Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients

Background: Although treatment of severe mental disorders should strive to optimize quality of life (QOL) for the individual patient, little is known about variations in QOL domains and related psychopathologic and psychosoci al factors in patients suffering from schizophrenia, schizoaffective disord er, and/or mood disorders. We hypothesized that QOL in severe mental disord er patients would have a more substantial relationship with psychosocial fa ctors than with illness-associated factors. Method: A case-control, cross-sectional design was used to examine QOL of 2 10 inpatients who met DSM-IV criteria for a severe mental disorder and who were consecutively admitted to closed, open, and rehabilitation wards. Foll owing psychiatric examination, 210 inpatients were assessed using standardi zed self-report measures of QOL, insight, medication side effects, psycholo gical distress, self-esteem self-efficacy, coping, expressed emotion, and s ocial support. QOL ratings for patients and a matched control group (175 no npatients) were compared. Regression and factor analyses were used to compa re multidimensional variables between patients with schizophrenia and schiz oaffective and mood disorders. Results: In all QOL domains, patients were less satisfied than nonpatient c ontrols. Patients with schizophrenia reported less satisfaction with social relationships and medication when compared with patients with schizoaffect ive and/or mood disorders. Regression analysis established differential clu sters of predictors for each group of patients and fur various domains of Q OL. On the basis of the results of factor analysis, we propose a distress p rotection model to enhance life satisfaction for severe mental disorder pat ients. Conclusion: Psychosocial factors rather than psychopathologic symptoms affe ct subjective QOL of hospitalized patients with severe mental disorders. Th e findings enable better understanding of the combining effects of psychopa thology and psychosocial factors on subjective life satisfaction and highli ght targets for more effective intervention and rehabilitation.