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Stewart K, Hancock N, Chapparo C, Stancliffe RJ. Functional Performance and the Allen Cognitive Level Screen for Adults With Mental Illness: A Scoping Review. Am J Occup Ther 2022; 76:23223. [PMID: 35239954 DOI: 10.5014/ajot.2022.045757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Research involving the use of the Allen Cognitive Level Screen (ACLS) in mental health practice has been available for more than 40 yr, yet there has been no comprehensive synthesis and review of this body of literature. OBJECTIVE To review, summarize, compare, and evaluate the existing literature regarding the relationship between the ACLS and the functional and adaptive functional performance of adults living with mental illness. DATA SOURCES Searches with no date limits were conducted in the CINAHL, MEDLINE, PsycINFO, ProQuest, and OTseeker databases. Study Selection and Data Collection: A five-stage scoping review methodology was used to examine peer-reviewed English-language literature reporting on the relationship between ACLS scores and functional and adaptive functional performance of adults with mental illness. Information from 15 studies was charted, collated, and numerically and thematically summarized. FINDINGS A positive relationship between ACLS scores and in-the-moment performance was consistently reported. The relationship of ACLS scores to community living performance was less consistent. Methods of assessing performance, complexity of tasks assessed, and timing of assessments affected relationships with cognition as measured by ACLS. Gaps in the literature were identified. CONCLUSIONS AND RELEVANCE Findings raise questions about how, why, and when occupational therapists use the ACLS. Increased examination is needed of what aspects of performance and functional cognition reliably determine people's ability to live successfully in the community. What This Article Adds: This article provides the first synthesis of the existing literature on the relationship between ACLS scores and functional and adaptive functional performance of people living with mental illness.
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Affiliation(s)
- Kylie Stewart
- Kylie Stewart, BAppSc (OT), is PhD Candidate, Faculty of Medicine and Health, Centre for Disability Research and Policy, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia, and Senior Occupational Therapist, Mental Health Therapy and Recovery Service Mental Health Centre Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia;
| | - Nicola Hancock
- Nicola Hancock, PhD, BAppSc (OT), is Associate Professor, Faculty of Medicine and Health, Centre for Disability Research and Policy, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Christine Chapparo
- Christine Chapparo, PhD, DipOT (NSW), MA, is Associate Professor, Faculty of Medicine and Health, Centre for Disability Research and Policy, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Roger J Stancliffe
- Roger J. Stancliffe, PhD, BSc (Hons University Medal) (Psychology), MA (Hons), is Professor Emeritus, Faculty of Medicine and Health, Centre for Disability Research and Policy, Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Nevarez-Flores AG, Breslin M, Carr VJ, Morgan VA, Waterreus A, Harvey C, Sanderson K, Neil AL. Proposing a causal pathway for health-related quality of life in people with psychotic disorders. J Psychiatr Res 2021; 138:550-559. [PMID: 33990026 DOI: 10.1016/j.jpsychires.2021.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to establish independent predictors for health-related quality of life (HRQoL) in people with psychotic disorders, and the mediating role of global functioning in those relationships. Data for 1642 people collected as part of the second Australian National Survey of Psychosis were analyzed. The Assessment of Quality of Life (AQoL)-4D and the Personal and Social Performance scale were used for assessing HRQoL and global functioning respectively. The study commenced with a theoretical model comprised of 26 sociodemographic and clinical variables. A predictive model for HRQoL was built up using a purposeful selection strategy to arrive at a set of clinically meaningful, independent predictors. The mediating effect of global functioning was then assessed. Seven variables were found to have an independent effect on HRQoL: perception of loneliness, number of negative symptoms, use of psychotropic and anticholinergic medications, course of disorder, lifetime histories of chronic pain and cardiovascular disease and living arrangements at the time of the interview. All variables except perceived loneliness and chronic pain were partially mediated through global functioning. This final model explained 46% of the variance in HRQoL, with loneliness and number of negative symptoms the strongest predictors. Evidence in support of a credible causal pathway for HRQoL in people with psychotic disorders, mediated by global functioning was presented. The importance of the quality of social relationships was highlighted, and potential targets for improving the HRQoL of this population identified.
