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Published in: Social Psychiatry and Psychiatric Epidemiology 5/2009

01-05-2009 | ORIGINAL PAPER

Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia

Authors: Carin J. Meijer, Maarten W. J. Koeter, Mirjam A. G. Sprangers, Aart H. Schene

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 5/2009

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Abstract

Introduction

The concept ‘quality of life’ (QoL) has become increasingly important as an outcome measure in the evaluation of services and in clinical trials of people with schizophrenia. This study examines the mediating role of health related quality of life (HRQoL) in the prediction of general quality of life (GQoL).

Method

QoL and other patient- and illness characteristics (psychopathology, overall functioning, illness history, self-esteem and social integration) were measured in a group of 143 outpatients with schizophrenia. GQoL was measured by the Lancashire Quality of Life Profile and HRQoL was measured by the MOS SF-36. To test the temporal stability of our findings, assessments were performed twice with an 18-month interval.

Results

We found that patient’s GQoL is predicted mainly by anxiety and depression and self-esteem and to a lesser extent by global functioning and social integration. At both time intervals HRQoL appeared to be a significant mediator of the relationship between anxiety and depression and self esteem versus patient’s GQoL.

Conclusions

The results of this study are important for mental health professionals, as these provide more insight in the mechanisms by which they could improve the GQoL of their patients with schizophrenia. The results confirm that diagnosis and treatment of anxiety and depression in outpatients with schizophrenia deserves careful attention of clinicians. Also strategies and specific interventions to improve self-esteem of patients with schizophrenia are very important to maximise patient’s QoL.
Literature
1.
go back to reference Baron RM, Kenny DAJ (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Pers Soc Psychol 51:1173–1182CrossRef Baron RM, Kenny DAJ (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Pers Soc Psychol 51:1173–1182CrossRef
2.
go back to reference Becker T, Knapp M, Knudsen HC, Schene AH, Tansella M, Thornicroft G, Vazquez-Barquero JL (2000) Aims, outcome measures, study sites and patient sample. EPSILON study 1. European Psychiatric Services: inputs linked to outcome domains and needs. Br J Psychiatry 39:s1–s7CrossRef Becker T, Knapp M, Knudsen HC, Schene AH, Tansella M, Thornicroft G, Vazquez-Barquero JL (2000) Aims, outcome measures, study sites and patient sample. EPSILON study 1. European Psychiatric Services: inputs linked to outcome domains and needs. Br J Psychiatry 39:s1–s7CrossRef
3.
go back to reference Becker T, Leese M, Krumm S, Ruggeri M, Vazquez-Barquero JL, EPSILON Study Group (2005) Needs and quality of life among patients with schizophrenia in five European centres: what is the impact of global functioning scores? Soc Psychiatry Psychiatr Epidemiol 40(8):628–634PubMedCrossRef Becker T, Leese M, Krumm S, Ruggeri M, Vazquez-Barquero JL, EPSILON Study Group (2005) Needs and quality of life among patients with schizophrenia in five European centres: what is the impact of global functioning scores? Soc Psychiatry Psychiatr Epidemiol 40(8):628–634PubMedCrossRef
4.
go back to reference Chisholm D, Knapp MRJ, Knudsen HC, Amaddeo F, Gaite L, Van Wijngaarden B (2000) Client socio-demographic and service receipt inventory—European version: development of an instrument for international research: EPSILON study 5. Br J Psychiatry 177:s28–s33CrossRef Chisholm D, Knapp MRJ, Knudsen HC, Amaddeo F, Gaite L, Van Wijngaarden B (2000) Client socio-demographic and service receipt inventory—European version: development of an instrument for international research: EPSILON study 5. Br J Psychiatry 177:s28–s33CrossRef
