Quality of life in patients with comorbid serious mental illness and chronic diseases: A structural equation model

Gender Differential Morbidity in Quality of Life and Coping Among People Diagnosed with Depression and Anxiety Disorders

BACKGROUND/OBJECTIVES

Psychosocial and cultural determinants have a special influence on the development, manifestation and prognosis of common mental disorders such as anxiety and depression. The objectives of this study were to define the psychosocial profile of the people most vulnerable to the development of these health problems, analyse the symptomatology and health determinants that may influence these from a gender perspective, and evaluate the quality of life and coping strategies among the adult population with this diagnosis in a rural area of Catalonia (Spain).

METHODS

An observational, cross-sectional, and analytical study was conducted on 180 people diagnosed with anxiety or depression. Patients completed an ad hoc sociodemographic questionnaire, the Brief Symptom Checklist (LSB-50), the Quality of Life Scale (EQ-5D-5L) and the Brief Cope Inventory (COPE-28).

RESULTS

Women aged 45-64 with a low socioeconomic profile may be more vulnerable to common mental disorders, although psychiatric symptomatology was more pronounced in men. Women were more likely to have problems with mobility (aOR= 2.93, p = 0.039) and daily activities (aOR = 2.75, p = 0.033), as well as lower self-perceived health scores (p = 0.002). Women used active coping, venting and seeking social support as coping strategies, while men used behavioural disengagement.

CONCLUSIONS

It has been observed that the people most susceptible to developing depression and anxiety disorders may have a specific profile. Although a greater number of women have these common mental disorders, men tend to have more noticeable symptomatology. The coping strategies most used also differ according to gender.

Review of community-based interventions for people with serious mental illness, focusing on learning instrumental activities of daily living and enhancing wellbeing

This review synthesises evidence on community-based interventions designed to support individuals with serious mental illness (SMI) in learning instrumental activities of daily living (IADLs). Given the increasing prevalence of SMI affecting over 500 million people worldwide, and associated functional impairments, effective interventions are critically needed. This review of thirty studies represented a range of global contexts and intervention types, which were categorised into simple IADLs (e.g. household chores), complex IADLs (e.g. financial management), and recreational IADLs (e.g. leisure activities). Findings demonstrated that community-based interventions significantly improved IADLs, promoting functional independence and overall well-being. Thematic analysis identified five key mechanisms for success: individualised goal-setting, structured programs with practical learning, engagement of support systems, integration into daily life, and use of innovative technologies. The review highlighted that personalised and practical IADL interventions, supported by robust community and technological resources, were most effective. When effective, interventions enhance practical skills of individuals while also contributing to emotional well-being, social connections, and personal fulfilment. Despite promising results, the review notes variability in study designs and outcomes, suggesting a need for consistent and long-term evaluations. Nonetheless, review insights offer valuable guidance for designing future interventions to better support autonomy and community integration of individuals with SMI.

Quality of life among people with mental illness attending a psychiatric outpatient clinic in Ethiopia: a structural equation model

Background

Mental illness is one of the most severe, chronic, and disabling public health problems that affects patients' Quality of life (QoL). Improving the QoL for people with mental illness is one of the most critical steps in stopping disease progression and avoiding complications of mental illness. Therefore, we aimed to assess the QoL and its determinants in patients with mental illness in outpatient clinics in Northwest Ethiopia in 2023.

Methods

A facility-based cross-sectional study was conducted among people with mental illness in an outpatient clinic in Ethiopia. The sampling interval was decided by dividing the total study participants who had a follow-up appointment during the data collection period (2400), by the total sample size 638, with the starting point selected by lottery method. The interviewer-administered WHOQOL BREF-26 tool was used to measure the quality of life (QoL) of people with mental illness. The domains of QoL were identified, and indirect and direct effects of variables were calculated using structural equation modelling with SPSS-28 and Amos-28 software. A p-value of < 0.05 and a 95% CI were used to evaluate statistical significance.