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Affiliation(s)
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Vaughan J Carr
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, St Vincent's Hospital, Darlinghurst Sydney, New South Wales, Australia; Department of Psychiatry, School of Clinical Sciences, Monash Medical Centre, Monash University, Clayton Melbourne, Victoria, Australia
| | - Vera A Morgan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; North Western Mental Health, Melbourne, Victoria, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; School of Health Sciences, University of East Anglia. Norwich Research Park Norwich, NR4 7TJ, UK
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
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Kaltsidis G, Grenier G, Cao Z, L'Espérance N, Fleury MJ. Typology of changes in quality of life over 12 months among currently or formerly homeless individuals using different housing services in Quebec, Canada. Health Qual Life Outcomes 2021; 19:128. [PMID: 33882927 PMCID: PMC8061013 DOI: 10.1186/s12955-021-01768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background In health and social service evaluations, including research on homelessness, quality of Life (QOL) is often used as a key indicator of well-being among service users. However, no typology has been developed on changes in QOL over a 12-month period for a heterogenous sample of homeless individuals. Methods Cluster analysis was employed to identify a typology of change in QOL for 270 currently or formerly homeless individuals using emergency shelters, temporary housing (TH) and permanent housing (PH) services in Quebec (Canada). Participant interviews were conducted at baseline and 12 months later. An adapted Gelberg–Andersen Model helped organize QOL-related sociodemographic, clinical, and service use variables into predisposing, needs, and enabling factors, respectively. Comparison analyses were performed to determine group differences. Results Four groups emerged from the analyses: (1) young women in stable-PH or improved housing status with moderately high needs and specialized ambulatory care service use, with improved QOL over 12 months; (2) middle-age to older men with stable housing status, few needs and low acute care service use, with most improvement in QOL over 12 months; (3) older individuals residing in stable-PH or improved housing status with very high needs and reduced QOL over 12 months; and (4) men in stable-TH or worse housing status, with high substance use disorder, using few specialized ambulatory care services and showing decline in QOL over 12 months. Conclusions Findings suggest that positive change in QOL over 12 months was mainly associated with fewer needs, and stability in housing status more than housing improvement. Specific recommendations, such as assertive community treatment and harm reduction programs, should be prioritized for individuals with high needs or poor housing status, and among those experiencing difficulties related to QOL, whereas individuals with more favourable profiles could be encouraged to maintain stable housing and use services proportional to their needs.
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Affiliation(s)
- Gesthika Kaltsidis
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Nadia L'Espérance
- Centre Intégré Universitaire de Santé et de Services Sociaux, Trois-Rivières, Quebec, Canada
| | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
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Roux P, Urbach M, Fonteneau S, Berna F, Brunel L, Capdevielle D, Chereau I, Dubreucq J, Faget-Agius C, Fond G, Leignier S, Perier CC, Richieri R, Schneider P, Schürhoff F, Tronche AM, Yazbek H, Zinetti-Bertschy A, Passerieux C, Brunet-Gouet E. Psychiatric disability as mediator of the neurocognition-functioning link in schizophrenia spectrum disorders: SEM analysis using the Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) scale. Schizophr Res 2018; 201:196-203. [PMID: 29941294 DOI: 10.1016/j.schres.2018.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 11/17/2022]
Abstract
The functional outcome in schizophrenia spectrum disorders is affected by multiple factors such as cognitive performance and clinical symptoms. Psychiatric disability may be another important determinant of functional outcome. The purpose of this study was to test whether schizophrenia symptoms and psychiatric disability mediated the association between cognition and functioning. Between April 2013 and July 2017, we included 108 community-dwelling adults with stable schizophrenia spectrum disorder in a multicenter study. Psychiatric disability was assessed with the Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) scale by relatives of patients. ECPDS focused on the broad array of motivational, neurocognitive, sociocognitive, and metacognitive impairments that result in activity restrictions. We used a battery of tests to assess seven cognition domains (processing speed, attention/vigilance, working, verbal and visual memory, reasoning and problem solving, and executive functioning) and cross-sectional structural equation modeling (SEM) for the mediation analyses. We estimated the one-year temporal stability of ECPDS scores in 45 participants. The model provided showed good fit and explained 43.9% of the variance in functioning. The effect of neurocognition on functioning was fully mediated by symptoms (proportion mediated: 36.5%) and psychiatric disability (proportion mediated: 31.3%). The ECPDS score had acceptable one-year temporal stability. The ECPDS scale has satisfactory psychometric properties, and shows significant convergence with neurocognition and functioning, suggesting a role for this tool in the routine evaluation of cognitive remediation needs. Our model validates psychiatric disability as a crucial step from cognitive impairment to restricted participation in life situations.
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Affiliation(s)
- Paul Roux
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France.
