Predictors of quality of life in a longitudinal study of users with severe mental disorders

Health and Quality of Life Outcomes

Jean Caron²  Norbert Schmitz²  Jacques Tremblay²  Jean-Marie Bamvita¹  Guy Grenier¹  Marie-Josée Fleury¹ 

[1] Douglas Hospital Research Centre, 6875 LaSalle Blvd., Montreal, Quebec H4H 1R3, Canada;Department of Psychiatry, McGill University, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, Quebec H4H 1R3, Canada

关键词: Severe mental disorders;    Social support;    Needs;    Subjective quality of life;   

Others  :  823587
DOI  :  10.1186/1477-7525-11-92

 received in 2013-02-07, accepted in 2013-06-03,  发布年份 2013

【 摘 要 】

Background

Since the end of the 20th century, quality of life has become a key outcome indicator in planning and evaluation of health services. From a sample of 297 users with severe mental disorders from Montreal (Canada), this study aimed to identify the key predictors of subjective quality of life (SQOL).

Methods

Users were recruited and interviewed from December 2008 to September 2010 and re-interviewed approximately 18 months later. A comprehensive framework including socio-demographic data, clinical, needs and functionality variables, negative life events, social support and healthcare service use, and appreciation data were considered as predictors. Clinical records and eight standardized instruments were used.

Results

Lower severity of needs, schizophrenia, better social integration, better reassurance of worth, fewer drug abuse problems, and living in supervised housing are predictors of SQOL. With regard to needs, absence or lower severity of needs in the areas of company, daytime activities, social exclusion, safety to self, and benefits are linked to SQOL.

Conclusion

Reducing the severity of needs is especially beneficial to ensure a higher SQOL for users with severe mental disorders. To improve SQOL, priority must be given to programs and interventions that promote the development of a stimulating and supportive social network, and maintain a plurality of residential services matching the functional abilities of users.