Results

A total of 636 (99.7%) participants agreed to participate and completed the data collection. The mean score of overall QoL of people with mental illness in the outpatient clinic was 49.6 ± 10 Sd. The highest QoL was found in the physical health domain (50.67 ± 9.5 Sd), and the lowest mean QoL was found in the psychological health domain (48.41 ± 10 Sd). Rural residence, drug nonadherence, suicidal ideation, not getting counselling, moderate or severe subjective severity, family does not participate in patient care and a family history of mental illness had an indirect negative effect on QoL. Alcohol use and psychological health domain had direct positive effect on QoL. Furthermore, objective severity of illness, having low self-esteem, and having history of mental illness in the family had both direct and indirect effect on QoL. Furthermore, sociodemographic factors (rural residence, illiterate educational status, not married marital status), social support-related factors (poor self-esteem, family not participating in patient care), substance use factors (alcohol use, tobacco use) and clinical factors (high objective and subjective severity of illness, not getting counselling, suicidal ideation, higher number of episodes, comorbid illness, family history of mental illness, poor drug adherence) directly and indirectly affected QoL.

Conclusions

In this study, the QoL of people with mental illness was poor, with the psychological health domain the most affected. Sociodemographic factors, social support-related factors, drug use factors, and clinical factors, directly and indirectly affected QoL through the mediator variables of physical health domains, psychological health domains, social relation health domains, and environmental health domains. In order to improve the QoL of people with mental illnesses, we recommend that emphasis be given to addressing the QoL of those with mental illness, including the development of policy and practice responses that address the above identified factors.

Health-Related Quality of Life of People Who Inject Drugs: The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study

OBJECTIVES

There is limited research on health-related quality of life (HRQoL) among people who inject drugs (PWID). We evaluated the HRQoL and associated factors among a cohort of PWID in Australia.

METHODS

Participants were enrolled in an observational cohort study (the Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage Study) from May 2018 to September 2019 (wave 1) and November 2019 to June 2021 (wave 2). Participants completed the EQ-5D-5L survey at enrolment. Two-part models were used to assess the association of clinical and socioeconomic characteristics with EQ-5D-5L scores.

RESULTS

Among 2395 participants (median age, 43 years; 66% male), 65% reported injecting drug use in the past month, 20% had current hepatitis C virus (HCV) infection, and 68% had no/mild liver fibrosis (F0/F1). Overall, the mean EQ-5D-5L and EQ-visual analog scale scores were 0.78 and 57, respectively. In adjusted analysis, factors associated with significantly lower EQ-5D-5L scores include older ages, female (marginal effect = -0.03, P = .014), being homeless (marginal effect = -0.04, P = .040), and polysubstance use (marginal effect = -0.05, P < .001). Factors associated with significantly higher EQ-5D-5L scores were being Aboriginal/Torres Strait Islander (marginal effect = 0.03, P = .021) and recent injecting drug use in the past 12 months. Current HCV infection and liver fibrosis stage were not associated with reduced HRQoL among the study participants.

CONCLUSIONS

PWID experienced a lower HRQoL compared with the general population. Further research is needed to understand HRQoL in this population to facilitate the development of multifaceted care models for PWID beyond HCV cure and inform health economic analyses for identifying optimal health strategies for PWID.

Diabetes self-care behaviours among people diagnosed with serious mental illness: A cross-sectional correlational study

WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with serious mental illness have a high risk of diabetes and are more likely to develop type 2 diabetes at ages below 60 years. Effective diabetes self-care behaviours among people diagnosed with serious mental illness can improve glycaemic control and reduce vascular complications. Few studies have investigated diabetes self-care behaviours and their associations with health literacy and self-efficacy in people diagnosed with serious mental illness. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Diabetes self-care behaviours in people diagnosed with serious mental illness were suboptimal; the least frequently performed self-care activities were self-monitoring of blood glucose. Factors associated with diabetes self-care behaviours are gender, age, communicative and critical health literacy and self-efficacy. Self-efficacy is the strongest predictor of self-care behaviours among people diagnosed with comorbid serious mental illness and type 2 diabetes. WHAT ARE THE IMPLICATIONS OF PRACTICE?: Mental health nurses should assess diabetes-specific health literacy of people diagnosed with serious mental illness to ensure that they possess the knowledge and skills related to diabetes self-care. When treating young people and those with newly diagnosed type 2 diabetes, nurses should incorporate strategies to minimise their perceptions of diabetes-related distress and increase their confidence in managing comorbid diabetes. ABSTRACT: Introduction People diagnosed with serious mental illness (SMI) experience greater challenges in managing their type 2 diabetes mellitus (T2DM) than do those diagnosed with T2DM alone. Aim This study investigated diabetes self-care activities and the factors associated with these activities in people diagnosed with SMI in a hospital setting. Methods A cross-sectional correlational study was conducted among 126 people diagnosed with comorbid SMI and T2DM in Taipei, Taiwan, between October 2020 and April 2021. Data were collected using self-report questionnaires and a chart review. Three-step hierarchical multiple regression analysis was used to identify factors associated with diabetes self-care behaviours. Results Diabetes self-care behaviours in people diagnosed with SMI were suboptimal overall. Hierarchical multiple regression analyses revealed that age (β = 0.18, p = .037) and self-efficacy (β = 0.27, p = .004) significantly associated with diabetes self-care behaviours. Discussion Self-efficacy is the strongest predictor of self-care behaviours among people diagnosed with comorbid SMI and T2DM. Implications for Practice Mental health professionals should focus on enhancing confidence in managing comorbid diabetes in people diagnosed with comorbid SMI, especially young people and those with newly diagnosed T2DM.

Nurses' views on the provision of physical healthcare for individuals with comorbid mental illness and chronic disease

The prevalence of chronic diseases (such as diabetes, obesity, cancer, heart disease, and chronic obstructive pulmonary disease) continues to increase among patients with mental illness. This cross-sectional study investigated the factors affecting nurses' views on the provision of physical healthcare to patients with comorbid mental illness and chronic disease. In total, 369 nurses working in mental health were assessed for the physical healthcare attitudes and practices using the Physical Health Attitude Scale for Mental Health Nurses. The results of generalized linear modelling indicated that nurses' involvement in physical healthcare was associated with psychiatric mental health nurse credentials (B = 1.560, 95% CI = 0.292-2.828, P = 0.016) and their confidence in delivering physical healthcare was associated with prior physical healthcare training (B = 0.639, 95% CI = 0.104-1.174, P = 0.019). In addition, the frequency with which the nurses engaged in physical healthcare practices was associated with working in a community unit (B = -7.416, 95% CI = -9.652 to -5.180, P < 0.001), involvement in physical healthcare (B = 0.349, 95% CI = 0.162-0.535, P < 0.001), and confidence in delivering physical healthcare (B = 1.148, 95% CI = 0.776-1.519, P < 0.001). Our findings suggest that interventions aiming to help nurses assess and improve their own physical healthcare practices should consider nurses' background and patients' physical health needs in various settings and focus on cultivating an organizational culture that gives nurses confidence in providing physical healthcare.

