The Correlates of Quality of Life Among Jordanian Patients With Schizophrenia

Social Stigma Toward Individuals with Schizophrenia in a Lebanese Population

Background

Schizophrenia has been recognized as the most stigmatized mental disorder, imposing a substantial burden on affected individuals. However, no prior studies have investigated social stigma toward individuals with schizophrenia in Lebanon.

Purpose

We aimed to examine three components of social stigma including knowledge, attitude, and behavior toward individuals with schizophrenia in a Lebanese population and to explore associated factors with the level of social stigma.

Patients and Methods

A cross-sectional online survey was administered, and data from 469 participants were gathered from January 31, 2023, to February 18, 2023. We used previously validated questionnaires to assess the knowledge, attitude (Social Distance Scale), and behavior (Reported and Intended Behavior Scale) of participants toward individuals with schizophrenia. The score for each section was calculated and used to explore the associations between sociodemographic factors and the levels of stigma in each domain.

Results

The study participants had a moderate understanding of schizophrenia. However, a substantial proportion showed negative attitudes and unfavorable behaviors toward individuals with schizophrenia. We identified several sociodemographic factors associated with the knowledge, attitude, and behavior scores. Notably, a higher knowledge score and more positive attitudes were positively correlated with improved intended behaviors.

Conclusion

This study highlights the pervasive stigma encompassing issues in knowledge, attitudes, and behavior surrounding schizophrenia in a Lebanese population. Our study suggests a pressing need for targeted interventions to increase public awareness and decrease the social stigma of schizophrenia in Lebanon.

Examination of internalized stigma, quality of life, and happiness in patients with schizophrenia

BACKGROUND

Happiness in patients with schizophrenia is a neglected concept that needs to be developed. Determining the relationship between internalized stigma, quality of life, and happiness, which is important for the prognosis of schizophrenia, will reveal why it is necessary to focus on activities that will increase happiness in patients with schizophrenia.

AIM

This study aimed to compare the levels of internalized stigma, quality of life, and happiness in patients with schizophrenia.

METHODS

A descriptive and correlational research design was used. The research population consisted of patients who applied to the psychiatry outpatient clinic of a hospital in eastern Turkey during the research period and were diagnosed with schizophrenia according to the DSM-5 diagnostic criteria; 87 voluntary patients who agreed to participate in the study constituted the research sample. A personal information form, the Internalized Stigma of Mental Illness Scale (ISMI), the World Health Organization Quality-of-Life Scale (WHOQOL-BREF), and the Subjective Happiness Scale (SHS) were used for data collection.

RESULTS

According to the patients' ISMI, WHOQOL-BREF-TR, and SHS scores, patients perceived internalized stigma above the moderate level in all sub-dimensions. In general, their quality of life was moderate (the highest mean score was on the national environment domain and the lowest mean score was on the social domain); the mean SHS score was 13.02 ± 5.53. There was a strong and negative correlation between the mean SHS score and the total ISMI score and a strong and positive correlation between SHS and the physical, mental, social, and national environment domains of WHOQOL-BREF-TR.

CONCLUSIONS

It was determined that the mean internal stigma score of the patients decreased and their mean quality of life score increased as their mean subjective happiness score increased. It is recommended clinical studies be carried out to increase happiness in patients with schizophrenia.

Health-related quality of life and associated factors among patients with schizophrenia at comprehensive specialised hospitals in the Northwest Ethiopia: a multicentre cross-sectional study

OBJECTIVES

The aim of this study was to assess the health-related quality of life (HRQoL) and associated factors among patients with schizophrenia at comprehensive specialised hospitals in Northwest Ethiopia.

DESIGN AND SETTING

A cross-sectional study was conducted among 422 patients with schizophrenia who were followed at comprehensive specialised hospitals in Northwest Ethiopia from 1 June to 30 August 2022.

PARTICIPANTS

All adult patients with schizophrenia who had regular follow-up in the outpatient departments of the selected hospitals were study participants.

MAIN OUTCOME MEASURES

The main outcome of this study was HRQoL which was measured using the WHO Quality of Life Scale-Bref Version. Data entry and analysis were done using Epi-data version 4.6.1 and SPSS version 24, respectively. Linear regression was used to assess the association between quality of life and independent variables. Variables with a p value <0.05 at a 95% CI were considered statistically significant.

