The sensitivity of quality-of-life scale WHOQOL-100 to psychopathological measures in schizophrenia

The relationship between psychopathology, occupational balance, and quality of life among people with schizophrenia

OBJECTIVE

There is an increased risk of occupational imbalance and poor quality of life (QoL) if one has schizophrenia. Although evidence suggests a relationship between psychopathology and QoL, the association of occupational balance (OB) with QoL in schizophrenia is unclear. This study aimed to investigate the associations among psychopathology, occupational balance, and QoL in schizophrenia.

METHODS

This was a cross-sectional study carried out in a Community Mental Health Center (CMHC). Ninety-five individuals aged 18 years or older with the diagnosis of schizophrenia participated in the study. All participants completed a sociodemographic form, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale in Schizophrenia (CDSS), Occupational Balance Questionnaire-11 Turkish Version (OBQ11-T), and the World Health Organisation Quality of Life Assessment Instrument (WHOQOL-100-TR). Relationships among clinical and depressive symptoms, OB, and QoL variables were examined through correlation analysis, and then multiple linear regression analysis was performed to determine the variables that have influences on QOL.

RESULTS

The study participants had low OB scores and the lowest mean in the WHOQOL-social relationships subscale. WHOQOL-overall QoL score demonstrated a moderate negative correlation with the PANSS-total score and PANSS-general psychopathology subscale score (r = -0.422, r = -0.463, P < 0.001) and a mild negative correlation with the CDSS-total score (r = -0.390, P < 0.001). OBQ11-T total score showed a moderate positive correlation with the WHOQOL-overall score (r = 0.549; P < 0.001). Findings from the multiple linear regression analysis revealed that OBQ11-T (β = -0.467, P = 0.000) and PANSS-general psychopathology (β = -0.221, P = 0.045) were significant predictors of the overall QoL, explaining 48% of the variance in the overall QoL (adjusted R²  = .43, P < 0.001).

CONCLUSION

Our study findings showed that OB and general psychopathology are determinants that should be considered in improving the QoL in individuals with schizophrenia. Thereby, addressing the symptoms of general psychopathology and occupational factors to improve the QoL may be achieved with the incorporation of occupation-based programmes to routine treatment. However, further research is required.

Quality of life measures in schizophrenia

The recognition of the importance of evaluating the quality of life of patients with schizophrenia highlighted the importance ofdeveloping appropriate instruments. In this paper we review the available quality of life instruments focusing on their conceptual framework, structure, administration and psychometric properties. First, we address the generic instruments that have been validated for schizophrenic populations, namely the World Health Organization Quality of Life Assessment (WHOQOL), the Medical Outcome Study (MOS) 36-Item Short-Form Health Survey (SF-36) and the EuroQoL-5 Dimensions (EQ-5D). Then, we focus on instruments that have been specifically developed for patients with schizophrenia and other or severe mentally illness such as the Quality of Life Scale (QLS), the Quality of Life Interview (QoLI), the Lancashire Quality of Life Profile (LQoLP), the Sevilla Quality of Life Questionnaire (SQLQ), the Personal Evaluation of Transitions in Treatment (PETIT), and the Quality of Life Questionnaire in Schizophrenia (S-QoL).

Validation and extension of the Motivation and Pleasure Scale-Self Report (MAP-SR) across the schizophrenia spectrum in the Chinese context

BACKGROUND

Developed based on the Clinical Assessment Interview for Negative Symptoms (CAINS), the Motivation and Pleasure Scale-Self Report (MAP-SR) was designed to address the conceptual and psychometric limitations of other instruments assessing negative symptoms. We sought to validate and extend the applicability of the MAP-SR in the Chinese context across the schizophrenia spectrum.

METHODS

Three samples, including college students, individuals with social anhedonia and patients with schizophrenia, were recruited. Test-retest reliability, internal consistency, factor structure, and convergent/discriminant validity of the MAP-SR were examined. The group differences between the three participant groups were examined.

RESULTS

A four-factor structure of the MAP-SR was found consistently in all three groups of participants. The scale showed convergent/discriminant validity in patients with schizophrenia and individuals with social anhedonia, along with good reliability found in schizophrenia patients. The MAP-SR was also able to distinguish individuals with SocAnh and patients with SZ from matched controls.

CONCLUSIONS

The MAP-SR is a valid and reliable instrument in assessing negative symptoms in individuals along the schizophrenia spectrum.

Subjective quality of life among patients with schizophrenia spectrum disorder and patients with major depressive disorder

BACKGROUND

The goal of clinicians and healthcare workers providing treatment to patients with psychiatric disorders, has shifted over time from focusing on the symptoms alone towards functional improvement. In this study, we aimed to compare the subjective quality of life (QoL) among patients with schizophrenia spectrum disorders and major depressive disorder (MDD).

METHODS

QoL scores were collected using 36-item Short Form Survey Instrument. QoL scores were compared between 203 outpatients with schizophrenia spectrum disorders and 185 outpatients with MDD using analysis of covariance. The Positive and Negative Syndrome Scale was administered to assess the severity of psychiatric symptoms among patients with schizophrenia and Personal Health Questionnaire-8 items was utilized to assess the severity of depressive symptoms among patients with MDD. The correlation coefficient (r) of socio-demographic factors and core psychiatric symptoms with QoL were analyzed using multiple linear regression.

