Social Aspects of the Quality of Life of Persons Suffering from Schizophrenia

Gitte Lee Mortensen^1*, Jayanti De², Mads Holme², Tina Neve³, Per Göran Torell⁴, Jonas Eberhard^5,6

¹Anthro Consult, Aarhus, Denmark.
²ReD Associates, Copenhagen, Denmark.
³Project CHANGE, Capital Region Psychiatry, Copenhagen, Denmark.
⁴European Federation of Associations of Families of People with Mental Illness (EUFAMI), Leuven, Belgium.
⁵Department of Clinical Science, Lund University, Lund, Sweden.
⁶Institute of Psychiatry, Psychiatry & Neuroscience (IoPPN), King’s College, London, UK.

DOI: 10.4236/ojpsych.2016.61005                

Abstract

Background: Several studies have shown that persons with schizophrenia (PWS) suffer from severely reduced quality of life (QoL). Impaired social functioning is a defining characteristic of schizophrenia (SZ) and social cognition deficits affect interpersonal relations and outcomes such as independent living, vocational functioning and employment status. Some studies have demonstrated important socio-cultural aspects of SZ, for instance by examining experiences of SZ in different developing countries and among minority groups in the Western world. The socio-cultural context is central to understanding patients’ experiences in any society, however. Using an anthropological approach, we use qualitative research methods to examine patient perspectives on SZ. Sampling and Methods: In-depth qualitative interviews are carried out with SZ patients in France, the UK and the USA representing diversity in Western mental health systems. Results: To the participants, the most important QoL aspects are close relations and support from loved ones, a safe home and comfort zone, and meaningful daily activities. Normalisation and independence act as central themes to patients’ QoL and hopes for social integration. The participants need a buffer zone consisting of social relations, a home and daily occupation that is flexible and may balance issues of equality/inequality, abnormality/normality, and dependence/independence. Conclusion: By using participatory methods, PWS may be involved in shaping their own treatment and recovery plans based on what is subjectively meaningful and beneficial to their mental health. QoL and functioning are closely linked to the socio-cultural context in which health care structures go hand in hand with health care cultures that shape patients’ expectations and preferences.

Keywords

Schizophrenia, Quality of Life, Socio-Cultural Aspects, Patient Perspectives, Qualitative Research

