Structural equation model of factors related to quality of life for community-dwelling schizophrenic patients in Japan

International Journal of Mental Health Systems

Eisuke Matsushima²  Naoko Watanabe¹  Hirofumi Nakamura³ 

[1] Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, 300-0394 Inashiki-gun, Ibaraki, Japan;Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan;Faculty of Nursing, Department of Nursing, Josai International University, 283-8555 1 Gumyo, Togane-City, Chiba, Japan

关键词: Structured equation modeling;    Regression analysis;    Self-esteem;    Self-efficacy;    Schizophrenia;    Quality of life;   

Others  :  1139355
DOI  :  10.1186/1752-4458-8-32

 received in 2014-05-17, accepted in 2014-07-17,  发布年份 2014

【 摘 要 】

Background

This study aimed to clarify how community mental healthcare systems can be improved.

Methods

We included 79 schizophrenic patients, aged 20 to 80 years, residing in the Tokyo metropolitan area who regularly visited rehabilitation facilities offering assistance to psychiatric patients and were receiving treatment on an outpatient basis. No subjects had severe cognitive disorders or were taking medication with side effects that could prevent the completion of questionnaires. Questionnaires included items related to quality of life, self-efficacy, self-esteem, psychosis based on the Behavior and Symptom Identification Scale, health locus of control, and socio-demographic factors. We performed multiple linear regression analysis with quality of life as the dependent variable and, based on covariance structural analysis, evaluated the goodness of fit of the resulting structural equations models.

Results

Self-efficacy, self-esteem, and degree of psychosis significantly impacted quality of life. Marital status, age, and types of medications also influenced quality of life. Multiple linear regression analysis revealed psychiatric symptoms (Behavior and Symptom Identification Scale-32 [daily living and role functioning] (Beta = −0.537, p < 0.001) and self-efficacy (Beta = 0.249, p < 0.05) to be predictors of total quality of life score. Based on covariance structural analysis, the resulting model was found to exhibit reasonable goodness of fit.

Conclusions

Self-efficacy had an especially strong and direct impact on QOL. Therefore, it is important to provide more positive feedback to patients, provide social skills training based on cognitive behavioral therapy, and engage patients in role playing to improve self-efficacy and self-concept.

