Subjective quality of life in schizophrenic outpatients in a Catalan urban site

Relationship between quality of life and social integration among patients with schizophrenia attending a Nigerian tertiary hospital

BACKGROUND

Despite decades of de-institutionalization and the best efforts of community mental health services, individuals with schizophrenia living outside the hospital may be described as in the community but not of the community, and remain in a very real sense socially excluded.

AIM AND OBJECTIVES

To determine the relationship between social integration and quality of life among patients with schizophrenia attending the outpatient clinic of the Neuropsychiatric Hospital Abeokuta in Nigeria.

METHODS

One hundred and fifty-one patients were recruited. Sociodemographic questionnaire, MINI-PLUS, WHOQOL-BREF, Social Integration Scale and PANSS were administered. Multivariable regression analyses were performed to identify the determinants of quality of life and the relationship with social integration.

RESULTS

The mean (± SD) age of the respondents was 40.00 (± 10.23), 56.3% were males, 37.1% were single. Independent predictors of lower quality of life were: (1) more severe psychopathology for the domains of general health (p = 0.003), social relationship (p = 0.019) and environment (p = 0.008); (2) longer duration of illness for the social relationship (p = 0.028) and environment (p = 0.015) domains; and (3) negative symptoms (p = 0.034) for the physical domain.

CONCLUSION

There is a need to pay closer attention to social outcome measures such as quality of life and level of social integration among patients with schizophrenia who come in contact with psychiatry services, and not just on symptom remission only.

Measuring quality of life in first-episode psychosis

Quality of life (QoL) measures are increasingly recognized as necessary parts of outcome assessments in psychosis. The present paper is a comprehensive study of patients with first-episode psychosis where QoL is measured by the commonly used Lehman Quality of Life Interview (L-QoLI). The aim is to examine if the L-QoLI maintain its original structure when used in a group of patients with first-episode psychosis, and to investigate what determines global subjective QoL with a specific emphasis on premorbid adjustment, duration of untreated psychosis (DUP) and clinical symptoms. The study indicates that the psychometric properties of the L-QoLI do not change significantly when used in first-episode samples. The patients report subjective and objective QoL in the fair to good range, with only a moderate association between the objective and subjective measures. Poor global satisfaction is predicted by being single, abusing drugs, being depressed, having a diagnosis of psychotic affective disorder, having poor premorbid social adjustment and DUP over 10 weeks. The study supports the notion that patients with first-episode psychosis construct QoL in the same way as other groups, and that longer durations of compromised function at this stage produces poor satisfaction with life rather than a downward readjustment of expectations.

Quality of life and psychopathology during the course of schizophrenia

OBJECTIVE

This study evaluated a population of outpatients with stable schizophrenia to analyze if relationships between patterns of symptomatology and quality of life (QOL) change during the time course of illness.

METHODS

We recruited 168 outpatients with stable schizophrenia, and we further divided our sample into 3 groups of patients (<or=36, 37-72, and >72 months of illness). Psychiatric assessment included the Quality of Life Scale, the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, and the Clinical Global Impression-Severity Scale. All clinical variables significantly related to Quality of Life Scale scores were subsequently analyzed using a multiple stepwise regression to assess their independent contribution to QOL in the 3 patient groups.

RESULTS

Quality of life and symptoms profiles were similar among patient groups. After controlling for potentially confounding variables, multiple regression revealed that depressive symptoms appeared to have a stronger relationship with QOL during the early 3-year course of the illness. In the period between 4 and 6 years of illness, negative symptoms were the most reliable predictors of QOL. After the 6-year course of illness, negative symptoms remained the most reliable predictors of QOL, together with severity of illness, whereas positive and depressive symptoms had a minor role.

CONCLUSIONS

Despite similar QOL and symptoms profiles, these findings suggested that relationships among patterns of symptomatology and QOL change during the course of schizophrenia.

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.

Psychiatric symptoms and quality of life in schizophrenia: a meta-analysis

Quality of life (QoL) has been recognized as an important outcome of schizophrenia treatment, yet the determinants of QoL for individuals with schizophrenia are not well known. Research has consistently found psychiatric symptoms to be negatively related to QoL, however, findings concerning the strength of these relationships have been mixed, making it difficult to determine the degree to which such symptoms are related to poor QoL. This research presents a systematic meta-analysis of studies examining the relationship between psychiatric symptoms and QoL in schizophrenia, in an effort to elucidate the determinants of QoL for this population. A total of 56 studies were extracted from literature searches of relevant databases for empirical reports published between 1966 and 2005 examining the relationship between positive, negative, and/or general psychiatric symptoms and QoL. Weighted effect size analyses revealed small relationships between psychiatric symptoms and QoL, with general psychopathology showing the strongest negative associations across all QoL indicators. Moderator analyses indicated that variation in effect sizes could be accounted for by differing operationalizations of QoL, study design, sample, and participant treatment setting. In particular, positive and negative symptoms were more strongly related to poor QoL among studies of schizophrenia outpatients, whereas general psychopathology showed a consistent negative relationship with QoL across all study samples and treatment settings. Implications for future research and treatment development are discussed.

