A comparison of the quality of life of severely mentally ill people in UK & German samples

Depression severity mediates stigma and quality of life in clinically stable people with schizophrenia in rural China

BACKGROUND

Depressive symptoms associated with schizophrenia are closely related to stigma and quality of life(QOL). There is, however, no thorough research on the connection between the three. This study sought to investigate the possible factors influencing depressive symptoms in people with schizophrenia (PWS) in rural Chaohu, China, and to further explore the role of depression severity in stigma and lifestyle quality.

METHODS

Eight hundred twenty-one schizophrenia patients accomplished the entire scale, including the 9-item Patient Health Questionnaire (PHQ-9), the Social Impact Scale (SIS), and the World Health Organization on Quality of Life Brief Scale(WHOQOL-BREF). A straightforward mediation model was employed to determine if the intensity of the depression could act as a mediator between stigma and QOL.

RESULTS

Two hundred seventy-nine schizophrenia patients (34%) had depressive symptoms (PHQ ≥ 10), and 542 patients (66%) did not (PHQ < 10). Logistic regression showed that marital status, job status, physical exercise, standard of living, and stigma contributed to the depressed symptoms of schizophrenia. Depression severity partially mediated the effect between stigma and QOL, with a mediating effect of 48.3%.

CONCLUSIONS

This study discovered a significant incidence of depressed symptoms associated with schizophrenia, with depression severity serving as a mediator variable connecting stigma and QOL and partially moderating the association.

Typology of individuals with substance dependence based on a Montreal longitudinal catchment area study

This study sought to develop a typology of individuals with substance dependence (ISD) based on a longitudinal survey (n = 2,434) and 121 ISD. The latter were divided into three groups: newly abstinent individuals, chronic dependents and acute dependents. Individuals' typology was developed by cluster analysis. Newly abstinent individuals had fewer emotional problems and mental disorders in the previous 12 months. Four classes of ISD were identified, labelled respectively "chronic multi-substance consumption and mental disorders comorbidities," "multi-substance consumption," "alcohol and marijuana consumption" and "alcohol consumption only." Strategies adapted to each of these profiles could be promoted for more effective treatment.

A cluster-analytical approach toward real-world outcome in outpatients with stable schizophrenia

BACKGROUND

This study aims to empirically identify profiles of functioning, and the correlates of those profiles in a sample of patients with stable schizophrenia in a real-world setting. The second aim was to assess factors associated with best profile membership.

METHODS

Three hundred and twenty-three outpatients were enrolled in a cross-sectional study. A two-step cluster analysis was used to define groups of patients by using baseline values for the Heinrichs-Carpenter Quality of Life Scale (QLS) total score. Logistic regression was used to construct models of class membership.

RESULTS

Our study identified three distinct clusters: 50.4% of patients were classified in the "moderate" cluster, 27.9% in the "poor" cluster, 21.7% in the "good" cluster. Membership in the "good" cluster versus the "poor" cluster was characterized by less severe negative (OR=.832) and depressive symptoms (OR=.848), being employed (OR=2.414), having a long-term relationship (OR=.256), and treatment with second-generation antipsychotics (SGAs) (OR=3.831). Nagelkerke R(2) for this model was .777.

CONCLUSIONS

Understanding which factors are associated with better outcomes may direct specific and additional therapeutic interventions, such as treatment with SGAs and supported employment, in order to enhance benefits for patients, as well as to improve the delivery of care in the community.

Are self-stigma, quality of life, and clinical data interrelated in schizophrenia spectrum patients? A cross-sectional outpatient study

BACKGROUND

Current research attention has been moving toward the needs of patients and their consequences for the quality of life (QoL). Self-stigma is a maladaptive psychosocial phenomenon disturbing the QoL in a substantial number of psychiatric patients. In our study, we examined the relationship between demographic data, the severity of symptoms, self-stigma, and QoL in patients with schizophrenia spectrum disorder.

METHODS

Probands who met International Classification of Diseases-10 criteria for schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, or delusional disorder) were recruited in the study. We studied the correlations between the QoL measured by the QoL Satisfaction and Enjoyment Questionnaire, self-stigma assessed by the Internalized Stigma of Mental Illness, and severity of the disorder measured by the objective and subjective Clinical Global Impression severity scales in this cross-sectional study.

