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Illness Perception Mediates the Effect of Illness Course on the Quality of Life of Mexican Patients with Psychosis

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Abstract

Learning about possible factors influencing, positively or negatively, the Quality of Life (QoL) of patients with psychosis is an important task for both, research and treatment. The study examined the association of illness course with QoL in a sample of Mexican patients with psychosis. It was hypothesized that illness perception would mediate the relation of illness course to QoL. Sixty-one (56 % female) patients were interviewed and assessed for illness course (relapses, residual symptoms, and diagnosis), QoL, and illness perception. Mediation analyses (simple and multiple) with bootstrapping procedures were applied, including residual symptoms as the predictor of QoL, and illness perception dimensions as candidate mediators. Residual symptoms, rather than a relapsing course or a diagnosis of schizophrenia, have a diminishing effect in the subjective QoL. This effect is fully mediated by illness perception, particularly by the cognitive and the emotional representations. Results underscore the importance that patients’ beliefs have on their perceived QoL, encouraging further research and development of interventions targeting illness perceptions.

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References

  • Almond, S., Knapp, M., Francios, C., Toumi, M., & Brugha, T. (2004). Relapse in schizophrenia: costs, clinical outcomes and quality of life. The British Journal of Psychiatry, 184(4), 346–351. doi:10.1192/bjp.184.4.346.

    Article  Google Scholar 

  • Altamura, A. C., Bassetti, R., Sassella, F., Salvadori, D., & Mundo, E. (2001). Duration of untreated psychosis as a predictor of outcome in first-episode schizophrenia: a retrospective study. Schizophrenia Research, 52(1), 29–36. doi:10.1016/S0920-9964(00)00187-0.

    Article  Google Scholar 

  • Alvarado, R., & Muñoz, K. (2006). Estudio psicométrico del Cuestionario Sevilla para valorar la calidad de vida en personas con trastornos mentales severos, en una muestra Chilena. Revista Chilena de Neuro-Psiquiatría, 44(4), 249–257. doi:10.4067/S0717-92272006000400003.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington: Author.

    Google Scholar 

  • Apiquián, R., Páez, F., Loyzaga, C., Cruz, E., Gutiérrez, D., Suárez, J. A., et al. (1997). Estudio Mexicano sobre el primer episodio psicótico: resultados preliminares, características sociodemográficas y clínicas. Salud Mental, 20, 1–7.

    Google Scholar 

  • Awad, A. G., & Voruganti, L. N. P. (2000). Intervention research in psychosis: issues related to the assessment of quality of life. Schizophrenia Bulletin, 26(3), 557–564.

    Article  Google Scholar 

  • Bechdolf, A., Pukrop, R., Köhn, D., Tschinkel, S., Veith, V., Schultze-Lutter, F., et al. (2005). Subjective quality of life in subjects at risk for a first episode of psychosis: a comparison with first episode schizophrenia patients and healthy controls. Schizophrenia Research, 79(1), 137–143. doi:10.1016/j.schres.2005.06.008.

    Article  Google Scholar 

  • Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The Brief Illness Perception Questionnaire. Journal of Psychosomatic Research, 60(6), 631–637. doi:10.1016/j.jpsychores.2005.10.020.

    Article  Google Scholar 

  • Broadbent, E., Kydd, R., Sanders, D., & Vanderpyl, J. (2008). Unmet needs and treatment seeking in high users of mental health services: the role of illness perceptions. The Australian and New Zealand Journal of Psychiatry, 42, 147–153. doi:10.1080/00048670701787503.

    Article  Google Scholar 

  • Browne, S., Clarke, M., Gervin, M., Waddington, J. L., Larkin, C., & O’Callaghan, E. (2000). Determinants of quality of life at first presentation with schizophrenia. The British Journal of Psychiatry, 176(2), 173–176. doi:10.1192/bjp.176.2.173.

    Article  Google Scholar 

  • Burns, J. K., Jhazbhay, K., & Emsley, R. A. (2011). Causal attributions, pathway to care and clinical features of first-episode psychosis: a South African perspective. The International Journal of Social Psychiatry, 57(5), 538–545. doi:10.1177/0020764010390199.

    Article  Google Scholar 

  • Caqueo-Urízar, A., & Lemos-Giráldez, S. (2008). Calidad de vida y funcionamiento familiar de pacientes con esquizofrenia en una comunidad latinoamericana. Psicothema, 20(4), 577–582.

