Psychotic symptoms and quality of life: A mediation analysis of daily-life coping

doi:10.1016/j.psychres.2017.09.034

Psychiatry Research

Volume 262, April 2018, Pages 505-509

https://doi.org/10.1016/j.psychres.2017.09.034 Get rights and content

Highlights

•
Psychotic symptoms and daily-life coping can predict self-reported quality of life.
•
Coping mediates the effect of positive psychotic symptoms over quality of life.
•
Depression symptoms are strongly related with each quality of life dimension.

Abstract

Prior studies suggest the relationship between psychotic symptoms and Quality of Life (QoL) may be mediated by diverse constructs. QoL in schizophrenia-related disorders has been related with coping with daily stressors. Based on previous studies, our hypothesis was that coping mediates the relationship between psychotic symptoms and QoL. Therefore, the aim of the study was to test the hypothesis in a sample of people with schizophrenia-related disorders from a community rehabilitation center. Sixty-six patients were assessed using PANSS, WHOQOL-BREF questionnaire, and COPE Inventory. Regression analyses were performed for each WHOQOL-BREF dimension using PANSS and COPE factors as predictors. Mediation analysis was performed for each WHOQOL-BREF dimension using significant PANSS scales as predictors and significant COPE factors as mediators. Sobel test showed that Self-Sufficient (Problem-focused) coping mediates the relationship between PANSS Positive and WHOQOL-BREF Psychological and WHOQOL-BREF Environmental scores. Results suggest that coping style based on personal abilities and oriented to the stressors mediates the relationship between positive symptoms and QoL associated to well-being and environmental features. However, in our study no coping style mediated the relationship between negative symptoms and QoL. Depressive symptoms predicted each QoL dimension and were not mediated by any coping style.

Introduction

Schizophrenia-related disorders (SCHZ) are characterized by persistent psychotic symptoms, chronic course, and poor Quality of Life (QoL). The World Health Organization (WHO) defines QoL as a state of physical, mental, and social well-being that comprises objective indicators and subjective evaluations about personal development, emotional well-being, and meaningful life (WHO, 1995). Research of QoL in SCHZ has been constrained by the distinction between objective measurements (assessed by an expert) and subjective evaluation (self-reported measures), which are poorly correlated (Hayhurst et al., 2014). Some authors prefer to use SCHZ patients’ self-reported measurements due congruency with WHO's definition of QoL (Hayhurst et al., 2014, Tomotake, 2011, Voruganti et al., 1998). Moreover, a subjective approach entails considerate QoL as a multidimensional construct that is affected by other constructs, like coping with daily stressors. The Distress/Protection Vulnerability Model (Ritsner, 2007) relates QoL with coping strategies and provides a link between theoretical research and clinical practice. According to Ritsner (2007) QoL is the result of the interaction between stressors and protective factors against them, therefore QoL tends to diminish when stress exceeds protection factors.

QoL in people suffering from SCHZ is related with daily-life coping styles (Yanos and Moos, 2007). SCHZ patients are capable of identify which coping style they use and combine different coping strategies (Phillips et al., 2009), tend to use avoidance and less likely to apply task-oriented coping (Horan et al., 2007, Horan and Blanchard, 2003). Moreover, when coping and psychotic symptoms are taken into account, both explain more than 50% of variance of QoL (Holubova et al., 2015).

Based on the literature reviewed above we hypothesized that 1) intensity and frequency of psychotic symptoms will predict QoL, 2) coping style will mediate the relationship between QoL and psychotic symptoms. Thus, the aim of the present study was to assess coping style as a mediator between psychotic symptoms and QoL in a sample of SCHZ patients from a public rehabilitation center.

Section snippets

Procedure and participants

A cross-sectional study was conducted between December 2014 and December 2015 in a public community rehabilitation center for people with SCHZ. Inclusion criteria were 1) age between 18–65; 2) a clinical record of paranoid schizophrenia, undifferentiated schizophrenia, or schizoaffective disorder; 3) being in a stable post-acute phase of illness; and 4) being able to understand and read Spanish language. Ethical approval was granted by the university research ethics committee.

Sixty-eight

Results

Sixty-eight patients were assessed against inclusion criteria. Two were not interested in participate. The sample was mainly composed of paranoid schizophrenic patients (47%) with a mean age of 37.88 (SD = 7.65), primary education (31.8%), and mean duration of illness of 12.25 (SD = 6.38) years. PANSS, WHOQOL-BREF and COPE scores met parametric assumptions. There were no differences in any outcome when sex and diagnostic groups were compared. Table 1 shows detailed data of demographic and

Discussion

The main finding is that self-sufficient coping mediates between positive psychotic symptoms and QoL related to psychological well-being and environment. Also our data pointed that there is a strong relation between depressive symptoms and QoL which is not mediated by any dimension of daily-life coping.

