Quality of life studies in nursing science (2). Community adjustment of chronic schizophrenics: effects on life satisfaction and self-esteem (2)]

The purpose of this study was to test two community adjustment models of the chronically mentally ill developed by this author. The study was to determine the effects of daily living, work, family, and social adjustment on life satisfaction and self-esteem as well as to determine the effects of chronicity and symptomatology on the four adjustments. Twenty schizophrenic inpatients and 120 schizophrenic outpatients from a psychiatric hospital in Tokyo participated in the study: the former group was used for a pilot study of the instruments and the latter for the model testing. Seven instruments were used; two self-administered questionnaires of the Life Satisfaction Scale and the Rosenberg Self-Esteem Scale, two structured interview schedules of the Adjustment Scales and a modified version of the Psychiatric Evaluation Form, the Demographic and Psychiatric History Form, the Cantril Ladder of Satisfaction, and the Global Assessment Scale. Two direct effects of family and social adjustment (beta = 0.326 and 0.262 respectively) explained 22.2% of the variance in life satisfaction. Two direct effects of symptomatology (beta = -0.216) and family adjustment (beta = 0.185) accounted for 10.6% of the variance in self-esteem. It was assumed that dropping of symptomatology as a direct effect on life satisfaction was a type two error. In addition, chronicity and social adjustment failed to enter into the equation of self-esteem due to the type two error as well. The culturally characteristic pattern that emerged was that relationship-oriented variables were directly effective on life satisfaction and self-esteem. However, task-oriented variables of daily living adjustment and work adjustment did not account for life satisfaction and self-esteem despite the hypothetical links in the models. It was concluded that interpersonal relationships were especially important for the well-being of Japanese schizophrenics living in the community. The lack of direct effects of daily living and work adjustment suggested that autonomy in living did not heighten the well-being of the subjects, a result that was different than the findings of American studies. It was probably because that Japanese people in general value interdependence among family members, therefore, relatives of the mentally ill tend to play more roles to take care for them.