5.
go back to reference Cramer JA, Rosenheck R, Xu W, Thomas J, Henderson W, Charney DS (2000) Quality of life in schizophrenia: a comparison of instruments: department of veterans affairs cooperative study group on clozapine in refractory schizophrenia. Schizophr Bull 26:659–666PubMed Cramer JA, Rosenheck R, Xu W, Thomas J, Henderson W, Charney DS (2000) Quality of life in schizophrenia: a comparison of instruments: department of veterans affairs cooperative study group on clozapine in refractory schizophrenia. Schizophr Bull 26:659–666PubMed
6.
go back to reference Dingemans PM, Linszen DH, Lenior ME, Smeets RM (1995) Component structure of the expanded brief psychiatric rating scale (BPRS-E). Psychopharmacology 122:263–267PubMedCrossRef Dingemans PM, Linszen DH, Lenior ME, Smeets RM (1995) Component structure of the expanded brief psychiatric rating scale (BPRS-E). Psychopharmacology 122:263–267PubMedCrossRef
7.
go back to reference Fitzgerald PB, Williams CL, Corteling N, Filia SL, Brewer K, Adams A, de Castella AR, Rolfe T, Davey P, Kulkarni J (2001) Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand 103:387–392PubMedCrossRef Fitzgerald PB, Williams CL, Corteling N, Filia SL, Brewer K, Adams A, de Castella AR, Rolfe T, Davey P, Kulkarni J (2001) Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand 103:387–392PubMedCrossRef
8.
go back to reference Gaite L, Vazquez-Barquero JL, Borra C, Ballesteros J, Schene A, Welcher B, Thornicroft G, Becker T, Ruggeri M, Herran A, the EPSILON Study Group (2002) Quality of life in patients with schizophrenia in five European countries: the EPSILON study. Acta Psychiatr Scand 105:283–392PubMedCrossRef Gaite L, Vazquez-Barquero JL, Borra C, Ballesteros J, Schene A, Welcher B, Thornicroft G, Becker T, Ruggeri M, Herran A, the EPSILON Study Group (2002) Quality of life in patients with schizophrenia in five European countries: the EPSILON study. Acta Psychiatr Scand 105:283–392PubMedCrossRef
9.
go back to reference Hansson L, Bjorkman T (2007) 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 16(1):9–16PubMedCrossRef Hansson L, Bjorkman T (2007) 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 16(1):9–16PubMedCrossRef
10.
go back to reference Huppert JD, Weiss KA, Lim R, Pratt S, Smith TE (2001) Quality of life in schizophrenia: contributions of anxiety and depression. Schizophr Res 1:171–180CrossRef Huppert JD, Weiss KA, Lim R, Pratt S, Smith TE (2001) Quality of life in schizophrenia: contributions of anxiety and depression. Schizophr Res 1:171–180CrossRef
11.
go back to reference Jarbin H, Hansson L (2004) Adult quality of life and associated factors in adolescent onset schizophrenia end affective psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 39(9):725–729PubMedCrossRef Jarbin H, Hansson L (2004) Adult quality of life and associated factors in adolescent onset schizophrenia end affective psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 39(9):725–729PubMedCrossRef
12.
go back to reference Kasckow JW, Twamley E, Mulchahey JJ, Carroll B, Sabai M, Strakowski SM, Patterson T, Jeste DV (2001) Health-related quality of well-being in chronically hospitalized patients with schizophrenia: comparison with matched outpatients. Psychiatry Res 5:69–78CrossRef Kasckow JW, Twamley E, Mulchahey JJ, Carroll B, Sabai M, Strakowski SM, Patterson T, Jeste DV (2001) Health-related quality of well-being in chronically hospitalized patients with schizophrenia: comparison with matched outpatients. Psychiatry Res 5:69–78CrossRef