RESULTS

As compared to patients with MDD, patients with schizophrenia reported better health scores in all QoL subdomains, except for physical function (PF). Among patients with schizophrenia, old age was correlated with better mental health (MH, r = 0.35) and PF (r = 0.37). Compared to those of Chinese ethnicity, those of Malay, Indian and other ethnicity were correlated with worse PF (r = - 0.43 for Malays; r = - 0.30 for Indians and r = - 0.34 for other ethnicities). Longer duration of mental illness was correlated with worse MH (r = - 0.30), worse PF (r = - 0.38) and worse scores on role limitations due to physical health problems (RP, r = - 0.30). Among patients with MDD, older age was correlated with worse PF (r = - 0.33) and patients without comorbid physical illness reported less bodily pain (r = 0.45) and better general health (r = 0.34). Moreover, all psychiatric symptoms among patients with schizophrenia were negatively correlated with QoL, but the strength of the correlation was less than that between depressive symptoms and QoL among patients with MDD.

CONCLUSION

Patients with schizophrenia generally reported better QoL as compared to patients with MDD. The correlates of QoL differed between patients with schizophrenia and patients with MDD. This study adds to the understanding of QoL among patients with mental illnesses and may aid in better management of these patients with different psychiatric diagnoses.

Quality of Life in Schizophrenia: A Meta-Analysis of Comparative Studies

Studies and findings regarding the impact of schizophrenia on quality of life (QOL) has been highly variable. This meta-analysis compared QOL between schizophrenia subjects and healthy controls with a focus on standardized measures. A systematic literature search was conducted through Pubmed, PsycINFO, EMBASE, Cochrane Library and Web of Science databases. Only studies using the World Health Organization Quality of Life (WHOQOL) or its brief version or the Short Form-36 Health Survey (SF-36) were included. Fifteen case-control studies with 2195 schizophrenia subjects and 1508 healthy controls were included in this meta-analysis. The WHOQOL/WHOQOL-BREF score was significantly lower in physical health (SMD = -1.80, 95% CI: -2.31 to -1.28, P < 0.001), psychological health (SMD = -1.28, 95% CI: -1.72 to -0.83, P < 0.001), social relationships (SMD = -1.60, 95% CI: -2.05 to -1.15, P < 0.001), and environment domains (SMD = -0.98, 95% CI: -1.38 to -0.59, P < 0.001) in schizophrenia subjects compared to controls. The SF-36 score was significantly lower in both physical (SMD = -1.09, 95% CI: -1.41 to -0.76, P < 0.001 and mental health domains (SMD = -2.08, 95% CI: -3.58 to -0.59, P = 0.006) in schizophrenia subjects than in controls. Subgroup and meta-regression analyses found that age, male gender, illness duration and income have significant moderating effects on QOL. The meta-analysis of studies with standardized measures confirmed that QOL in schizophrenia subjects is significantly lower than healthy controls. Effective interventions should be developed to improve QOL for this population.

Schizotypal traits and their relation to rejection sensitivity in the general population: Their mediation by quality of life, agreeableness and neuroticism

Schizotypal traits are a cluster of personality styles suggesting a potential liability for schizophrenia-spectrum disorders. Interpersonal schizotypal traits include cognitive disorganisation which consists of social anxiety, and introvertive anhedonia which consists of a lack of pleasure in social activities. Rejection sensitivity is evident all along this continuum. This study aimed to determine whether psychosocial quality of life (QOL), neuroticism and agreeableness mediates the relation between schizotypy and rejection sensitivity. Three hundred and eighteen participants from a predominantly University student population completed an online survey measuring schizotypy, rejection sensitivity, quality of life, and the five-factor personality traits. A regression analysis determined the prediction of rejection sensitivity by schizotypy, quality of life, and the five personality traits. Analyses examined the mediation of the relation between interpersonal schizotypy and rejection sensitivity by psychological QOL, social QOL, neuroticism, and agreeableness. Cognitive disorganisation and introvertive anhedonia predicted greater rejection sensitivity, which in turn were mediated by psychological QOL, social QOL, neuroticism, and agreeableness. The findings show that interpersonal schizotypy relates to greater rejection sensitivity. Psychosocial factors that lower one's ability to have positive feelings, trusting relationships, and prosocial behaviour, and personality traits that increase worrying mediate this association.

Neurophysiological correlates of Avolition-apathy in schizophrenia: A resting-EEG microstates study

Background

The “Avolition-apathy” domain of the negative symptoms was found to include different symptoms by factor analytic studies on ratings derived by different scales. In particular, the relationship of anhedonia with this domain is controversial. Recently introduced negative symptom rating scales provide a better assessment of anhedonia, allowing the distinction of anticipatory and consummatory aspects, which might be related to different psychopathological dimensions. The study of associations with external validators, such as electrophysiological, brain imaging or cognitive indices, might shed further light on the status of anhedonia within the Avolition-apathy domain.

Objectives

We used brain electrical microstates (MSs), which represent subsecond periods of quasi-stable scalp electrical field, associated with resting-state neural networks (and thus with global patterns of functional connectivity), to test whether the component symptoms of Avolition-apathy share the same correlates.