【 授权许可】

   
2014 Nakamura et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Gate L, Vazquez-Barquero JL, Borra C, Ballesteros J, Schene A, Welcher B, Thornicroft G, Becker T, Ruggeri M, Herran A, The Epsilon Study Group: Quality of life in patients with schizophrenia in five European countries: The EPSILON study. Acta Psychiatr Scand 2002, 105:283-292.
• [2]Fitzgerald PB, De Castella AR, Filia K, Collins J, Brewer K, Willams CL, Davay P, Kulkarni J: A longitudinal study of patient- and observer-rated quality of life in schizophrenia. Psychiatry Res 2003, 119(1):55-62.
• [3]Ritsner M: Predicting changes in domain specific quality of life of schizophrenia patients. J Nerv Ment Dis 2003, 191(5):287-294.
• [4]Huppert JD, Weiss KA, Lim R, Pratt S, Smith TE: Quality of life in schizophrenia: contributions of anxiety and depression. Schizophr Res 2001, 51(2):171-180.
• [5]Isoishi E, Mishina H, Sugimoto H, Suzuki M: Evaluation of subjective quality of life for psychiatric day care users: Using WHO/QOL-26. J Iwamizawa Munic Gen Hosp 2001, 26:47-53. (in Japanese)
• [6]Suzuki Y, Yoshimura Y, Hisamura M, Miyaoka H: Quality of life of schizophrenic patients: An examination using “Difficulty Score” as an index. Kitasato Med 2001, 31:309-318. (in Japanese)
• [7]Kadoya K: Development of life satisfaction scale for evaluating the quality of life of patients with mental illness. J Kyoto Prefect Univ Med 1995, 104:1413-1424. (in Japanese)
• [8]Rosenberg M: Society and the adolescent self-image. Princeton, NJ: Princeton Univ Press; 1965.
• [9]Sakano Y, Tohjoh M: The general self-efficacy scale (GSES): Scale development and validation. Jpn J Behav Ther 1986, 12(1):73-82. (in Japanese)
• [10]Bandura A: Self-efficacy: Toward a unifying theory of behavioral change. Psychological Rev 1977, 84:191-215.
• [11]Horie Y: A Japanese version of the Health Locus of Control Scales. Jpn J Health Psychol 1991, 4(1):1-7. (in Japanese)
• [12]Rotter JB: Generalized expectancies for internal versus external control of reinforcement. Psychol Monographs 1966, 609:80-94.
• [13]Walston BS, Walston KA, Kaplan GD, Maides S: Development and validation of Health Locus of Control (HLC) Scale. J Consult Clin 1976, 44:580-585.
• [14]Eisen SV, Dill DL, Grob MC: Reliability and validity of a brief patient-report instrument for psychiatric outcome evaluation. Hosp Commun Psychiatry 1994, 45:242-247.
• [15]Schermelleh-Engel K, Moosbrugger H, Muller H: Evaluating the fit of structural equation models: tests of significance and descriptive goodness-of fit measures. MPR Online 2003, 8:23-74.
• [16]Skantze K, Malm U, Dencker SJ, May PR: Quality of life in schizophrenia. Nord Psykiatr Tidsskr 1990, 44:71-75.
• [17]Skantze K, Malm U, Dencker SJ, May PR, Corrigan P: Comparison of quality of life with standard of living in schizophrenic outpatients. Brit J Psychiatry 1992, 161:797-801.
• [18]Link BG, Cullen FT, Frank J, Wozniak J: The social rejection of former mental patients. Understanding why labels matter. Am J Soc 1987, 92:141-150.
• [19]Watson AC, Corrigan P, Larson JE, Sells M: Self-stigma in people with mental illness. Schizophr Bull 2007, 33:1312-1318.
• [20]Rosenfield S: Factors contributing to the subjective quality of life of the chronic mentally ill. J Health Soc Behav 1992, 33:299-315.
• [21]Kunikata H, Mino Y, Nakajima K: Quality of life of schizophrenic patients living in the community. The relationship with personal characteristics, objective indicators and self-esteem. Psychiatry Clin Neurosci 2005, 59(2):163-169.
• [22]Ruggeri M, Warner R, Bisoffi G, Fontecedro L: Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach. Brit J Psychiatry 2001, 178:268-275.
• [23]Award AG, Voruganti LNP, Heslegrave RJ: A conceptual model of quality of life in schizophrenia. Qual Life Res 1997, 6:21-26.
• [24]Lauer G: The quality of life issue in chronic mental illness. In Psychology and Promotion of Health. Edited by Dauwalder JP. Seattle: Hogrefe & Huber; 1994:28-34.
• [25]Lehman AF: The well-being of chronic mental patients. Assessing their quality of life. Arch Gen Psychiatry 1983, 40:369-373.
• [26]Lehman AF: The effects of psychiatric symptoms on quality of life assessments among the chronically mentally ill. Eval Prog Planning 1983, 6:143-151.
• [27]Baker F, Intagliata J: Quality of life in the evaluation of community support systems. Eval Prog Planning 1982, 5:69-79.
• [28]Baumgardner AH, Kaufman CM, Levy PE: Regulating affect interpersonally: When low esteem leads to greater enhancement. J Personality Soc Psychol 1989, 56(6):907-921.
• [29]Glynn SM, Marder SR, Liberman RP, Blair K, Wirshing WC, Wirshing DA, Ross D, Mintz J: Supplementing clinic-based skills training with manual-based community support sessions: effect on social adjustment of patients with schizophrenia. Am J Psychiatry 2002, 159(5):829-837.
• [30]Helperin S, Nathan P, Drummond P, Castle D: A cognitive-behavioural, group-based intervention for social anxiety in schizophrenia. Aust N Z J Psychiatry 2000, 34(5):809-813.