Quality of life in schizophrenic patients: the influence of sociodemographic and clinical characteristics and satisfaction with social support

Art Therapy as a Nursing Intervention for Individuals With Schizophrenia

The aim of the current study was to determine the effects of group art therapy on clinical symptoms, alexithymia, and quality of life among people with schizophrenia. This single-blinded, randomized controlled trial was performed with 66 individuals with schizophrenia from a community mental health center in western Turkey between September 2021 and February 2022. Following art therapy, the intervention group had lower severity of positive, negative, and general psycho-pathology symptoms; lower levels of alexithymia; and higher levels of psychological health, social relationships, and total quality of life than the control group; and the difference between groups was statistically significant (p < 0.05). Results reveal that art therapy combined with pharmacological therapy contributes to good clinical outcomes among individuals with schizophrenia. This evidence can guide psychiatric nurses to use art therapy to reduce psychopathology severity and increase functionality and quality of life among individuals with schizophrenia. [Journal of Psychosocial Nursing and Mental Health Services, 62(5), 29-38.].

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.

The effect of interpersonal relations theory-based motivational interviews on functional remission and insight levels of patients with schizophrenia: A randomized controlled trial

BACKGROUND

Using therapeutic techniques and conducting motivational interviews in communication with patients with schizophrenia increases individuals' functional remission, insight, and motivation levels.

AIM

This single-blind, randomized controlled study examines the effect of Interpersonal Relations Theory-Based motivational interviews on functional remission and insight levels in patients with schizophrenia.

METHODS

The participants of this study were 40 patients with schizophrenia randomly assigned to either the experimental or control groups (20 in each group). The researchers carried out a 6-session Interpersonal Relations Theory-based motivational interview with the participants in the experimental group. Study data were collected using a demographic questionnaire, the Functional Remission of General Schizophrenia Scale (FROGS), and the Scale for Assessing the Three Components of Insight (SAI).

RESULTS

Social Functioning, Health and Treatment, Daily Living Skills, and SAI scores of the individuals in the intervention group were statistically higher than those in the control group (p < 0.05) in the post-intervention and follow-up measures. There was a positive and significant correlation between the post-intervention Social Functioning, Health and Treatment, Daily Life Skills, and total FROGS scores and the SAI score of the individuals in the intervention group (p < 0.05).

CONCLUSIONS

It was concluded that motivational interviews based on Interpersonal Relations Theory were effective in increasing the insights and functionality of patients with schizophrenia. Psychiatric nurses' practice of motivational interviews based on the therapeutic relationship is considered to increase the quality of care and satisfaction of patients with schizophrenia. It is recommended that this practice be used extensively in clinical practice.

The relations between socio-demographic information and negative symptoms, mental health, and quality of life: a latent profile analysis with psychotic patients in Kosovo

The current study aims to identify meaningful psychotic patients' profiles by examining certain combinations of patient's demographic and socio-economic variables (sex, age, marital status, number of children, cohabitant and level of education). Moreover, we aim to assess whether there is any significant effect of class membership (profile) on negative symptoms, health state, and quality of life among psychotic patients. A convenience sample of 103 patients (age: M = 22, SD = 1.75), was drawn from the clinical populations of Kosovo. Demographic and socio-economic data was obtained through individual interviews, meanwhile a battery of questionnaires was used to assess negative symptoms, mental health, and quality of life of patients. The 4-class solution was selected as the best fitting model and used in subsequent analyses. Results indicated a significant effect of class membership on health state, quality of life and negative symptoms. Practical implications are discussed.