Method

We analyzed multichannel resting EEGs in 142 individuals with schizophrenia (SCZ) and in 64 healthy controls (HC), recruited within the add-on EEG study of the Italian Network for Research on Psychoses. Relative time contribution, duration and occurrence of four MS classes (MS-A/-B/-C/−D) were calculated. Group differences on MS parameters (contribution and duration) and their associations with negative symptom domains (assessed using the Brief Negative Symptoms Scale) were investigated.

Results

SCZ, in comparison to HC, showed increased contribution and duration of MS-C. The contribution of MS-A positively correlated with Avolition-apathy, but not with Expressive deficit. Within the Avolition-apathy domain, anticipatory anhedonia, avolition and asociality, but not consummatory anhedonia, showed the same correlations with MS-A contribution.

Conclusion

Our findings support the existence of distinct electrophysiological correlates of Avolition-apathy with respect to Expressive deficit, and lend support to the hypothesis that only the anticipatory component of anhedonia shares the same pathophysiological underpinnings of the Avolition-apathy domain.

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Microstate C contribution and duration were increased in SCZ compared to HC.

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Avolition-apathy was correlated with the contribution of microstate A.

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Avolition-apathy might be associated with sensory processing deficit.

Dimensional symptom severity and global cognitive function predict subjective quality of life in patients with schizophrenia and healthy adults

Over the last several decades Quality of Life (QoL) has become increasingly important as an indicator of treatment outcomes; particularly in schizophrenia spectrum disorders because of its close association with functional disability. Numerous studies seeking to elucidate the factors that contribute to QoL in this population have implicated both symptom severity and cognition in determining QoL but the findings have been mixed. The critical factors that appear to impede the lack of consensus in the extant literature examining determinants of QoL include the heterogeneity of the samples and measures examined as well as medication effects across different studies. Thus, the present study sought to address some of these issues by examining the relationship between subjective QoL and both symptom severity and cognitive function in a relatively homogeneous patient sample of patients and a community control sample assessed for dimensional symptom severity. Our results suggest that both global cognitive function and psychiatric symptoms have a significant impact on the subjective QoL of both people with schizophrenia spectrum disorders and psychiatrically healthy adults. Specifically, we found that a global index of cognition as well as self-reported avolitional and depressive symptoms were significantly predictive of QoL in both samples. These findings highlight the importance of addressing cognitive, depressive and avolitional symptoms in the treatment of patients with schizophrenia spectrum disorders and suggest that improvements in these domains may have a meaningful impact on their overall QoL.

Psychotic symptoms and quality of life: A mediation analysis of daily-life coping

Prior studies suggest the relationship between psychotic symptoms and Quality of Life (QoL) may be mediated by diverse constructs. QoL in schizophrenia-related disorders has been related with coping with daily stressors. Based on previous studies, our hypothesis was that coping mediates the relationship between psychotic symptoms and QoL. Therefore, the aim of the study was to test the hypothesis in a sample of people with schizophrenia-related disorders from a community rehabilitation center. Sixty-six patients were assessed using PANSS, WHOQOL-BREF questionnaire, and COPE Inventory. Regression analyses were performed for each WHOQOL-BREF dimension using PANSS and COPE factors as predictors. Mediation analysis was performed for each WHOQOL-BREF dimension using significant PANSS scales as predictors and significant COPE factors as mediators. Sobel test showed that Self-Sufficient (Problem-focused) coping mediates the relationship between PANSS Positive and WHOQOL-BREF Psychological and WHOQOL-BREF Environmental scores. Results suggest that coping style based on personal abilities and oriented to the stressors mediates the relationship between positive symptoms and QoL associated to well-being and environmental features. However, in our study no coping style mediated the relationship between negative symptoms and QoL. Depressive symptoms predicted each QoL dimension and were not mediated by any coping style.

A history of health-related quality of life outcomes in psychiatry

Health-related quality of life (HRQoL) is a multidimensional concept that includes subjective reports of symptoms, side effects, functioning in multiple life domains, and general perceptions of life satisfaction and quality. Rather than estimating it from external observations, interview, or clinical assessment, it is best measured by direct query. Due to a perception that respondents may not be reliable or credible, there has been some reluctance to use self-report outcomes in psychiatry. More recently, and increasingly, HRQoL assessment through direct patient query has become common when evaluating a range of psychiatric, psychological, and social therapies. With few exceptions, psychiatric patients are credible and reliable reporters of this information. This article summarizes studies that highlight the development, validation, and application of HRQoL measures in psychiatry. Thoughtful application of these tools in psychiatric research can provide a much-needed patient perspective in the future of comparative effectiveness research, patient-centered outcomes research, and clinical care.

Quality of life in schizophrenia spectrum disorders: associations with insight and psychopathology

Therapeutic interventions in chronic mental illness face the important challenge to pursuit the quality of life (QOL) of patients. Insight into chronic mental illness, though a prerequisite for treatment adherence and a positive therapeutic outcome, has shown adverse associations with subjective QOL. This study aims to explore the contribution of psychopathological symptoms on the ambiguous role of insight on QOL. Seventy-two outpatients with schizophrenia spectrum disorders were assessed using the positive and negative syndrome scale, the scale to assess unawareness of mental disorder, and the WHOQOL-100 instrument for the assessment of quality of life. Insight was found to associate inversely with quality of life. Among psychopathological symptoms, depressive symptoms were the strongest negative contributor on QOL. Mediation analysis revealed that the effects of awareness of the consequences of illness on QOL were largely mediated by depressive symptoms (full mediation for the effect on physical and psychological domain and partial mediation for the effect on independence and environment domain of the QOL). Our results suggest that the inverse relationship between insight and subjective quality of life is partially mediated by depressive symptoms. We discuss theoretical and therapeutic implications of the findings, in conjunction with similar recent research data.