    Google Scholar 

  • Caron, J., Lecomte, Y., Stip, E., & Renaud, S. (2005). Predictors of quality of life in schizophrenia. Community Mental Health Journal, 41(4), 399–417. doi:10.1007/s10597-005-5077-8.

    Article  Google Scholar 

  • Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.

    Article  Google Scholar 

  • Devins, G. M. (2010). Using the Illness Intrusiveness Ratings Scale to understand health-related quality of life in chronic disease. Journal of Psychosomatic Research, 68(6), 591–602. doi:10.1016/j.jpsychores.2009.05.006.

    Article  Google Scholar 

  • Dorian, M., Ramírez-García, J. I., López, S. R., & Hernández, B. (2008). Acceptance and expressed emotion in Mexican American caregivers of relatives with schizophrenia. Family Process, 47(2), 215–228. doi:10.1111/j.1545-5300.2008.00249.x.

    Article  Google Scholar 

  • Felix, R., & Garcia-Vega, J. (2012). Quality of life in Mexico: a formative measurement approach. Applied Research in Quality of Life, 7, 223–238.

    Article  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for the DSM-IV axis I disorders (SCID). New York: New York State Psychiatric Institute, Biometrics Research.

    Google Scholar 

  • Foldemo, A., & Bogren, L. (2002). Need assessment and quality of life in outpatients with schizophrenia: a 5-year follow-up study. Scandinavian Journal of Caring Sciences, 16(4), 393–398. doi:10.1046/j.1471-6712.2002.00107.x.

    Article  Google Scholar 

  • Gaite, L., Vázquez-Barquero, J. L., Borra, C., Ballesteros, J., Schene, A., Welcher, B., et al. (2002). Quality of life in patients with schizophrenia in five European countries: the EPSILON study. Acta Psychiatrica Scandinavica, 105(4), 283–292. doi:10.1034/j.1600-0447.2002.1169.x.

    Article  Google Scholar 

  • Giner, J., Ibañez, E., Baca, E., Bobes, J., Leal, C., & Cervera, S. (1997). Desarrollo del Cuestionario Sevilla de Calidad de Vida (CSCV). Actas Luso-Españolas de Neurología y Psiquiatría, 25(supl. 2), 11–23.

    Google Scholar 

  • Gladis, M. M., Gosch, E. A., Dishuk, N. M., & Crits-Christoph, P. (1999). Quality of life: expanding the scope of clinical significance. Journal of Consulting and Clinical Psychology, 67(3), 320–331. doi:10.1037/0022-006X.67.3.320.

    Article  Google Scholar 

  • Gómez-de-Regil, L., Kwapil, T. R., Blanqué, J. M., Vainer, E., Montoro, M., & Barrantes-Vidal, N. (2010). Predictors of outcome in the early course of first-episode psychosis. The European Journal of Psychiatry, 24(2), 87–97.

    Article  Google Scholar 

  • Górna, K., Jaracz, K., Rybakowski, F., & Rybakowski, J. (2008). Determinants of objective and subjective quality of life in first-time-admission schizophrenic patients in poland: a longitudinal study. Quality of Life Research, 17(2), 237–247. doi:10.1007/s11136-007-9296-z.

    Article  Google Scholar 

  • Harvey, C. A., Jeffreys, S. E., McNaught, A. S., Blizard, R. A., & King, M. B. (2007). The Camden Schizophrenia Surveys III: five-year outcome of a sample of individuals from a prevalence survey and the importance of social relationships. The International Journal of Social Psychiatry, 53(4), 340–356. doi:10.1177/0020764006074529.

    Article  Google Scholar 

  • Hirschberg, S. (2006). Quality of life and symptomatology in people with schizophrenia. (ProQuest information & learning). Dissertation Abstracts International: Section B: The Sciences and Engineering, 66(10-B), 5682.

    Google Scholar 

  • Huppert, J. D., & Smith, T. E. (2001). Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor. The Journal of Nervous and Mental Disease, 189(10), 669–675. doi:10.1097/00005053-200110000-00003.

    Article  Google Scholar 

  • Ibañez, E., Giner, J., Cervera, S., Baca, E., Bobes, J., & Leal, C. (1997). El Cuestionario Sevilla de Calidad de Vida: propiedades psicométricas. Actas Luso-Españolas de Neurología y Psiquiatría, 25(Supl. 2), 24–31.

    Google Scholar 

  • Jablensky, A., & Sartorius, N. (2008). What did the WHO studies really find? Schizophrenia Bulletin, 34(2), 253–255. doi:10.1093/schbul/sbm151.

