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PSYCHIATRY

RESEARCII
ELSEVIER Rcseurch60(l q'r?)15l-166
Psychiarry

Profilesof subjectivequaiity of life in schizophrenicin- and


out-patientsamples

Wolfgarg Kaisera*,StefanPriebe', Wally Barr', Karin Hoffmannb,


MargareteIsermanfla,Ute-Uhike Roder-Wannerb, peter Huxley.
'Krafie ta4
Spondau,Oenli.h.r Beteich Cnesikg.Bttul)!, Cn{insdn.27 33,D.1358s Bertin, cmn!
zbteillaEltu Sozialpstchiah., Feie UniEE&t Benin, I'lakieMllee 19,D.145A Alnn, cenonr
'
Schootof Psrchitt4 .ni BehaLiowatlhiences, The UniN6 ) oJ Man(h4kt, rNod RM4 MtNh6@ M13 opL, UK

Rerned I r De*mber loqr: rc\scd 2r luh laco.a(epjrd , O.roner t9oo

For the use of subjectilequalityof life as an evaluaxoDcrnerion,n lhould bc known i{ nmures re retiable.ro
wbal extenl they are infloencedby other variablesand rbether diffelence!and similalitiescan be oerecreoacros
lreatmentsitxatiors. Quality of life profiles(Berhne! Lrhensgudlitllspro /Lancaqhire ou.tir] of Life profite) of
440 schizopbrenicpatients(from Bedin, Germany and from Wales, UK) w€re eMdined. Reliabihrresdiffered
betwecnlife domainsand Sroups.Tle innuenceof orher variableswas moderateand vaned betseen rhe srouDs.
Seve.alsisnifcant differencesbetweensubsamplcs could be shovn berweenjn,patiemswith a shoner prese;t si{}
and oul-patients.In addition,inrerestingsimilaritiesi. profije pauemsbetweenin-patjentswith a longersray(> 2
yea.sland ouGpatientscanbe fouDd.Beingadrnitkd to a psychiatrichospirals€enslo havean influenceon the tevel
and structureof subjectivequaiity of life for sone rirne.Being in a psichiarrjchospiralfor a toDgerrime see6s10
coincidewith a stabilizalionof leveland srrudure of subjeclivequaliryof tife: Fururereportson subjectivequatiryoi
life shouldiDciudediagnostically homogeneous sanpling and conr.ol the @ffelationwith psychopatholos/. Further
researchis neededto chnfy the impad of olher va;ables(e.e.lengrhofstay, cognitivevarinbles,ireatmenrfealures)
on patients'satisfactionin differentsettings. O 1997ElsevierScienceIreland Lrd. AU righrsresened

(qrrolds Communilymental healdrsenices;Evaluationsrudies;I])ng-tlm care;ScbizopbreDia

1 lntroduction nificancein both sociolog/and socialpsycholos/


(Stracket al., 1991;Diener, 1984)dnd in research
Sincethe early 1980stie conceptof subjecrive in communirypsychiarryrohver (l Jd.,Iilgb..
qu:,ti[ of life ha5 as,umedmore :'nd more rig. The applicationof the conceptin the field of
mental health was origirated by Lebman et al.
(1982)in studieswhichexploredthe qualiryof life
"Cor6ponding among chronicallymenially disabledpeople in
author. Tel.i +49 (O) 30 37014551,tax:
+ 4 9 ( 0 1 3 03 t 0 1 3 5 0 5 communiryfacilitiesin l-os Angele. and in a

