Subjective assessments of the quality of life, well-being and self-efficacy in patients with schizophrenia

Aim:  The present study examined three kinds of subjective assessment scales in the same patient group with schizophrenia to analyze the correlations among scores obtained in relation to the background data.
Method:  Thirty-six patients with schizophrenia were examined with the 26-item short form of the World Health Organization Quality of Life (WHO-QOL 26), Subjective Well-being under Neuroleptic drug treatment: Short Japanese version (SWNS) and Self-Efficacy for Community Life scale (SECL) for subjective assessment scales, five kinds of neurocognitive tests, Positive and Negative Syndrome Scale (PANSS) for clinical symptom, Social Functioning Scale (SFS), and Global Assessment of Functioning (GAF) scale for social functioning.
Result:  The scores for delusions (components of positive syndrome), anxiety and depression (components of general psychopathology) on the PANSS significantly correlated with QoL and subjective well-being scores. In contrast, the scores for components of negative syndrome were not correlated with the subjective assessment scores. Furthermore, none of the clinical symptom scores were correlated with the score in self-efficacy scale. The SFS and GAF scores were significantly correlated with the subjective assessment scores. There were significant correlations among the scores on the three subjective assessment scales.
Conclusion:  Each scale has different features and should be utilized depending upon the expected effect of treatment or the purpose of assessment. The treatments provided to patients must be directed at improving both psychological and social impairments, in order to enhance the social functioning and QoL of patients.     

Observations on Alzheimer disease: a comparison of services in Japan and the United States

In both Japan and the United States, families provide most of the care to Alzheimer patients, but in Japan, the patient is more likely to live in a multi-generational setting. Three types of programs are described and compared: support groups, day care centers, and institutional care. Despite rapid growth in services, neither country yet provides a uniformly satisfactory level of service.     

Play or hard work: Unpacking well-being at preschool

Well-being or quality of life is thought to give a more accurate picture of the impact a condition has on day-to-day functioning than traditional outcome measures. This study sought to examine the relationship between engagement in play and well-being for preschool children with and without developmental coordination disorder (DCD). A quasi-experimental design was used with two independent groups of preschool children aged 4–6 years with (n = 32) and without (n = 31) probable DCD. Play skills were assessed using the Play Observation Scale based on 30 min of videotape of free-play at preschool. Well-being was assessed using a parent-proxy version of the Revised Children Quality of Life Questionnaire (KINDL^R). Spearman rho correlations were performed to examine the relationship between play and well-being. Well-being at preschool was significantly lower for the children in the DCD group however overall well-being was not significantly different. Engagement in type of social play (solitary, parallel or group) was found to predict well-being for the typically developing children. For the children with DCD, engagement in group play was not associated with well-being. An explanation for this difference may be that children with DCD may not experience free-play at preschool as “play” but rather as hard work. Further research is needed to determine why children with DCD experience lower well-being at preschool than their peers and to investigate children's perceptions of free-play. This may enable teachers and therapists to better support children with DCD in the preschool environment.     

Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlates

Objective: Subjective quality of life (QOL) is dependent upon culture and its evaluation based on one’s particular belief system. This study aimed to examine the subjective QOL of Nigerian out‐patients with schizophrenia and its correlates. Method: Out‐patients with Schizophrenia (n = 99) completed the WHOQOL‐BREF as a measure of their subjective QOL. Sociodemographic, illness related and medication related details were also obtained. Results: Overall, 21 patients (21.2%) were categorised as having ‘good’ and 36 (36.4%) as having ‘poor’ subjective QOL. ‘Poor’ subjective QOL correlated with anxiety/depression symptoms (OR 4.88, 95% CI 2.93–11.48), comorbid medical problems (OR 4.75, 95% CI 1.43–16.33), unemployment (OR 3.75, 95% CI 1.25–11.72) and poor social support (OR 4.60, 95% CI 1.49–14.28). Conclusion: Efforts to improve the QOL of patients with schizophrenia in this environment should encompass the identified variables. Larger, longitudinal and multi‐centred studies are needed to adequately identify factors predicting QOL in this environment.     