RESULTS

A total of 109 psychotic patients and 91 healthy controls participated in the study. Compared with the control group, there was a lower QoL and a higher score of self-stigmatization in psychotic patients. We found the correlation between an overall rating of self-stigmatization, duration of disorder, and QoL. The level of self-stigmatization correlated positively with total symptom severity score and negatively with the QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and the score of self-stigma were significantly associated with the QoL.

CONCLUSION

Our study suggests a negative impact of self-stigma level on the QoL in patients suffering from schizophrenia spectrum disorders.

Predictive typology of subjective quality of life among participants with severe mental disorders after a five-year follow-up: a longitudinal two-step cluster analysis

BACKGROUND

This study aims to create a predictive typology of quality of life at five-year follow-up of 204 individuals with severe mental disorders, according to clinical, socio-demographic, and health service use variables.

METHODS

Participant typology was carried out by means of two-step cluster analysis. Independent variables were measured at T0 and subjective quality of life (SQOL) at T2.

RESULTS

Analysis yielded four classes. SQOL at T2 was higher than the mean in Class 4 ("Older, poorly educated single men living in supervised housing, with psychotic disorders but with few serious needs, receiving substantial help from services") and lower than the mean in Class 2 ("Young females with serious needs and co-occurring mental and addiction disorders living in independent apartments").

CONCLUSION

Given that predictive SQOL varies in relation to combinations of associated variables, it would be useful for treatments or service programs to target specific predictors to the different profiles.

Predictors of quality of life in a longitudinal study of users with severe mental disorders

Background

Since the end of the 20th century, quality of life has become a key outcome indicator in planning and evaluation of health services. From a sample of 297 users with severe mental disorders from Montreal (Canada), this study aimed to identify the key predictors of subjective quality of life (SQOL).

Methods

Users were recruited and interviewed from December 2008 to September 2010 and re-interviewed approximately 18 months later. A comprehensive framework including socio-demographic data, clinical, needs and functionality variables, negative life events, social support and healthcare service use, and appreciation data were considered as predictors. Clinical records and eight standardized instruments were used.

Results

Lower severity of needs, schizophrenia, better social integration, better reassurance of worth, fewer drug abuse problems, and living in supervised housing are predictors of SQOL. With regard to needs, absence or lower severity of needs in the areas of company, daytime activities, social exclusion, safety to self, and benefits are linked to SQOL.

Conclusion

Reducing the severity of needs is especially beneficial to ensure a higher SQOL for users with severe mental disorders. To improve SQOL, priority must be given to programs and interventions that promote the development of a stimulating and supportive social network, and maintain a plurality of residential services matching the functional abilities of users.

Influence of anxiety and depression on quality of life of people with schizophrenia in the eastern region of poland

Schizophrenia is the most severe and most debilitating mental illness, which is one of the first ten causes of disability in youth and elderly people. Regarding many consequences that schizophrenia brings for individual and social functioning of ill people, their assessment of the quality of their lives seems to be interesting. The aim of this study is to evaluate the incidence and severity of anxiety and depression as well as analysis of the impact level of anxiety and depression on life quality of people with schizophrenia. A group of patients with schizophrenia from psychiatric centers was involved in a study. A set of methods, included: author's questionnaire, the quality of life scale WHOQOL-BREF, and the hospital anxiety and depression scale (HADS). Anxiety disorders occurred in more than 78% of respondents, while depressive disorders in more than half of respondents. The more severe anxiety and depressive disorders, the lower values were observed in all tested components of quality of life. The study of quality of life of the mentally ill patients should be conducted on a continuous basis in order to explore the current factors influencing the improvement of their psychophysical welfare. It is necessary to promote prohealthy mental lifestyle.

Factors influencing subjective quality of life in patients with schizophrenia and other mental disorders: a pooled analysis

Subjective quality of life (SQOL) is an important outcome in the treatment of patients with schizophrenia. However, there is only limited evidence on factors influencing SQOL, and little is known about whether the same factors influence SQOL in patients with schizophrenia and other mental disorders. This study aimed to identify the factors associated with SQOL and test whether these factors are equally important in schizophrenia and other disorders. For this we used a pooled data set obtained from 16 studies that had used either the Lancashire Quality of Life Profile or the Manchester Short Assessment of Quality of Life for assessing SQOL. The sample comprised 3936 patients with schizophrenia, mood disorders, and neurotic disorders. After controlling for confounding factors, within-subject clustering, and heterogeneity of findings across studies in linear mixed models, patients with schizophrenia had more favourable SQOL scores than those with mood and neurotic disorders. In all diagnostic groups, older patients, those in employment, and those with lower symptom scores had higher SQOL scores. Whilst the strength of the association between age and SQOL did not differ across diagnostic groups, symptom levels were more strongly associated with SQOL in neurotic than in mood disorders and schizophrenia. The association of employment and SQOL was stronger in mood and neurotic disorders than in schizophrenia. The findings may inform the use and interpretation of SQOL data for patients with schizophrenia.