Subjective quality of life among first-episode psychosis patients in Chennai, India and Montreal, Canada

Differences in subjective quality of life among persons receiving early intervention for psychosis in varying geo-sociocultural contexts have rarely been examined. Our prospective longitudinal study compared the quality of life of persons with first-episode psychosis receiving two years of similar early intervention in Chennai, India and Montreal, Canada. We hypothesized that general life satisfaction would be higher in Chennai compared to Montreal, and that social relations (a specific quality of life component) would also be higher in Chennai and positively contribute to general life satisfaction. Participants completed the general satisfaction and social relations domains of the Wisconsin Quality of Life Index at baseline, months 12 and 24. Baseline weighted mean general satisfaction and social relations scores were in the low to moderate range. Generalized estimating equation analyses showed that general satisfaction scores increased with time [Wald χ² (1) = 125.28, p < 0.001] and were higher in Chennai than in Montreal [Wald χ² (1) = 7.50, p = 0.006]. Social relations scores showed the highest association with general satisfaction scores (B = 0.52), followed by positive symptom remission (B = 0.24) and gender (B = 0.18) with Chennai males having the highest general satisfaction scores. Social relations weighted mean scores increased with time [Wald χ² (1) = 87.30, p < 0.001] and were positively associated with years of education [Wald χ² (1) = 4.76, p = 0.029] and early negative symptom remission [Wald χ² (1) = 7.38, p = 0.007]. Our results suggest that subjective quality of life may improve following early intervention for psychosis across contexts. Our findings advance knowledge about the role of sociocultural (e.g., gender) and clinical factors in influencing subjective outcomes in psychosis, and point to social support networks and symptom remission as avenues to boost quality of life.

The mediating effects of social support on the association between depression and life satisfaction among patients with schizophrenia or bipolar disorder

Patients with schizophrenia or bipolar disorders in community had poor psychosocial functioning, social support, and life satisfaction. However, the interaction effects of social support and depression on life satisfaction remains unclear. Thus, we examined these associations among patients with schizophrenia or bipolar disorder. This cross-sectional study was conducted from October to December 2020 in Shenzhen, China. Information on social support, depression, and life satisfaction was assessed by standardized questionnaires through a face-to-face interview. Hierarchical multiple regression analysis was performed to estimate the associations of social support and depression with life satisfaction and to explore the mediation effect of social support. A total of 293 patients aged 39.7 ± 11.1 years (males: 47.1 %) were included in this study. Social support was positively associated with high life satisfaction (explaining 7.2% of the variance), while depression was negatively associated with life satisfaction (explaining 17.8% of the variance). Furthermore, social support mediated 12.5% of the association between depression and life satisfaction. Social support and depression were significantly associated with life satisfaction in patients with schizophrenia or bipolar disorders. Moreover, social support mediated the association between depression and life satisfaction in this population. Health interventions that benefit social support should be promoted to alleviate the negative impact of depression on their life satisfaction.

Impact of Childhood Trauma and Adult Separation Anxiety Disorder on Quality of Life in Individuals with Schizophrenia

Background

Childhood trauma and anxiety disorders are common in individuals with schizophrenia. This study aimed to investigate the effects of childhood trauma and adult separation anxiety disorder on the quality of life of individuals with schizophrenia.

Methods

This cross-sectional study included 111 individuals with schizophrenia and 85 control subjects. The separation anxiety symptom inventory (SASI), adult separation anxiety questionnaire (ASAQ), Positive and Negative Syndrome Scale (PANSS), childhood trauma questionnaire (CTQ), and World Health Organization quality of life questionnaire (WHOQoL-BREF) were administered to the participants.

Results

More individuals with schizophrenia than control subjects were unemployed and single (p<0.05). Individuals with schizophrenia scored significantly higher on the SASI, ASAQ, and CTQ (p<0.05), whereas the control subjects scored significantly higher on the WHOQoL-BREF (p<0.05). ASAQ scores had mild positive correlations with total PANSS and PANSS subscale scores, and moderate positive correlations with total CTQ, CTQ emotional subscale scores, and CTQ physical abuse subscale scores. A negative moderate correlation was found between ASAQ and total WHOQoL-BREF scores. Mediation analysis revealed that CTQ scores significantly affected total WHOQoL-BREF and ASAQ scores. The model pathway for ASAQ scores showed a significant direct and indirect effect of CTQ on the total WHOQoL-BREF scores.

