Self-esteem in persons with schizophrenia. A Nordic multicentre study

Background: Deinstitutionalisation has led to many people with serious mental illness spending most of their time outside psychiatric institutions. Not much is known about their subjective life. The paper presents the results of analysis of self-esteem in a group of non-institutionalised people with schizophrenia. Methods: Interviews were conducted with random samples of people with schizophrenia receiving out-patient services in ten psychiatric centres in the five Nordic countries. The following instruments were used: The Interview Schedule for Social Interaction (ISSI), Camberwell Assessment of Needs, Lancashire Quality of Life Profile and the Rosenberg self-esteem scale, GAF and BPRS. The Rosenberg scale provided the main data for this paper and three different measures of self-esteem were used (positive self-esteem, negative self-esteem and overall self-esteem). Results: A total of 418 people took part in the study. Total participation rate was 55%. Multiple regression analysis showed the three self-esteem measurements to be mainly related to mental health and other subjective variables, and to lesser extent to social network. Demography played a negligible role, only (female) sex being associated with positive and gross self-esteem. Anxiety/depression and affect balance were the strongest predictors of positive, negative and gross self-esteem, and having at least one close friend was associated with positive and gross self-esteem. Conclusion: variations in self-esteem were mainly explained by differences in anxiety/depression and affect balance, and to extent also with satisfaction with the relations to one's family. Having at least one friend was the strongest social network predictor and sex the only significant demographic variable

Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: A Nordic multicentre study

Background: Few studies have investigated differences between subjective and externally assessed quality of life in individuals with a severe mental illness. In a sample of 387 patients with schizophrenia living in the community the present study investigated the association between subjective and interviewer-rated quality of life, clinical and sociodemographic factors related to the two assessments, and if discrepancies in the assessments were related to any clinical or social features of the patients. Method: The study was a Nordic multicentre study with a cross-sectional design. Instruments used were the Lancashire Quality of Life Profile, the Brief Psychiatric Rating Scale, the Interview Schedule for Social Interaction, Camberwell Assessment of Needs and General Assessment of Functioning. Results: The correlation between subjective and interviewer-rated quality of life was moderate (ICC=0.33). More severe affective symptoms, fewer emotional relations and a lower monthly income were related to poorer subjectively rated quality of life but in a stepwise multiple regression analysis accounted for only 14.1 of the variance. Poorer interviewer-rated quality of life was mainly related to a more severe psychopathology but also to a lower monthly income, fewer emotional relations and not being employed. Together these factors accounted for 45.5 of the variance. A greater discrepancy between the subjective and the interviewer rating was found in patients with less affective symptoms, unemployment, and a better social network. Conclusion: Only a moderate correlation between subjective and interviewer-assessed global quality of life was found, implying that the sources of assessment differed, as was also shown in subsequent regression models. It is concluded that both perspectives on the patient's quality of life may be valuable for treatment planning, especially in cases where differences in quality of life assessment related to the patient's psychopathology may be expected

Schizophrenia and contact with health and social services: A Nordic multi-centre study

Background: In a Nordic multi-centre study investigating the life and care situation of persons with schizophrenia living in the community, factors explaining use of health and social services were examined. Method: Four hundred and eighteen individuals with schizophrenia from 10 sites were interviewed about their contact with different services (support functions within and outside the mental health services, general practitioners (GPs), physicians in the mental health, psychotherapy, day-care and inpatient treatment), psychopathology, social network and needs for care. Results: Physicians and support contacts within the mental health system were most used and GPs and psychotherapy least. Three groups of variables were stabile predictors of contact: rural-urban differences, diagnoses (hebephrenic schizophrenia associated with less contact with physicians in the mental services and more with GPs) and health needs as experienced by the patients. No differences between the centres with regard to total service use were found, but the patterns of contact reflected urban-rural variance. A low number of health needs predicted contact with physicians within the mental health services, whereas a high number of such needs was related to contact with GPs and support functions within the mental health services. Social relations exhibited the highest number of unmet needs. Conclusions: Contact with physicians working in the mental health services was much more common than contact with GPs. Based on a broad spectre of demographic, clinical and network variables, it was not possible to find models that explained substantial parts of the variance of service use. Patterns of contact were different in rural, town and city-surroundings, and with the exception of psychotherapy, the rural pattern was characterized by use of less specialized services. The importance of health needs and diagnosis as predictors of contact illustrate the profound and lasting effects on health of having a diagnosis of schizophrenia