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

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

Empirical evidence for using subjective quality of life as an outcome variable in clinical studies A meta-analysis of correlates and predictors in persons with a major mental disorder living in the community

This paper presents data from a systematic review and meta-analysis of published quality of life (QOL) studies on the subjective general well-being (GWB) of persons with major mental disorder (MMD) who live in the community. Four research questions were addressed: (1) What is the subjective QOL in persons with MMD who live in the community? (2) Are any specific subjective subdomains of QOL superior predictors of subjective GWB? (3) Is there an association between measures of psychopathology and subjective GWB? (4) Is there an association between sociodemographic variables and subjective GWB? We initially considered 134 potentially relevant articles, but only 42 studies reporting on 49 study units (N=6774 persons with MMD) met criteria of acceptable quality or relevance to be included in the meta-analysis. First, we found that measures of subjective GWB were relatively high. Second, certain subdomains such as Leisure and Social relations were strong predictors of subjective GWB, while the links between both Personal safety and Work, and GWB were weak. Third, we found that the empirical basis for using subjective QOL as an outcome variable in clinical research is scant. In particular, the relationship between changes in measures of psychopathology and subjective QOL appears to be obscure. Finally, the present study failed to confirm any stable relationship between sociodemographic factors and subjective GWB in persons with MMD who live in the community. Consequences of the findings for clinical practice and research are discussed. Limitations inherent in the meta-analytic approach in general, and the lack of homogeneity in the reviewed studies, need to be considered when interpreting the results of this meta-analysis.

Quality of life in patients receiving opioid maintenance therapy. A comparative study of slow-release morphine versus methadone treatment

BACKGROUND/AIMS

In recent years, quality of life (QoL) assessments have proved useful for evaluating and comparing drug treatment programs. To compare QoL of patients maintained on methadone versus slow-release morphine, a prospective, randomized, double-blind, double-dummy, cross-over study was conducted.

METHODS

Over two 7-week study phases, participants received either oral slow-release morphine capsules followed by methadone oral solution or vice versa. QoL status was assessed at baseline, week 7, and week 14 using the German version of the Lancashire Quality of Life Profile.

RESULTS

No statistically significant difference was found between methadone and slow-release morphine in any QoL domain. A significant time effect for nearly all QoL domains was observed after 14 weeks of opioid medication, independent of the chosen drug (general well-being, p < 0.001; mental health, p = 0.001; general state of health, p = 0.018; leisure time at home, p = 0.034; leisure time out of the home, p = 0.008). Furthermore, this study revealed that even short-term maintenance yields significantly higher QoL scores in the important domain of general well-being.

CONCLUSION

These results indicate that slow-release morphine has effects comparable to methadone on patient-reported QoL data and is thus a promising option for treatment of opioid-dependent subjects.

Evaluation of schizophrenic patients quality of life

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

The quality of life of people with schizophrenia living in community in Rio de Janeiro, Brazil

INTRODUCTION

The influence of sociodemographics and clinical factors on the quality of life (qol) of an individual with schizophrenia is being widely studied, particularly in developed countries. The de-institutionalization process that is taking course in Brazil, to a less symptoms-focused approach, makes necessary the assessment of the qol of these patients living in the community.

OBJECTIVES

To evaluate factors related to the qol in patients diagnosed with schizophrenia or schizo-affective disorder, and who are users of one of the two municipal community mental health services of a Rio de Janeiro district, Brazil.

MATERIAL AND METHODS

A cross-sectional study was carried out. Selected patients were interviewed with Brazilian versions of Lancashire Quality of Life Profile, Brief Psychiatric Rating Scale and Calgary Depression Scale for Schizophrenia.

RESULTS

A total of 136 patients participated in the study. Most of them were single and lived with their relatives, had low educational level, were unemployed and had low income. A great number of the interviewed did not have any social contact outside the family and leisure activity, except watching television and/or listening to the radio. Finances and work situation had the lowest satisfaction level. Educational level, presence of positive and depressive symptoms, hospital admissions were negatively associated with qol. For those receiving state benefit, perceived qol increased with age. These predictors explained more than 42% of the total subjective qol score variance.