13.
go back to reference Kemmler G, Holzner B, Neudorfer C, Meise U, Hinterhuber H (1997) General life satisfaction and domain-specific quality of life in chronic schizophrenic patients. Qual Life Res 6:265–273PubMedCrossRef Kemmler G, Holzner B, Neudorfer C, Meise U, Hinterhuber H (1997) General life satisfaction and domain-specific quality of life in chronic schizophrenic patients. Qual Life Res 6:265–273PubMedCrossRef
14.
go back to reference Koivumaa-Honkanen HT, Viinamaki H, Honkanen R, Tanskanen A, Antikainen R, Niskanen L, Jaaskelainen J, Lehtonen J (1996) Correlates of life satisfaction among psychiatric patients. Acta Psychiatr Scand 94:372–378PubMedCrossRef Koivumaa-Honkanen HT, Viinamaki H, Honkanen R, Tanskanen A, Antikainen R, Niskanen L, Jaaskelainen J, Lehtonen J (1996) Correlates of life satisfaction among psychiatric patients. Acta Psychiatr Scand 94:372–378PubMedCrossRef
15.
go back to reference Kusel Y, Laugharne R, Perrington S, McKendrick J, Stephenson D, Stockton-Henderson J, Barley M, McCaul, r, Burns, T (2007). Measurement of quality of life in schizophrenia: a comparison of two scales. Soc Psychiatry Psychiatr Epidemiol 42(10):819–823PubMedCrossRef Kusel Y, Laugharne R, Perrington S, McKendrick J, Stephenson D, Stockton-Henderson J, Barley M, McCaul, r, Burns, T (2007). Measurement of quality of life in schizophrenia: a comparison of two scales. Soc Psychiatry Psychiatr Epidemiol 42(10):819–823PubMedCrossRef
16.
go back to reference Lasalvia A, Ruggeri M, Santolini N (2002) Subjective quality of life: its relationship with clinician-rated and patient-rated symptomatology: the south-verona outcome project 6. Psychother Psychosom 71:275–284PubMedCrossRef Lasalvia A, Ruggeri M, Santolini N (2002) Subjective quality of life: its relationship with clinician-rated and patient-rated symptomatology: the south-verona outcome project 6. Psychother Psychosom 71:275–284PubMedCrossRef
17.
go back to reference Leese M, Schene A, Koeter M, Meijer K, Bindman J, Mazzi M, Puschner B, Burti L, Becker T, Moreno M, Celani D, White IR, Thonicroft G (2008) SF-36 scales, and simple sums of scales, were reliable quality-of-life summaries for patients with schizophrenia. J Clin Epidemiol 61:588–596PubMedCrossRef Leese M, Schene A, Koeter M, Meijer K, Bindman J, Mazzi M, Puschner B, Burti L, Becker T, Moreno M, Celani D, White IR, Thonicroft G (2008) SF-36 scales, and simple sums of scales, were reliable quality-of-life summaries for patients with schizophrenia. J Clin Epidemiol 61:588–596PubMedCrossRef
18.
go back to reference Meijer CJ, Schene AH, Koeter MW (2002) Quality of life in schizophrenia measured by the MOS SF-36 and the Lancashire quality of life profile: a comparison. Acta Psychiatr Scand 105:293–300PubMedCrossRef Meijer CJ, Schene AH, Koeter MW (2002) Quality of life in schizophrenia measured by the MOS SF-36 and the Lancashire quality of life profile: a comparison. Acta Psychiatr Scand 105:293–300PubMedCrossRef
19.
go back to reference Van Nieuwenhuizen C, Schene AH, Koeter MW, Huxley PJ (2001) The Lancashire quality of life profile: modification and psychometric evaluation. Soc Psychiatry Psychiatr Epidemol 36:36–44CrossRef Van Nieuwenhuizen C, Schene AH, Koeter MW, Huxley PJ (2001) The Lancashire quality of life profile: modification and psychometric evaluation. Soc Psychiatry Psychiatr Epidemol 36:36–44CrossRef
20.
go back to reference Van Nieuwenhuizen Ch, Schene AH, Boevink WA, Wolf JRLM (1997) Measuring the quality of Life of clients with severe mental illness: a review of instruments. Psychiatr Rehabil J 20:33–41 Van Nieuwenhuizen Ch, Schene AH, Boevink WA, Wolf JRLM (1997) Measuring the quality of Life of clients with severe mental illness: a review of instruments. Psychiatr Rehabil J 20:33–41