Conclusion

Childhood trauma predicts adult separation anxiety disorder, which partially mediates the impact of childhood trauma on quality of life in individuals with schizophrenia. Therapeutic interventions for adult separation anxiety disorder in individuals with schizophrenia and a history of childhood trauma may help increase their quality of life.

An evaluation of the disability, insight and self-care agency of schizophrenia patients

AIM

This study aims to evaluate the disability, insight and self-care agency of schizophrenia patients.

DESIGN AND METHOD

This descriptive study was conducted with 100 patients in remission who had a diagnosis of schizophrenia at community mental health centers.

RESULTS

The schizophrenia patients had poor insight and moderate self-care agency. The self-care agency of schizophrenia patients is a neglected issue in medicine, and is associated with positive and negative symptoms, insight and disability.

IMPLEMENTATION RESULTS

The results can guide community mental health center nurses to increase the quality of life of schizophrenia patients in remission and to help reintegrate them into society.

Assessing evidence for seasonality of hospital admissions for schizophrenia in Queensland, Australia: a time series observational study

Most evidence on seasonal admission patterns for schizophrenia derives from the Northern Hemisphere with results from the Southern Hemisphere less documented. This study examines seasonal patterns in hospital admissions due to schizophrenia in Queensland, Australia, a large area that has a range of different climatic features. Daily hospital admissions data for people with the primary diagnosis of schizophrenia were collected from Queensland Health Department for the period from January 1996 to December 2015. A generalised linear regression model with Quasi-Poisson distribution was used to assess seasonal admission patterns across different climatic regions. The evidence for seasonality was also explored in subgroups that had different socio-demographic characteristics or history of prior hospitalisation for psychiatric disorders. Overall, a significant winter pattern (RR 1.05, 95%CI 1.01-1.13) was found with a peak in August (RR 1.08, 95%CI 1.03-1.17) in temperate Southeast Queensland. However, the hot humid North and Far North Queensland showed a peak in October (RR 1.10, 95%CI 1.02-1.22). Males (RR 1.11, 95%CI 1.07-1.14), people aged 40-59 years old (RR 1.10, 95%CI 1.05-1.15) and those who had never married (RR 1.09, 95%CI 1.06-1.12), were Australian by birth (RR 1.07, 95%CI 1.04-1.10) or were unemployed (RR 1.13, 95%CI 1.09-1.18) had significantly higher risk for hospital admissions, particularly during the winter months. The seasonal admission pattern for schizophrenia did not change significantly according to admission status and history of outpatient or community psychiatric treatment. The study found some evidence for seasonality of hospital admissions for schizophrenia that differed from northern tropical to southern temperate regions of Queensland.

Quality of Life and Functioning of People With Mental Disorders Who Underwent Deinstitutionalization Using Assisted Living Facilities: A Cross-Sectional Study

Context

People with mental disorders can acquire long-term disabilities, which could impair their functioning and quality of life (QoL), requiring permanent care and social support. Systematic data on QoL and functioning, which could support a better management of these people, were not available.

Objective

To analyze the QoL, level of functioning and their association with sociodemographic and clinical factors of people with mental disorders who underwent deinstitutionalization using assisted living facilities.

Methods

A Cross-sectional study was conducted between July 2018 and July 2019, through interviews using the World Health Organization Quality of Life (WHOQOL-BREF) to determine the QoL scores, and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) to determine the level of functioning. All adults (≥18 years old) with mental disorders, who underwent deinstitutionalization, users of assisted living facilities and assisted by the Psychosocial Assistance Centers III, in a city in the state of São Paulo, Brazil, were selected. For statistical analysis of the associated factors, Student’s t-test was used for dichotomous variables and ANOVA for polynomial variables. Pearson correlation coefficient was used to measure the association between QoL and functioning scores.

