Determinants of quality of life among people diagnosed with schizophrenia at outpatient clinics

Quality of life among people living with mental illness and predictors in Africa: a systematic review and meta-analysis

INTRODUCTION

Quality of life (QoL) of patients with mental illness has been examined internationally but to a lesser extent in developing countries, including countries in Africa. Improving QoL is vital to reducing disability among people with mental illness. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of QoL and associated factors among people living with mental illness in Africa.

METHODS

Using the PICOT approach, Scopus, MEDLINE, PsycINFO, CINAHL, Embase, the Web of Science, and Google Scholar were searched. A structured search was undertaken, comprising terms associated with mental health, mental illness, QoL, and a list of all African countries. The Joanna Briggs Institute Quality Appraisal Checklist is used to evaluate research quality. Subgroup analysis with Country, domains of QoL, and diagnosis was tested using a random-effect model, and bias was assessed using a funnel plot and an inspection of Egger's regression test. A p value, OR, and 95% CI were used to demonstrate an association.

RESULTS

The pooled prevalence of poor QoL was 45.93% (36.04%, 55.83%), I2 = 98.6%, p < 0.001). Subgroup analysis showed that Ethiopia (48.09%; 95% CI = 33.73, 62.44), Egypt (43.51%; 95% CI = 21.84, 65.18), and Nigeria (43.49%; 95% CI = 12.25, 74.74) had the highest mean poor QoL prevalence of the countries. The pooled prevalence of poor QoL by diagnosis was as follows: bipolar disorder (69.63%; 95% CI = 47.48, 91.77), Schizophrenia (48.53%; 95% CI = 29.97, 67.11), group of mental illnesses (40.32%; 95% CI = 23.98, 56.66), and depressive disorders (38.90%; 95% CI = 22.98, 54.81). Being illiterate (3.63; 95% CI = 2.35, 4.91), having a comorbid medical illness (4.7; 95% CI = 2.75, 6.66), having a low monthly income (3.62; 95% CI = 1.96, 5.27), having positive symptoms (0.32; 95% CI = 0.19, 0.55), and having negative symptoms (0.26; 95% CI = 0.16, 0.43) were predictors of QoL. Thus, some factors are significantly associated with pooled effect estimates of QoL.

CONCLUSIONS

The current systematic review and meta-analysis showed that almost half of patients with mental illness had poor QoL. Being illiterate, having a comorbid medical condition, having a low monthly income, having positive symptoms, and having negative symptoms of mental illness were independent predictors of poor QoL. This systematic review and meta-analysis emphasize that poor QoL of people with mental illness in Africa needs attention to reduce its negative consequences.

Effects of Goal Management Training on self-efficacy, self-esteem, and quality of life for persons with schizophrenia spectrum disorders

Persons with schizophrenia often show executive dysfunction assessed with both subjective (self-report) and objective (neuropsychological tests) measures. In a recent randomized controlled trial (RCT), subjective executive functioning in everyday life was improved following Goal Management Training (GMT). The aim of the current study is to investigate the potential of GMT to improve secondary well-being outcomes from that RCT, including self-esteem, self-efficacy, and quality of life in persons with schizophrenia spectrum disorders. Since well-being is frequently lower in persons with schizophrenia compared to healthy individuals, further knowledge about well-being as an outcome after cognitive remediation may have implications for clinical treatment. Sixty-five participants were randomly assigned to GMT (n = 31) or a waiting list control condition (n = 34). Assessments were conducted at baseline (T1), immediately after the intervention (T2-5 weeks), and at six-month follow-up (T3). Measures included the Rosenberg Self-Esteem Scale, the Perceived Quality of Life Scale, and the General Self-Efficacy Scale. Results were analyzed using a linear mixed model analysis for repeated measures. There were no significant effects of GMT on self-esteem or quality of life. Only the GMT group showed a significant increase in self-efficacy that was most evident at six months follow-up, F(1, 34) = 10.71, p = 0.002, d = 0.71. Improved self-efficacy was found to correlate significantly with a reduction in perceived executive dysfunction in an exploratory post hoc analysis. Our findings demonstrate the potential of GMT in improving self-efficacy in schizophrenia Clinical trial registration:https://clinicaltrials.gov, NCT03048695.

Influence of mental health service provision on the perceived quality of life among psychiatric outpatients: associations and mediating factors

Objective

To investigate the relationship between perceived mental health service provision and quality of life (QoL) as perceived by patients in psychiatric outpatient care.

Methods

A total of 373 adult patients registered at 15 psychiatric outpatient clinics in three regions in central and southern Sweden were included in the study. Survey data were collected using a questionnaire on mental health service provision, symptom severity, recovery, clinical diagnosis, sociodemographics (serving as independent variables) and QoL (serving as the dependent variable). Three aspects of mental health service provision were used: patients’ perceived quality of care, perceived staff-patient interaction, and patient reported psychiatric treatments. Structural equation modelling was used to model the relationship among the variables.