The current study examined until what extent clinical symptoms can predict QoL in SCHZ patients. Our first hypothesis was partially supported by the data. Positive and negative psychotic symptoms

Financial support

This work was supported by the Operative Project FSE 2014–2020 funded by the European Social Fund-European Commission (FPI71806/2015) and the Board of Innovation, Research and Tourism of the Balearic Islands under grant number FPI/1806/2015 in the frame of the Project FFI2013-43270-P funded by the Spanish Ministry of Economy and Competitiveness.

Conflicts of interest

Authors report no potential conflict of interest.

References (32)

M. Alessandrini et al.
A structural equation modelling approach to explore the determinants of quality of life in schizophrenia
Schizophr. Res.
(2016)
E.A.M. El Sheshtawy
Coping with stress and quality of life in schizophrenic patients
Asian J. Psychiatr.
(2011)
G. Fervaha et al.
Clinical determinants of life satisfaction in chronic schizophrenia: data from the CATIE study
Schizophr. Res.
(2013)
W.P. Horan et al.
Emotional responses to psychosocial stress in schizophrenia: the role of individual differences in affective traits and coping
Schizophr. Res.
(2003)
W.P. Horan et al.
Stress and coping responses to a natural disaster in people with schizophrenia
Psychiatry Res.
(2007)
J.a. Litman
The COPE inventory: dimensionality and relationships with approach- and avoidance-motives and positive and negative traits
Personal. Individ. Dif.
(2006)
C. Montemagni et al.
Relative contributions of negative symptoms, insight, and coping strategies to quality of life in stable schizophrenia
Psychiatry Res.
(2014)
S. Örsel et al.
The sensitivity of quality-of-life scale WHOQOL-100 to psychopathological measures in schizophrenia
Compr. Psychiatry
(2004)
P. Rocca et al.
A cluster-analytical approach toward real-world outcome in outpatients with stable schizophrenia
Eur. Psychiatry
(2016)
R.S. Wallwork et al.
Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia
Schizophr. Res.
(2012)

P.T. Yanos et al.

Determinants of functioning and well-being among individuals with schizophrenia: an integrated model

Clin. Psychol. Rev.

(2007)

C.S. Carver et al.

Assessing coping strategies: a theoretically based approach

J. Personal. Soc. Psychol.

(1989)

A. Georgiades et al.

Resilience, recovery style, and stress in early psychosis

Psychosis

(2015)

A. Harper et al.

Development of the world health organization WHOQOL-BREF quality of life assessment

Psychol. Med.

(1998)

Hayes, A.F., 2016. The PROCESS macro for SPSS and SAS. 〈http://processmacro.org/index.html〉 (accessed 5 January...

Cited by (11)

