Patient-reported needs predict perceived psychosocial disability and quality of life beyond symptom severity in schizophrenia

Symptom contributors to quality of life in schizophrenia: Exploratory factor and network analyses

Individuals with schizophrenia and other associated disorders experience significant disturbance to their quality of life (QoL) due to a multitude of co-occurring symptoms. Popular evidence-based practices (EBPs) devote significant effort to reduce positive symptomatology in order to prevent relapse, while emerging research posits that other symptoms (cognitive deficits, negative and affective symptoms) are more indicative of QoL disturbance. This study sought to examine the impact of symptom constructs on QoL and attempt to infer directionality of influence via network analysis. A total of 102 recovery phase adult outpatients with schizophrenia spectrum disorders were assessed on positive, negative, and affective symptomatology, in addition to QoL and cognitive abilities. Exploratory factor analysis and network analysis were performed to identify associations and infer directed influence between symptom constructs, and a directed acyclic graph was constructed to observe associations between symptom domains and QoL. Factor analysis results indicated that individual measures align with their respective symptom constructs. Strong factor correlations were found between QoL and the negative and affective symptom constructs, with weaker associations found between positive symptoms and cognition. Visualization of the network structure illustrated QoL as the central cluster of the network, and examination of the weighted edges found the strongest connectivity between QoL, negative symptomatology, and affective symptoms. More severe negative and affective symptoms were most directly linked with poorer QoL and may prove to be integral in attaining positive outcomes in schizophrenia treatment. Incorporation of psychosocial treatments in addition to pharmacotherapy may prove effective in targeting negative and affective symptoms.

The preferences for the telemedicine and standard health care services from the perspective of the patients with schizophrenia

BACKGROUND

With the rapid development of telemedicine, has enabled new and various ways to deliver health care services for patients with schizophrenia. However, it is not clear that the newly emerged is better than the standard or not from the perspective of patients with schizophrenia. This study aims to explore their preferences between telemedicine and standard health care services and their associated factors.

METHODS

The cross-sectional study was conducted at the Ningan hospital's inpatient department in Yinchuan, and collected socio-demographic and clinical information, the preferences regarding telemedicine (WeChat, telephone, and Email), and the standard health care services (community health center and home visit). The socio-demographic and clinical characteristics associated with the five-health care service delivery ways were assessed by descriptive analysis, and the associated impact factors of preferences of patients with schizophrenia were analyzed by multiple logistic regression.

RESULTS

Among the 300 participants, most of them chose WeChat (46.3%), some of them tended to telephone (35.4%) and community health center (11.3%), and a few of them accepted home visits (4.7%), and Email (2.3%). There are so many associated factors that affected the patients with schizophrenia to choose their favorite health care services, of which age, gender, employment, residence, and duration of illness were the independent impact factors.

CONCLUSIONS

The cross-sectional study surveyed the preferences between telemedicine and standard health care services in patients with schizophrenia's opinion, disclosed independent impact factors, as well as compared the advantage and disadvantages of these. According to our findings, the best health care services should be based on the preferences of the patients with schizophrenia and adapt to realistic conditions. This provides valuable evidence to improve the health care situation, facilitate the continuity of health care services, and achieve holistic rehabilitative outcomes for the patients with schizophrenia.

Psychopathological Determinants of Quality of Life in People with Borderline Personality Disorder

BACKGROUND

Subjective quality of life (SQOL) in people with borderline personality disorder (BPD) is a marker of disease burden; a crucial treatment outcome; an indicator of psychosocial functioning; and a measure of interventions' effectiveness. Given the dearth of consolidated data, the current study examined psychopathological determinants of global and domain-specific SQOL in people with BPD.

METHODS

Hierarchical regression models were employed to examine in BPD patients (n = 150) the relationships of the number of BPD diagnostic criteria; the co-occurrence of other personality disorders (PDs); depression; state and trait anxiety; suicidality; self-harming; alcohol and substance use disorders with SQOL indices, namely physical health, psychological health, social relationships, environment, overall QOL and overall health. SQOL was estimated using the WHOQOL-BREF instrument.

RESULTS

Co-existing symptomatology such as depression, state and trait anxiety, and personality pathology, namely the co-occurrence of other PDs, exhibited significant associations with global and domain-specific SQOL, albeit depression was the strongest determinant of the most SQOL domains. In contrast, the number of BPD diagnostic criteria and central illness features such as suicidality, self-harming behaviour, and impulsivity manifested through alcohol and substance use did not exhibit significant associations with any SQOL dimension.

CONCLUSIONS

Comprehensive assessment of depressive symptoms should be regularly implemented in BPD services to facilitate early detection and treatment, thereby ensuring patients' SQOL. Accordingly, tackling anxiety and other PDs co-occurrence through appropriate interventions can facilitate more effectively SQOL improvement. Our findings can be explained by the hypothesis that co-existing psychopathology such as depression, anxiety and co-occurrence of other PDs in BPD patients represent illness severity indices rather than comorbid disorders, and might fully mediate the effect of BPD traits on SQOL. Future mediation analysis is required to elucidate this hypothesis.

Fear of COVID-19 Impact on Professional Quality of Life among Mental Health Workers

Several studies have examined the impact of the COVID-19 pandemic on healthcare workers' mental health, but only a few have investigated its detrimental effect on the mental well-being of mental health workers (MHWs).

BACKGROUND

The current study aimed to explore the effect of the fear of COVID-19 (FCV-19) on professional quality of life dimensions, namely compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in MHWs above and beyond sociodemographic and professional factors.

METHODS

Hierarchical linear regression models were employed to examine the relationship of extreme FCV-19 with CS, BO, and STS in MHWs (n = 224), after considering sociodemographic variables as potential confounding factors. Extreme FCV-19 was operationalized as a binary variable with a cut-off score of ≥16.5 considered as extreme fear.

RESULTS

We found that extreme FCV-19 in MHWs is linked with increased compassion fatigue (BO and STS), and this relationship is exacerbated by younger age in regard to BO and by female gender concerning STS. CS remains unaffected by severe FCV-19, and it is higher in older participants.

CONCLUSION

Organizational support is required to protect MHWs' mental well-being and ensure the quality of care they provide during prolonged crises, such as the COVID-19 pandemic. Measures that intensify a sense of safety, protection, and control against COVID-19 infections in mental health services should be included in the recommendations that may reduce BO and STS among MHWs.