【 授权许可】

   
2013 Fleury et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bengtsson-Tops A, Hansson L, Sandlund M, Bjarnason O, Korkeila J, Merinder L, Nilsson L, Sorgaard KW, Vinding HR, Middelboe T: Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: a Nordic multicentre study. Qual Life Res 2005, 14:221-229.
• [2]Caron J, Mercier C, Diaz P, Martin A: Socio-demographic and clinical predictors of quality of life in patients with schizophrenia or schizo-affective disorder. Psychiatry Res 2005, 137:203-213.
• [3]Evans S, Huxley P, Priebe S: A comparison of the quality of life of severely mentally ill people in UK & German samples. Int J Soc Psychiatry 1999, 46:47-56.
• [4]Ruggeri M, Nosè M, Bonetto C, Cristofalo D, Lasalvia A, Salvi G, Stefani B, Malchiodi F, Tansella M: Changes and predictors of change in objective and subjective quality of life: multiwave follow-up study in community psychiatric practice. Br J Psychiatry 2005, 187:121-130.
• [5]Gupta S, Kulhara P, Verma SK: Quality of life in schizophrenia and dysthemia. Acta Psychiatr Scand 1998, 97:290-296.
• [6]Baker F, Intagliata J: Quality of life in the evaluation of community support systems. Eval Program Plann 1982, 5:69-79.
• [7]Lehman AF, Ward NC, Linn LS: Chronic mental patients: the quality of life issue. Am J Psychiatry 1982, 139:1271-1276.
• [8]Sullivan G, Wells KB, Leake B: Quality of life of seriously mental ill persons in Mississipi. Hosp Community Psychiatry 1991, 42:752-754.
• [9]Pinkney AA, Gerber GJ, Lafave HG: Quality of life after psychiatric rehabilitation: the clients’ perspectives. Acta Psychiatr Scand 1991, 83:86-91.
• [10]Barry MM, Zissi A: Quality of life as an outcome measure in evaluating mental health services: a review of the empirical evidence. Soc Psychiatry Psychiatr Epidemiol 1997, 32:38-47.
• [11]Heider D, Angermeyer MC, Winkler I, Schomerus G, Bebbington PE, Brugha T, Azorin JM, Toumi M: A prospective study of Quality of life in schizophrenia in three European countries. Schizophr Res 2007, 93:194-202.
• [12]Lam JA, Rosenheck RA: Correlates of improvement in quality of life among homeless persons with serious mental illness. Psychiatr Serv 2000, 51:116-118.
• [13]Piat M, Sabetti J, Bloom D: The transformation of mental health services to a recovery-oriented system of care: Canadian decision maker perspectives. Int J Soc Psychiatry 2010, 56:168-177.
• [14]Kirby MJL: Out of the shadows at last. SaT ed edition. Ottawa: The Senate of Canada; 2006:28. [The Standing Senate Committe on Social Affairs] pp. 281
• [15]Anthony WA: Recovery from the mental illness: the guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal 1993, 16:11-23.
• [16]Arnold LM, Witzeman KA, Swank ML, McElroy SL, Keck PEJ: Health-related quality of life using the SF-36 in patients with bipolar disorder compared with patients with chronic back pain and the general population. J Affect Disord 2000, 57:235-239.
• [17]Cramer V, Torgersen S, Kringlen E: Mood disorders and quality of life. A community study. Nord J Psychiatry 2010, 64:58-62.
• [18]Ruggeri M, Gater R, Bisoffi G, Barbui C, Tansella M: Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona outcome project 5. Acta Psychiatr Scand 2002, 105:131-140.
• [19]Huppert JD, Weiss KA, Lim R, Pratt S, Smith TE: Quality of life in schizophrenia; contributions of anxiety and depression. Schizophr Res 2001, 51:171-180.
• [20]Narvaez JM, Twamley EW, McKibbin CL, Heaton RK, Patterson TL: Subjective and objective quality of life in schizophrenia. Schizophr Res 2008, 98:201-208.
• [21]Leisse M, Kallert TW: Social integration and the quality of life of schizophrenic patients in different types of complementary care. Eur Psychiatry 2000, 15:450-460.
• [22]Staring AB, Mulder CL, Duivenvoorden HJ, De Haan L, Van der Gaag M: Fewer symptoms vs. More side-effects in schizophrenia? opposing pathways between antipsychotic medication compliance and quality of life. Schizophr Res 2009, 113:27-33.
• [23]Holloway F, Carson J: Subjective quality of life, psychopathology, satisfaction with care and insight: an exploratory study. Int J Soc Psychiatry 1999, 45:259-267.
• [24]Lasalvia A, Bonetto C, Malchiodi F, Salvi G, Parabiaghi A, Tansella M, Ruggeri M: Listening to patients’ needs to improve their subjective quality of life. Psychol Med 2005, 35:1655-1665.