Validation of the Chinese version of Perception of Care in an acute psychiatric ward in Hong Kong

INTRODUCTION

This study aimed to validate and culturally adapt the Perception of Care (PoC) for patients receiving acute psychiatric inpatient services in Hong Kong.

METHODS

The PoC was translated and culturally adapted into a written Chinese version (C-PoC). Subjects completed C-PoC, Chinese version of Admission Experience Survey (C-AES) and World Health Organization Quality of Life Measure (WHOQOL-BREF). They were then rated by assessors with Brief Psychiatric Rating Scale (BPRS), Hamilton Rating Scale for Depression, Hamilton Rating Scale for Anxiety and Extrapyramidal Symptom Rating Scale. Explorative factor analysis and correlation between C-PoC, WHOQOL-BREF and C-AES served as the theoretical basis of construct validity. Multivariate analysis was used to identify predictors of satisfaction.

RESULTS

The C-PoC has a four-factor structure that resembles the original scale with demonstrating satisfactory construct validity and test-re-test reliability. Psychiatric symptom ratings did not predict any satisfaction ratings. Extrapyramidal symptoms predicted poorer satisfaction. Younger patients with affective diagnoses had better satisfaction.

DISCUSSION

The C-PoC is a psychometrically sound translation of the original scale. The current study paves the way for further studies among Chinese-speaking communities on the determinants and implications of patients' satisfaction by offering a psychometrically sound and yet concise instrument.

Negative symptoms and depression predict lower psychological well-being in individuals with schizophrenia

Previous studies have demonstrated that negative symptoms are linked to lower rates of recovery in individuals with schizophrenia when recovery is defined objectively in terms of symptom remission, vocational outcome, and social functioning. In the current study, we followed up these prior investigations by examining the other aspect of recovery, the subjective component, to determine whether negative symptoms predict lower self-reported well-being. Participants included 56 individuals with schizophrenia and 33 controls who completed self-report measures of psychological, social, and emotional well-being. Individuals with schizophrenia also completed a battery of symptom measures. Results indicated that individuals with schizophrenia self-reported lower psychological well-being than controls in relation to all 6 domains assessed: autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. However, there were no differences between groups on global self-reported emotional or social well-being. In addition, negative symptoms and depression were found to be significant predictors of psychological well-being among individuals with schizophrenia. These findings indicate that lower psychological well-being may be characteristic of individuals in the chronic phase of schizophrenia, particularly those with negative symptoms and/or depression. Implications for recovery-focused psychosocial programs are discussed.

Measuring patient-reported outcomes in psychosis: conceptual and methodological review

BACKGROUND

There are calls to use patient-reported outcomes (PROs) routinely across mental health services. However, the use of PROs in patients with psychosis has been questioned.

AIMS

To examine the concepts and measures of four widely used PROs: treatment satisfaction, subjective quality of life, needs for care and the quality of the therapeutic relationship.

METHOD

We conducted a literature search of academic databases on concepts, characteristics and psychometric properties of the four PROs in patients with psychosis.

RESULTS

Although numerous concepts and measures have been published, evidence on the methodological quality of existing PROs is limited. Measures designed to assess distinct PROs showed a considerable conceptual, operational and empirical overlap, and some of them also included specific aspects. The impact of symptoms and cognitive deficits appears unlikely to be of clinical significance.

CONCLUSIONS

The popularity of PROs has not been matched with progress in their conceptualisation and measurement. Based on current evidence, some recommendations can be made. Distinct and short measures with clinical relevance and sufficient psychometric properties should be preferred. Future research should optimise the validity and measurement precision of PROs, while reducing assessment burden.

Anhedonia is an important factor of health-related quality-of-life deficit in schizophrenia and schizoaffective disorder

The aim of the current study was to investigate an association of physical and social hedonic deficits with health-related quality of life (HRQL), controlling for related distressing and protective factors. Eighty-seven stable patients with schizophrenia (SZ) and schizoaffective disorder (SA) were assessed using the revised Physical Anhedonia Scale (PAS) and the Social Anhedonia Scale (SAS), the Quality of Life Enjoyment and Life Satisfaction Questionnaire (Q-LES-Q), and related factors. Hedonic and HRQL deficit scores did not reach significant differences between SZ and SA patients. General and domain-specific Q-LES-Q scores were significantly correlated with PAS and SAS scores independent of the adverse effects and psychopathological symptoms. Dissatisfaction with HRQL increased from "normal hedonics" (4.8%) to "hypohedonics" (28.6%) and "double anhedonics" (66.7%). Permanently dissatisfied patients who revealed deterioration in general quality of life across 10 years had significantly higher PAS and SAS scores than did patients who were permanently satisfied and improved. An exploratory factor analysis yielded a three-factor solution; PAS and SAS scores were joined to the second factor together with Q-LES-Q, self-efficacy, coping styles, and social support scores. PAS scores accounted for 7% to 13% of the total variance in three domains and in the general quality-of-life alterations. SAS scores did not predict variability in the Q-LES-Q domains. Therefore, physical and social hedonic deficits significantly associated with poor HRQL independent of the adverse effects and psychopathological symptoms of SZ/SA. Physical anhedonia may be a predictor for quality-of-life deficit.

