Factors affecting WHOQOL-26 in community-dwelling patients with schizophrenia

OBJECTIVE: Schizophrenic patients' quality of life (QOL) has become increasingly important due to shift of mental health care from hospitals to communities. This paper describes a longitudinal study conducted to clarify relationships among the QOL, self-esteem, depressive mood, and uncooperativeness of schizophrenic patients identified in the authors' previous crosssectional study. METHODS: Subjects were 61 schizophrenic patients attending day care at mental hospitals. They were assessed initially, and again after a 12-month follow-up. The assessment was carried out using the Rosenberg Self-Esteem Scale, WHOQOL-26 Scale, and the Brief Psychiatric Rating Scale, and included personal characteristics. Covariance structure analysis (Synchronous Effects Model) was conducted to clarify the relationships between self-esteem and the WHOQOL-26 Scale, and between psychiatric states (depressive mood and uncooperativeness) and self-esteem, while controlling for subjects' individual characteristics and use of antipsychotics as confounding factors. RESULTS: The results indicated that self-esteem had a significantly positive effect on the WHOQOL-26 Scale while depressive mood and uncooperativeness were without significant effects. CONCLUSIONS: The results provide evidence that the enhancement and maintenance of self-esteem may be an effective method of improving WHOQOL-26 in schizophrenic patients.