håkansson C, Eklund M. Experience of meaning in everyday occupations among unemployed people with severe mental illness. Scand J Occup Ther 2010; 19:49-58. [DOI: 10.3109/11038128.2010.540038] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Veilleux N, Goffaux P, Boudrias M, Mathieu D, Daigle K, Fortin D. Quality of life in neurooncology—age matters. J Neurosurg 2010; 113:325-32. [DOI: 10.3171/2010.2.jns091707] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Object
Due partly to therapeutic improvements and prolonged patient survival, the field of neurooncology is gradually undergoing a philosophical shift, progressively moving toward a more functional approach to patient welfare. This shift includes, as one of its defining objectives, the promotion of elevated levels of quality of life (QOL) and quality of health (QOH) for patients of all ages. Unfortunately, an adult life-stage perspective has never been used to study the long-lasting impact of age on well-being in neurooncology patients.
Methods
In this study, the authors assessed and compared the QOL and QOH scores of 42 younger adults (≤ 40 years of age) and 88 older adults (> 40 years of age) presenting with a primary supratentorial tumor.
Results
After having controlled for biomedical and treatment-related factors, the authors discovered that older adults reported lower functional well-being and poorer neurocognitive functioning than younger adults. This age difference appeared earlier than expected (developing as early as middle age), suggesting an accelerated effect of disease on the aging process. Importantly, it was also found that the variables that predict QOL and QOH differed depending on patient age. For example, support from friends was a significant predictor of QOL for younger adults, whereas the capacity to continue enjoying life was a significant predictor for older adults. Moreover, the presence of a high-grade tumor and increased physical pain had a negative impact on the QOH of younger adults, whereas increased difficulty with concentration negatively impacted the QOH of older adults.
Conclusions
These age differences clearly warn against consolidating the QOL or QOH scores of younger and older adults, and instead suggest that age at diagnosis is essential when considering patient perspective, and when establishing tailored support programs.
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Abstract
PURPOSE OF REVIEW Schizophrenia is a complex neurobehavioral disorder for which there are many promising new treatments. There is, however, a discrepancy in outcome measure reports when they are obtained from patients, relatives, caregivers, or professionals, making it difficult to determine the level of recovery. This lack of agreement may result from limitations of the measurement tools themselves, which are not comprehensive and may be measuring different aspects of outcome. Alternatively, it could be that the conceptual understanding of outcome and recovery require development. RECENT FINDINGS For various reasons, patients assessed as 'recovered' remain excluded from mainstream society. We are of the opinion that present outcome measures do not capture real-life situations. We propose that the concept of recovery be carefully defined and the gold standard of outcome should incorporate social and clinical parameters. We attempt to redefine recovery. Patients who have shown clinical improvement do not necessarily do well in everyday situations even though there is obvious clinical improvement. Therefore, it has been repeatedly argued that a consensus of recovery should be determined and that routine clinical practice should then adapt to the agreed criteria. SUMMARY We argue that the outcome measures should be multidimensional and consist of at least two parameters: clinical remission and social outcome.
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