01651731/9tl$r7.00 O 199t ElsevierScienceIreland Lrd. All righrsreseFed


P . 1 .Sf 0 1 65 - 1 ? 8 I ( 9 6 ) 0 2 9 58 - 7
154 W leuta ol / Py.hut4 R6drh66 (t@7) ItJ 1o6

comparativestudywith chronicmenralpatientsin schizophrenia bascdon ICD 10 criteria-Mentally


a statehospitaland conmunitytreatmentsettings retardedpatientsor patientswith additionalneu-
in Baltimore (Irhman et al., 1986).In his second rologicaldisorden or substanceabusewere ex-
study l€hman reported that significantmain ef- cluded.
fecls.benreenfour samples o[ communiDresi. SampleA are patients(n : 68) during the first
denlsand state hospitalpatientswith mixeddiag- 3 weeks of their first admissionto 7 differen!
noses(affectjvedisorder,6-257,; schizophrema, psychiatrichospitalsor departmentsof psychiatry
54-86%; mentallyfetarded,0 197.),on ihe sub- at gcneralhospitalsin Berlin dnd Potsdam,Ger-
jectnerariable.of his Oualiryof Life lnteFJie$. many.They were consecutively admittedbetween
could no longer be found after adjushents to May and December1994.SampleB - patients
rake accounrof rllnessand demogrrphic!ari- (n = 76) with a prcsenthospitalstayof between6
ables.Other studies(Simpsonet al., 1989;Warner monthsand 2 years- and sampleC patients
and Huxley, 1993) showed few differences (n = 99)with a presenthospitalstayof more than
betweencommuniryseltings,but lowerscoresm a 2 years were examjnedin a studyof deinstitu-
fe\r domains for long-rermin-parient..There is tionaljsation,which includedall patientsof th.ee
someevidencethat differencesin communitvset- dislrict.ol (tormerWest)Berlin$ ho $ere hospi-
tjngs could be a result of different interventions, talizedduring the fint half of 1994and had a stay
like different componentsof case management in hospitalof more than 6 months(Priebeet al.,
(Hudey and warner, 1992)or educationgroups
1996).SampleD were patients (n:64) of the
(Atkinson et al., 1996).
oulpatientclinic of NeFenklinik Spandau'(and
For use as an evaluationc terion, though, it former in-patientsof that hospital).Patientsare
should be known whether subjectivemeasures referred ro out-patient-clinics(Institursambulan,
difier betweendiagno.ric-all! consrstenlgroupsin zen)becauseof the lengthofpreviousstaysin the
difierent settingsand to what extent subjective hospital andlor needsfor additionalsocial sup-
quality of life is influenced by other variables. port in addition to pharmacological/psychiatric
The presentstud-\7 set out to examinethe fol- treatment.SampleE are out-patients(r = 79) of
lowing queslions in six diagnosticaliyhomoge-
the Departmenlof SocialPsychiatryat the Freie
neous samplesof schiophrenjc in' and out-pa,
Uni!e,siril Berlin. which is a comprehensive
lients-
community care system serving the district of
Charlottenburg(in the centre of Berlin). It in-
1. Can subjectivemeasuresof quaiity of life be
cludes three partial hospitalizationprograms,
assumedro be reliable?
community-based seryiccsaDdvadousout-patient
2. Is there an impact of deoographicor illness
facilities.Continuityof careis guaranteedby case
relatedvariabieson subjectivequality of life?
managers. SampleF consistsof out-patients(, =
3. Can differencesor similaritiesbe found across
51) treatedbythe Rlyl CommunityMentalHealth
different treatmentsituations?
Team, which offers social srpport and pharmaco-
2. M€thods logicalrreahenl for ahout 350 patienrsin a
semi-ruralarea on lhe Nonh Walescoait in the
2.1. Descnption of different settings UK. The team cariry for all of these patients
contaitu'ucial sorkersand nurses.and paLients
We comparedfive groupsof schizophrericr- are refered for the samereasonsas sampleD.
all from Berlin, Germany- plus a samplefrom
Wales, UK. The German patientshad received
ICD l0 dragnoses lor schuophrenL aF20)duDng 'During
$c rine oflhc data collcclio. NepenHinik Span-
their hospiial stay fuom psychiatristswho were
dauwasa psychiatrichospnal.Since01/01/95 il wasadnDs
trainedin the applicalionof ICD 10 criteria.The batively cha.ged inlo a depanoenr oi a ecneral hspnal:
Welsb palients had a clinical diagnosis of kankenhaus Spandau,OertlrcherBereichGriesingeslraB..
w K'iJu a al. / Pqrhiar,, R6@rch 66 4997) 15j- 166 155