    Google Scholar 

  • Jablensky, A., Sartorius, N., Ernberg, G., & Anker, M. (1992). Schizophrenia: manifestations, incidence and course in different cultures: a World Health Organization ten-country study. Psychological Medicine, 20, 1–97.

    Google Scholar 

  • Jabs, B. E., Krause, U., Althaus, G., Bartsch, A. J., Stöber, G., & Pfuhlmann, B. (2004). Differences in quality of life and course of illness between cycloid and schizophrenic psychoses—a comparative study. The World Journal of Biological Psychiatry, 5, 136–142. doi:10.1080/15622970410029925.

    Article  Google Scholar 

  • Kao, Y., Liu, Y., Cheng, T., & Chou, M. (2011). Subjective quality of life and suicidal behavior among Taiwanese schizophrenia patients. Social Psychiatry and Psychiatric Epidemiology. doi:10.1007/s00127-011-0361-0.

  • Lasalvia, A., Ruggeri, M., & Santolini, N. (2002). Subjective quality of life: its relationship with clinician-rated and patient-rated psychopathology. The South-Verona outcome project 6. Psychotherapy and Psychosomatics, 71(5), 275–284. doi:10.1159/000064809.

    Article  Google Scholar 

  • Leventhal, H., Nerenz, D. R., & Steele, D. J. (1984). Illness representations and coping with health threats. In A. Baum, S. E. Taylor, & J. E. Singer (Eds.), Handbook of psychology and health, volume IV: Social psychological aspects of health (pp. 219–252). Hillsdale: Erlbaum.

    Google Scholar 

  • Lobban, F., Barrowclough, C., & Jones, S. (2004). The impact of beliefs about mental health problems and coping on outcome in schizophrenia. Psychological Medicine, 34(7), 1165–1176. doi:10.1017/S003329170400203X.

    Article  Google Scholar 

  • Lobban, F., Barrowclough, C., & Jones, S. (2005). Assessing cognitive representations of mental health problems. I. The Illness Perception Questionnaire for schizophrenia. British Journal of Clinical Psychology, 44(2), 147–162. doi:10.1348/014466504X19497.

    Article  Google Scholar 

  • Lundberg, B., Hansson, L., Wentz, E., & Björkman, T. (2008). Stigma, discrimination, empowerment and social networks: a preliminary investigation of their influence on subjective quality of life in a Swedish sample. The International Journal of Social Psychiatry, 54(1), 47–55. doi:10.1177/0020764007082345.

    Article  Google Scholar 

  • Malla, A., & Payne, J. (2005). First-episode psychosis: psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin, 31(3), 650–671. doi:10.1093/schbul/sbi031.

    Article  Google Scholar 

  • Malla, A. K., Norman, R. M. G., McLean, T. S., & McIntosh, E. (2001). Impact of phase-specific treatment of first episode of psychosis on Wisconsin Quality of Life Index (client version). Acta Psychiatrica Scandinavica, 103(5), 355–361. doi:10.1034/j.1600-0447.2001.00200.x.

    Article  Google Scholar 

  • Miglioretti, M., Mazzini, L., Oggioni, G. D., Testa, L., & Monaco, F. (2008). Illness perceptions, mood and health-related quality of life in patients with amyotrophic lateral sclerosis. Journal of Psychosomatic Research, 65(6), 603–609. doi:10.1016/j.jpsychores.2008.05.012.

    Article  Google Scholar 

  • Möller, H., Bottlender, R., Wegner, U., Wittmann, J., & Strauß, A. (2000). Long-term course of schizophrenic, affective and schizoaffective psychosis: focus on negative symptoms and their impact on global indicators of outcome. Acta Psychiatrica Scandinavica, 102, 54–57. doi:10.1034/j.1600-0447.2000.00010.x.

    Article  Google Scholar 

  • Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L. D., & Buick, D. (2002). The Revised Illness Perception Questionnaire (IPQ-R). Psychology and Health, 17(1), 1–16. doi:10.1080/08870440290001494.

    Article  Google Scholar 

  • Narvaez, J. M., Twamley, E. W., McKibbin, C. L., Heaton, R. K., & Patterson, T. L. (2008). Subjective and objective quality of life in schizophrenia. Schizophrenia Research, 98(1–3), 201–208. doi:10.1016/j.schres.2007.09.001.