Education, ethnicity, and subjective life quality of recently discharged inpatients with schizophrenia

To inform psychiatric practice and research that enhances subjective quality of life (SQL) in diverse persons with schizophrenia, this study explored whether SQL differs in blacks and whites with varying educational attainment. Participants were interviewed upon discharge from 4 New York City psychiatric hospitals and after 3 months in community care (N = 264, mean age of 37 years, 61% male, 56% black). Linear regression equations predicted white and black SQL from educational attainment and control variables (ethnicity, age, functioning level, symptom severity). Educational accomplishment predicted lower SQL (F = 3.53, df = 4,227, p < 0.01), especially among whites (F = 5.87, df = 4,92, p < 0.001). However, the association was statistically insignificant in blacks who had SQL peaks and valleys with more years of school. Findings suggest that psychiatric care and research should account for educational and cultural variation in assessing and promoting SQL.

Schizophrenia and quality of life: a one-year follow-up in four EU countries

BACKGROUND

This article systematically monitors the quality of life (QOL) of patients with schizophrenia from seven different sites across four European countries: France, Ireland, Portugal and Spain.

METHODS

A one-year prospective cohort study was carried out. Inclusion criteria for patients were: a clinical lifetime diagnosis of schizophrenia according to ICD-10 (F20) diagnostic criteria for research, age between 18 and 65 years and at least one contact with mental health services in 1993. Data concerning QOL were recorded in seven sites from four countries: France, Portugal, Ireland and Spain, and were obtained using the Baker and Intagliata scale. At baseline, 339 patients answered the QOL questionnaire. At one-year follow-up, Spain could not participate, so only 263 patients were contacted and 219 agreed to take part. QOL was compared across centres by areas and according to a global index. QOL was correlated with presence of clinical and social problems, needs for care and interventions provided during the one-year follow-up.

RESULTS

We did not find any link between gender and QOL. There were some significant differences between centres concerning many items. What is more, these differences were relative: in Lisbon where the lowest level of satisfaction was recorded, people were satisfied with food but highly dissatisfied with finances, whereas in St Etienne, where the highest level of satisfaction was recorded, people were less satisfied with food when they were more satisfied with finances. The evolution in one year among those respondents who took part in the follow-up (excluding the subjects from Granada) showed different patterns depending on the items.

CONCLUSION

The four countries have different resources and patients live in rather different conditions. However, the main differences as far as their QOL is concerned very much depend on extra-psychiatric variables, principally marital status and income.

The quality of life of the mentally ill living in residential facilities: findings from a national survey in Italy

Quality of Life (QOL) is an outcome measure particularly useful to assess the effects of deinstitutionalization policies. To date no large-scale study has been conducted in residential facilities (RFs). Participants included 1492 subjects living in 174 RFs (20% of the total) randomly sampled in 15 Italian regions. Assessment instruments included the WHOQOL-Bref, the GAF, and the Physical Health Index (PHI). WHOQOL scores of residents were compared with those of healthy subjects (N = 65) and outpatients with schizophrenia (N = 162). Multivariate analyses were used to examine the relationship between selected patients' characteristics and WHOQOL scores. Mean WHOQOL scores of residents were similar to those of outpatients with schizophrenia, and substantially lower than those of healthy controls. Lower scores on WHOQOL domains were associated with schizophrenia and non-affective psychoses, unipolar depression, anxiety or somatoform disorders, shorter duration of illness, positive, negative or mood symptoms, lower GAF scores, no participation in internal activities, and PHI score. Our findings are consistent with previous studies. The present study highlights a marked difference between patients in RFs and healthy controls in the social domain. This suggests the need of well-designed rehabilitation plans, tailored to patients' needs, to foster the development of their independence and, ultimately, improve their QOL.

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.

Ethnicity and life quality of recently discharged inpatients with schizophrenia

Three months after inpatient discharge, quality of life was examined in 259 individuals with schizophrenia. As in findings by Lehman, Rachuba, and Postrado (1995), Black participants reported a higher quality than Whites after controlling for gender, degree of psychopathology, functioning level, substance abuse, and baseline life quality. Implications are discussed.

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.