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Millier, U.S., Angermeyer, M.C., Chauhan, D., Murthy, V., Toumi, M. and Cadi-Soussi, N. (2014) Humanistic Burden in Schizophrenia: A Literature Review. Journal of Psychiatric Research, 54, 85-93. http://dx.doi.org/10.1016/j.jpsychires.2014.03.021
[2]	Saha, S., Chant, D., Welham, J. and McGrath, J. (2005) A Systematic Review of the Prevalence of Schizophrenia. PLoS Medicine, 2, e141. http://dx.doi.org/10.1371/journal.pmed.0020141
[3]	American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition (DSM-5), APA, Washington.
[4]	Hirsch, S.R. and Weinberger, D.R. (2003) Schizophrenia. Wiley-Blackwell, Oxford.
[5]	Velligan, D.I. and Alphs, L.D. (2008) Negative Symptoms in Schizophrenia: The Importance of Identification and Treatment. Psychiatric Times, 25, 1-2.
[6]	Emsley, R., Chiliza, B. and Asmal, L. (2013) The Evidence for Illness Progression after Relapse in Schizophrenia. Schizophr Res, 148, 117-121. http://dx.doi.org/10.1016/j.schres.2013.05.016
[7]	Awad, A.G. and Voruganti, L.N.P. (2012) Measuring Quality of Life in Patients with Schizophrenia. An Update. Pharmacoeconomics, 30, 183-195. http://dx.doi.org/10.2165/11594470-000000000-00000
[8]	Kingston Stevens, A., McNichol, J. and Magalhaes, L. (2009) Social Relationships in Schizophrenia: A Review. Personality and Mental Health, 3, 203-216. http://dx.doi.org/10.1002/pmh.82
[9]	Yanos, P.T. and Moos, R.H. (2007) Determinants of Functioning and Well-Being among Individuals with Schizophrenia: An Integrated Model. Clinical Psychology Review, 27, 58-77. http://dx.doi.org/10.1016/j.cpr.2005.12.008
[10]	Bobes, J., Paz Garcia-Portilla, M., Bascaran, M.T., Saiz, P.A., Bousono, M., et al. (2007) Quality of Life in Schizophrenic Patients. Dialogues in Clinical Neurosciences, 9, 215-226.
[11]	Hooley, J.M. (2010) Social Factors in Schizophrenia. Current Directions in Psychological Science, 19, 238-242. http://dx.doi.org/10.1177/0963721410377597
[12]	Birgenheir, D.G. and Pepper, C.M. (2013) Social Functioning across the Course of Schizophrenia. Current Psychiatry Reviews, 9, 284-292. http://dx.doi.org/10.2174/15734005113096660006
[13]	Burns, T. and Patrick, D. (2007) Social Functioning as an Outcome Measure in Schizophrenia Studies. Acta Psychiatrica Scandinavica, 116, 403-418. http://dx.doi.org/10.1111/j.1600-0447.2007.01108.x
[14]	Lepage, M., Bodnar, M. and Bowie, C.R. (2014) Neurocognition: Clinical and Functional Outcomes in Schizophrenia. Canadian Journal of Psychiatry, 59, 5-12.
[15]	Brüne, M., Dimaggio, G. and Lysaker, P.H. (2011) Metacognition and Social Functioning in Schizophrenia: Evidence, Mechanisms of Influence and Treatment Implications. Current Psychiatry Reviews, 7, 239-247. http://dx.doi.org/10.2174/157340011797183210
[16]	Hoertnagl, C.M. and Hofer, A. (2014) Social Cognition in Serious Mental Illness. Current Opinion in Psychiatry, 27, 197-202. http://dx.doi.org/10.1097/YCO.0000000000000055
[17]	Prouteau, A. and Doron, J. (2008) Prédicteurs cognitifs des différentes dimensions du fonctionnement dans la communauté dans la schizophrénie: revue de la literature et perspectives. L’Encéphale, 34, 360-368. http://dx.doi.org/10.1016/j.encep.2006.06.003
[18]	Elis, O., Caponigro, J.M. and Kring, A.M. (2013) Psychosocial Treatments for Negative Symptoms in Schizophrenia: Current Practices and Future Directions. Clinical Psychology Review, 33, 914-928. http://dx.doi.org/10.1016/j.cpr.2013.07.001
[19]	Brown, E.C., Tas, C. and Brüne, M. (2012) Potential Therapeutic Avenues to Tackle Social Cognition Problems in Schizophrenia. Expert Review of Neurotherapeutics, 12, 71-81. http://dx.doi.org/10.1586/ern.11.183
[20]	Dixon, L.B., Dickerson, F., Bellack, A.S., Bennett, M., Dickinson, D., Goldberg, R.W., et al. (2010) The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements. Schizophrenia Bulletin, 36, 48-70. http://dx.doi.org/10.1093/schbul/sbp115
[21]	Mueser, K.T., Deavers, F., Penn, D.L. and Cassisi, J.E. (2013) Psychosocial Treatments for Schizophrenia. Annual Review of Clinical Psychology, 9, 465-497. http://dx.doi.org/10.1146/annurev-clinpsy-050212-185620
[22]	Price, M.A., Hill, C.D., Williams, V.S.L., Morlock, R.J., Leeuwenkamp, O. and Patterson, T.L. (2008) Measures of Functional Status and Quality-of-Life in Schizophrenia. Current Psychiatry Reviews, 4, 28-38. http://dx.doi.org/10.2174/157340008783743839
