Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia
Introduction
In the last few decades, the assessment of quality of life (QOL) has gained considerable importance in the evaluation of therapeutic interventions and treatment outcome, particularly in relation to chronic illnesses. QOL, which measures an individual’s perception of his position in life, within the context of his culture and value systems (WHO, 1994), is considered one of the long-term goals of medical interventions, in addition to the traditional ‘end’ points of symptom control and prolongation of life (Meltzer, 1999).
Satisfaction with life and improvement in QOL are particularly important in people with chronic disabling illnesses such as schizophrenia, who often require long-term use of health resources in order to remain stable. In such patients, some of whom may still have residual symptoms despite optimal therapeutic interventions; subjective well-being and satisfaction with life are important milestones for measuring treatment success.
QOL as an outcome measure may be assessed subjectively or measured based on some objectively determined criteria. Self-reported QOL by people living with schizophrenia, as a measure of treatment outcome, has been a subject of intense debate, its reliability being questioned by some authors who assert that such a measure may be biased by factors inherently associated with the illness, such as cognitive deficits, affective blunting, poor insight and lack of motivation for improvement (Jenkins, 1992, Atkinson et al., 1997). In spite of these criticisms, it is now generally agreed that the best arbitrator of QOL is the person living that life and not an external expert (Voruganti et al., 1998, Basu, 2004)
Extant research findings have inconsistently reported an association of QOL with socio-demographic and clinical variables. Poor QOL has been associated with the male gender, single marital status, low income, unemployment, poor social support, higher educational attainment and stigma, while being in a paid job is associated with good QOL (Bryson et al., 2002, Cardoso et al., 2005, Adewuya and Makanjuola, 2009, Prince, 2007, Hsiung et al., 2010). Although negative symptoms and depression have been consistently associated with poor QOL, other clinical variables such as the presence and severity of psychopathology, the presence of co-morbid medical illness and the number of medications taken have not demonstrated consistent relationships with poor QOL (Packer et al., 1997, Fitzgerald et al., 2001, Cardoso et al., 2005; Marhawa et al., 2008; Adewuya and Makanjuola, 2009).
Previous studies in Nigeria had reported the deplorable living conditions of persons with serious mental illness in the context of poor access to health resources and high prevalence of stigmatisation (Gureje et al., 2005, Adewuya et al., 2010). The objective living condition of Nigerian patients with schizophrenia is poor, characterised by high rates of unemployment, limited social relationships and poor transportation (Adewuya and Makanjuola, 2010). These factors coupled with other socioeconomic and cultural influences, such as negative beliefs about causes of mental illness (Adebowale and Ogunlesi, 1999), may potentially affect treatment adherence and outcome including QOL. However, only few studies in Nigeria conducted in small samples, assessing a few variables and with largely inconsistent findings, have examined the QOL of patients with schizophrenia (Olusina and Ohaeri, 2003, Adewuya and Makanjuola, 2009, Adewuya and Makanjuola, 2010). While it could be assumed that some relationships might exist between socio-demographic variables, illness-related variables and QOL, the extent to which these factors contribute to the variation in the QOL of patients has not been examined by previous studies in Nigeria. Against the background of adverse socioeconomic conditions experienced by patients with schizophrenia living in a developing country setting such as Nigeria, we hypothesised that socio-demographic variables will be more significant determinants of subjective QOL than clinical or illness-related factors.
This study aimed to investigate the aforementioned hypothesis by examining certain socio-demographic and clinical determinants of subjectively perceived QOL and their relative contributions to specific domains of QOL among outpatients with schizophrenia in Nigeria.
Section snippets
Study Setting and Participants
This study was part of a larger study that focussed on treatment adherence and QOL among a clinic sample of patients with schizophrenia and the detailed methodology had been explained elsewhere (Adelufosi et al., 2012). Briefly, the study was conducted at the outpatient psychiatric clinic of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria, a specialist hospital that offers both inpatient and outpatient psychiatric services to individuals in the southwestern part of Nigeria as
Baseline Characteristics
Respondents comprised 163 males (52.1%) and 150 females (47.1%). The majority of respondents (65.5%) were single, while 34.5% were in a partner relationship. Most of the respondents had low levels of education (62.9%), 30.4% had high level of education, while 6.7% had no formal education. As many as 275 participants (87.9%) lived with at least one other person, while 38 (12.1%) lived alone. Majority of the participants had low illness severity as indicated by their BPRS scores, which ranged
Discussion
The results from this study have demonstrated that the QOL of Nigerian outpatients with schizophrenia is significantly associated with socio-demographic and clinical variables such as employment status, monthly income, perceived social support, satisfaction with outpatient care, outpatient clinic default, medication adherence, illness severity as rated by BPRS scores and daily medication dose. Similar associations have been reported in previous studies in other parts of the world (Ritsner et
Conclusion
This study showed that both socio-demographic and clinical factors are associated with QOL among patients with schizophrenia in Nigeria. Improvements in patients’ QOL may occur when health-care providers enhance quality of service by increasing patients’ satisfaction with services and strengthening their social support. As socio-demographic and clinical variables explained only a modest amount of variance in subjective QOL, it is important to examine the potential contributions of other
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