Pathways between early visual processing and functional outcome in schizophrenia

BACKGROUND

Early visual processing deficits are reliably detected in schizophrenia and show relationships to poor real-world functioning. However, the nature of this relationship is complex. Theoretical models and recent studies using statistical modeling approaches suggest that multiple intervening factors are involved. We previously reported that a direct and significant association between visual processing and functional status was mediated by a measure of social perception. The present study examined the contribution of negative symptoms to this model.

METHOD

We employed structural equation modeling (sem) to test several models of outcome, using data from 174 schizophrenia out-patients. Specifically, we examined the direct and indirect relative contributions of early visual processing, social perception and negative symptoms to functional outcome.

RESULTS

First, we found that, similar to social perception, a measure of negative symptoms mediated the association between visual information processing and functional status. Second, we found that the inclusion of negative symptoms substantially enhanced the explanatory power of the model. Notably, it was the experiential aspect of negative symptoms (avolition and anhedonia) more than the expressive aspect (affective flattening and alogia) that accounted for significant variance in functional outcome, especially in the social component of the construct of functional outcome.

CONCLUSIONS

Social perception and negative symptoms play relevant roles in functional impairment in schizophrenia. Both social perception and negative symptoms statistically mediate the connection between visual processing and functional outcome. However, given the lack of association between social perception and negative symptoms, these constructs appear to have an impact on functioning through separate pathways.

Impact of panic attacks on quality of life among patients with schizophrenia

OBJECTIVE

Schizophrenia patients had decreased levels of quality of life compared to normal population. The aim of this study was to investigate the impact of panic attacks on quality of life in patients with schizophrenia.

METHODS

Eighty-eight patients with schizophrenia and 85 healthy subjects were included in the study. World Health Organization Quality of Life Instrument-Short Form (WHOQOL-Bref) was given to patients and healthy subjects to assess quality of life. Panic module of Structured Clinical Interview for DSM-IV (SCID) was administered to patients for diagnosis of panic attacks and panic disorder. Positive and Negative Syndrome Scale (PANSS) for symptom severity and Calgary Depression Scale (CDS) for depressive symptoms were administered to the patients.

RESULTS

Patients with schizophrenia demonstrated significantly lower scores compared to healthy controls in all domains of WHOQOL-Bref. Twenty-five patients (28.4%) with schizophrenia had panic attacks (PA) and 10 patients (11.4%) met criteria for panic disorder (PD). Schizophrenia patients with PA had significantly lower scores on psychological domain of WHOQOL-Bref compared to the patients without PA. Schizophrenic patients with panic attacks had higher CDS scores than patients without PA. In the multivariate regression analyses the variance in psychological domain of WHOQOL-Bref was explained by depression rather than panic attack.

CONCLUSION

In patients with schizophrenia comorbid panic attacks may have a negative impact on quality of life, which is associated with depression significantly. Panic attacks and depressive symptomatology must be examined comprehensively in order to improve quality of life in patients with schizophrenia.

Proxy and patients ratings on quality of life in patients with schizophrenia and bipolar disorder in Korea

PURPOSE

This study aimed to assess the agreement between patient and proxy ratings of Quality of life (QoL) in patients with psychotic mental illnesses.

METHODS

The abbreviated version of the WHO quality of life scale (WHOQOL-BREF) and 36-item short-form health survey (SF-36) were administered to patient-family proxy pairs of 81 schizophrenia patients with mild symptoms and 50 euthymic bipolar disorder patients. Paired t-tests and the intraclass correlation coefficient (ICC) were used to evaluate the level of agreement between patient and proxy ratings of QoL.

RESULTS

At the group level, small standardized differences (0.0-0.3 for schizophrenia, 0.0-0.5 for bipolar disorder) between patient and proxy mean scores were found for most domains in both QoL measures. At the individual level, moderate to good agreement (ICC) was found (schizophrenia: ICC 0.4-0.7 on WHOQOL-BREF; 0.4-0.7 on SF-36; bipolar disorder: ICC 0.4-0.7 on WHOQOL-BREF; 0.6-0.7 on SF-36). The reported agreement was higher than that reported for similar measures in the psychiatric population. These results may be due to the fact that our subjects had mild clinical symptoms and frequent family interaction.

CONCLUSION

These findings suggest that family proxy rating of patients' QoL can be used as a reasonable estimate of the patients' QoL for stable schizophrenia and bipolar patients in Korea.

Quality of life in mentally ill, physically ill and healthy individuals: the validation of the Greek version of the World Health Organization Quality of Life (WHOQOL-100) questionnaire

OBJECTIVE

The World Health Organization Quality of Life (WHOQOL-100) questionnaire is a generic quality of life (QoL) measurement tool used in various cultural and social settings and across different patient and healthy populations. The present study examines the psychometric properties of the Greek version, with an emphasis on the ability of the instrument to capture QoL differences between mentally ill, physically ill and healthy individuals.

METHODS

A total of 425 Caucasian participants were tested, as to form 3 groups: (a) 124 psychiatric patients (schizophrenia n = 87, alcohol abuse/dependence n = 37), (b) 234 patients with physical illness (hypertension n = 139, cancer n = 95), and (c) 67 healthy control individuals.