For the comparisonof the similairy of the significandy greater for in-patients (A-C) and
profile pattems (seeSection3 and Table 6) 6nd- particulariylower jD oulpatient sampleF.
ings ftom a self-administeredapplicationof the Most of the patientsin all the samplesare oD
Berliner Irbensqualit.itsprofil to medical sru- neuroleptics.Information about doseswai avail-
dents ai the Freie UniversitetBerlin (n = 175; able only for the ceman samples (A E). They
mean age+S.D.: 26.013.6;women:45%) are are significantly higher for in-patients wjth longer
also sho*n. present hospital stays (B,C). Relatively few
patierts (<5%) receive additional continuous
2.2. Sampb charucteri.stics:
demography medication with antiparkinsonian, anti-de-
pressanl,anti-adiety d gs or lithium or carba-
ln-patientswith a presentstayover 2 years(C) mazepine.
and out-patient-clinicparients(D) are the oldest
(nlean age+ S.D.: 53.4:t 14.0and 49.0i 11.0* 2.4. lnxtrumenE and data collcction
C > A,B,E,F; D > A.E).
Fint adrnissions (A) are significantly younger Quality of life was examined using Oliver's
(meant S.D.: 30.2a 10.3)than all other gruups; (Oiiver, 1991,1992;Oliver et al., in press)l-an-
the orhers (B,E,F) are in between- range of cashire Quality of Life Profile Gample F)
means:42.4-43.4(differencesin age:dI = 5, F = and its German ve.sion, the Berliner Lebens-
31.2, P < 0.001.- Bonferroni ad.iusted multiple qualitatsprofil(Priebe et al., 195) (samplesA
meanj comparisons, at least P < 0.05). througbE). Both versionscontain identicalitems
SampleA hasa predominance ofwomen(71%), and domainsfor direct comparison.
and sampleF of men (68%), the other samples Tle l-ancashrreOuality ol LiIe Profile is an
range ftom 417, ro 47V. women (differencesm adaptationi.r the United Kingdom of Lehrnan's
gender:df:5, x' :21.8, P < 0.001). original work and €onsistsof demographicand
A number of oufpatients of the psychiatric objectivedata dnd subjectivesatisfactionscalesas
hospital (D) live in group homes or supervhed well. For the assessment of subjectivequality of
aparrnents (22/o). A tlird of rhe Welsh sample life the inlewjews use seven-pointsatisfaction
(F) lives in hostelsbut, on the other hand, 16% scales(from 'terdble' to 'deiighted'in the original
own a hous€.For the in-patientsamples(exclud- version)and resultscan be calculatedfor differ-
ing first adrnissions)
and the Welsb samplemore ent areasof quality of life.
peopleare single (B.C.F:bl o6a, rs. A,D,E: Psychopathology was rated using the BPRS
43-4'lVo)(df:5, x' : 14.6,P < 0.05). (Overall and Gorbam, 1962).Information about
previoushospitalizationand diagnoses were takeD
2.3. Samplecharacbi:tics: i rrcssrclated uariables from medical records. Neuroleptic doses were
transformedinto chlorpromazineequivalentsac-
Table I (meansexcepl neurolepric rrearmetrl. co.ding lo Jahn and Mussgay(1989).
standarddeviationsare not sholm for the sakeof The quality of life assessments were admm$"
clarityofpresentationof the table)showsrhar the tered togetherwith the psychoparhological raring
durationof illnessis longestfor rhe in-patientsof (for some patients in two sessions).Ttey were
sampleC and out-patjentsof the psychiatrichos- don€ by psychiatrists(samplesA and E), clinical
pitai (D) Gonf€roni adjusted mulripie me.ln psychologists (samplesB, C and D) and a trained
comparisons,at leasl P < 0.05; letters together socialworker (sampleF). The in-patientsdid not
with meansindicatesignificantlydifferinggroups). know the interviewers,who were not involvedin
Tle cumularivenumber ol ho5pirahzJlions is lheir presenttreatment,from personalcontacts.
greater for tbe in-patient samplesB and C and Tbe raten of all of the out-patientsampleswere
rhe cumulati\e durarion oi hospitalzalionis members of the treatment teams - althougb
greatestfor those with the longer present stay again not directly involvedin the presenttreaC
(C). A5 well. pslchoparhological disrurbrnceis ment of mos! cases.
W Koistet ol. /Psr.hiatry Revorch 66 (197) 153 166