Results

Out of 359 people who underwent deinstitutionalization with mental disorders, 147 met the eligibility criteria. The mean total score for the WHOQOL-BREF was 66.5 ± 13.4 and the mean score for WHODAS 2.0 was 10.4 ± 7.6. An association was found between people who were studying (n = 65.8; 95%CI, 63.5–68.1 vs. n = 73.9; 95%CI, 67.5–80.3; p = 0.04) and better WHOQOL-BREF QoL scores or WHODAS 2.0 levels of functioning (n = 10.9; 95%CI, 9.6–12.2 vs. n = 5.1; 95%CI, 2.5–7.7; p = 0.01). A weak negative correlation (r = 0.41) emerged between higher QoL scores and functioning improvement.

Conclusion

This study indicates that the QoL of the sample is associated by their functioning levels, which, in turn, may reflect on their social interactions. Public policies that favor interventions increasing socialization of this population can result in better health outcomes. The QoL and functioning scores provide valuable insights to develop public policies more suited to this population profile.

Gender difference in quality of life (QoL) among outpatients with schizophrenia in a tertiary care setting

BACKGROUND

Patients with mental illness report lower quality of life (QoL) compared to the general population. Prior research has found several differences in clinical features and experiences of male and female patients with schizophrenia. Given these differences, it is also important to explore if there are any gender differences in terms of their QoL. This study aimed to investigate differences in QoL between and within each gender among outpatients with schizophrenia in Singapore.

METHODS

A total of 140 outpatients were recruited through convenience sampling at the Institute of Mental Health, Singapore. QoL was measured using the brief version of World Health Organization Quality of Life (WHOQOL-BREF) which consists of four domains: physical health, psychological health, social relationships, and environment. QoL scores of males and females were compared using independent t-tests, and multiple linear regressions were used to examine sociodemographic correlates of QoL in the overall sample and within each gender.

RESULTS

There was no significant difference in QoL domain scores between genders. Among males, Indian ethnicity (versus Chinese ethnicity) was positively associated with physical health (β=3.03, p=0.018) while males having Technical Education/ Diploma/ A level education (versus Degree and above) were positively associated with social relationships domain (β=2.46, p=0.047). Among females, Malay ethnicity (versus Chinese ethnicity) was positively associated with physical health (β=1.95, p=0.026) psychological health (β=3.21, p=0.001) social relationships (β=2.17, p=0.048) and environment (β=2.69, p=0.006) domains, while females who were separated/divorced (versus single) were inversely associated with psychological health (β=- 2.80, p=0.044) and social relationships domains (β=- 4.33, p=0.011). Females who had Secondary and below education (versus Degree and above) were inversely associated with social relationships (β=- 2.29, p=0.028) and environment domains (β=- 1.79, p=0.048).

CONCLUSIONS

The findings show the importance of treatments targeting QoL to attend to both the clinical features of the illness as well patient's sociodemographic characteristics.

Medical Comorbidities in 181 Patients With Bipolar Disorder vs. Schizophrenia and Related Psychotic Disorders: Findings From a Single-Center, Retrospective Study From an Acute Inpatients Psychiatric Unit