Confirming the multidimensionality of psychological well-being among Korean immigrant mothers in the United States

Ryff’s Psychological Well-Being (PWB) Scale is a theoretically derived instrument that focuses on six dimensions of eudaimonic well-being. Although the PWB scale has been widely used in both clinical and general samples with different sociodemographic characteristics, its factor structure within first-generation Korean immigrant mothers requires examination, as they often face sociocultural challenges due to immigration-related experiences (e.g., acculturation stress, being socially and culturally segregated, following heritage cultural obligations to be a “wise mother and good wife,” or taking less prestigious jobs) that could negatively influence their well-being. This study examined the factor structure of an 18-item version of the PWB scale in a sample of 169 first-generation Korean immigrant mothers of young children in the United States. A second-order confirmatory factor analysis did not support the original factor structure of the PWB scale. More importantly, high correlations among some of the PWB subscales suggested that the PWB factors may not be distinct from each other and the number of factors should be reduced. Exploratory factor analysis was conducted on the four highly correlated factors in subsequent analyses, and three new factors (Satisfaction with Life, Goal Orientation, and Positive Self-Perceptions) were identified. The newly derived PWB factors were negatively correlated with mothers’ depressive symptoms. These findings advanced our understanding of psychological well-being in first-generation Korean immigrant mothers and highlighted the need to consider sociocultural factors in mental health research with this population.     

Antisocial behavioral syndromes and 3-year quality-of-life outcomes in United States adults

Goldstein RB, Dawson DA, Smith SM, Grant BF. Antisocial behavioral syndromes and 3‐year quality‐of‐life outcomes in United States adults. Objective: To examine 3‐year quality‐of‐life (QOL) outcomes among United States adults with Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM‐IV) antisocial personality disorder (ASPD), syndromal adult antisocial behavior without conduct disorder (CD) before age 15 [adulthood antisocial behavioral syndrome (AABS), not a DSM‐IV diagnosis], or no antisocial behavioral syndrome at baseline. Method: Face‐to‐face interviews (n = 34 653). Psychiatric disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM‐IV Version. Health‐related QOL was assessed using the Short‐Form 12‐Item Health Survey, version 2 (SF‐12v2). Other outcomes included past‐year Perceived Stress Scale‐4 (PSS‐4) scores, employment, receipt of Supplemental Security Income (SSI), welfare, and food stamps, and participation in social relationships. Results: Antisocial personality disorder and AABS predicted poorer employment, financial dependency, social relationship, and physical health outcomes. Relationships of antisociality to SSI and food stamp receipt and physical health scales were modified by baseline age. Both antisocial syndromes predicted higher PSS‐4, AABS predicted lower SF‐12v2 Vitality, and ASPD predicted lower SF‐12v2 Social Functioning scores in women. Conclusion: Similar prediction of QOL by ASPD and AABS suggests limited utility of requiring CD before age 15 to diagnose ASPD. Findings underscore the need to improve prevention and treatment of antisocial syndromes.     

Randomized double blind comparison of olanzapine vs. clozapine on subjective well-being and clinical outcome in patients with schizophrenia

OBJECTIVE: This randomized double-blind multicenter trial evaluated the effects of olanzapine vs. clozapine on subjective well-being, quality of life (QOL) and clinical outcome. METHOD: The primary objective was to demonstrate non-inferiority of olanzapine, mean dosage 16.2 +/- 4.8 (5-25 mg/day) vs. clozapine, mean dosage 209 +/- 91 (100-400 mg/day) regarding improvement on the 'Subjective Well-Being under Neuroleptic Treatment' (SWN) Scale after 26 treatment weeks in 114 patients with schizophrenia. Secondary outcome parameters included: Munich QOL Dimension List (MLDL), Positive and Negative Symptom Scale (PANSS), Clinical Global Impression (CGI). RESULTS: SWN scores improved significantly in both groups, olanzapine was non-inferior to clozapine (group difference 3.2 points in favor of olanzapine; 95% CI: 4.2;10.5). MLDL-satisfaction, PANSS and CGI-S improved similarly, olanzapine yielded a higher CGI Therapeutic Index. Individual SWN and PANSS changes correlated only moderately (r = -0.45). CONCLUSION: Olanzapine was non-inferior to clozapine. The lack of a marked correlation between PANSS and SWN improvements indicates that patients and psychiatrists perceive treatment differently.     

Subjective well-being of visually impaired older adults living in the community

ABSTRACT

Objectives: Vision impairment is one of the most common disabilities among older adults, and it has a substantial impact on well-being. The present study constructs an integrative model to identify which variables derived from four dimensions of life (physical/functional, social, psychological and environmental) combined with sociodemographic variables explain the overall subjective well-being (SWB) visually impaired older adults living in the community.

Method: A total of 121 severe visually impaired persons, aged 60 and over (M = 77.4, range 60–95), participated in the study. Personal, face-to-face interviews were conducted with participants at social centers or at their homes. Research tools consisted of valid and reliable questionnaires.