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2.5. Statisticalanalyses (A, 6%; B,28%, C,35Ea;D,11%;


their families:
E, 20%; F,6%).As a result,for somemultivariate
'work' and 'family' had to be
Relinbilig estimateswere calculatedusing a statisticalanai)ses
slightly transformed formula giver by Horst excludedor calculatedseparately.
(1954).Additionaily Cronbach'salpha was calcu-
laled for a profile set consisting of the 3.2. Reliabilities
items/scalesfor: general well-being,leisure, 6-
nances.living situation.satet!.socialrehtions. Table 2 shows coefficicnts for an estimate of
'instrumental reliability' (Hors! 1954; Lienert,
mentalhealth (work and family excludedfor rea-
sonsmentionedlater). 1969).For the whole samplethey were sufiicienl
A principalcomponentsfactor analysiswasun- for group comparisonsalthough valucs in some
dcrtaken to test the homogencityof the profile singlescalesfor some subsamplesare somewhat
and the varianceof the differen! sub-areas. toolow(<0.7).
Multiple regressionswere calculatedto deteci Tbe valuesfor Cronbach'salpha,which implies
joint vadance between quality of life variables the precondilionlhai quality of life is a consistent
andlor other significanily differing variables conceptand which a.csesses the consistencyand
betweenthe groups. homogfnciqof rhe qudlin ot lile profile.dgain
ANOVds (first factor: 'setting',secondfactor: are sufficienlfor the whole samplebut somewhat
'psychopathology') were carried out to show dif- problematicfor samplesA and B.
ferencesbetweenthe groups.Resultswere Bon- This correspondslo the results of a principal
felroni adjusted as were all other statislics componentsfactorialanalysis(seeTable 3) which
supportsfor all patients acrossall settingsthe
Coeflicientswere also cal€ulatedfor the reli- assumptionofhomogeneityof the quality of life
abiliry of the resulringprofile pattcms for each profile. A single factor solutioD accouDtedfor
group and for the similaritybetweenthe profiles 301 uf lhe varianceot this'generul5JlisfJcrion
usinga derivativeftom Lienert (1969)of Cattell's factor'. A first factor (F1) accountingfor even
/r lcartell. lqaq) as a coefficrcntror srmil"riry more variance(42-,{67,)car b€ deinonstrated ior
betweenprofile patterns. samplesC-F,whereassecondfaclors(F2) in these
samples(% of variance:1517) are characterized
3. Results by diffcrent items.Again, samplesA and B show
less homogeneous3-faclor solutionswith a re-
3.1. Interuiews duced varianceof thc {irst factor ot 30Eo and
3l%, respectiveb'.
ln sampleA (first admissioN)only one of the
patientswho were able to be inte iewedrefused. 3.3. Relationrbetueenqualiry of lile and
For the other in-patientssamples(B and C) 19% demogrophicor ilhess related Lvnables
of the original217interviewscouldnot be carried
o8 (12% of the palients were psychopathologi In all the samples.there was no signjnc.ant
cally too distu.bedand 7% refused1()be inler- rr.ociarionberqeen.e\ and'ubjecliv( 5ali\lac-
viewed).Fof the oulpatienlsamples the Dumber tion in rhc difterent domains of qualiry of life
of patients\'/ho could not be inteNiewedbecause (pointbiscrial correlations).Nor *as there any
of severepsychopatholos/was relativelysmauer significantassociationwiih levels of neuroleptic
(D, 3; E, 8; F, 0). nedication(chlorpromazineequivalenis).
Resultsof the satisfactionscoresfor the areas fable 4 repo'l' rhe re.ulL\oi sepJlrt( re$e\_
of 'work' ard 'family' could be obtainedonly for sion analysesincludingvariableswith sig ficant
ponroosoi the srmples.becausemany palicnls correlations(giving only the amountsof shared
'70%;
were uremployed:(A, 41Vc;B, 83o/c:C, D, varianceabove l\q. for tbe subsamples). This
860/o;E, 64Vo;F, 827,) or had no contact wilh sho\r. thar the i6$ci:,lion hehveen olher !ari-
V Kaijt et ot. / Ptchbtrtt ReteaEh 66 (199?)153-166