Introduction: Medical comorbidities (MCs) represent a significant burden in terms of more frequent hospitalizations and overall lower life expectancy among people with severe mental disorders, such as schizophrenia and related psychotic disorders (SZ) and bipolar disorder (BD). The present article aims to compare the prevalence of MCs and to examine the associated characteristics as marital status, job occupation, level of education, and living arrangements, between BD and SZ patients. Methods: One-hundred-eight-one patients with MCs (85/47% had BD and 96/53% had SZ) were recruited retrospectively from the Acute Inpatients Psychiatry Unit of Policlinico Tor Vergata, Rome, between January-2017 and December-2020. MCs were: cardiovascular diseases (CVD), bacterial infections, mycoses, viral diseases, neoplasms, musculoskeletal, respiratory tract, urological and male genital, gynecological, neurological, gastrointestinal, metabolic syndrome, nutritional, and metabolic diseases. Results: BD had more MC than SZ (36.2 vs. 28.2%, respectively, p = 0.04). CVD and metabolic MC were more common among BD (51.8 vs.34.4%; 51.8 vs.35.3%; p = 0.018; p = 0.039; respectively), while viral diseases were more frequent in SZ (13.5 vs.3.5%, p = 0.035). Hypertension was common in both psychiatric illnesses (81.8% BD vs. 65.6% SZ, p = 0.18). Obesity was the most frequent metabolic disease in both BD and SZ (75% BD vs. 73.5% SZ, p = 0.91), followed by diabetes mellitus (52.3% BD vs. 55.9% SZ, p = 0.93), metabolic syndrome (54.5% BD vs. 47.1% SZ, p = 0.67) and dysthyroidism (47.7% BD vs. 25.7% SZ, p = 0.093). After performing a binary logistic regression analysis, only two MCs showed a statistically significant association: patients with SZ had an OR of 2.01 [CI 95% (1.00-4.01)] for CVD compared to BD; on the other hand, patients with BD had an OR of 16.57 [CI 95% (3.58-76.77)] for gynecological diseases compared to SZ patients. Conclusions: MCs are common among people with severe mental illness, especially CVD and metabolic diseases, highlighting the need for a more collaborative relationship between general medical providers and psychiatrists.

The role of insecure attachment and cognitive biases in the social functioning of schizophrenia spectrum patients

OBJECTIVE

The study investigates the relationship between cognitive biases and attachment styles and social functioning.

METHOD

Fifty-three patients (28 females, age M = 41.73, SD = 11.71) with the diagnosis of schizophrenia participated in the study. We measured attachment styles, cognitive biases, and social functioning using self-report questionnaires. Relationships among variables were investigated with correlational and regression analyses.

RESULTS

Correlation analysis indicated that social engagement, interpersonal behavior, pro-social activities, and independence-performance significantly correlate with both attachment styles and cognitive biases. However, in regression analysis, after controlling for attachment styles, only subjective cognitive problems turned out to be a significant predictor of social functioning.

CONCLUSIONS

These preliminary findings might suggest that both attachment styles and cognitive biases are associated with social functioning. Nonetheless, when considered together it might suggest attachment styles have a higher contribution than cognitive biases to social engagement, interpersonal behavior, and pro-social activities decline in schizophrenia spectrum disorders.

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.

Adherence to Antipsychotic Medication and Quality of Life in Latin-American Patients Diagnosed with Schizophrenia

PURPOSE

The purpose of this study was to describe the association between adherence to antipsychotic medication and quality of life (QoL) in a sample of individuals diagnosed with schizophrenia.

METHODS

Two hundred fifty-three patients were included from three public mental health services from Bolivia, Peru, and Chile. Data were collected using the Drug Attitude Inventory (DAI-10) and the Schizophrenia Quality of Life short-version questionnaire (SQoL-18), which considers 8 dimensions.

RESULTS

Significant associations were found between adherence to antipsychotic medication treatment and QoL (S-QoL-18 index: β = 0.26, p = 0.004; self-esteem: β = 0.37, p = 0.000; and sentimental life: β = 0.20, p = 0.033). Associations of clinical and socio-demographic variables with QoL were identified: severity of psychotic symptoms, awareness of the disease, gender, age, and ethnicity were found to be associated with a lower level of QoL (β from 0.14 -0.56).

CONCLUSION

This study provides evidence of the association between adherence to treatment and quality of life in patients diagnosed with schizophrenia. Therefore, as in developed countries, improving adherence to antipsychotic medication would appear to be an important issue to address to improve patients' QoL in Latin American countries.