The importance of social comparisons for high levels of subjective quality of life in chronic schizophrenic patients.
ABSTRACT In schizophrenic patients, quality of life (QoL) studies often find high levels of general life satisfaction and satisfaction in various life domains despite deprived living conditions. Therefore, the usefulness of QoL as an outcome indicator has been questioned. Since social comparison processes have been postulated to be related to the level of satisfaction, this hypothesis was analysed empirically by the present study in schizophrenic patients. Satisfaction and social comparisons of 148 schizophrenic inpatients and 66 mentally healthy controls were examined with regard to the domains 'health' and 'family' by means of a standardised interview. The schizophrenic patients had a history of either long-term (n = 75) or short-term (n = 73) restricted and deprived living conditions. Long-term patients showed significantly higher satisfaction levels than short-term patients. They compared themselves predominantly laterally or downwards with fellow inpatients. Significant relationships between the direction of social comparisons and satisfaction ratings were found in all three samples. Social comparisons proved to be important for the level of satisfaction in schizophrenic patients. Results indicate that experiences of restricted and deprived living conditions induce accommodation processes and response-shifts that should be taken into account in the interpretation of quality-of-life data.
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ABSTRACT: BACKGROUND: Subjective quality of life (SQOL) is an established outcome measure in schizophrenia. In spite of the substantial proportion of elderly in the total schizophrenia population, evaluation of their SQOL and its determinants has been scarce and findings from epidemiological samples are lacking. METHODS: We assessed SQOL in elderly Dutch patients with schizophrenia or schizoaffective disorder (n=107; mean age 68years), treated within a psychiatric catchment area. Demographic, clinical and social variables were evaluated for their impact on SQOL. RESULTS: The mean SQOL score was 4.83, moderately surpassing the midpoint of the SQOL scale. Nearly half of all patients (47.7%) reported an overall favorable SQOL. Of the total variance in SQOL, clinical variables explained 50%, and social variables explained 16%, while demographic factors did not contribute. In multivariable analysis, less self-reported depressive symptoms, worse global neurocognition, and higher observer-based level of social functioning significantly predicted a higher SQOL, explaining 53% of the total variance. CONCLUSION: The relatively high level of SQOL in this epidemiological sample of elderly patients is in line with what has been reported for both older and younger schizophrenia populations. Depressive symptoms are a robust predictor of SQOL in late life schizophrenia, clearly outweighing psychotic symptoms. This finding has major clinical relevance, as depression is amenable to therapeutic intervention.Schizophrenia Research 05/2013; · 4.59 Impact Factor
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ABSTRACT: OBJECTIVE: To analyse whether a subjective quality-of-life (QoL) instrument (QLiS-Quality-of-Life in Schizophrenia), developed on the basis of a large number of open-ended interviews with schizophrenic patients, has sufficient discriminant and convergent validity to justify its application as a schizophrenia-specific QoL instrument. METHOD: The discriminant and convergent validity of the QLiS (comprising 12 subscales) was analysed in a cross-sectional study. Schizophrenic persons (n = 135) from different care settings were surveyed using the QLiS, the WHOQOL-Bref, the SWN and 7-point satisfaction items. Partial correlational analyses and regression analyses controlling for general life satisfaction were conducted comparing the QLiS subscales with those of the other instruments. RESULTS: Positive correlation coefficients were found among all subscales of the QLiS and the other QoL instruments (WHOQOL-BREF from r = 0.29 to r = 0.72; SWN, r = 0.14 to r = 0.83; satisfaction scales, r = 0.18 to r = 0.69). One QLiS subscale (cognitive functioning) was shown to be empirically redundant (r>0.80) to the mental functioning subscale of the SWN. All other subscales proved to have unique variance. The non-QLiS QoL instruments only accounted for substantial amounts of variance (>20% after controlling for global life satisfaction) in the QLiS subscales leading a normal life, appreciation by others, appraisal of accommodation/housing and social contacts. DISCUSSION: Most of the QLiS subscales can be regarded as sufficiently distinct from other QoL instruments, and thus show evidence of discriminant and convergent validity. CONCLUSION: A subjective QoL questionnaire with high content validity can provide additional empirical information about schizophrenics' QoL not accounted for by other common QoL instruments.Quality of Life Research 06/2012; · 2.41 Impact Factor
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ABSTRACT: Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder characterized by two distinct phenomena: obsessions which are recurrent, intrusive thoughts, images or impulses, and/or compulsions which are repetitive covert or overt actions that are carried out to decrease anxiety. OCD commonly affects young adults, is associated with other comorbid mental illnesses and often has a large treatment gap (the proportion of individuals who have OCD and require care but do not receive treatment). OCD thus runs a chronic and disabling course which compromises an individual's functioning and well-being and ultimately has a rather detrimental impact on the lives of both patients and their families. Researchers and clinicians are increasingly paying attention to humanistic outcomes to encompass broader indicators of disease burden and outcome, one of which is quality of life (QoL). In this review, we provide a summary of the current knowledge of QoL in OCD, its socio-demographic and clinical correlates, and the effects of therapeutic interventions on QoL among those with OCD. Overall, studies indicate that those with OCD had diminished QoL across all domains relative to normative comparison subjects. Patients with OCD scored better on QoL domains than patients with major depressive disorder (MDD), whereas they showed no difference or scored worse than patients with schizophrenia. Although research on socio-demographic correlates of QoL in OCD is largely contradictory, most studies suggest that symptom severity and comorbid depression or depressive symptoms are predictors of decreased QoL in OCD, with numerous studies showing this association across multiple domains associated with QoL. Studies assessing QoL as an outcome of treatment have found an improvement in QoL in people with OCD after treatment with pharmacotherapy or cognitive behavioural therapy with some studies suggesting that this improvement in QoL is correlated with improvement in symptoms. A few studies have also evaluated other forms of treatment like partial hospitalisation programmes and deep brain stimulation for those with treatment-resistant OCD and found that QoL scores improve with treatment. A major gap in the field is the lack of instruments that measure QoL specifically in patients with OCD. It is evident that OCD affects specific domains and thus there is a pressing need for the development of multidimensional instruments that are reliable and valid. There is also a need for studies assessing QoL in individuals with OCD among both clinical and community samples with adequate sample size to examine socio-demographic and clinical correlates simultaneously. These populations ought to be followed longitudinally to examine QoL with the clinical course of the illness, and to help establish temporal relationships. Studies that examine improvements in QoL with treatment need to be designed carefully: sample size requirements should be met, raters must be blinded, and randomly assigning subjects to different arms would ensure that some of the inherent biases in open-label studies are avoided. QoL is an important component that measures the impact of OCD on an individual and QoL goals must be incorporated as an outcome measure of therapeutic interventions.CNS Drugs 04/2013; · 4.38 Impact Factor