High internalized stigma among community-dwelling patients with schizophrenia: Associations with sociodemographic and clinical characteristics, personality traits and health-related quality of life

Stigma attached to schizophrenia among patients is a global concern to mental health advocates. The extent of internalized stigma experienced by consumers with schizophrenia living in the community and its correlates have not been fully explored. This study aimed to examine the prevalence of high internalized stigma and its association with sociodemographic and clinical characteristics, personality traits and aspects of health-related quality of life among community-dwelling consumers with schizophrenia. A descriptive, correlational study with a cross-sectional design was conducted with 149 consumers from outpatient psychiatric clinics of two hospitals in Taiwan. Face-to-face interviews with structured questionnaires were adopted. Data were analysed with descriptive statistics, chi-squares tests, independent t-tests and a binary logistic regression analysis. Approximately 41.6% of consumers with schizophrenia experienced high internalized stigma. In the subscales, a high experience of discrimination experience (43.6%) was reported, followed by alienation (34.2%), social withdrawal (28.2%), stereotype endorsement (24.8%) and stigma resistance (20.8%). Being younger at the onset of schizophrenia, attaining lower education, having a history of suicidality, fewer positive personality traits and poor aspects of health-related quality of life were significantly associated with high internalized stigma. Personality traits in the domains of emotional stability and conscientiousness and social and environmental aspects of health-related quality of life appeared to be the most relevant to risk of high internalized stigma. Anti-stigma initiatives coupled with personality-traits modules and modifications of health-related quality of life are suggested for mental health professionals and policy makers to ameliorate internalized stigma among community-dwelling consumers with schizophrenia.

Green Fabrication and Release Mechanisms of pH-Sensitive Chitosan-Ibuprofen Aerogels for Controlled Transdermal Delivery of Ibuprofen

Ibuprofen is a potent non-steroidal anti-inflammatory drug due to its analgesic, antipyretic, and anti-inflammatory actions. However, its poor solubility in water makes it difficult to manufacture ibuprofen tablets, which limited the application of ibuprofen in drug delivery systems. Polymer–drug aerogels have attracted huge interest in optimizing the drug delivery efficiency and improving the physicochemical characteristics and therapeutic quality. Here, chitosan–ibuprofen aerogels with excellent swelling, high biocompatibility, and better drug delivery efficiency were synthesized by a simple method. Our study found that the chitosan–ibuprofen aerogels exhibited remarkably improved thermal stability, excellent swelling ratio, and high drug loading. As a consequence of these favorable properties, the chitosan–ibuprofen aerogels exhibited improved drug delivery efficiency and achieved drug prolonged administration. Our study highlights the great potential of polymer–drug aerogels in improving the drug delivery efficiency of transdermal drug delivery systems.

Effectiveness of a brief family strengths-oriented therapeutic conversation intervention for patients with schizophrenia and their caregivers

PURPOSE

To examine the effects of a brief family strengths-oriented therapeutic conversation (FAM-SOTC) intervention on symptom severity of patients with schizophrenia and family coping and caregiver burden for family caregivers.

DESIGN

A quasi-experimental research design with repeated measures.

METHODS

A convenience sample of 72 dyads of patient-family caregivers was recruited from randomized inpatient psychiatric rehabilitation units in a psychiatric hospital in Taiwan. Sixty-one patient-family caregiver dyads that comprised the intervention group (n = 29) and control group (n = 32) completed questionnaires at four time points (baseline, immediate, one- and three-months post-intervention). Demographic questionnaires and clinical information, Brief Psychiatric Rating Scale, Family Crisis-Orientation Personal Evaluation Scales, and Zarit Burden Interview were used to collect data. Generalized estimating equations were used to assess the differences in symptom severity, family coping, and caregiver burden between the two groups.

FINDINGS

As compared to the control group, the intervention group showed statistically significant improvements over three months in symptom severity as well as family coping, especially acquiring social support, reframing, and mobilizing social support for family caregivers. Caregiver burden in the intervention group was ameliorated immediately and one month after the intervention rather than a three-month post-intervention.

CONCLUSIONS

A brief FAM-SOTC intervention proved to be favorable for alleviating psychiatric symptoms of patients coupled with an improvement in family coping and burden in family caregivers encountering schizophrenia.

CLINICAL RELEVANCE

Integration of a brief family therapeutic conversation intervention into the routine psychiatric rehabilitation services delivery is recommended to help patients and their family caregivers effectively manage schizophrenia.