RESULTS

Confirmatory factor analysis was performed indicating that a four-factor model can provide an adequate instrument structure for the participating groups (GFI 0.92). Additionally, internal consistency of the instrument was shown to be acceptable, with Cronbach's alpha values ranging from 0.78 to 0.90 regarding the four -domain model, and from 0.40 to 0.90 regarding the six-domain one. Evidence based on Pearson's r and Independent samples t-test indicated satisfactory test/retest reliability, as well as good convergent validity tested with the General Health Questionnaire (GHQ-28) and the Life Satisfaction Inventory (LSI). Furthermore, using Independent samples t-test and one-way ANOVA, the instrument demonstrated good discriminatory ability between healthy, mentally ill and physically ill participants, as well as within the distinct patient groups of schizophrenic, alcohol dependent, hypertensive and cancer patients. Healthy individuals reported significantly higher QoL, particularly in the physical health domain and in the overall QoL/health facet. Mentally ill participants were distinctively differentiated from physically ill in several domains, with the greatest difference and reduction observed in the social relationships domain and in the overall QoL/health facet. Within the four distinct patient groups, alcohol abuse/dependence patients were found to report the most seriously compromised QoL in most domains, while hypertensive and cancer patients did not report extensive and significant differences at the domain level. However, significant differences between patient groups were observed at the facet level. For example, regarding the physical domain, physically ill participants reported more compromised scores in the pain/discomfort facet, while mentally ill participants in the facets of energy/fatigue, daily living activities and dependence on medication.

CONCLUSION

The findings of the study indicate that the Greek version of WHOQOL-100 provided satisfactory psychometric properties supporting its use within general and pathological populations and in the context of national and crosscultural QoL measurement.

Associação da qualidade de vida com dor, ansiedade e depressão

O objetivo deste estudo foi verificar associação entre qualidade de vida relacionada à saúde e dor, ansiedade e depressão em indivíduos de 35 a 60 anos. Foram avaliados 304 indivíduos (244 mulheres, 60 homens) com queixa de dor, divididos em três grupos segundo a característica da dor: dor difusa e crônica (DDC), dor regional (DR) e dor esporádica (DE). A intensidade da dor foi avaliada por uma escala visual analógica, ansiedade pelo Inventário de Ansiedade Traço-Estado, depressão pela escala de depressão de Beck e a qualidade de vida (QV), pelo questionário Short-Form Health Survey - SF-36. A média de idade foi 49,1±6,8 anos; 80,3% eram do sexo feminino; e 35% da amostra referiu dor difusa e crônica. Os resultados mostram que o grupo DDC apresentou os sintomas mais intensos de dor, ansiedade, depressão e pior qualidade de vida, seguido pelos grupos DR e DE, com diferença estatisticamente significante (p<0,001). A correlação entre qualidade de vida e depressão foi forte (r=-0,73) e moderada entre qualidade de vida e dor (r=-0,41), entre QV e ansiedade-traço (r=-0,65), e entre QV e ansiedade-estado (r=-0,58) (p<0,0001). Os indivíduos com dor difusa e crônica foram pois os que apresentaram os sintomas mais intensos e pior qualidade de vida; e esta mostrou-se correlacionada negativamente à depressão, dor e ansiedade.

Quality of life across the schizotypy spectrum: findings from a large nonclinical adult sample

OBJECTIVE

It is well documented that patients with schizophrenia have impoverished quality of life (QOL). Efforts to determine the underpinnings of this impoverishment have implicated negative symptoms more than positive or disorganized symptoms. However, only a minority of individuals with the liability to schizophrenia will ever show manifest illness, and it is presently unclear the degree to which QOL is affected in individuals with subclinical symptoms of the disorder (ie, schizotypy). The present study examined the relative contributions of negative, positive, and disorganized schizotypy symptoms to QOL.

METHODS

Measures of schizotypal symptoms and subjective and objective QOL were obtained from a sample of 1395 adults.

RESULTS

Measures of schizotypal symptoms significantly corresponded to all measures of QOL, although the magnitude of correlations were significantly larger for subjective than objective measures. The negative symptom dimension explained a substantial portion of unique variance in the social domains of QOL above and beyond that accounted for by the other schizotypy dimensions.

CONCLUSIONS

These findings highlight the deleterious impact of schizotypal symptoms, particularly negative symptoms. Further research clarifying the mechanism underlying this relationship is called for.

Psychometric properties of the Satisfaction with Daily Occupations (SDO) instrument and the Manchester Short Assessment of Quality of Life (MANSA) in women with scleroderma and without known illness

This study investigated whether two instruments devised for people with mental illness, the Satisfaction with Daily Occupations (SDO) instrument and the Manchester Short Assessment of Quality of Life (MANSA), showed appropriate psychometric properties in terms of internal consistency, convergent/divergent validity, and discriminant validity when used with other samples. The study group comprised two female samples, one with physical disability (scleroderma) and one reference sample without known illness. It was hypothesized that the associations from SDO would be low or moderate to both general life satisfaction and self-rated health. The results confirmed that the associations were equal in size in both samples, but still the relationship to general life satisfaction in the scleroderma sample was somewhat higher than expected. Regarding the MANSA quality of life, the hypotheses were that the quality of life-index would show high correlations with general life satisfaction and moderate with self-rated health, and these hypotheses were confirmed for the reference sample, indicating that quality of life as measured by the MANSA converged with general life satisfaction but mainly diverged from self-rated health. In the scleroderma sample, the association to health was higher than expected. Both instruments appeared to reflect constructs that were stable across the two investigated groups, and both measures could distinguish the disability group from the healthy group. The SDO obtained a good value on internal consistency in the sample with scleroderma but a somewhat low value in the reference group, while the quality of life aspect of the MANSA exhibited good internal consistency in both samples. The instruments showed promising properties, indicating that they could be used for the target groups. However, both measures need further testing of psychometric properties.