RESULTS

The mean score of the overall Quality of Life Scale-Brief Version was 22.42±3.60. No formal education (ß=-1.53; 95% CI: -2.80 to -0.27), duration of treatment (ß = -3.08; 95% CI: -4.71 to -1.45), comorbidity (ß=-1.14; 95% CI: -1.99 to -0.29), substance use (ß=-0.89; 95% CI: -1.56 to -0.23), extrapyramidal side effects (ß=-2.02; 95% CI: -2.90 to -1.14), non-adherence (ß=-0.83; 95% CI: -1.44 to -0.23), and antipsychotic polypharmacy (ß=-1.77; CI: -2.57 to -0.96) were negatively associated with quality of life.

CONCLUSION AND RECOMMENDATION

In this study, the social domain was recorded as having the lowest mean score, which may indicate that patients with schizophrenia could need better psychosocial support. Patients with a longer duration of treatment, who had comorbid illnesses, were substance users, developed EPS, were non-adherent to medications and were on antipsychotic polypharmacy, needs critical follow-up to improve HRQoL.

Cultural Misconceptions, Attitudes, Knowledge, and Beliefs About Mental Illness Among Jordanian Nurses Working in Psychiatric Units

Background This study examined cultural misconceptions and attitudes about mental illness and their correlates among Jordanian nurses working in psychiatric units. Method A descriptive, cross-sectional, correlational research design was used. A sample of 157 mental health nurses completed the study. Participants provided information about their demographics and attitudes, knowledge, and cultural misconceptions regarding mental illness. Results Negative attitudes toward mental illness were associated with sex, workplace, marital status, age, income, and years of experience. Stigma toward mental illness was associated with sex, workplace, marital status, age, years of experience, and knowledge regarding mental illness. Various cultural myths and beliefs regarding mental illness were reported. Attitudes and stigma toward mental illness differed based on cultural myths and beliefs. Conclusion Educational programs to raise awareness of and reduce stigma toward mental illness are required not only for the general public but also for some health care providers working in psychiatric units. [J Contin Educ Nurs. 2022;53(11):513-520.].

Cognitive illness representations among Israeli Arabs diagnosed with depression and their relationship with health-related quality of life

BACKGROUND

The number of studies that have assessed cognitive illness representations among people diagnosed with depression, and their relationship to health outcomes, has clearly grown. Nevertheless, the relationship between cognitive illness representations and health-related quality of life (HRQoL) has received very little research attention.

AIMS

This study examined cognitive illness representations, based on the self-regulation model (SRM), and the contribution of each dimension of these cognitive illness representations to health-related quality of life (HRQoL) among Israeli Arabs diagnosed with depression.

METHODS

A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive illness representations (identity, timeline, consequences, personal control, treatment control, and coherence), HRQoL, and sociodemographic and health characteristics.

RESULTS

Participants reported high levels of negative perceptions in the identity, timeline, and consequences dimensions, and moderate levels in the dimensions of personal control, treatment control, and coherence. Also, participants reported low levels of HRQoL. Identity, consequences, and coherence were found to be the main determinants of HRQoL.

CONCLUSION

This study underlines the crucial role of the identity, consequences, and coherence dimensions in the HRQoL of individuals diagnosed with depression. The findings indicate that clinical interventions targeting cognitive illness representations of individuals with depression, and in particular identity, consequences, and coherence, might be helpful in improving the HRQoL of this population.

Prediction of quality of life in schizophrenia using machine learning models on data from Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial

While research focus remains mainly on psychotic symptoms, it is questionable whether we are placing enough emphasis on improving the quality of life (QoL) of schizophrenia patients. To date, the predictive power of QoL remained limited. Therefore, this study aimed to accurately predict the QoL within schizophrenia using supervised learning methods. The authors report findings from participants of a large randomized, double-blind clinical trial for schizophrenia treatment. Potential predictors of QoL included all available and non-redundant variables from the dataset. By optimizing parameters, three linear LASSO regressions were calculated (N = 697, 692, and 786), including 44, 47, and 41 variables, with adjusted R-squares ranging from 0.31 to 0.36. Best predictors included social and emotion-related symptoms, neurocognition (processing speed), education, female gender, treatment attitudes, and mental, emotional, and physical health. These results demonstrate that machine learning is an excellent predictive tool to process clinical data. It appears that the patient’s perception of their treatment has an important impact on patients’ QoL and that interventions should consider this aspect.

Trial registration: ClinicalTrials.gov Identifier: NCT00014001.

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.

