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Clarke EL, Allott K, Anderson JFI, Gao CX, Filia KM, Killackey E, Cotton SM. Heterogeneity of quality of life in the later stages of first-episode psychosis recovery. Qual Life Res 2023; 32:769-780. [PMID: 36378390 PMCID: PMC9992035 DOI: 10.1007/s11136-022-03277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE First-episode psychosis (FEP) is characterised by wide heterogeneity in terms of symptom presentation and illness course. However, the heterogeneity of quality of life (QoL) in FEP is not well understood. We investigated whether subgroups can be identified using participants' responses on four QoL domains (physical health, psychological, social relationships, and environmental) 18-months into the recovery phase of FEP. We then examined the discriminant validity of these subgroups with respect to clinical, cognitive, and functioning features of FEP. METHOD Demographic and clinical characteristics, QoL, cognition, and functioning were assessed in 100 people with FEP at the 18-month follow-up of a randomised controlled trial of Individual Placement Support, which aims to facilitate vocational recovery. QoL was measured using the World Health Organisation's QoL-BRIEF. A two-stage clustering approach using Ward's method and Squared Euclidean Distance with a k-means confirmation was conducted. Multinomial logistic regressions were used to establish external validity. RESULTS Three QoL subgroups emerged: a 'good' subgroup with relatively high QoL across all domains (31%), an 'intermediate' subgroup with relatively low psychological QoL (48%) and a 'poor' subgroup with markedly low social relationship QoL (21%). Negative symptoms, depressive symptoms, social/occupational functioning, and social inclusion at follow-up predicted subgroup membership. Sensitivity analysis found similar results. CONCLUSION Although some individuals with FEP have QoL comparable to individuals without mental ill health, QoL can remain concerningly low despite treatment efforts. Future research on interventions that target factors associated with poor QoL, such as low social inclusion, is required to counteract prolonged poor QoL in FEP.
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Affiliation(s)
- E L Clarke
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - K Allott
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - C X Gao
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - K M Filia
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - E Killackey
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - S M Cotton
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
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Filia KM, Cotton SM, Watson AE, Jayasinghe A, Kerr M, Fitzgerald PB. Understanding the Barriers and Facilitators to Employment for People with Bipolar Disorder. Psychiatr Q 2021; 92:1565-1579. [PMID: 34097245 DOI: 10.1007/s11126-021-09931-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
People with Bipolar Disorder (BD) consistently report a desire for employment; however, this is not reflected in employment figures. Individuals' perceptions of barriers to employment, along with endorsement of facilitators to employment remain under-investigated. We aimed to address this limitation by: (i) first examining differences in employed versus unemployed individuals (demographic, clinical, functioning); then (ii) identifying barriers and/or facilitators to employment, perception of same, and subsequent impact on employment. We assessed demographics, functioning, and illness-related characteristics in 35 participants with BD (19 employed, 16 unemployed). Participants were asked to indicate perception of common barriers and facilitators to employment. Groups did not differ regarding demographic or clinical variables. High levels of absenteeism, termination of last role and commonly perceived barriers were attributed to mental ill-health. 93.3% of unemployed participants reportedly desired employment, and more perceived barriers were observed in the unemployed group. Identified facilitators included increased support and flexible work strategies. A comprehensive understanding of perceptions of limiting and helpful factors related to employment for people with BD was obtained. These findings have implications for service provision, encouraging targeted discussion, and tailored treatment approaches to individual's unique perceptions of factors related to employment.
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Affiliation(s)
- K M Filia
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.
| | - S M Cotton
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - A E Watson
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - A Jayasinghe
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,School of Psychology, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - M Kerr
- Orygen; Centre for Youth Mental Health, University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - P B Fitzgerald
- Department of Psychiatry, Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University, 888 Toorak Road, Camberwell, VIC, 3124, Australia
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Abstract
BACKGROUND Previous research has predominately focused on patients with mental illness as the instigators, rather than the victims, of violence and criminal activity. However, patients with schizophrenia appear to experience a higher degree of victimization compared to general community samples. We aimed to establish the 1-month prevalence of violent and non-violent victimization in a sample of patients with schizophrenia spectrum disorders and to investigate the determinants of victimization. METHOD Reports of violent and non-violent victimization were recorded in 348 patients in Dandenong, an outer metropolitan suburb of Melbourne, Australia along with the subjective perception of patients as to their degree of protection from being robbed or attacked. Patients reporting victimization were compared with those who did not, across a range of clinical and psychosocial variables. RESULTS 11.2% of the sample reported being the victim of non-violent crime and 4.3% the victim of violent crime in the 1-month period. 23.2% reported dissatisfaction with their protection against being attacked or robbed. The major determinant of victimization was the lack of any meaningful daily activity. CONCLUSIONS Patients with schizophrenia spectrum disorders are at increased risk of victimization, both of the violent and non-violent type. Further research is required to understand the pathways through which victimization occurs and to understand whether psychosocial interventions can reduce victimization in this patient population.
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Affiliation(s)
- Paul B Fitzgerald
- Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University Department of Psychological Medicine, Melbourne, Australia.
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