Fatores associados à qualidade de vida de pacientes com esquizofrenia

OBJETIVO: O tratamento de portadores de transtornos mentais graves e crônicos tem experimentado grandes mudanças no Brasil, com uma crescente valorização de tratamentos de base comunitária. Estes pacientes passam, concomitantemente, a receber um tratamento que valoriza antes a sua reinserção social e melhora das condições de vida, do que a mera abolição de seus sintomas principais. Assim, torna-se fundamental a avaliação da qualidade de vida dos pacientes vivendo na comunidade. MÉTODO: Uma revisão bibliográfica foi realizada com o objetivo de descrever a distribuição dos fatores sociodemográficos e clínicos que influenciam a qualidade de vida de indivíduos com esquizofrenia. RESULTADOS: Foram selecionados 25 estudos, a maior parte de países europeus. A maioria foi realizada na década de 90. Quase todos os estudos eram seccionais, e a maior parte avaliou amostras de indivíduos vivendo na comunidade. Os fatores sociodemográficos, excetuando a renda mensal, não se mostraram associados à qualidade de vida. Contudo, alguns estudos encontraram associações entre gênero, idade, estado civil e escolaridade com a qualidade de vida. Os sintomas depressivos e ansiosos se mostraram associados a uma pior qualidade de vida em diversos estudos. Observou-se associação similar quanto aos sintomas negativos e positivos da esquizofrenia, mas sem a mesma consistência. CONCLUSÕES: Os estudos não foram consistentes quanto à associação entre fatores sociodemográficos e clínicos e qualidade de vida de pacientes com esquizofrenia. É possível que essa heterogeneidade de achados seja decorrente tanto de aspectos vinculados à doença quanto ao desenho desses estudos, pouco adequados à investigação de associações causais.

Community mental healthcare in England: associations between service organisation and quality of life

The present authors set out to explore the relationship between different forms of service organisation and quality of life (QoL) for service users. Four mental health trusts and their corresponding social services departments were recruited to exemplify: (1). high and low levels of integration between health and social services; and (2). high and low levels of targeting at users with severe mental health problems. The authors used the Lancashire Quality of Life Profile, and chose their sample size to be able to detect a difference of 0.5 in subjective satisfaction scales. Analysis of covariance was used to investigate the simultaneous impact of variables representing user characteristics, objective and subjective QoL, and service organisation. Two hundred and sixty users selected at random from the active caseloads of mental health services in the four districts were interviewed at time 1 and 232 people were interviewed 6 months later (time 2). No bias was detected in the non-respondents at time 2. The authors found few differences between districts. As in other similar studies, QoL seemed to be stable for the whole sample over time. In 6 months, general satisfaction with leisure increased and the number of people who had been in hospital fell. Negative affect score was the only variable found to be associated with subjective QoL, and no predictors of objective QoL were identified. There was some evidence of better objective outcomes for people in receipt of integrated mental health services. They socialised more, and seemed to have less difficulty accessing police and legal services. The results also suggest that interventions targeted at negative affect could have benefits for subjective QoL.

Quality of life and other characteristics of Viennese mental health care users

BACKGROUND

The purposes of this study are (1) to characterise patients with different treatment experiences, (2) to evaluate differences in quality of life (QoL) among patients with different treatment experiences, (3) to evaluate changes in QoL following community resettlement, and (4) to find predictors of overall life satisfaction (OLS).

METHODS

Treatment experiences are defined according to service use as follows: (a) user of in- and outpatient services (overall users), (b) user of inpatient (inpatients) or (c) outpatient facilities only (outpatients). Demographic and clinical data of 425 psychiatric patients are analysed cross-sectionally in relation to their treatment experiences. QoL of former inpatients is followed up after hospital discharge.

RESULTS

Long-term 'overall users' have a significantly higher QoL than long-term 'outpatients' or 'inpatients'. QoL of former inpatients increases after discharge. Predictors of higher OLS are high income, high subjective social functioning (SFQ), good self-rated health, satisfactory QoL domains as well as being single or cohabiting, diagnosis of schizophrenia, 'outpatients', and 'overall users'. Together they explain 63% of the variance in patients' subjective OLS.

CONCLUSION

QoL is independent of illness severity. Deinstitutionalisation improves QoL and OLS is mainly predicted by subjective variables.