Results: Five variables explained the older adults' variability in SWB: self-rated health, sense of meaning in life, functional independence in activity of daily living (ADL), sense of control of one's environment (Mastery) and the participant's age. The explained variance percentage was found to be high (61%). In contrast to expectations, social-environmental variables proved to be only of secondary significance in explaining SWB variability.

Discussion: Variables derived from the psychological dimension appear more significant than the social-environmental variables in explaining SWB among visually impaired older adults. These variables should be considered when developing intervention programs intended to increase SWB within this unique population group.     

Subjective quality of life in out-patients with schizophrenia: clinical and utilization correlates

The relationship between subjective quality of life (QOL), clinical measures, and service utilization was measured in out-patients with schizophrenia. A total of 72 subjects completed the Quality of Life Interview and were also assessed by means of the Positive and Negative Syndrome Scale, a battery of neuropsychological tests, and two measures of social functioning. Use of psychiatric services over a 2-year period was ascertained from comprehensive records. Global subjective QOL was lower than patients' satisfaction with specific life domains. There were few significant correlations between satisfaction with, and objective measures of, specific life areas. In a multiple regression, patients' global subjective QOL was inversely related to their scores on the PANSS depression factor, and to the number of psychiatrist out-patient visits.     

家居和老年公寓老人生活质量对比分析

目的了解家居和老年公寓老年人的生活幸福度和生活质量。方法采用整群抽样的方法,随机抽取城市社区和老年公寓60岁以上老人300人,用总体幸福感量表、生活质量综合评定问卷进行调查。结果居住于社区家庭的老年人个人和家庭的经济收入、人均住房面积明显高于老年公寓的老人(p=0．00);老年公寓老人的精神紧张度和情绪波动明显高于居住于社区者(p=0．00);生活质量总体评价、总体幸福感等方面两者无显著性差异。结论老年公寓是一种可取的社会化养老方式,但仍有多项因子分显示老年公寓的老人低于社区老人,老年人的养老观念和养老方式仍趋向于社区家庭。     

Post-earthquake quality of life and psychological well-being: longitudinal evaluation in a rural community sample in northern China

This study aims to observe longitudinal change of quality of life (QOL) and psychological well-being in a community sample affected by an earthquake and to examine the relationship between QOL and disaster exposure, post-disaster support and other related variables. The subjects, from two villages at different distances from the epicenter, were assessed using the brief version of the World Health Organization Quality of Life Assessment (WHOQOL-BREF) and three subscales of a symptoms checklist at 3 months (n=335) and 9 months (n=253) after the earthquake, respectively. Exposure to the earthquake was associated with multidimensional impairment in QOL, including physical, psychological and environmental domains at 3 months, and psychological and environmental domains at 9 months. The victims also suffered significantly more psychological distress in terms of depression, somatization and anxiety. At both assessment points the group that experienced lower initial exposure but then received less post-disaster help reported poorer QOL and psychological well-being. The two victim groups also differed significantly in changing trend along time. The group that received more support showed a general improvement in post-disaster well-being from 3 months to 9 months. The results confirm that post-disaster variables could be as important to post-disaster psychosocial outcomes as variables of pre-disaster vulnerability and disaster per se. A comprehensive and prospective assessment of disaster effects is imperative for the better organization of disaster relief programs and psychosocial interventions.     

Subjective and external assessments of quality of life in schizophrenia: relationship to insight.

OBJECTIVE: This study assessed the manner in which insight influenced schizophrenic patients' evaluation of their objective life conditions and the concurrent validity between patients' and clinicians' assessments of patients' global quality of life. METHOD: Forty out-patients who fulfilled DSM-III-R criteria for schizophrenia were independently interviewed using the Lancashire Quality of Life Profile and the Standard of Living Interview. Insight was assessed using a self-report questionnaire, the Insight Scale. RESULTS: For insightful patients there was a significant but modest correlation between objective and subjective indicators of quality of life. Likewise, a significant correlation between subjective and external evaluations of global quality of life was limited to those individuals who had good insight. CONCLUSION: Diminished insight may limit the usefulness of the self-report methodology for assessing quality of life for some individuals with schizophrenia.     

Proactive aging: a longitudinal study of stress, resources, agency, and well-being in late life

Objectives: Using the Proactivity Model of Successful Aging, we examined how internal and external resources contribute to the maintenance of psychological well-being and social activities among older adults who experience normative stressors of aging. Outcome variables in this study are collectively referred to as quality of life (QOL). We also examined the mediating role of proactive adaptations between internal and external resources and QOL indicators.