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Sandrine Fonteneau
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France; Strasbourg University Hospital, INSERM U1114, Strasbourg Federation of Translational Psychiatry, Strasbourg, France
| | - Lore Brunel
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry team, Université Paris-Est Créteil (UPEC), AP-HP, DHU Pe-PSY, Department of Adult Psychiatry, University Hospitals H Mondor, Créteil, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France; Academic Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, University of Montpellier 1, INSERM 1061, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France; CMP B, Clermont-Ferrand University Hospital, EA 7280, Faculty of Medicine, Auvergne University, Clermont-Ferrand, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Catherine Faget-Agius
- Fondation FondaMental, Créteil, France; Academic Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | | | - Sylvain Leignier
- Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Claire-Cécile Perier
- Fondation FondaMental, Créteil, France; Psychosocial Rehabilitation Reference Centre, Alpes Isère Hospital, Grenoble, France
| | - Raphaëlle Richieri
- Fondation FondaMental, Créteil, France; Academic Department of Psychiatry (AP-HM), Sainte-Marguerite University Hospital, Marseille, France
| | - Priscille Schneider
- Fondation FondaMental, Créteil, France; Strasbourg University Hospital, INSERM U1114, Strasbourg Federation of Translational Psychiatry, Strasbourg, France
| | - Franck Schürhoff
- Fondation FondaMental, Créteil, France; INSERM U955, Translational Psychiatry team, Université Paris-Est Créteil (UPEC), AP-HP, DHU Pe-PSY, Department of Adult Psychiatry, University Hospitals H Mondor, Créteil, France
| | - Anne-Marie Tronche
- Fondation FondaMental, Créteil, France; CMP B, Clermont-Ferrand University Hospital, EA 7280, Faculty of Medicine, Auvergne University, Clermont-Ferrand, France
| | - Hanan Yazbek
- Fondation FondaMental, Créteil, France; Academic Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, University of Montpellier 1, INSERM 1061, Montpellier, France
| | - Anna Zinetti-Bertschy
- Fondation FondaMental, Créteil, France; Strasbourg University Hospital, INSERM U1114, Strasbourg Federation of Translational Psychiatry, Strasbourg, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
| | - Eric Brunet-Gouet
- Fondation FondaMental, Créteil, France; Department of Adult Psychiatry, Versailles Hospital, Le Chesnay, France; HandiRESP Laboratory, EA4047, Health Sciences Department Simone Veil, University of Versailles Saint-Quentin-En-Yvelines, Montigny-le-Bretonneux, France
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Lim MWZ, Lee J. Determinants of Health-Related Quality of Life in Schizophrenia: Beyond the Medical Model. Front Psychiatry 2018; 9:712. [PMID: 30618882 PMCID: PMC6305274 DOI: 10.3389/fpsyt.2018.00712] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/04/2018] [Indexed: 01/05/2023] Open
Abstract
Background: Improving Quality of Life (QoL) in Schizophrenia is an important treatment objective in the shift toward person-centered and recovery-oriented care. Health-Related Quality of Life (HRQoL) is a focused aspect of QoL that is directly impacted by healthcare intervention. This aim of the current study was to ascertain the clinical determinants of HRQoL in Schizophrenia and their collective contribution to HRQoL. Methods: 157 stable outpatients with schizophrenia were recruited for this study. Data collected included sociodemographic information and clinical characteristics. HRQoL was assessed on the RAND-36. Psychopathology was assessed on the Positive and Negative Syndrome Scale (PANSS) and functioning measured on the Global Assessment Scale (GAS). Findings: Multiple regression revealed that the Physical Health Component (PHC) of the RAND-36 was associated with positive symptoms (beta = -0.218, p = 0.005) and presence of psychiatric comorbidity (beta = -0.215, p = 0.003). The Mental Health Component (MHC) was associated with depressive (beta = -0.364, p < 0.001) and positive (beta = -0.175, p = 0.021,) symptoms. Symptoms, functioning, presence of psychiatric comorbidities, gender and age account for 20.3% of the total variance observed in HRQoL. Conclusion: Depressive and positive symptoms are key clinical determinants of HRQoL in people with schizophrenia. However, the medical model-looking solely at clinical determinants-could not account for a large proportion of variance in HRQoL. Hence, future research beyond the medical model is required to uncover the determinants of HRQoL in Schizophrenia. Identifying these factors will contribute toward developing a holistic and person-centered management plan for people with schizophrenia.