Health-related quality of life among Israeli Arabs diagnosed with depression: the role of illness representations, self-stigma, self-esteem, and age

BACKGROUND

Studies that examined health-related quality of life (HRQoL) and related factors among people diagnosed with depression, have only focused on sociodemographic and clinical factors. This study examined the contribution of illness representations (IRs), self-stigma, self-esteem, and age group (younger adults aged 18 to 64 and older adults aged 65+) to HRQoL among Israeli Arabs diagnosed with depression.

METHODS

A convenience sample of 160 Israeli Arabs with depression completed measures of cognitive and emotional IRs, self-stigma, self-esteem, HRQoL, and sociodemographic and health characteristics.

RESULTS

Participants reported low levels of HRQoL, with the older adults reporting significantly lower levels of HRQoL in comparison to those reported by the younger adults. Low levels of HRQoL were significantly associated with negative cognitive and emotional IRs, high levels of self-stigma, and low levels of self-esteem. Cognitive IRs, self-stigma, self-esteem, and age group were found to be the main determinants of HRQoL.

LIMITATIONS

Limitations of the study include use of a cross-sectional design among culturally homogeneous sample. This limits the generalizability of our results and conclusions, and prevented us from determining causal relationships.

CONCLUSIONS

This study emphasizes the role of cognitive IRs, self-stigma, and self-esteem, as well as age, in the HRQoL of individuals diagnosed with depression. Intervention programs should be mindful of these determinants in order to improve the HRQoL of individuals diagnosed with depression.

Relationships between social stigma, stigma experience and self-stigma and impaired quality of life in schizophrenia across three Latin-American countries

The relationships between stigma and quality of life in schizophrenia (QoL) have been extensively explored but have mostly focused on self-stigma and self-esteem and have never been explored in Latin-America. The objective of this study was to determine which stigma dimensions were associated with QoL in a sample of community-dwelling SZ subjects of three Latin-American countries. Stabilized outpatients with SZ were recruited in three Mental Health Services in three Latin-American countries: Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Stigma and Qol-SZ were evaluated by self-administered questionnaires, the Internalized Stigma of Mental Illness scale (ISMI-12) and the SQoL-18. 253 participants were included. In multivariate analyses, QoL has been associated with each stigma dimension (social stigma, stigma experience and self-stigma), independently of age, gender, education level, ethnicity, age at illness onset, illness symptomatology and mental health treatment. More specifically, social stigma was significantly associated with impaired psychological and physical well-being, self-esteem and friendship. Self-stigma was significantly associated with impaired psychological well-being, self-esteem and autonomy. The present results confirm the importance of stigma in QoL of SZ subjects and identify new targets to develop stigma-orientated programs. Most of the previous programs have focused on self-stigma while social stigma has shown to be associated with a wide range of impaired QoL areas. Stigma and QoL may have a bidirectional relationship and targeting some specific QoL areas (like autonomy through self-empowerment approaches) may also improve the effectiveness of these programs to reduce stigma impact on the quality of life of subjects with schizophrenia. Future studies should also explore differences across countries as subjects from Bolivia were more frequently Aymara and reported higher stigma and lower QoL than SZ subjects from other countries.

Schizophrenia in the context of mental health services in Palestine: a literature review

BACKGROUND

Mental health conditions remain a significant cause of disability in the Arab World. Palestinians are predominantly at a higher risk for mental health problems due to their chronic exposure to political violence, prolonged displacement, and others as limited professional, educational, financial opportunities and mental health services. Schizophrenia is an overwhelming mental illness that affects nearly one percent of the various populations throughout the world. Studies have shown patients with schizophrenia die prematurely and have lower life expectancy compared to the general population. Moreover, antipsychotic medications and client's lifestyle play a significant role in increased morbidity and mortality in these patients. The present study willingly undertakes a literature review on schizophrenia in the context of mental health services in Palestine.

METHODS

Studies were identified through PubMed, Science Direct, Google Scholar, CINAHL, Semantic Scholar and Elsevier.

RESULTS

Twenty-four studies were included in this review; 11 articles related to schizophrenia and thirteen articles related to mental health services in Westbank and Gaza. Results revealed the life of patients with schizophrenia in Palestine is complicated. Barriers as lacking awareness about mental illness, stigma, inconsistent availability of medications, absence of multidisciplinary teamwork, insufficient specialists, fragmented mental health system, occupation, and other obstacles stand in the face of improving the quality of life among these patients.

