Differences in Quality of Life Domains and Psychopathologic and Psychosocial Factors in Psychiatric Patients. [CME]
J Clin Psychiatry 2000;61(11):880-889
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Background: Although treatment of severe mental
disorders should strive to optimize quality of life (QOL) for the
individual patient, little is known about variations in QOL
domains and related psychopathologic and psychosocial factors in
patients suffering from schizophrenia, schizoaffective disorder,
and/or mood disorders. We hypothesized that QOL in severe mental
disorder patients would have a more substantial relationship with
psychosocial factors than with illness-associated factors.
Method: A case-control, cross-sectional design
was used to examine QOL of 210 inpatients who met DSM-IV criteria
for a severe mental disorder and who were consecutively admitted
to closed, open, and rehabilitation wards. Following psychiatric
examination, 210 inpatients were assessed using standardized
self-report measures of QOL, insight, medication side effects,
psychological distress, self-esteem, self-efficacy, coping,
expressed emotion, and social support. QOL ratings for patients
and a matched control group (175 nonpatients) were compared.
Regression and factor analyses were used to compare
multidimensional variables between patients with schizophrenia
and schizoaffective and mood disorders.
Results: In all QOL domains, patients were less
satisfied than nonpatient controls. Patients with schizophrenia
reported less satisfaction with social relationships and
medication when compared with patients with schizoaffective
and/or mood disorders. Regression analysis established
differential clusters of predictors for each group of patients
and for various domains of QOL. On the basis of the results of
factor analysis, we propose a distress protection model to
enhance life satisfaction for severe mental disorder patients.
Conclusion: Psychosocial factors rather than
psychopathologic symptoms affect subjective QOL of hospitalized
patients with severe mental disorders. The findings enable better
understanding of the combining effects of psychopathology and
psychosocial factors on subjective life satisfaction and
highlight targets for more effective intervention and