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01.12.2014 | Research | Ausgabe 1/2014 Open Access

International Journal of Mental Health Systems 1/2014

Structural equation model of factors related to quality of life for community-dwelling schizophrenic patients in Japan

International Journal of Mental Health Systems > Ausgabe 1/2014
Hirofumi Nakamura, Naoko Watanabe, Eisuke Matsushima
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-4458-8-32) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

HN, NW, and EM conceptualized the rationale and design of the study. EM advised HN about data management for SPSS. HN, NW, and EM conducted statistical analyses and drafted the manuscript. All authors read and approved the final manuscript.



This study aimed to clarify how community mental healthcare systems can be improved.


We included 79 schizophrenic patients, aged 20 to 80 years, residing in the Tokyo metropolitan area who regularly visited rehabilitation facilities offering assistance to psychiatric patients and were receiving treatment on an outpatient basis. No subjects had severe cognitive disorders or were taking medication with side effects that could prevent the completion of questionnaires. Questionnaires included items related to quality of life, self-efficacy, self-esteem, psychosis based on the Behavior and Symptom Identification Scale, health locus of control, and socio-demographic factors. We performed multiple linear regression analysis with quality of life as the dependent variable and, based on covariance structural analysis, evaluated the goodness of fit of the resulting structural equations models.


Self-efficacy, self-esteem, and degree of psychosis significantly impacted quality of life. Marital status, age, and types of medications also influenced quality of life. Multiple linear regression analysis revealed psychiatric symptoms (Behavior and Symptom Identification Scale-32 [daily living and role functioning] (Beta = −0.537, p < 0.001) and self-efficacy (Beta = 0.249, p < 0.05) to be predictors of total quality of life score. Based on covariance structural analysis, the resulting model was found to exhibit reasonable goodness of fit.


Self-efficacy had an especially strong and direct impact on QOL. Therefore, it is important to provide more positive feedback to patients, provide social skills training based on cognitive behavioral therapy, and engage patients in role playing to improve self-efficacy and self-concept.
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