Emotional abuse and perceived stress: The most relevant factors in suicide behavior in first-episode psychosis patients
2022, Psychiatry Research
Citation Excerpt :
Previous meta-analytic evidence identified several predictors of suicide risk in people with schizophrenia (Challis et al., 2013), such as shorter length of illness, a younger age, higher intelligence quotient, history of tobacco and alcohol use, being male, history of attempted suicide, feelings of worthlessness, hopelessness, and poor treatment adherence. However, studies that focused specifically on populations with FEP showed other relevant predictors, such as being single, a family history of death by suicide, social isolation and limited external support, more psychopathology, and substance use, perceived stress and depressed mood (Challis et al., 2013; Courtet, 2018; López-Navarro et al., 2018; Madsen and Nordentoft, 2012; Nordentoft et al., 2011; Pelizza et al., 2021; Rossau and Mortensen, 1997). Childhood trauma (ChT) has recently become an important variable of study in the field of psychosis given its importance in the appearance of psychosis (Mittal and Walker, 2019; Stanton et al., 2020; Vila-Badia et al., 2021).
People with a mental disorder have a higher risk of suicidal behavior. Little research has examined the role of childhood trauma in suicide behavior, and even fewer studies have assessed the specific relevance of subtypes of childhood trauma and suicidal behavior in first-episode psychosis (FEP). The aims of the present study were: 1) to compare suicide behavior between FEP and HC; 2) to study the relationship between the five types of ChT and suicide risk in FEP controlling for confounding sociodemographic, clinical, and psychosocial variables. 95 patients diagnosed with FEP and 92 healthy control (HC) were recruited as a part of the PROFEP study. ChT was evaluated using The Childhood Trauma Questionnaire-Short Form (CTQ) and suicide behavior through The Suicide Risk Scale of Plutchik (SRSP). Our results showed that patients with FEP presented more suicide behavior (ideation, attempt, and suicide risk) than HC. Emotional abuse was the most relevant type of ChT in suicide ideation and suicide risk. After controlling for other relevant variables, perceived stress seemed to play an important role in suicide ideations, suicide attempt, and suicide risk. The results highlight the importance of assessing and considering in the clinical practice ChT and the perceived stress.
Mindfulness on Daily Life Coping in People Experiencing Psychosis: A Randomized Controlled Trial
2022, International Journal of Clinical and Health Psychology
Cognitive Behavior Therapy for psychosis (CBTp) is a recommended treatment for psychoses whose effect is mediated by coping. Mindfulness (MBI) have shown positive effects in psychosis. This study examines the hypothesis that combining CBTp+MBI could improve coping with day-to-day life in psychosis better than CBTp alone in people attending a public community rehabilitation center.
Fifty-six outpatients were recruited and randomly allocated either to CBTp or CBTp+MBI. Measures comprised PANSS interview and COPE Inventory. Data were analyzed using a repeated measures ANOVA and RCI calculation.
There were no statistical differences between groups at pre-treatment. Significant statistical differences were found for the interaction Treatment x Time in Mental disengagement (F = 5.65, p = .021, η² = .102), Acceptance (F = 7.69, p = .008, η² = .133), and Suppressing competing activities (F = 4.62, p = .037, η² = .085).
MBI promotes specific coping styles in people who experience psychosis that otherwise are not improved with CBTp. Only the MBI group improved acceptance of the presence of the stressor and reduced mental disengagement from the context. The intervention is feasible and effective for public healthcare settings.
La Terapia Cognitivo-Conductual para la psicosis (TCCp) es un tratamiento eficaz mediado por el afrontamiento del estrés. Las Intervenciones Basadas en Mindfulness (IBM) han demostrado efectos positivos en psicosis por lo que combinarlas con TCCp podría mejorar el afrontamiento. El estudio compara el efecto de la TCCp con TCCp+IBM sobre el afrontamiento en psicosis.
Cincuenta y seis participantes con psicosis fueron reclutados y asignados aleatoriamente a TCCp o TCCp+IBM. Los protocolos fueron sincronizados con las rutinas de los participantes. Las medidas incluyeron la entrevista PANSS y el inventario COPE. Los datos se analizaron con ANOVA de medidas repetidas y se calculó el RCI.
No hubo diferencias estadísticamente significativas entre grupos en el pre-tratamiento, sí las hubo en la interacción Tratamiento x Tiempo en desconexión mental (F = 5,65, p = 0,021, η² = 0,102), Aceptación (F = 7,69, p = 0,008, η² = 0,133), y Supresión de distractores (F = 4,62, p = 0,037, η² = 0,085).
La IBM fomenta estilos de afrontamiento en psicosis que la TCCp en solitario no. TCCp+IBM mejoró la aceptación del estresor y redujo la desconexión mental. La intervención es eficaz y viable en un contexto asistencial.
Mediation of the stigma in the influence of negative symptomatology over recovery in psychosis
2021, International Journal of Clinical and Health Psychology