LIMITATIONS

Palestine is a state that is seeking independence with a scarcity of resources. It has been described as "uncharted territories'' due to a lack of data, resources and records. As a result, there is insufficient data regarding schizophrenia in Palestine. Therefore, a thesis study that estimated 10 years' risk of coronary heart diseases in patients with schizophrenia was included.

CONCLUSIONS

Recommendations include ending the occupation as the leading cause of mental illness for Palestinians and implementing efficient and effective mental health nursing care through the multidisciplinary work and raising awareness regarding mental illness to fight the stigma.

The relationship between functional recovery and quality of life in patients affected by schizophrenia and treated at a community mental health center in Turkey

PURPOSE

The study was conducted to determine the levels of functional recovery and quality of life (QOL) among a group of patients suffering from schizophrenia treated at a Community Mental Health Center (CMHC) and to evaluate the relationship between these two treatment outcomes.

DESIGN AND METHODS

This observational study was implemented among 132 patients affected by schizophrenia treated at a CMHC in Turkey.

FINDINGS

A statistically significant positive correlation was found between the general and subscale mean scores of the functional remission of general schizophrenia scale and the mean score of all domains of the World Health Organization QOL (r = 0.63-0.33; P < .001).

PRACTICE IMPLICATIONS

QOL increases as the functional recovery levels increase. Nursing practices should be planned to improve functional recovery levels of patients.

A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

BACKGROUND

Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions.

METHODS

We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations.

RESULTS

Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes.

CONCLUSIONS

Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.

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

PURPOSE

The study examines the determinants of the quality of life (QoL) among outpatients with schizophrenia in Jordan.

DESIGN AND METHODS

A cross-sectional study design was used with 157 people with schizophrenia treated in outpatient clinics. Demographic, clinical and psychosocial variables were examined for their influence on QoL. Data were analysed with descriptive statistics, Pearson product moment correlation and stepwise forward multiple linear regression.

FINDINGS

The majority of the study participants were female, single, unemployed, had secondary level of education or less and were being supported financially by family members. QoL correlated negatively with advanced age, male gender, longer duration of illness, high body mass index and prescribed typical anti-psychotic medication. However, it was correlated positively with employment and being married. Illness duration, recurrent hospitalisation, knowledge level about schizophrenia, psychiatric symptoms and coping mechanisms were found to be key significant predictors of QoL among participants.

PRACTICAL IMPLICATIONS

The study findings enhance our understanding of socio-demographic, clinical and psychosocial characteristics influencing the QoL in people with schizophrenia. Involvement of families in the management process may improve patients' ability to be integrated in the community and be more socially active.

The correlation between the quality of life and clinical variables among outpatients with schizophrenia

The study identifies the correlation between the quality of life (QoL) among outpatients with schizophrenia and clinical outcomes. A cross-sectional study design was used with 157 people with schizophrenia treated in outpatient clinics. Demographic, clinical and psychosocial variables were examined for their influence on QoL. Data were analysed with descriptive statistics, Pearson product moment correlation and stepwise forward multiple linear regression. The majority of the study participants were female, single, unemployed, had secondary level of education or less and were being supported financially by family members. QoL correlated negatively with advanced age, male gender, longer duration of illness, high body mass index and prescribed typical anti-psychotic medication. However, it was related positively with employment and being married. Illness duration, recurrent hospitalisation, knowledge level about schizophrenia, psychiatric symptoms and coping mechanisms were found to be key significant predictors of QoL among participants. The study findings enhance our understanding of socio-demographic, clinical and psychosocial characteristics influencing the QoL in people with schizophrenia. Involvement of families in the management process may improve patients' ability to be integrated in the community and be more socially active.

Cultural misconceptions and public stigma against mental illness among Lebanese university students

PURPOSE

The purpose of this study was to examine cultural misconceptions about mental illness and how they are associated with the public stigma against mental illness among Lebanese university students.

METHODS

A sample of 203 participants completed the study. Data about cultural misconceptions, attitudes about mental illness, and public stigma of mental illness were obtained. The researchers examined the mean difference in public stigma according to cultural beliefs about mental illness.

RESULTS

The majority of students believe that mental health professionals have inadequate knowledge and expertise to treat mental disorders. Various cultural misconceptions about mental illness were reported. Public stigma significantly differed based on these cultural misconceptions.

CONCLUSION

Psychiatric nurses should play a vital role in reshaping the inappropriate cultural view about mental illness.