Method: Based on five annual interviews of a sample of 1000 community-dwelling older adults in Florida (effective N?=?561), we tested the lagged effects of stressors on two indicators of QOL, four years later. In the full longitudinal model, using structural equations, we estimated the direct effects of internal and external resources on QOL, along with indirect effects through proactive adaptations.

Results: Stressors negatively influenced QOL four years later. Internal and external resources led to better QOL four years later, both directly and indirectly through proactive adaptations of marshaling support and planning for the future.

Conclusion: These findings lend support to the Proactivity Model of Successful Aging by documenting the value of proactive adaptations (i.e., exercise, planning ahead, and marshaling support) as proximate influences on QOL outcomes (i.e., depressive symptomatology and social activities). Findings suggest that older adults can maintain successful aging even in the face of health-related and social stressors by invoking accumulated resources to deal actively with the challenges of aging.     

Stroke rehabilitation in Switzerland versus the United States: a preliminary comparison

This article compares the structure and process of rehabilitation for stroke patients at 2 internationally recognized rehabilitation hospitals, Klinik Valens ("Valens") in Switzerland and the William Donald Schaeffer Rehabilitation Hospital at Kernan ("Kernan") in the United States. Although the patient mix, structure, and process of rehabilitation were similar in many regards, there were some important differences. Most notably, on average, patients at the U.S. hospital were discharged from rehabilitation at approximately the same day poststroke that rehabilitation began in Switzerland. Patients remained in an inpatient setting an average of 40 days longer in Switzerland (for the combination of acute care and rehabilitation) and had significantly higher levels of functioning at discharge when compared to their U.S. counterparts. The authors' findings suggest that Europe may offer opportunities for rehabilitation research that would be difficult to duplicate in the United States and highlight policy-relevant questions for future studies aimed at developing efficient managed care systems for stroke survivors.     

Development and characteristics of a well-being enhancing psychotherapeutic strategy: well-being therapy

This article describes the main characteristics and technical features of a novel psychotherapeutic strategy, well-being therapy. This paper outlines the background of its development, the structure of well-being therapy, its key concepts and technical aspects. Well-being therapy is based on Ryff's multidimensional model of psychological well-being, encompassing six dimensions: autonomy, personal growth, environmental mastery, purpose in life, positive relations and self-acceptance. The goal of this therapy is improving the patients' levels of psychological well-being according to these dimensions, using cognitive-behavioral techniques. It may be applied as a relapse-preventive strategy in the residual phase of affective (mood and anxiety) disorders, as an additional ingredient of cognitive-behavioral packages, in patients with affective disorders who failed to respond to standard pharmacological or psychotherapeutic treatments and in body image disturbances. The clinical studies supporting its efficacy are illustrated.     

Quality of life and well-being of patients with myasthenia gravis

The cardinal symptom of myasthenia gravis (MG) is weakness of voluntary muscles, a feature that may restrict full participation in life activities. In turn, such limitations may negatively affect quality of life (QOL) and well-being among individuals with the disease. In the present study, we administered a measure of QOL to 27 patients with generalized MG. Results revealed that functional status was negatively impacted in the domains of physical functioning, energy, and general health. However, a clinically meaningful difference was evident only on perceived ability to accomplish physical tasks. The results suggest that although MG requires accommodations in physical activities, general QOL and well-being does not differ markedly from the general population.     

The neurology training in the United States and Japan]

The practice of neurology, like many other fields of medicine, currently faces a number of critical problems in the United States mostly by cumbersome restrictions designed to contain rapidly escalating medical costs. Fortunately, however, the residency training has maintained the spirit of the time-tested tradition, which has served the medical community well ever since its inception in 1910. The system has continued with little modifications after a switch of internship to Basic Residency Program (PG1) in the late 1960s. In comparison, the neurology training in Japan suffers from following deficiencies: 1) a paucity of bedside teaching in most medical schools, necessitating the initiation of unprepared residents into patient care; 2) an insufficient number of staff, especially at a governmental school, precluding an adequate coverage of neurological subspecialities such as electrophysiology and neuropathology; 3) absence of a tutorialship from senior to junior residents, and from interns to medical students, mostly for the lack of organization and logistics; and 4) no incentive to specialize without board certification by the governmental agencies or proper recognition by insurance providers. We must address these fundamental issues to promote neurology as an independent discipline for improved care of patients with neurological disorders.