• [25]Slade M, Leese M, Cahill S, Thornicroft G, Kuipers E: Patient-rated mental health needs and quality of life improvement. Br J Psychiatry 2005, 187:256-261.
• [26]Wiersma D, van Busschbach J: Are needs and satisfaction of care associated with quality of life? An epidemiological survey among the severely mentally ill in the Netherlands. Eur Arch Psychiatry Clin Neurosci 2001, 251:239-246.
• [27]Margolese HC, Carlos Negrete J, Tempier R, Gill K: A 12-month prospective follow-up study of patients with schizophrenia-spectrum disorders and substance abuse: Changes in psychiatric symptoms and substance use. Schizophr Res 2006, 83:65-75.
• [28]Björkman T, Hansson L: Predictors of improvement in quality of life of long-term mentally ill individuals receiving case management. Eur Psychiatry 2002, 17:33-40.
• [29]Lasalvia A, Bonetto C, Salvi G, Bissoli S, Tansella M, Ruggeri M: Predictors of changes in needs for care in patients receiving community psychiatric treatment: a 4-year follow-up study. Acta Psychiatrica Scandinavica Supplement 2007, 116:31-41.
• [30]Slade M, Leese M, Ruggeri M, Kuipers E, Tansella M, Thornicroft G: Does meeting needs improve quality of life? Psychother Psychosom 2004, 73:183-189.
• [31]Xiang YT, Wang CY, Chiu HF, Zhao JP QC, Chan SS, Lee EH, Ungavi GS: Socio-demographic and clinical determinants of quality of life in Chinese patients with schizophrenia: a prospective study. Qual Life Res 2010, 19:317-322.
• [32]Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS: Subjective quality of life in outpatients with schizophrenia in Honk Kong and Beijing: relationship to socio-demographic and clinical factors. Qual Life Res 2008, 17:27-36.
• [33]Huppert JD, Smith TE: Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor. J Nerv Ment Dis 2001, 189:669-675.
• [34]Bengtsson-Tops A, Hansson L: Quantitative and qualitative aspects of the social network in schizophrenic patients living in the community. Relationship to sociodemographic characteristics and clinical factors and subjective quality of life. Int J Soc Psychiatry 2001, 47:67-77.
• [35]Priebe S, Roeder-Wanner UU, Kaiser W: Quality of life in first-admitted schizophrenia patients: a follow-up study. Psychol Med 2000, 30:225-230.
• [36]Baker F, Jodrey D, Intagliata J: Social support and quality of life of community support clients. Community Ment Health J 1992, 28:397-411.
• [37]Caron J, Tempier R, Mercier C, Leouffre P: Components of social support and quality of life in severely mentally ill, low income individuals and a general population group. Community Ment Health J 1998, 34:459-475.
• [38]Hansson L, Björkman T: Are factors associated with subjective quality of life in people with severe mental illness consistent over time- A 6-year follow-up study. Qual Life Res 2007, 16:9-16.
• [39]Kondrat DC, Early TJ: Battling in the trenches: case managers’ ability to combat the effects of mental illness on consumers’ perceived quality of life. Community Ment Health J 2011, 47:390-398.
• [40]Yanos PT, Rosenfield S, Horwitz AV: Negative and supportive social interactions and quality of life among persons diagnosed with severe mental illness. Community Ment Health J 2001, 37:405-419.
• [41]Ritsner MS, Lisker A, Arbitman M: Ten-year quality of life outcomes among patients with schizophrenia and schizoaffective disorders: I. Predictive value of disorder-related factors. Qual Life Res 2012, 21:837-847.
• [42]Eklund M, Hansson L, Bejerholm U: Relationships between satisfaction with occupational factors and health-related variables in schizophrenia outpatients. Soc Psychiatry Psychiatr Epidemiol 2001, 36:79-83.
• [43]Nordt C, Müller B, Rössler W, Lauber C: Predictors and course of vocational status, income, and quality of life in people with severe mental illness: A naturalistic study. Soc Sci Med 2007, 65:1420-1429.
• [44]Röder-Wanner UU, Oliver JP, Priebe S: Does quality of life differ in schizophrenic women and men? An empirical study. Int J Soc Psychiatry 1997, 43:129-143.
• [45]Mercier C, Péladeau N, Tempier R: Age, gender and quality of life. Community Ment Health J 1998, 34:487-500.