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ables(age,durationof iliness,cumulativenumber 3.a. Qusliry of tifeprofles - dilferent:esand


and duration of hospitalizatjonand BPRS-total-
scorerand rhe qudliryof lite profiledomainsi!
moderat€.For the whole sampleit does not ex-
'rnentalhealth'.The BPRS The results of ANOVAS of the salisfaction
ceed 107. exceptfor
scores ot generdlwell-beinglnd eighl domains
total scoreis alwaysnegativelycorrelatedwith lhe
as dependent variables,the setting as the first
subjcctivequality of life in differert domains.For (BPRS total score,
factor and psychopathologr'
the whole sampleadditionallyage and the num-
median:40) as the secondfactor did not showany
ber of hospitaliations arc positivelycorrelated
signilicantinteractionbetwe€nboth facton in any
('safely' and 'work') and the duratioDof iliness
'safety'. domain.
showsa negativecorrelationwilh
Significantdifierencesbelweenthe groups/set-
For thc subsamplesthe pattern of association 'generalwell-being'and in
tjngs can be found in
varies markedly by setting and quality of life the areas of
'living situation', 'safety',
'mental
domain.The BPRS total scoreaccounlsfor most h(rlrh .rnd work ,seeTJhle5 givingBonferroni
of thc negativeconclations with qualjty of lifc adjustedP valuesand Bonferroniadjustcdmultr-
variables.The cumulativenumber and duration ple mean comparisoDs, at leasl P < 0.05;lette^
of hospitalization,duration oI illness and age togethcr with meansindicatesignjficantlydiffer-
show severalsignificantcorrelationswhich differ mg groupsr-
jn their directionsand arensbetweenthe groups.
Compaisons betwecn the six gloups show
As it might be confusingto presentthe values within thc ouapatientsno significantdifferences
tor atl 35 significantp valueswe refer to those and within the in patients three significantdjf-
for equivalert multiple regressionanalyseswith ferencesbut a number of signiicanl differences
'generalsalisfactionfac-
the factor scoresof the (total: i4) between in'patient and our-patient
tor' (acrossall subjects)as dependentvariables. groups:for the firsi admissions(A): 8, for tn-pa-
For the total samplethe resultswere:n':0.09, tientswith a presenlstaybetween6 monthsand 2
F: 10.5,P < 0.m1;BPRStotalscore:b = -0 25, years (B): 5; and for those with a stay of more
P < 0.001;age: b :0.12, P < 0.05; total number than 2 years(C): L -
of hospitalizations:b: -0.12, P < 0.05 (b= The mean.coreslor dre o groupsin domain(
standardpartial regressioncoefficients). of the quality of life intcwiewsare givenas pro-
In separatc analysesfor the subsamplesfor fil€ patiernsof scoresin Fig. l. Cattell (1949)had
(P
sampleA no vaiable reachedthe limirs < 0-05) defineda patlem or profil€ of psychological data
lo enter the analysis.For sampleB the exPlained as '... a systemof measurableparts in a whole.
variarceis 17% (R' :0.17, F=11.9, P<0.01) The persislent relations which tie parts into a
rnd rhe cumulJrivedurarionof hospiraliTarions whole and distinguishil from oiher wholes.botb
cho\..r i,gnrficanrneg:,lrve uni!ariare currclalioo in fact and in human perception,range flom
(b- -0.42, P<0-01). The valucsfor tlle other simple quantitativeand spatiai relations to ihe
mosl complexfunctional, causai,evideniial,and
psychological relations'(p. 280.).
. sanpleC: R1 : 0.16,F - 5.68,P < 0.01;BPRS (For the representationof psychologicaltest-
tolui score:b = -0.11, P 0.01:(umularire or questionnaire'resuits it hasbecomeconventio_
time in the hospital:, - 0.26,P < 0.05; nal 1()join lhe values by a 1ine, although this
sampleD: R? = 0.09,lr = 6.36,P < 0.05;BPRS tends to give a misleadingimpressionof move_
total score:b: -0.31, P < 0.05; ment betweenthe points.)
ramplcL: R' 0.0o.F = 5.3-.P. 0.05:BPRS The reiiabilitiesof the profileswere:A,0 79; B,
tolai score:b: -0.29, P < 0.05; 0.80;C, 0.64;D, 0.54iE, 0.60;F, 0.50 I' order to
sampleF: R: = 0.09,F= 4.11,P< 0.05;BPRS be inte.pretableihe reliability should be >05
tolal score:b = -0.30, P <0.05. (Lienert, 1969)which is reachedby all profiles
162 ,f. Kaiw et ot. / Psychiaiy tuseath 66 4997) 153 166