[23]	Brissos, S., Molodynski, A., Videira Dias, V. and Figueira, M.L. (2011) The Importance of Measuring Psychosocial Functioning in Schizophrenia. Annals of General Psychiatry, 10, 18. http://dx.doi.org/10.1186/1744-859X-10-18
[24]	Burns, J. (2009) Dispelling a Myth: Developing World Poverty, Inequality, Violence and Social Fragmentation Are Not Good for Outcome in Schizophrenia. African Journal of Psychiatry, 12, 200-205. http://dx.doi.org/10.4314/ajpsy.v12i3.48494
[25]	Myers, N.L. (2011) Update: Schizophrenia across Cultures. Current Psychiatry Reports, 13, 305-311. http://dx.doi.org/10.1007/s11920-011-0208-0
[26]	Aloba, O., Fatoye, O., Mapayi, B. and Akinsulore, S. (2013) A Review of Quality of Life Studies in Nigerian Patients with Psychiatric Disorders. African Journal of Psychiatry, 16, 333-337. http://dx.doi.org/10.4314/ajpsy.v16i5.44
[27]	Asmal, L., Mall, S., Kritzinger, J., Chiliza, B., Emsley, R. and Swartz, L. (2011) Family Therapy for Schizophrenia: Cultural Challenges and Implementation Barriers in the South African Context. African Journal of Psychiatry, 14, 367-371. http://dx.doi.org/10.4314/ajpsy.v14i5.3
[28]	Cantor-Graae, E. (2007) The Contribution of Social Factors to the Development of Schizophrenia: A Review of Recent Findings. Canadian Journal of Psychiatry, 52, 277-286.
[29]	Bhui, K. and Tsangarides, N. (2008) Culture and Schizophrenia. Psychiatry, 7, 454-457. http://dx.doi.org/10.1016/j.mppsy.2008.08.005
[30]	Kalra, G., Bhugra, D. and Shah, N. (2012) Cultural Aspects of Schizophrenia. International Review of Psychiatry, 24, 441-449. http://dx.doi.org/10.3109/09540261.2012.708649
[31]	Lamb, H.R.L. and Weinberger, L.E. (2005) The Shift of Psychiatric Inpatient Care from Hospitals to Jails and Prisons. Journal of the American Academy of Psychiatry and the Law, 33, 529-534.
[32]	Falkhoury, W. and Priebe, S. (2007) Deinstitutionalization and Reinstitutionalization: Major Changes in the Provision of Mental Healthcare. Psychiatry, 6, 313-316. http://dx.doi.org/10.1016/j.mppsy.2007.05.008
[33]	Llorca, P.M., Miadi-Fargier, H., Lancon, C., Jasso Mosqueda, G., Casadebaig, F., et al. (2005) Cost-Effectiveness Analysis of Schizophrenic Patient Care Settings: Impact of an Atypical Antipsychotic under Long-Acting Injection Formulation. Encephale, 31, 235-246. http://dx.doi.org/10.1016/S0013-7006(05)82390-5
[34]	Verdoux, H. (2007) The Current State of Adult Mental Health Care in France. European Archives of Psychiatry and Clinical Neurosciences, 257, 64-70. http://dx.doi.org/10.1007/s00406-006-0693-z
[35]	Fraser, W.S. (2002) The Patient’s Journey: Mapping, Analysing and Improving Healthcare Processes. Kingsham Press, Chichester.
[36]	Strauss, A. and Corbin, J. (1998) Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Sage, London.
[37]	WintherJorgensen, M. and Phillips, L. (1999) Diskursanalyse som teori og metode (Discourse Analysis as a Theory and Method). Roskilde University Press, Roskilde.
[38]	Kvale, S. (1996) An Introduction to Qualitative Research Interviewing. Sage Publications, Thousand Oaks.
[39]	Trujols, J., Portella, M.J., Iraurgi, I., Campins, M.J., Sinol, N. and Pérez de losCobos, J. (2013) Patient-Reported Outcome Measures: Are They Patient Generated, Patient-Centred or Patient-Valued? Journal of Mental Health, 22, 555-562. http://dx.doi.org/10.3109/09638237.2012.734653
[40]	Becker, T. and Kilian, R. (2008) Daily Living: Does This Matter for People with Mental Illness? International Review of Psychiatry, 20, 492-497. http://dx.doi.org/10.1080/09540260802564417
[41]	Malterud, K. (2011) Kvalitative metoder i medisinsk forskning: en innforing. Universitetsforlaget. University of Copenhagen, Copenhagen.
[42]	Karow, A. and Pajonk, F.G. (2006) Insight and Quality of Life in Schizophrenia: Recent Findings and Treatment Implications. Current Opinion in Psychiatry, 19, 637-641. http://dx.doi.org/10.1097/01.yco.0000245754.21621.c9
[43]	Tseng, W.S. (2001) Handbook of Cultural Psychiatry. Academic Press, San Diego.
[44]	Lin, K.M. and Kleinman, A.M. (1988) Psychopathology and Clinical Course of Schizophrenia: A Cross-Cultural Perspective. Schizophrenia Bulletin, 14, 555-567. http://dx.doi.org/10.1093/schbul/14.4.555