Results

Variables in mental health service provision showed few direct associations with patients’ perceived QoL. Instead, the associations of mental health service provision on QoL were mainly mediated through symptom severity and recovery. These relationships were retained after adjusting for sociodemographic variables and clinical diagnoses. The final model achieved excellent goodness of fit (χ2 = 49.502, p = 0.230, RMSEA = 0.020, CFI = 0.997 and a SRMR = 0.024).

Conclusion

This study shows that mental health service provision is associated with patients’ perceived QoL; however, this association is mostly indirect and mediated by reduced symptom severity and increased recovery. This finding can help inform the design of future interventions to enhance service provision to improve patients’ QoL.

A Systematic Review on the Effectiveness of Antipsychotic Drugs on the Quality of Life of Patients with Schizophrenia

Pharmacological antipsychotic drug interventions represent the cornerstone of the management of patients with schizophrenia and other psychotic spectrum disorders. The choice of the "best" treatment should be made on the basis of several clinical domains. However, despite available treatments, the quality of life reported by patients with schizophrenia taking antipsychotics is still very poor, and this outcome is rarely taken into account in trials assessing the efficacy and effectiveness of antipsychotic treatments. Therefore, we performed a systematic review in order to assess the impact of antipsychotic treatment on patients' quality of life. In particular, we aimed to identify any differences in the improvement in quality of life according to the (a) type of formulation of antipsychotic drugs (i.e., oral vs. depot vs. long-acting injectable); (b) type of the drug (first vs. second vs. third generation); and (c) patients' clinical characteristics. One hundred and eleven papers were included in the review. The main findings were as follows: (1) quality of life is usually considered a secondary outcome in trials on the efficacy and effectiveness of drugs; (2) second-generation antipsychotics have a more positive effect on quality of life; and (3) long-acting injectable antipsychotics are associated with a more stable improvement in quality of life and with a good safety and tolerability profile. Our systematic review confirms that quality of life represents a central element for selecting the appropriate treatment for people with schizophrenia. In particular, the availability of new treatments with a better tolerability profile, a proven effectiveness on patients' cognitive and social functioning, and with a more stable blood concentration might represent the appropriate strategy for improving the quality of life of people with schizophrenia.

Effects of Psychoeducation on People With Schizophrenia in Long-Term Care: An Intervention Study

The aim of the current study was to examine the effect of a psychoeducation intervention on knowledge, insight, and internalized stigma among people with schizophrenia in a long-term care (LTC) facility in Jordan. This study was conducted based on cluster randomization using a pre- and post-test design. The intervention group (n = 66) received seven sessions about schizophrenia over a 3-week period along with usual treatment. The control group (n = 56) received usual treatment only. The psychoeducation intervention significantly improved knowledge (15.5%) and insight (22.5%) and reduced stigma (18%) among participants in the intervention group compared to the control group (2.6%, 4.7%, and 3.6%, respectively). This study shows the importance of integrating psychoeducation interventions in routine care for people with schizophrenia in LTC. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 9-18.].

Impact of Cognitive Impairments on Health-Related Quality of Life in Schizophrenia

The impact of cognitive impairments on the health-related quality of life (HRQoL) in individuals with schizophrenia is unclear. The aim of this study was to examine the association between cognitive impairments and HRQoL in individuals with schizophrenia. A total of 609 individuals with schizophrenia were assessed on the Positive and Negative Syndrome Scale (PANSS) and a neurocognitive battery which comprised of the Wechsler Abbreviated Scale of Intelligence matrix reasoning, the Benton Judgment of Line Orientation Test, Continuous Performance Tests-Identical Pairs, and the Brief Assessment of Cognition in Schizophrenia. A cognitive factor g was derived from the neurocognitive battery. EuroQol five-dimensional (EQ-5D-5L) utility scores were derived from PANSS scores via a previously validated algorithm and used as a measure of HRQoL. Hierarchical multiple regression was conducted to examine the association between cognitive factor g and the EQ-5D-5L. Cognitive factor g (β = 0.189, t = 4.956, p < 0.001) was found to be significantly associated with EQ-5D-5L scores. Age (β = -0.258, t = -6.776, p < 0.001), sex (β = 0.081, t = 2.117, p = 0.035), and being employed (β = 0.091, t = 2.317, p = 0.021) were also significant predictors of EQ-5D-5L. Our results add to the extant literature on the burden cognitive impairments exact in individuals with schizophrenia. More research is needed to develop effective interventions for cognitive impairments in schizophrenia.