• [46]Kyle T, Dunn JR: Effects of housing circumstances on health, quality of life and healthcare use for people with severe mental illness: a review. Health Soc Care Community 2008, 16:1-15.
• [47]Browne G, Courtney M: Measuring the impact of housing on people with schizophrenia. Nurs Health Sci 2004, 6:37-44.
• [48]Wong YL, Filoromo M, Tennille J: From principles to practice: A study of implementation of supported housing for psychiatric consumers. Adm Policy Ment Health 2007, 34:13-28.
• [49]Middelboe T, Mackeprang T, Thalsgaard A, Christiansen PB: A housing support programme for the mentally ill: need profile and satisfaction among users. Acta Psychiatr Scand 1998, 98:321-327.
• [50]Tsai J, Bond GR, Salyers MP, Godfrey JL, Davis KE: Housing preferences and choices among adults with mental illness and substance use disorders: a qualitative study. Community Ment Health J 2010, 46:381-388.
• [51]Taylor RE, Leese M, Clarkson P, Holloway F, G T: Quality of life outcomes for intensive versus standard community mental health services. PRISM Psychosis Study 9. Br J Psychiatry 1998, 173:416-422.
• [52]Skantze K: Subjective quality of life and standard of living: a 10-year follow-up of out-patients with schizophrenia. Acta Psychiatr Scand 1998, 98:390-399.
• [53]Huxley P, Evans S, Burns T, Fahy T, Green J: Quality of Life outcome in a randomized controlled trial of case management. Soc Psychiatry Psychiatr Epidemiol 2001, 36:249-255.
• [54]Ritsner MS, Arbitman M, Lisker A, Ponizovsky AM: Ten-year quality of life outcomes among patients with schizophrenia and schizoaffective disorder II. Predictive value of psychosocial factors. Qual Life Res 2012, 21:1075-1084.
• [55]Ritsner M, Gibel A, Ratner Y: Determinants of changes in perceived quality of life in the course of schizophrenia. Qual Life Res 2006, 15:515-526.
• [56]Ritsner M: Predicting changes in domain-specific quality of life of schizophrenia patients. J Nerv Ment Dis 2003, 19:287-294.
• [57]Ritsner MS, Lisker A, Arbitman M, Grinshpoon A: Factor structure in the Camberwell Assessment of Need-Patient version: the correlations with dimensions of illness, personality and quality of life of schizophrenia patients. Psychiatry Clin Neurosci 2012, 66:499-507.
• [58]Fitzgerald PB, de Castella AR, Filia K, Collins J, Brewer K, Williams CL, Davey P, Kulkarni J: A longitudinal study of patient- and observer-rated quality of life in schizophrenia. Psychiatry Res 2003, 119:55-62.
• [59]APA: Diagnostic and Statistic Manual of Mental Disorders, 4th edition. Washington, DC: American Psychiatric Association; 1994.
• [60]Caron J, Mercier C, Tempier R: Une validation québécoise du Satisfaction with Life Domains Scale. Sante Ment Que 1997, 22:195-218.
• [61]Fleury MJ, Grenier G, J.M B, Tremblay J: Typology of persons with severe mental disorders. BMC Psychiatry 2013, 13:137. BioMed Central Full Text
• [62]Cutrona C, Russell D, Rose J: Social support and adaptation to stress by the elderly. Psychol Aging 1986, 1:47-54.
• [63]Hendryx M, Dyck DG, McBride D, Whitbeck J: A test of the reliability and validity of the Multnomah Community Ability Scale. Community Ment Health J 2001, 37:157-168.
• [64]Bohn MJ, Babor TF, Kranzler HR: The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medial settings. J Stud Alcohol 1995, 56:423-432.
• [65]Accietto C: La validation d'une version française du questionnaire A.U.D.I.T. "Alcohol Use Identification Test". Université de Genève; 2003.
• [66]Cocco KM, Carey KB: Psychometric properties of the Drug Abuse Screening Test in Psychiatric Outpatients. Psychol Assessment 1998, 10:408-414.
• [67]Durbin J, Goering P, Streiner DL, Pink G: Continuity of care: Validation of a new self-report measure for individuals using mental health services. Journal of Behavioral Health Services & Research 2004, 31:279-296.
• [68]Gravel R, Béland Y: The Canadian Community Health Survey: mental health and well-being. Can J Psychiatry 2005, 50:573-579. 69
• [69]Barbato A, Monzani E, Schiavi T: Life satisfaction in a sample of outpatients with severe mental disorders: a survey in northern Italy. Qual Life Res 2004, 13:969-973.
• [70]Kovess-Masféty V, Xavier M, Moreno Kustner B, Suchocka A, Sevilla-Dedieu C, Dubuis J, Lacalmontie E, Pellet J, Roelandt J-L, Walsh D: Schizophrenia and quality of life: a one-year follow-up in four EU countries. BMC Psychiatry 2006, 6:39. BioMed Central Full Text