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Fig. l. Proile parlcms.

Sinilanlies bet*een proile pattehs (Cauelit ,p, sinilariies > 0.85 ae printe.t in botd g?c)

B c D
Fint addisions l.-palicntj tn-patienll Out-patient- Depannenr of Scjal Cjmnunirv Menlat
<2ycaft >2yeE clinic pEvchiarry BealrhTe@
B
l.-patients<2years 0.93
c
In-paiienrs>2yean 0.85 0,92
D
Out-parienl<linic 0.65 0.67
E
Departnenr oi Seiai tsychial,f, 0.i7 0.80 0.9f, 0.92
F
Comunfty Menhl Heatth Tead l).s9 o.92 0.96 0.83 0,93
Mcdial stldents 0.63 0.66 0.79 0.84 0.8? 0.59
W.Koiss et ul. / Pslchbtry Rdeorch 66 (1997)153-166

Table 6 showsthe overail similaritiesof the toadingsfo. each group and with a third of the
prolilc-pattens accordingto our .e-classification first factor percentof variance.In samplesA and
(values > 0.85 prinled in bold twe). In-patients B. lhe percenlol vsflrnceof the 6rrl faclol is
wirh a longer stal fC) and the pijtrent'irom remarkublyreduceddnd t$o idioryncraric lac-
Wales (F) share most simil:rity with all other tors' can be found.
profile patterns.The out-patientclinic patients Even if a one-factorsolution tesults it may be
(D) are the most differert ftom all oiher pr€mature to make a decisionfor or againsta
prr-rfrl<-paurrns. Frr!r admtsions{Ai and in-pa- homogeneous,single fxclor/dimension solution
tientswith a shortersiay (B) are rather similar to for the constructionofmeasuresfor qualityof Iife
the other in-patient sanples and to the Welsh profilesfor the mentallyill. There is an addilional
pulienls nol lo the cerman uul-pxlienl5am- need to cla{ry the concepttheoreticallyand to
ples. examineother innuenceson it. Being admitted
Table 6 also showsfor comparativepurposes for the first time or afler a relapse to a pslrchiatri€
rhe sirnilaritiesto a profile pattem of a group of hospitalseemsro be of significantimportancefor
medicalstudents(rneans:generalwelfbeing, 5.3; the structureof subjectivequality of life for some
leisure, 5.7; finances,4.5; living situation, 4.8; time. This cannotbe explainedonly by the sever_
safcry, 5-2; social relations,5.5; mental health, it_vof the illnessas samplesA and B do not differ
5.5;work, 4.8;famil,v,5.2).The studentsapproach from the lory-tem in-patients(C) with respectto