21.
go back to reference Oliver JP, Huxley PJ, Priebe S, Kaiser W (1997) Measuring the quality of life of severely mentally ill people using the Lancashire quality of life profile. Soc Psychiatry Psychiatr Epidemiol 32:76–83PubMedCrossRef Oliver JP, Huxley PJ, Priebe S, Kaiser W (1997) Measuring the quality of life of severely mentally ill people using the Lancashire quality of life profile. Soc Psychiatry Psychiatr Epidemiol 32:76–83PubMedCrossRef
22.
go back to reference Packer S, Husted J, Cohen S, Tomlinson G (1997) Psychopathology and quality of life in schizophrenia. J Psychiatry Neurosci 22:231–234PubMed Packer S, Husted J, Cohen S, Tomlinson G (1997) Psychopathology and quality of life in schizophrenia. J Psychiatry Neurosci 22:231–234PubMed
23.
go back to reference Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40:879–891PubMedCrossRef Preacher KJ, Hayes AF (2008) Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 40:879–891PubMedCrossRef
24.
go back to reference Priebe S, Kaiser W, Huxley PJ, Roder-Wanner UU, Rudolf H (1998) Do different subjective evaluation criteria reflect distinct constructs? J Nerv Ment Dis 186:385–392PubMedCrossRef Priebe S, Kaiser W, Huxley PJ, Roder-Wanner UU, Rudolf H (1998) Do different subjective evaluation criteria reflect distinct constructs? J Nerv Ment Dis 186:385–392PubMedCrossRef
25.
go back to reference Ritsner M (2003) Predicting changes in domain-specific quality of life of schizophrenia patients. J Nerv Ment Dis 191:287–294PubMedCrossRef Ritsner M (2003) Predicting changes in domain-specific quality of life of schizophrenia patients. J Nerv Ment Dis 191:287–294PubMedCrossRef
26.
go back to reference Rosenberg M (1965) Society and the adolescent self image. Princeton University Press, Princeton Rosenberg M (1965) Society and the adolescent self image. Princeton University Press, Princeton
27.
go back to reference Ruggeri M, Koeter M, Schene A, Bonetto C, Vàzquez-Barquero JL, Becker T, Knapp M, Knudsen HC, Tansella M, Thornicroft G (2005) Factor solution of the BPRS-expanded version in schizophrenic outpatients living in five European countries. Schizophr Res 75:107–117PubMedCrossRef Ruggeri M, Koeter M, Schene A, Bonetto C, Vàzquez-Barquero JL, Becker T, Knapp M, Knudsen HC, Tansella M, Thornicroft G (2005) Factor solution of the BPRS-expanded version in schizophrenic outpatients living in five European countries. Schizophr Res 75:107–117PubMedCrossRef
28.
go back to reference Russo J, Trujillo CA, Wingerson D, Decker K, Ries R, Wetzler H, Roy-Byrne P (1999) The MOS 36-item short form health survey: reliability, validity, and preliminary findings in schizophrenic outpatients. Med Care 36:752–756CrossRef Russo J, Trujillo CA, Wingerson D, Decker K, Ries R, Wetzler H, Roy-Byrne P (1999) The MOS 36-item short form health survey: reliability, validity, and preliminary findings in schizophrenic outpatients. Med Care 36:752–756CrossRef
29.
go back to reference Sainfort F, Becker M, Diamond R (1996) Judgements of quality of life of individuals with severe mental disorders: patient self-report versus provider perspectives. Am J Psychiatry 153:497–502PubMed Sainfort F, Becker M, Diamond R (1996) Judgements of quality of life of individuals with severe mental disorders: patient self-report versus provider perspectives. Am J Psychiatry 153:497–502PubMed
30.
go back to reference Salokangas RK, Honkonen T, Stengard E, Koivisto AM (2001) To be or not to be married–that is the question of quality of life in men with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 36:381–390PubMedCrossRef Salokangas RK, Honkonen T, Stengard E, Koivisto AM (2001) To be or not to be married–that is the question of quality of life in men with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 36:381–390PubMedCrossRef