• [71]Caron J, Corbière M, Mercier C, Diaz P, Ricard N: The construct validity of the client questionnaire of the Wisconsin Quality of Life index - a cross-validation study. Int J Methods Psychiatr Res 2003, 12:128-138.
• [72]Becker M, Diamond R, Sainfort F: A new patient focused index for measuring quality of life in persons with severe and persistent mental illness. Qual Life Res 1993, 2:239-251.
• [73]Caron J: Predictors of quality of life in economically disadvantaged populations in Montreal. Social Indicator Research 2012, 107:411-427.
• [74]Fleury MJ, Grenier G, Bamvita JM: Help received from relatives and services to satisfy needs of adults with severe mental disorders. Health 2013, 5:200-211.
• [75]Fleury MJ, Grenier G, Bamvita JM, Piat M, Tremblay J: Adequacy of help received among individuals with severe mental disorders. Administration and Policy in Mental Health 2013. Epub ahead of print
• [76]Fleury MJ, Grenier G, JM B, Tremblay J: Factors associated with needs of users with severe mental disorders. Psychiatr Q 2012. Epub ahead of print
• [77]UK700Group: Predictors of quality of life in people with severe mental illness. Study methodology with baseline analysis in the UK700 trial. Br J Psychiatry 1999, 175:426-432.
• [78]Werner S: Subjective well-being, hope, and needs of individuals with serious mental illness. Psychiatry Res 2012, 196:214-219.
• [79]Bengtsson-Tops A, Hansson L: Clinical and social needs of schizophrenic outpatients living in the community: the relationship between needs and subjective quality of life. Soc Psychiatry Psychiatr Epidemiol 1999, 34:513-518.
• [80]Landolt K, Rössler W, Burns T, Ajdacic-Gross V, Galderisi RS, Libiger J, Naber D, Derks EM, Kahn RS, Fleishchacker WW: The interrelation of needs and quality of life in first-episode schizophrenia. Eur Arch Psychiatry Clin Neurosci 2011, 262:207-216.
• [81]Slade M, Leese M, Taylor R, Thornicroft G: The association between needs and quality of life in an epidemiologically representative sample of people with psychosis. Acta Psychiatr Scand 1999, 100:149-157.
• [82]Hansson L, Sandlund M, Bengtsson-Tops A, Bjarnason O, Karlsson H, Mackeprang T, Merinder L, Nilsson L, Sorgaard K, Vinding H, Middelboe T: The relationship of needs and quality of life in persons with schizophrenia living in the community. A Nordic multi-center study. Nord J Psychiatry 2003, 57:5-11.
• [83]Caron J, Mercier C, Martin A, Stip E: Le rôle du soutien social, du fardeau familial et de la satisfaction des services dans la détresse psychologique et la qualité de vie des familles de personnes atteintes de schizophrénie. Sante Ment Que 2005, 30:165-191.
• [84]Langeland E, Wahl AK: The impact of social support on mental health service users’ sense of coherence: A longitudinal panel survey. Int J Nurs Stud 2009, 46:830-837.
• [85]Skantze K, Malm U, Dencker SJ, May PR, Corrigan P: Comparison of quality of life with standard of living in schizophrenic patients. Br J Psychiatry 1992, 161:797-801.
• [86]Priebe S: Social Outcomes in schizophrenia. Br J Psychiatry Suppl 2007, 50:s15-s20.
• [87]Siegfried N: A review of comorbidity: major mental illness and problematic substance use. Aust N Z J Psychiatry 1998, 32:707-717.
• [88]Singh J, Mattoo SK, Sharan P, Basu D: Quality of life and its correlates in patients with dual diagnosis of bipolar affective disorder and substance dependence. Bipolar Disord 2005, 7:187-191.
• [89]Cedereke M, Ojehagen A: Patients’ needs during the year after a suicide attempt. A secondary analysis of a randomised controlled intervention study. Soc Psychiatry Psychiatr Epidemiol 2002, 37:357-363.
• [90]Wennström E, Sörbom D, Wiesel FA: Factor Structure in the Camberwell Assessment of Need. Br J Psychiatry 2004, 185:505-510.
• [91]Fleury MJ, Piat M, Grenier G, Bamvita JM, Boyer R, Lesage A, Tremblay J: Components associated with adequacy of help for consumers with severe mental disorders. Administration and Policy in Mental Health and Mental Health Services Research 2010, 37:497-508.
• [92]Rüesch P, Graf J, Meyer PC, Rössler W, Hell D: Occupation, social support and quality of life in persons with schizophrenic or affective disorders. Soc Psychiatry Psychiatr Epidemiol 2004, 39:686-694.