greater similarity with the German ouGpatients the BPRS total scores.Other possibleinfluences
and againwith the in-patienrsof sampleC (> 2 re.C.p(r\ondliDldcto15. cugnitire!lrirl'ler. arti
years'presentstayin the hospjtal). tudes,life events)havenot been d€tecledfor the
mentallyill so far.
4. Discussion
4.2. Relatian of tubje.tiDe qualitt of llfe to atfut
1.1. Methodalogicalimpliations of fndings
P.)choparholog) has lhe greule\rcorrelalron
The meaDrelirbiliq csrimates in differ(ntdc
with all life domainsand witb the generalquality-
mdrns ol the &'l,ncr Leb<nsquJllSr.profil/
oHife faclor. The associalionbetweenother de-
kncashire Qu:llity of Life Profilewere srfficient variablesand qualit-v
mographicorillness-related
for comparisons beiween groups (although they
of life variesbetweengroups.So psychopathology
remain somewhatproblematjcin the areas of
is lhe only robust predictor of subjectivequalily
leisure,socialrclalions,menlal heallh aDdsafety)
of life acrossall settings.
and differ betwcenthe subsamples.
We should stress,though, that these findings
For all of thesevariableswith lower reliabili-
are limited to thc ptrtientswho were interviewed.
iics. exceptmental health, the score is a mean
If those not intefliewed had been taken inio
from two questions, each of which is of a rather
accountlhe 'reaf impact of psychopatholog/on
high cognitivecomplexity.Schizophrenic parienls,
quality of life in schizophrenicsmight have been
who suffcr from a variety of cognitive problems
higher-
might ha!e stecilicditljculliesrn diFIe'entiaring
ihejr answers,when cognitivelycomplexconcep- 1.3. Dwrences ond similanics
lual demandsare made.
The valuesfor Cronbach'salphaas well as lhc Cornparedio Lehmanh (Lehman et al., 1986)
results of the factor analysesindicate that lhe earlier findingsour studyshowsthat the opportu-
honogeneiryfor the wholeprofilediffen between niry ro demonstratereal differencesin qualilv of
the sampleswith a shorrertirnc in the hospital(A life bctweencornmuniryresidentsand hospital-
aDdB) dnd lhr orher'.Foldmnle. C-F rherei' ized psychiatdcpaticnts seems lo be betler if
a dominalionof a 'generalsatisfactionfactor' and diagnosticallymore homogeneoussamplcs are
a second'idiosyncraticfacror' wilh diffeing item siudied.
w rrisdn at./ Pr.hi^ry Resorchbb 1191)7)
153-j66 165

