In individuals with schizophrenia, duration and severity of mental illness, health status, mutuality, employment and household income influence quality of life
- Correspondence to
: Dr Matthew M Kurtz
Department of Psychology, Judd Hall, Wesleyan University, Middletown, CT 06459, USA,
Implications for practice and research
The quality of relationships with caregivers should be considered by clinicians as a means for improving the quality of life (QoL) of individuals with schizophrenia.
The current findings suggest that family therapy may have substantial benefit for individuals with schizophrenia's sense of well-being as well.
Future research should aim to measure several key illness domains linked to subjective life satisfaction such as illness insight and skills in cognitive function to clarify the role of caregiver relationships to other closely linked illness domains.
These findings argue for developing novel treatment strategies for improving communication between caregivers and those cared for in schizophrenia treatment.
Traditionally intervention studies in schizophrenia have focused on symptom reduction as an endpoint. The past decade, however, has witnessed a sea change in the methodology of assessment of outcomes in schizophrenia. Influenced by the recovery movement in mental health, the success of antipsychotic medications for symptom management and the growing number of individuals with schizophrenia living in the community, indices of symptom reduction have been largely supplanted by broader indices of improvement in community integration, function and well-being. The current study by Hsiao and colleagues is focused on subjective well-being in schizophrenia.
The authors report findings from a cross-sectional study of factors associated with subjective QoL in a sample of 148 community-dwelling, largely chronic patients with schizophrenia. Patients were identified by their primary outpatient mental healthcare provider. A comprehensive measure of subjective QoL that included subscales focused on physical state, psychological health, social relationships and environmental characteristics was administered along with other demographic and clinical measures in a 30-min assessment session.
The authors report that age of onset and duration of illness, health status, total symptoms and employment status and household income all bore a modest relationship to satisfaction with life. Measures of mutuality, the degree to which patients viewed their relationship with their primary caregiver as supportive, had a larger, statistically significant relationship with subjective QoL. Follow-up regression analyses revealed that relationships with a primary caregiver played the largest role in determining satisfaction with life in this sample relative to other findings.
Determinants of satisfaction with life, also called subjective QoL, such as contentedness with one's living situation, social relationships, employment status and psychological state in schizophrenia, has emerged as a specific domain of burgeoning research interest.1 While in its earliest conceptualisations, the concept of QoL was viewed as multidimensional, consisting of both objective achievement in domains of work function, social relationships and other key outcome domains on the one hand and parallel measures of life satisfaction in these same domains on the other2 research to date has largely focused on objective measures of QoL, and the study of subjective measures remains neglected. For this reason, the study by Hsiao and colleagues is particularly timely. As pointed out by the authors, the results of this study should be interpreted with some degree of caution for two reasons. First the results are cross-sectional and thus it remains unclear to what degree caregiver relationships are causative with respect to satisfaction with life—stronger links would be established by showing that changes in caregiver relationships are mirrored by changes in satisfaction with life when studied longitudinally. Second the sample is Taiwanese and the emphasis placed on caregiving relationships within a specific culture that attaches considerable value on interdependence may have implications for generalisation of these findings to cultures where the notion of interdependence is less salient.