31.
go back to reference de Souza LA, Coutinho ES (2006) The quality of life of people with schizophrenia living in community in Rio de Janeiro, Brazil. Soc Psychiatry Psychiatr Epidemiol 41(5):347–356PubMedCrossRef de Souza LA, Coutinho ES (2006) The quality of life of people with schizophrenia living in community in Rio de Janeiro, Brazil. Soc Psychiatry Psychiatr Epidemiol 41(5):347–356PubMedCrossRef
32.
go back to reference Tollefson GD, Andersen SW (1999) Should we consider mood disturbance in schizophrenia as an important determinant of quality of life? J Clin Psychiatry 60:s23–s29 Tollefson GD, Andersen SW (1999) Should we consider mood disturbance in schizophrenia as an important determinant of quality of life? J Clin Psychiatry 60:s23–s29
33.
go back to reference Tunis SL, Croghan TW, Heilman DK, Johnstone BM, Obenchain RL (1999) Reliability, validity, and application of the medical outcomes study 36-item short-form health survey (SF-36) in schizophrenic patients treated with Olanzapine versus Haloperidol. Med Care 37:678–691PubMedCrossRef Tunis SL, Croghan TW, Heilman DK, Johnstone BM, Obenchain RL (1999) Reliability, validity, and application of the medical outcomes study 36-item short-form health survey (SF-36) in schizophrenic patients treated with Olanzapine versus Haloperidol. Med Care 37:678–691PubMedCrossRef
34.
go back to reference Ventura J, Nuechterlein KH, Subotnik KL, Gutkind D, Gilbert EA (2000) Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item brief psychiatric rating scale. Psychiatry Res 97:129–135PubMedCrossRef Ventura J, Nuechterlein KH, Subotnik KL, Gutkind D, Gilbert EA (2000) Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item brief psychiatric rating scale. Psychiatry Res 97:129–135PubMedCrossRef
35.
go back to reference Ware JE, Kosinski MA, Keller SD (1994) SF-36 physical and mental health summary scales: a user’s manual. The Health Institute, New England Medical Center, Boston Ware JE, Kosinski MA, Keller SD (1994) SF-36 physical and mental health summary scales: a user’s manual. The Health Institute, New England Medical Center, Boston
36.
go back to reference Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I: conceptual framework and item selection. Med Care 30:473–483PubMedCrossRef Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I: conceptual framework and item selection. Med Care 30:473–483PubMedCrossRef
37.
go back to reference Wilson IB, Cleary PD (1995) Linking clinical variables with health related quality of life: a conceptual model of patient outcomes. JAMA 273:59–65PubMedCrossRef Wilson IB, Cleary PD (1995) Linking clinical variables with health related quality of life: a conceptual model of patient outcomes. JAMA 273:59–65PubMedCrossRef
38.
go back to reference Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablenski A, Regier D, Sartorius N (1990) SCAN: schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatry 47:589–593PubMed Wing JK, Babor T, Brugha T, Burke J, Cooper JE, Giel R, Jablenski A, Regier D, Sartorius N (1990) SCAN: schedules for clinical assessment in neuropsychiatry. Arch Gen Psychiatry 47:589–593PubMed
Metadata
Title
Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia
Authors
Carin J. Meijer
Maarten W. J. Koeter
Mirjam A. G. Sprangers
Aart H. Schene
Publication date
01-05-2009
Publisher
Steinkopff-Verlag
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 5/2009
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-008-0448-4

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