Effect of thought disorders on quality of life in patients with schizophrenia

OBJECTIVE

The aim of the present study was to investigate the impact of thought disorder on quality of life in patients with schizophrenia.

METHODS

Seventy two patients with schizophrenia and 46 healthy subjects were included in the study. World Health Organization Quality of Life Instrument Short Forum (WHOQOL-BREF) was given to patients and healthy subjects to assess quality of life. Thought and Language Index (TLI) for thought disorders, Positive and Negative Syndrome Scale (PANNS) for symptom and Calgary Depression Scale (CDS) for depressive symptoms were administered to the patients.

RESULTS

The comparison of quality of life between patients and healthy subjects showed a significant difference except environmental domain. There were no significant correlations between thought disorder and quality of life in patients with schizophrenia.

CONCLUSION

The present study revealed that quality of life was lower in patients with schizophrenia compared to healthy subjects. There was no relation between thought disorders and quality of life in schizophrenia. Patients with schizophrenia were aware of their quality of life perception.

Health-related quality of life in patients with conversion disorder with seizures

Objective. The concept of Health-Related Quality of Life (HRQOL) is important for both the prevention and progress of psychiatric diseases. In the literature, we are aware that there are a few studies on HRQOL among patients with conversion disorder with seizure. Our aim is to measure the HRQOL in Turkey among patients with conversion disorder with seizure and to compare the quality of life of this study group to a healthy control group and to different types of epileptic patient groups. Methods. A total of 330 subjects was included in this study; 102 patients were included in the conversion disorder group, 121 patients were included in the epileptic group and 93 subjects were included in the healthy control group. WHOQOL-100 scale and Trait Anxiety Inventory (TAI) were administered to these groups. Results. HRQOL for the patients with conversion disorder was worse than the control group except for the environment and social relations domains. The generalized epilepsy patients had better physical and psychological health, compared with the patients with conversion disorder. Compared with the partial epilepsy group, HRQOL for the patients with conversion disorder was better in psychological, environmental, social relationship domains. Conclusion. Considering these disorders, patients with conversion disorder need long-term psychiatric treatment. Carrying out this study in our country will be an advantage for the cross-cultural studies which will be undertaken out in the future.

Sexuality and quality of life

The purpose of this research was to explore the relationships between sexual activity and intimacy and quality of life (QOL) of older adults. The authors' research question was "To what extent do age, gender, marital status, health status, education, satisfaction with personal relationships, sexual activity, and satisfaction with intimacy explain older adults' ratings of QOL?" A secondary analysis was conducted using results from a cross-sectional survey. Data were available from a convenience sample of 426 individuals living in British Columbia, Canada, who volunteered to complete the questionnaire. Instruments included the WHOQOL-100, WHOQOL-OLD, and a demographic data sheet. It was found that the strongest contributors to the variance of overall QOL were satisfaction with personal relationships, followed by health status andsexual activity. Age, gender, marital status, and education were not significant. The implications for gerontological nurses include the need to support personal relationships for older adults, to encourage health promotion, and to ensure sexuality is discussed with older adults.

Quality of life for patients with schizophrenia in a Japanese psychiatric hospital

Providing a good quality of life (QOL) has recently been recognized as a central purpose of health care in psychiatry. In this study, we performed a detailed evaluation of the subjective QOL of schizophrenic inpatients and examined the relationship of QOL to various patient characteristics. This study was conducted on schizophrenic inpatients and nursing staff members in a Japanese private psychiatric hospital. As a result, only depression showed a weak, but significant, relationship with subjective QOL. Other characteristics showed no meaningful correlation to subjective QOL. Comparison between the schizophrenic group and the nursing staff group revealed that schizophrenic inpatients showed a lower QOL in the domains of physical health and social relationships. Schizophrenia itself and/or accompanying disabilities might induce lower subjective QOL. It is difficult to determine what the important factors are, except for depression, for subjective QOL of schizophrenic inpatients. However, depression should receive more attention for the QOL in the physical health and psychological health domains.