Background/Objective: The interest in recovery processes in psychotic disorders has boosted the necessity of knowledge about the factors that could influence in such recovery. Negative symptomatology and the stigma have been negatively linked to the recovery process in psychosis. The aim of this investigation is to improve the understanding of how the recovery process is affected by negative symptomatology based on the analysis of the mediating effects of the internalized stigma. Method: The sample was composed of 114 people that had experienced, at some point in their life, at least one clinically relevant psychotic episode. CAPE-42, STORI and ISMI were used for the evaluation. The macro PROCESS for SPSS was used. The indirect effect was calculated using 10.000 samples of bootstrap for the bootstrap confidence intervals (IC) corrected for bias. Results: The results show that the influence of negative symptomatology predicts the stigmatization of the person regarding his disorder. This predicts a negative influence in the recovery process of the psychosis. Conclusions: These results back the importance of adding the reduction of the stigma as a specific strategy to improve the recovery process in psychotic disorders.
Antecedentes/Objetivo: El interés por los procesos de recuperación en los trastornos psicóticos ha impulsado la necesidad de conocer los factores que podrían influir en dicha recuperación. La sintomatología negativa y el estigma se han relacionado negativamente con el proceso de recuperación de la psicosis. El objetivo de esta investigación es mejorar la comprensión sobre cómo el proceso de recuperación se ve afectado por la sintomatología negativa a partir del análisis de los efectos mediadores del estigma internalizado. Método: La muestra estuvo compuesta por 114 personas que habían experimentado, en algún momento de su vida, al menos un episodio psicótico clínicamente relevante. Para la evaluación se usaron el CAPE-42, STORI and e ISMI. Se utilizó el macro PROCESS para SPSS. El efecto indirecto se calculó utilizando 10.000 muestras de bootstrap para los intervalos de confianza (IC) de bootstrap corregidos por sesgo. Resultados: Los resultados muestran que la influencia de la sintomatología negativa predice la estigmatización de la persona con respecto a su trastorno, y esto predice una influencia negativa en el proceso de recuperación de la psicosis. Conclusiones: Estos resultados respaldan la importancia de sumar la reducción del estigma como estrategia específica para mejorar el proceso de recuperación en los trastornos psicóticos.
Impact of changes in social anxiety on social functioning and quality of life in outpatients with schizophrenia: A naturalistic longitudinal study
2020, Journal of Psychiatric Research
Citation Excerpt :
Park et al. (2016) reported that a change in QOL predicted a change in anxiety symptoms along a longitudinal trajectory. While depression is well known to be related to QOL, positive symptoms are also reportedly associated with QOL (Desalegn et al., 2020; Lopez-Navarro et al., 2018). Depressive and positive symptoms are key clinical determinants of health-related QOL, which represents an aspect of QOL that is directly affected by healthcare interventions (Lim and Lee, 2018).
The prevalence of comorbid social anxiety disorder among patients with schizophrenia is currently attracting attention, and symptoms of social anxiety are reportedly associated with various clinical features. However, the contribution of social anxiety to social functioning and quality of life (QOL) over time remains obscure. The aim of this study was to examine the impact of changes in social anxiety symptoms on social functioning and QOL among outpatients with schizophrenia. Of the 207 outpatients who were eligible at baseline, 118 patients agreed with and completed a follow-up investigation at least 1 year (695.8 days on average) after the baseline study. Stepwise multiple regressions examining the change in social functioning using demographic data and changes in clinical variables as explanatory variables demonstrated that the changes in social anxiety and general psychopathology contributed to the change in the Social Functioning Scale, while the changes in clinical severity and negative symptoms contributed to the change in the Global Assessment of Functioning scale. Stepwise multiple regressions for the change in QOL demonstrated that the changes in social anxiety and depression contributed to the change in the World Health Organization QOL scale, Brief version, and the changes in social anxiety and positive symptoms contributed to the Subjective Well-being Under Neuroleptic Drug Treatment, Short Form. The results revealed that the changes in social anxiety symptoms were significantly associated with the change in functional outcome among patients with schizophrenia. Treatments targeting social anxiety seem to be key to achieving a full recovery in patients with schizophrenia.
Coping styles mediate the association between negative life events and subjective well-being in patients with non-affective psychotic disorders and their siblings
2019, Psychiatry Research
Citation Excerpt :
In patients with psychotic disorders, coping styles have shown to act as mediators for quality of life measures; Ritsner et al. (2003) found that emotion-oriented coping styles partially mediate the relationship between the distress of psychopathology (anxiety/depression, severity of activation) and psychological distress on the one hand and subjective quality of life, on the other hand. López-Navarro found that problem focused coping styles mediate the relation between positive symptoms and the WHOQOL-psychological subdomain (López-Navarro et al., 2018). Among the limited amount of studies in this field, Ritsner et al. (2003) showed that task oriented strategies and distraction from the stressor, here assessed with social diversion or a substitute task, is positively correlated with levels of quality of life in patients with psychotic disorders.