Quality of Life in Patients with Chronic Psychotic Disorders: A Practical Model for Interventions in Romanian Mental Health Centers

Background and Objectives: Current psychiatric care is increasingly focusing on patients' quality of life (QoL). Research is still trying to determine the main factors which influence QoL. The present study aims to assess the QoL of patients with chronic psychotic-spectrum disorders, as well as its relation to symptomatology, functionality, adaptive behavior, and perceived level of recovery. Materials and Methods: The study included a sample of 78 patients with chronic psychosis. Symptomatology and illness severity were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale-Severity (CGI-S) scales, respectively. The Global Assessment of Functioning Scale (GAFS) and the Adaptive Behavior Assessment System II (ABAS-II)-Adult Form were used for the assessment of patients' functionality, and the Quality-of-Life Inventory (QOLI) scale was applied for the evaluation of QoL. Results: According to the CGI-Severity scale, 20.5% of the patients were borderline mentally ill, and 24.4% were mildly ill. The highest number of patients (34.6%) were moderately ill, while 14.1% and 2.6% were markedly ill and severely ill, respectively. Among the moderately ill patients, more than half (63%) were patients with schizophrenia, 18.5% were patients with delusional disorder, and 18.5% were patients with schizoaffective disorder. Most of the patients (43.6%) presented moderate functioning deficiency, while 38.5% of the patients presented severe deficiency, according to the GAFS score. When assessed with the ABAS, we observed that almost half of the patients (44.9%) showed an average functioning across skill areas in the conceptual, social, and practical domains. A percent of 67.9% of the patients presented an average QoL, while 15.4% and 12.8% showed a very low and low QoL. QoL was not influenced by the patients' symptomatology, gender, and education level. Having children, family support, better social and conceptual skills, and a higher perceived level of recovery was correlated with an increased QoL, hierarchical multiple regression R2 = 0.379, F(9, 68) = 2.616, and p = 0.012. Conclusions: Psychiatric interventions in psychosis should focus not only on symptoms' control, but also on improving social and family support, as well as adaptive skills to increase the patients' QoL.

Knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among people diagnosed with schizophrenia in a long-term care facility

PURPOSE

This study assessed the level of knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among patients with schizophrenia in Jordan.

DESIGN AND METHODS

A cross-sectional survey was conducted on 135 patients diagnosed with schizophrenia, who had been admitted to the largest psychiatric hospital in Jordan.

FINDINGS

The participants had a low level of knowledge, insight, and a high level of internalized stigma. No correlation was found between these variables. Meanwhile, the educational level and vacation were found to be predictors of knowledge.

PRACTICE IMPLICATIONS

This can help psychiatric nurses to identify which area needs to be improved to ensure the best service and care is provided to patients diagnosed with schizophrenia.

Phenome-wide and genome-wide analyses of quality of life in schizophrenia

BACKGROUND

Schizophrenia negatively affects quality of life (QoL). A handful of variables from small studies have been reported to influence QoL in patients with schizophrenia, but a study comprehensively dissecting the genetic and non-genetic contributing factors to QoL in these patients is currently lacking.

AIMS

We adopted a hypothesis-generating approach to assess the phenotypic and genotypic determinants of QoL in schizophrenia.

METHOD

The study population comprised 1119 patients with a psychotic disorder, 1979 relatives and 586 healthy controls. Using linear regression, we tested >100 independent demographic, cognitive and clinical phenotypes for their association with QoL in patients. We then performed genome-wide association analyses of QoL and examined the association between polygenic risk scores for schizophrenia, major depressive disorder and subjective well-being and QoL.

RESULTS

We found nine phenotypes to be significantly and independently associated with QoL in patients, the most significant ones being negative (β = -1.17; s.e. 0.05; P = 1 × 10-83; r2 = 38%), depressive (β = -1.07; s.e. 0.05; P = 2 × 10-79; r2 = 36%) and emotional distress (β = -0.09; s.e. 0.01; P = 4 × 10-59, r2 = 25%) symptoms. Schizophrenia and subjective well-being polygenic risk scores, using various P-value thresholds, were significantly and consistently associated with QoL (lowest association P-value = 6.8 × 10-6). Several sensitivity analyses confirmed the results.

CONCLUSIONS

Various clinical phenotypes of schizophrenia, as well as schizophrenia and subjective well-being polygenic risk scores, are associated with QoL in patients with schizophrenia and their relatives. These may be targeted by clinicians to more easily identify vulnerable patients with schizophrenia for further social and clinical interventions to improve their QoL.

Depressive symptoms and quality of life in people with a diagnosis of schizophrenia: An exploratory study of the potential mediating role of health-promoting lifestyles

PURPOSE

To examine health-promoting lifestyles mediates the relationship between depressive symptoms and quality of life (QOL) in people with schizophrenia.