Quality of life in the Palestinian context: an inquiry in war-like conditions

This study aims to elucidate the concept of quality of life (QOL) in a unique environment characterized by protracted and ongoing conflict, beginning with the utilization of the WHOQOL-Bref as a starting point for discussion. It works to determine important health-related quality of life domains and items within each domain, and evaluate issues pertinent to the Palestinian population's understanding of life quality in the Occupied Palestinian Territory. Focus group discussions (FGD) were conducted with individuals living in the Gaza Strip and Ramallah District of the West Bank. Participants were asked if they understood the term QOL; and about the determinants of their own QOL, using open-ended questions. Participants were then presented with the WHOQOL-Bref questions and requested to assess their relevance and importance in determining their own QOL, and encouraged to suggest additional ones. A total of 150 men and women of various ages and socioeconomic classes participated in 13 FGD. A major finding is the all-encompassing impact of the political context on Palestinians' QOL assessment. The study demonstrates that political freedom, self-determination, participation in democratic processes and feeling involved in political decision-making are considered important contributors to people's QOL. The study raises the option of adding a new domain to the WHOQOL-Bref, allowing the study of its psychometric properties and its relationship to the rest of the instrument. This contribution should be particularly relevant to societies and cultures in conflict-affected zones and locales where violence and insecurity constitute an important part of life. The documentation of QOL, beyond fatal and non-fatal health outcomes, must remain an important objective of all evaluations in order to guide policy and resource allocation decisions directed towards improving peoples' lives in general and their health in particular.

Correlates of health-related quality of well-being in older patients with schizophrenia

Research on correlates of health-related quality of life (HRQOL) among older patients with schizophrenia has been very limited. This study evaluated the relative impact of positive, negative, and depressive symptoms, movement disorders, and cognitive impairment on HRQOL among middle-aged and older patients with schizophrenia or schizoaffective disorder. Participants were 199 patients aged 45 to 85 years. The study was cross-sectional. The primary outcome measure was the Quality of Well-Being scale, and correlates were measures of positive and negative symptoms, depression, abnormal movements, and cognitive performance. Severity of depressive symptoms and of cognitive impairment correlated significantly with HRQOL and independently affected HRQOL scores. The initiation/perseveration subscale of the Dementia Rating Scale had the largest impact. These findings suggest that depressive symptoms and cognitive functioning should be part of the routine assessment of older people with schizophrenia and may be targets for psychopharmacological and psychosocial interventions to improve HRQOL.

The WHO Quality of Life Assessment Instrument (WHOQOL-100)

This study scrutinizes the ability of the WHO quality of life assessment instrument (WHOQOL-100) to discriminate (1) between psychiatric outpatients and the general population, and (2) between subgroups of psychiatric outpatients. A sample of Dutch adult psychiatric outpatients (N = 410) completed the WHOQOL-100. In addition, DSM-IV Axis-I and Axis-II diagnoses were obtained. Compared with the general population, psychiatric outpatients scored significantly lower on all aspects of self-reported quality of life (QOL). Within the group of outpatients, participants with DSM-IV diagnoses had lower scores than those without. Participants with diagnoses on both Axis-I and Axis-II of DSM-IV (comorbidity) had the lowest self-reported QOL. It is concluded that in psychiatric outpatients, outcome scores of self-reported QOL were negatively related to presence and degree of psychopathology. The WHOQOL-100 has good discriminant ability for psychiatric outpatients.

PANSS syndromes and quality of life in schizophrenia

BACKGROUND

Results from factor analysis studies have suggested that a five-dimensional structure appears to be a better representation of the psychopathological data of the PANSS. The purpose of this study was the detailed investigation of the association of schizophrenia syndromes and single symptoms with quality of life (QOL) in acute and remitted patients. The leading hypotheses were: (1) affective symptoms, especially depression and anxiety, are mostly associated with QOL longitudinally and (2) in the acute phase, QOL is also associated with positive schizophrenia symptoms.

METHODS

For the present study, schizophrenia and schizophreniform patients were studied on admission, at the end of the acute phase and 6 months after hospitalization. Psychopathology was measured using the PANSS syndromes, QOL was assessed using disease-specific (SWN) and generic (MLDL, EDLQ) scales.

RESULTS

Eighty-four patients entered the study and were assessed during the acute phase taking into account their history and actual treatment. Results revealed anxiety as the most important symptom and depression as the most important syndrome associated with different areas of QOL during and after hospitalization. Also cognitive and negative symptoms were associated with different QOL domains, but both positive symptom clusters showed no substantial association with QOL.

CONCLUSIONS

Results of this longitudinal study investigating psychopathology and QOL in schizophrenia provide further support for the need to consider the psychopathological state and treatment setting when measuring QOL in schizophrenia and the need for a differential analysis of schizophrenia symptoms and QOL in the acute, mid-term and long-term phase. Anxiety reduction should be a critical goal of treatment in order to prevent further QOL impairment.

Validation of a subjective quality of life questionnaire (S.QUA.LA) in schizophrenia

We developed and validated a self-administered questionnaire (Subjective Quality of Life Analysis, S.QUA.L.A.) to measure subjective quality of life. S.QUA.L.A. is a multidimensional instrument. This scale includes 22 domains of life. It covers traditional areas (food, family relation etc)., and more abstract aspects of life (politic, justice, freedom, truth, beauty and art, love). For each domain, patients are asked to evaluate their degree of satisfaction. They have also to indicate how important this domain is for them. We questioned 92 patients with schizophrenia and 357 para-medical students. The research demonstrated reproducibility, high internal consistency reliability, and sensitivity to change. Principal components analysis with varimax rotation was performed. A five-factor solution was selected, showing a great contribution of different dimensions of the self. Determinants of quality of life were identified by using correlations with Lehman's Quality of Life Interview (QOLI), and with measures of psychopathology and social functioning. Satisfaction approach and QOLI showed the same construct. We confirmed the influence of symptoms of depression and anxiety on subjective quality of life assessment, and the poor impact of disease parameters.