Most of the differences exist between in, and studies of the risk of rehospitalization
out-patientsand no significanrdifferencescan be (Angermeyerand Kiihn, 1986).
demonstratedwithin the out-patienrs.Within the
in-patientsthere seemsto be an impact of their 5. Conclusions
lengthofpresentstayon satisfaction ratingswhich
could be explained b), udaptation level theoiy,
which was one of the 6^t tleories to explain 1. Beingadmittedto a psychiarrichospitdlseems
sutisfacLion (Srrucket al.. I9alr. lmp'c\sneevi- to have an influenceon the level and struc-
dencefor that theorycamefrom a studyby Brick- iure of subjective quality of life for some
mann ct al. (1978) with peoptc, who haye had time.
'eriouc itcciJenc anJ becomc paraplegic or 2. Beinga longerlime in a psychiaLric ho,piral
quadriplcgic:after a time they becamenearly as seemsto coinciJeqilh a srabilLarion ol letel
satisfiedas the geDeralpopulalion,though never and structure of subjecrivequaliry of life
quite as satjs{ied. (\e\cnheless.rhe speci6ccondirioDs of ho-
With regardto the sirnilarityofprofile patrerns, pitaliation in different hospitals andlor
the results show tlat rhe 'baselinesimiladty' is countdesmight lead 10 differing resutts.)
rather high comparedto orher psychological data 3. Even though reliabilities are suficienr for
and thereforewe had to raise the criterion for a mosrsubsamples andvariJbles. turtheicmprr-
higher degreeof similarity > 0.85.The resulrsof ical and theoreticalwork has ro be done to
lhe anallciiof profrleparernsshowrhrr rhereis clarifythecunceptanddetec!rhe influence oi
a slatisticalmethodavailablcwhich producesun- other variables.Apart from theoreticalques-
derstandableresults. We believe that the tech- tions (personalityfactors,etc.)a focusshould
niquecouldbe cxtendedro clinicalpractjcewhere be on rhc illenlification
ot tearuresol rhefirsr
proGlesof groupsand of singlecases(reiatedto $ee[s or monlhsLn the hospiralthat cirnbe
group mcansor as pre- and post test results)can ma pulatedfor improvingqualitvof life. Thc
be comparedin a way wbich avoidsrelianceupon ramet true for characrerislics ot out pi,lrenr
intuition or subjectiveinrerpretation of differ-
4. Psychopatholos/ is lhe only robust predicior
The profiie-pa$ernanalysisshowsas wetj rhar tor subl. i\e qualjryot Iie. Bur o\emll lhe
in-patientswith a longer sray in rhe hospitat(C, impacrseemslo be moderuleand doc, no.
> 2 years) seem reasonablycontenl with rheir atf(ct lhe $hol( conceplof \ubieclive quaLry
overalliife situationand they are more similar to of life ttnd the patients'satisfactionratings.
oulpatient-groupsand a non-psychiatricsample 5. A irali.licaltechnique wasapphedwhichen-
ihan the other in,patientswho havea shorterstay ableddifferenrprofileprIe'ns lo be com-
(A, B) eventhoughthe psychopathological distur- prredrnd o!erall\imilrririe,bErqe(ngroup5
banceis on tlle samelevelin all in-patientgruups. to be revealcd.
For the W€lshsampleit appearsto be rhe case 6. Future reports on subjectivequality of Ufe
that the greater heterogcneiryof the sample should include diagnosticauyhonogeneous
(especiallyin respectof their objectiveliving situ- samprng.
atron)scemsto be a problem.The combinationof
home ownershipand mdny patientsiiving in hos- R€ferences
tels suggeststhat the srmple is more heteroge-
neous,and lhis may have influencedthe resulls Atk,nson,t.A., Coia, D.A., Harpcr Cihour. w' and H.Aer,
for iNtance, by includinga grealerproportion J.P.(1996)The inpact ol educalionCroupstor peoplewnh
oi asymptomaticpatients.It is also possiblethar schizophredaon socialtun.tioningand qualiivoi life. 3r.r
diff€rencesberweenrhe urban and rural way of Ps!.hbbr 168, 199-2A1.
Angerneler, M.C. and Kiihd, L. {1986) Rehospnal
life had an influenceon subjecrivequaiiry of life, isierungsrisiko pr_vchish l('anker: Stadt versus tjnd. Ner-
which has been found to be the case in other
W Ka6t 4 ot. / Psrclthtry R6.4tch 66 (tD?) ls] 166

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