Coping styles are associated with levels of subjective well-being. Negative life events and reduced subjective well-being are more prevalent in patients with psychotic disorders. The aims of the current study were to test a mediation model, with coping styles as potential mediators of the relation between negative life events and subjective well-being in patients with psychotic disorders (N = 259), and aimed to repeat the potential mediation model in patients’ non-affected siblings (N = 309). Data pertains to a subsample of GROUP, a Dutch naturalistic cohort study. The Subjective Well-being under Neuroleptics-20 (SWN-20) scale was used to assess well-being. Coping styles were assessed with the Utrechtse Coping Lijst (UCL). Life events were assessed using an adaptation of the Interview of the Recent Life Event Scale (IRLES). Siblings, but not patients, who experienced negative life events in the previous three year period were more likely to experience a lower well-being. For both groups passive coping styles mediated the relation between negative life events and subjective well-being. Severity of positive, negative or affective symptoms did not change this relationship. Our findings point to a better recognition of copings styles as a therapeutic target to promote well-being and recovery.
Does mindfulness improve inhibitory control in psychotic disorders? A randomized controlled clinical trial
2020, International Journal of Clinical and Health Psychology
Citation Excerpt :
IRT comprised 26 one-hour weekly group sessions of cognitive behavior therapy techniques for symptom management as well as strategies for preventing relapse and conflict management. Bearing in mind the mediation effect of daily life stressors in the relationship between psychotic experiences and psychological well-being (López-Navarro, del Canto, Mayol, Fernández-Alonso, & Munar, 2018), group sessions were designed with a strong component of social skills training. Sessions one to six aimed to teach participants about the A-B-C schema and how feelings and thoughts are related with environment.
Background/Objective: Impaired Inhibitory Control (IC) is a core feature of psychotic disorders and is related with impaired social functioning in people experiencing psychosis. Despite research showing the benefits of mindfulness over IC in the general population, no study has assessed its effects on IC in psychoses. The aim of our study was to assess the effectiveness of a mindfulness-based intervention combined with integrated rehabilitation treatment in a sample of people diagnosed of psychotic disorders. Method: Fifty-six patients diagnosed with psychotic disorder were recruited and randomly allocated either to integrated rehabilitation treatment or integrated rehabilitation treatment enhanced with 26 mindfulness group sessions. Measures comprised PANSS interview, MAAS scale, and Stroop Color Word Test (SCWT). The primary outcome variable was the performance in the non-congruent trials of the SCWT. Results: There were no differences between groups at baseline. At post-treatment patients allocated to mindfulness group increased their scores in non-congruent trials of SCWT and in MAAS. At post-treatment mindfulness group scored higher than integrated rehabilitation treatment in MAAS. Conclusions: Data suggest that mindfulness added to integrated rehabilitation treatment may improve IC in psychosis. Results are convergent with prior works about the effect of mindfulness over cognitive performance in general population.
Antecedentes/Objetivo: Los déficits en el control inhibitorio (CI) son una característica central en trastornos psicóticos y se relaciona con funcionamiento social deteriorado en personas con síntomas psicóticos. A pesar de las investigaciones que muestran los beneficios del mindfulness sobre el CI, ningún estudio ha evaluado sus efectos en las psicosis. El objetivo de este estudio fue evaluar la eficacia de una intervención basada en mindfulness combinada con tratamiento rehabilitador integrado en una muestra de personas diagnosticadas con trastorno psicótico. Método: Cincuenta y seis pacientes diagnosticados con trastorno psicótico fueron reclutados y asignados aleatoriamente a tratamiento rehabilitador integrado o a tratamiento rehabilitador integrado mejorado con 26 sesiones grupales de mindfulness. Las medidas fueron la entrevista PANSS, la escala MAAS, y el Test Stroop de Palabras y Colores (TSPC). La variable resultado principal fue el rendimiento en los ensayos no congruentes del TSPC. Resultados: No hubo diferencias entre grupos antes del tratamiento. En el postratamiento los pacientes del grupo de mindfulness incrementaron sus puntuaciones en TSPC y en MAAS. El grupo de mindfulness puntuó más alto que el de tratamiento rehabilitador integrado en MAAS. Conclusiones: El mindfulness añadido al tratamiento rehabilitador integrado puede mejorar el CI en las psicosis. Los resultados son convergentes con los trabajos previos sobre el efecto del mindfulness en la población general.

View all citing articles on Scopus

¹: EvoCog Group, IFISC, Associated Unit to CSIC, Guillem Cifre Building, University of Balearic Islands. Ctra Valldemossa km 7,5. Balearic Islands, Spain.

View full text

Psychotic symptoms and quality of life: A mediation analysis of daily-life coping

Highlights

Abstract

Introduction

Section snippets

Procedure and participants

Results

Discussion

Financial support

Conflicts of interest

Schizophr. Res.

Asian J. Psychiatr.

Schizophr. Res.

Schizophr. Res.

Psychiatry Res.

Personal. Individ. Dif.

Psychiatry Res.

Compr. Psychiatry

Eur. Psychiatry

Schizophr. Res.

Clin. Psychol. Rev.

Assessing coping strategies: a theoretically based approach

J. Personal. Soc. Psychol.

Resilience, recovery style, and stress in early psychosis

Psychosis

Development of the world health organization WHOQOL-BREF quality of life assessment

Psychol. Med.