    Article  Google Scholar 

  • Nasrallah, H. A., & Lasser, R. (2006). Improving patient outcomes in schizophrenia: achieving remission. Journal of Psychopharmacology, 20(6), 57–61. doi:10.1177/1359786806071248.

    Article  Google Scholar 

  • Ng, R. M. K., Pearson, V., Lam, M., Law, C. W., Chiu, C. P. Y., & Chen, E. Y. H. (2008). What does recovery from schizophrenia mean? Perceptions of long-term patients. The International Journal of Social Psychiatry, 54(2), 118–130. doi:10.1177/0020764007084600.

    Article  Google Scholar 

  • Petrie, K. J., Broadbent, E., & Kydd, R. (2008). Illness perceptions in mental health: issues and potential aplications. Journal of Mental Health, 17(6), 559–564. doi:10.1080/09638230802523047.

    Article  Google Scholar 

  • Pinikahana, J., Happell, B., Hope, J., & Keks, N. A. (2002). Quality of life in schizophrenia: a review of the literature from 1995 to 2000. International Journal of Mental Health Nursing, 11(2), 103–111. doi:10.1046/j.1440-0979.2002.00233.x.

    Article  Google Scholar 

  • Pitkänen, A., Hätönen, H., Kuosmanen, L., & Välimäki, M. (2009). Individual quality of life of people with severe mental disorders. Journal of Psychiatric and Mental Health Nursing, 16(1), 3–9. doi:10.1111/j.1365-2850.2008.01308.x.

    Article  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 4, 717–731.

    Article  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.

    Article  Google Scholar 

  • Priebe, S., Roeder-Wanner, U. U., & Kaiser, W. (2000). Quality of life in first-admitted schizophrenia patients: a follow-up study. Psychological Medicine, 30(1), 225–230. doi:10.1017/S0033291798008253.

    Article  Google Scholar 

  • Ritsner, M., Modai, I., Endicott, J., Rivkin, O., Nechamkin, Y., Barak, P., et al. (2000). Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients. The Journal of Clinical Psychiatry, 61(11), 880–889.

    Article  Google Scholar 

  • Ritsner, M., Kurs, R., Gibel, A., Hirschmann, S., Shinkarenko, E., & Ratner, Y. (2003). Predictors of quality of life in major psychoses: a naturalistic follow-up study. The Journal of Clinical Psychiatry, 64(3), 308–315.

    Article  Google Scholar 

  • Rosen, K., & Garety, P. (2005). Predicting recovery from schizophrenia: a retrospective comparison of characteristics at onset of people with single and multiple episodes. Schizophrenia Bulletin, 31(3), 735–750. doi:10.1093/schbul/sbi017.

    Article  Google Scholar 

  • Rudnick, A. (2001). The impact of coping on the relation between symptoms and quality of life. Psychiatry: Interpersonal and Biological Processes, 64(4), 304–308. doi:10.1521/psyc.64.4.304.18599.

    Google Scholar 

  • Ruhrmann, S., Paruch, J., Bechdolf, A., Pukrop, R., Wagner, M., Berning, J., et al. (2008). Reduced subjective quality of life in persons at risk for psychosis. Acta Psychiatrica Scandinavica, 117(5), 357–368. doi:10.1111/j.1600-0447.2008.01152.x.

    Article  Google Scholar 

  • Savilla, K., Kettler, L., & Galletly, C. (2008). Relationships between cognitive deficits, symptoms and quality of life in schizophrenia. The Australian and New Zealand Journal of Psychiatry, 42(6), 496–504. doi:10.1080/00048670802050512.

    Article  Google Scholar 

  • Scharloo, M., Kaptein, A. A., Schlösser, M., Pouwels, H., Bel, E. H., Rabe, K. F., et al. (2007). Illness perceptions and quality of life in patients with chronic obstructive pulmonary disease. The Journal of Asthma, 44(7), 575–581. doi:10.1080/02770900701537438.

    Article  Google Scholar 

  • Schön, U., Denhov, A., & Topor, A. (2009). Social relationships as a decisive factor in recovering from severe mental illness. The International Journal of Social Psychiatry, 55(4), 336–347. doi:10.1177/0020764008093686.

    Article  Google Scholar 

  • Shahar, G., & Davidson, L. (2009). Participation-engagement: a philosophically based heuristic for prioritizing clinical interventions in the treatment of comorbid, complex, and chronic psychiatric conditions. Psychiatry: Interpersonal and Biological Processes, 72(2), 154–176. doi:10.1521/psyc.2009.72.2.154.