DESIGN AND METHODS

A cross-sectional exploratory study design was conducted. Two-hundred and seventy-three participants were administered demographic data, health-promoting lifestyle profile, Beck Depression Inventory II, and World Health Organization Quality of Life-BREF. The Hayes PROCESS macro was employed to analyze data.

FINDINGS

The results showed self-actualization fully mediated the environmental domain of QOL, physical health, psychological health, and social relationships domains were partial mediation.

PRACTICE IMPLICATIONS

This study recommends that professionals reinforce persons' self-actualization when the QOL is affected by depressive symptoms in people with schizophrenia.

Hope and belonging in patients with schizophrenia: A phenomenological study

PURPOSE

The aim of this study was to examine in depth the senses of hope and belonging in patients with schizophrenia and factors which affect these.

DESIGN AND METHODS

The data were collected through the phenomenological interview method and interpreted using Strauss and Corbin's approach to qualitative data analysis.

FINDINGS

Patients with schizophrenia reported that having hope and feeling a sense of belonging were very important to them and patients with the same diagnosis, and that being accepted by society, being employed and being productive increased their senses of both hope and belonging.

PRACTICE IMPLICATIONS

For the rehabilitation of patients with schizophrenia, which is a chronic disease, psychiatric nurses should carry out activities which increase their senses of hope and belonging.

Quality of life and its association with psychiatric symptoms and socio-demographic characteristics among people with schizophrenia: A hospital-based cross-sectional study

OBJECTIVES

To identify sociodemographic and illness-related factors associated with quality of life among people with Schizophrenia.

METHODS

A hospital-based cross-sectional study design was employed among 351 people with schizophrenia and attending the followup service at Jimma University Medical Center, psychiatric clinic during the study period. Participants were recruited using a systematic random sampling method and a sample fraction of two was used after the first person was identified by a lottery method. Data entry was done using EpiData version 3.1 and then exported to Statistical Package for Social Sciences version 25 for analysis. Multiple regression analysis was used to determine the statistically significant association between quality of life and independent variables.

RESULTS

Among the four domains of quality of life, respondents scored the lowest mean in the social relationships domain (10.14 ± 3.12). Final adjusted multiple regression model revealed, being divorced was negatively associated with the physical domain (β = -0.72, p = 0.02), having no formal education was negatively associated with physical health domain (β = -0.69, p = 0.001) and age was positively associated with the psychological domain (β = 0.371, p = 0.071). Being rural resident was negatively associated with physical domain (β = -0.48, p = 0.01), with environmental domain (β = -0.64, p = 0.03), with social relationships domain (β = -0.45, p = 0.04), and with overall quality of life (β = -1.93, p = 0.006). Positive symptoms (β = -0.22, p = 0.001), negative symptoms (β = -0.36, p = 0.001), and general psychopathology (β = -0.098, p = 0.006) were inversely associated with overall quality of life.

CONCLUSION

In this study, the social relationship domain of quality of life among people with schizophrenia has the lowest mean score. Some socio-demographic variables and psychiatric symptoms were found to be key significant associated factors of quality of life. Priority interventions to improve the social deficits and addressing psychiatric symptoms of people with schizophrenia is essential to improve their quality of life.

Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study

BACKGROUND

Little is known about the respective effects of depression and cognitive impairment on quality of life among older adults with schizophrenia spectrum disorder.

METHODS

We used data from the Cohort of individuals with Schizophrenia Aged 55-years or more (CSA) study, a large multicenter sample of older adults with schizophrenia or schizoaffective disorder (N = 353). Quality of life (QoL), depression and cognitive impairment were assessed using the Quality of Life Scale (QLS), the Center of Epidemiologic Studies Depression scale and the Mini-Mental State Examination, respectively. We used structural equation modeling to examine the shared and specific effects of depression and cognitive impairment on QoL, while adjusting for sociodemographic characteristics, general medical conditions, psychotropic medications and the duration of the disorder.

RESULTS

Depression and cognitive impairment were positively associated (r = 0.24, p < 0.01) and both independently and negatively impacted on QoL (standardized β = -0.41 and β = -0.32, both p < 0.01) and on each QLS quality-of-life domains, except for depression on instrumental role and cognitive impairment on interpersonal relations in the sensitivity analyses excluding respondents with any missing data. Effects of depression and cognitive impairment on QoL were not due to specific depressive symptoms or specific cognitive domains, but rather mediated through two broad dimensions representing the shared effects across all depressive symptoms and all cognitive deficits, respectively.

LIMITATIONS

Because of the cross-sectional design of this study, measures of association do not imply causal associations.

CONCLUSIONS

Mechanisms underlying these two broad dimensions should be considered as important potential targets to improve quality of life of this vulnerable population.