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Affiliation(s)
- Madeline W Z Lim
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore.,Department of Psychosis, Institute of Mental Health, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Adelufosi AO, Ogunwale A, Abayomi O, Mosanya JT. Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia. Psychiatry Res 2013; 209:320-5. [PMID: 23452754 DOI: 10.1016/j.psychres.2012.12.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 12/24/2012] [Accepted: 12/29/2012] [Indexed: 11/16/2022]
Abstract
This study aimed to measure the subjective quality of life (QOL) of Nigerian outpatients with schizophrenia and to examine its socio-demographic as well as clinical determinants. A total of 313 outpatients with schizophrenia participated in the study. Data were collected on socio-demographics, outpatient clinic attendance, perceived social support, perceived satisfaction with hospital care, medication adherence, illness severity and QOL. Multiple linear regression analysis was used to determine the amount of variance in the QOL domain scores explained by socio-demographic and clinical variables. Employment status, perceived social support, satisfaction with outpatient care, antipsychotic medication dose, Brief Psychiatric Rating Scale (BPRS) scores and medication adherence had significant relationships with all the QOL domains. Average monthly allowance and outpatient clinic default were significantly associated with all QOL domains except social relationship. Socio-demographic and clinical factors explained only a modest part (29.4%) of the variance in the QOL scores. It is likely that unmeasured 'internalised' determinants contribute in a much larger sense to the variation in subjective QOL.
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Affiliation(s)
- A O Adelufosi
- Department of Psychiatry, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria.
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van der Plas AGM, Hoek HW, van Hoeken D, Valencia E, van Hemert AM. Perceptions of quality of life and disability in homeless persons with schizophrenia and persons with schizophrenia living in non-institutional housing. Int J Soc Psychiatry 2012; 58:629-34. [PMID: 21878468 DOI: 10.1177/0020764011419056] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Homelessness is common in persons with schizophrenia. It is unclear how housing conditions and homelessness affect their quality of life and their disability. AIMS To explore the self-perceived quality of life and disability of homeless persons with schizophrenia and of those of persons with schizophrenia living in non-institutional housing. METHODS Seventy-six not-homeless and 50 homeless persons with schizophrenia were assessed using the World Health Organization's Quality of Life - short version (WHOQOL-Bref) and Disability Assessment Schedule (WHODAS-II). Univariate comparisons of the two groups were made for sociodemographic variables, clinical characteristics, perceived quality of life and disability. A regression model was used to adjust for potential confounding factors between quality of life, disability and housing. RESULTS After controlling for age, gender, marital status and age of first hospital admission, homeless persons had more positive scores for the quality of life domain 'health', for the disability domain 'getting along with people' and for the total disability score than persons in non-institutional housing. CONCLUSION Contrary to our expectations, the persons in non-institutional housing reported a lower quality of life and more disability than the homeless people. Future research should clarify whether non-institutional housing in and of itself can improve the well-being of people with schizophrenia.
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Affiliation(s)
- A G M van der Plas
- VU Medical Centre Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands.
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De Maeyer J, Vanderplasschen W, Lammertyn J, van Nieuwenhuizen C, Broekaert E. Exploratory study on domain-specific determinants of opiate-dependent individuals' quality of life. Eur Addict Res 2011; 17:198-210. [PMID: 21576964 DOI: 10.1159/000324353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 01/13/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Studies on determinants of quality of life (QoL) among opiate-dependent individuals are scarce. Moreover, findings concerning the role of severity of drug use are inconsistent. This exploratory study investigates the association between domain-specific QoL and demographic, social, person, health and drug-related variables, and potential indirect effects of current heroin use on opiate-dependent individuals' QoL. METHODS A cohort of opiate-dependent individuals who started outpatient methadone treatment at least 5 years previously (n = 159) were interviewed about their current QoL, psychological distress, satisfaction with methadone treatment and the severity of drug-related problems using the Lancashire Quality of Life Profile, the Brief Symptom Inventory, the Verona Service Satisfaction Scale for Methadone Treatment and the EuropASI. RESULTS None of the QoL domains were defined by the same compilation of determinants. No direct effect of current heroin use on QoL was retained, but path analyses demonstrated its indirect effects on the domains of 'living situation', 'finances' and 'leisure and social participation'. CONCLUSION These findings illustrate the particularity of each QoL domain and the need for a multidimensional approach to the concept. The relationship between current heroin use and various domains of opiate-dependent individuals' QoL is complex, indirect and mediated by psychosocial and treatment-related variables.
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Affiliation(s)
- J De Maeyer
- Department of Orthopedagogics, Ghent University, Belgium. Jessica.demaeyer @ ugent.be
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