    Google Scholar 

  • Stainsby, M., Sapochnik, M., Bledin, K., & Mason, O. J. (2010). Are attitudes and beliefs about symptoms more important than symptom severity in recovery from psychosis? Psychosis: Psychological, Social and Integrative Approaches, 2(1), 41–49. doi:10.1080/17522430903144386.

    Article  Google Scholar 

  • Svirskis, T., Korkeila, J., Heinimaa, M., Huttunen, J., Ilonen, T., Ristkari, T., et al. (2007). Quality of life and functioning ability in subjects vulnerable to psychosis. Comprehensive Psychiatry, 48(2), 155–160. doi:10.1016/j.comppsych.2006.10.008.

    Article  Google Scholar 

  • Theodore, K., Johnson, S., Chalmers-Brown, A., Doherty, R., Harrop, C., & Ellett, L. (2011). Quality of life and illness beliefs in individuals with early psychosis. Social Psychiatry and Psychiatric Epidemiology. doi:10.1007/s00127-011-0360-1.

  • Thorup, A., Petersen, L., Jeppesen, P., & Nordentoft, M. (2010). The quality of life among first-episode psychotic patients in the opus trial. Schizophrenia Research, 116(1), 27–34. doi:10.1016/j.schres.2009.10.006.

    Article  Google Scholar 

  • Topor, A., Borg, M., Di Girolamo, S., & Davidson, L. (2011). Not just an individual journey: social aspects of recovery. The International Journal of Social Psychiatry, 57(1), 90–99. doi:10.1177/0020764010345062.

    Article  Google Scholar 

  • Vanheusden, K., van der Ende, J., Mulder, C. L., van Lenthe, F. J., Verhulst, F. C., & Mackenbach, J. P. (2009). Beliefs about mental health problems and help-seeking behavior in Dutch young adults. Social Psychiatry and Psychiatric Epidemiology, 44(3), 239–246. doi:10.1007/s00127-008-0428-8.

    Article  Google Scholar 

  • Vázquez-Barquero, J. L., Cuesta, M. J., Castanedo, S. H., Lastra, I., Herrán, A., & Dunn, G. (1999). Cantabria first-episode schizophrenia study: three-year follow-up. The British Journal of Psychiatry, 174, 141–149. doi:10.1192/bjp.174.2.141.

    Article  Google Scholar 

  • Watson, P. W. B., Garety, P. A., Weinman, J., Dunn, G., Bbbington, P. E., Fowler, D., et al. (2006). Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 36(6), 761–770. doi:10.1017/S0033291706007458.

    Article  Google Scholar 

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Acknowledgments

LGR thanks the Consejo Nacional de Ciencia y Tecnología (CONACyT), Mexico, for funding number 187498. NBV and TRK are supported by the Spanish Ministry of Science and Innovation (PSI2008-04178), the Generalitat de Catalunya, Suport als Grups de Recerca (SGR2009672), and La Fundació La Marató de TV3 (091110). We thank the Hospital Psiquiátrico Yucatán (México) for its support and all who kindly took part as participants.

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All authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Hospital Regional de Alta Especialidad de la Península de Yucatán, Departamento de Planeación, Enseñanza e Investigación, Km. 8.5 Carretera Mérida-Cholul s/n Col. Maya, Mérida, Yucatán, 97134, México

    Lizzette Gómez-de-Regil

  2. Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain

    Lizzette Gómez-de-Regil

  3. Department of Psychology, University of North Carolina at Greensboro, P.O. Box 26170, Greensboro, NC, 27402-6170, USA

    Thomas R. Kwapil

  4. Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, 08193, Spain

    Neus Barrantes-Vidal

  5. Sant Pere Claver - Fundació Sanitària, Barcelona, Spain

    Neus Barrantes-Vidal

  6. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain

    Neus Barrantes-Vidal

  7. University of North Carolina at Greensboro, Greensboro, NC, USA

    Neus Barrantes-Vidal

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  1. Lizzette Gómez-de-Regil
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Correspondence to Lizzette Gómez-de-Regil.

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Gómez-de-Regil, L., Kwapil, T.R. & Barrantes-Vidal, N. Illness Perception Mediates the Effect of Illness Course on the Quality of Life of Mexican Patients with Psychosis. Applied Research Quality Life 9, 99–112 (2014). https://doi.org/10.1007/s11482-013-9211-4

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