Quality of Life in Long-Term Forensic Psychiatric Care: Comparison of Self-Report and Proxy Assessments

doi:10.1016/j.apnu.2015.01.004

Archives of Psychiatric Nursing

Volume 29, Issue 3, June 2015, Pages 162-167

https://doi.org/10.1016/j.apnu.2015.01.004 Get rights and content

Abstract

Objective

To compare quality of life (QoL) ratings of long term forensic psychiatric care patients with the ratings of psychiatric nurses, in which the nurses indicate how they think the patient would answer.

Methods

Agreement on QoL-scores according to the Forensic inpatient Quality of Life Questionnaire (FQL) was investigated for seventy- seven pairs of patients and psychiatric nurses from two forensic psychiatric long-care facilities where QoL is seen as an important treatment goal. This study also examined whether the amount of agreement was related to specific patient characteristics and characteristics of the patient- psychiatric nurse relationship.

Results

On group level, only small and mostly non-significant differences were found between patients’ and psychiatric nurses’ mean QoL scores. However, pairwise comparisons revealed poor agreement between patients’ and nurses’ QoL scores for half of the domains and moderate agreement on the other half of the domains, except for Leave, which was the only domain on which patients and their nurses had similar scores. Patient characteristics such as type of offence and type of psychopathology were negligibly related to the level of agreement. However, characteristics of the patient-nurse relationship such as age of the nurse and length of the patient-nurse relationship did influence the amount of consensus between patients’ and proxies’ QoL-scores significantly.

Conclusions

Nurses were not sufficiently able to accurately estimate their patients’ QoL experience and could probably benefit from a training aimed at assessing QoL of their patients and how to support their patients in optimizing their QoL themselves.

Section snippets

Subjects

The study has been conducted in two high secure long-care forensic psychiatric facilities in the Netherlands. Between 2011 and 2013, 77 unique pairs of patients and their case managers completed the FQL. This was 51% of the total population (N = 151) of the long-care wards at the times of measurement. Every patient and case manager was asked to participate in the study, except for patients who were unable to complete the questionnaire due to a psychotic episode and/or major chance of

QoL of Patients by Case Managers and Patients Themselves

The mean scores for the domains Hygiene, Social Relations, Affection and Autonomy differed significantly between patients and case managers, but these differences were relatively small (Table 2). In Table 2, the scores of patients and case managers on each of the 14 domains of de FQL, the overall QoL and acceptance of stay indicated that both patients and case managers assigned the highest satisfaction to the domain Hygiene, but patients were very dissatisfied with Leave and Sexuality. Case

Discussion

In the current study, the QoL of long-care forensic psychiatric patients has been examined as to how it was assessed by themselves and by proxies: their forensic nurses. To our knowledge, up until now no other study has been conducted that assessed the consensus between forensic psychiatric patients and their case managers concerning QoL. This study was also the first to have investigated the association of patient characteristics and characteristics of the patient-case manager relationship and

Conflict of interest

The authors have no conflicts of interest to report.

Ethical standards

Privacy of the patients and case managers was assured conform the policy of the institution. Patients provided written informed consent prior to the assessment and by assigning a unique research number to each participant the statistical analyses could be conducted on anonymous data. Involvement in the study was voluntary and all patients were informed of their right to withdraw consent before or during the study.

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Staff also expressed that patients need to be realistic about their applications for leave and take responsibility for maintaining their leave status. A study of long-term, male forensic patients' quality of life Schel et al. (2015) found subjects' self-ratings and case managers' proxy-ratings for the 2-item (α = 0.87) ‘Leave’ domain of the Forensic inpatient Quality of Life scale (Vorstenbosch, Bulten, Bouman, & Braun, 2007) did not differ significantly; both groups rated patient satisfaction with leave-related care poorly, and it was the lowest ranked of the tool's 14 domains. Walker et al. (2013) reported that both staff and patients felt community day leave facilitated reintegration and provided an opportunity to practice daily living skills.
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A measure that has specifically been developed in order to assess quality of life in forensic mental health settings is the Forensic Inpatient Quality of Life questionnaire (FQL) (Vorstenbosch, Bulten, Bouman, & Braun, 2007). A recent study (Schel et al., 2015) using the FQL in two long-term secure forensic psychiatric services in the Netherlands, indicated differences between self- and proxy-based reports of QoL. These results underscore the importance of involving different perspectives when assessing one's QoL, and of paying enough attention to the perception of forensic patients themselves.
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Quality of Life in Long-Term Forensic Psychiatric Care: Comparison of Self-Report and Proxy Assessments

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Subjects

QoL of Patients by Case Managers and Patients Themselves

Discussion

Conflict of interest

Ethical standards

Social Science and Medicine

Social Science & Medicine

Aggression and Violent Behaviour

Diagnostic and statistical manual of mental disorders (4th ed., text rev)

What do we know about quality of life in dementia? A review of the emerging evidence on the predictive and explanatory value of disease specific measures of health related quality of life in people with dementia

International Journal of Geriatric Psychiatry

Quality of life in patients with schizophrenia: comparison of self-report and proxy assessment

Social Psychiatry Psychiatric Epidemiology

Quality of life of violent and sexual offenders in community-based forensic psychiatric treatment

The Journal of Forensic Psychiatry & Psychology

Subjective Well-being and Recidivism in Forensic Psychiatric Outpatients

International Journal of Forensic mental Health

Quality of life of male outpatients with severe personality disorders or psychotic disorders: A comparison

Criminal Behaviour and Mental Health

Statistical power analysis for the behavioural sciences