Aims: To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases.
Design: Descriptive, cross-sectional study design.
Methods: In total, 204 patients with serious mental illness were recruited from two hospitals. Self-reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 - January 2019. The structural equation model was applied to examine the associations among the study variables.
Results: Internalized stigma (β = -0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = -0.207, p = .002) and psychiatric symptoms (β = -0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life.
Conclusion: The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population.
Impact: Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases.
目的: 探讨影响成年严重精神病兼慢性病患者生活质量的因素。 设计: 描述性横断面研究设计。 方法: 两所医院共计招募204名严重精神疾病患者。可通过简明精神病评定量表、精神病患者病耻感评估量表、患者激活措施和世界卫生组织生活质量量表的简要版本收集自我报告数据。数据收集时间为2018年7月至2019年1月。结构方程模型可用于检验不同变量之间的相关性。 结果: 内耻感 (β = −0.479, p = .002) 对生活质量的直接影响最大, 其次是患者激活度(β = 0.238, p = .002) 、并存病严重程度(β = −0.207, p = .002) 和精神症状 (β = −0.186, p = .006) 。此外, 精神症状直接影响并存病严重程度, 进而影响内耻感和患者的积极性, 最终影响其生活质量。 结论: 内耻感和生活质量的相关性可通过患者激活度来确定。这一发现为针对精神疾病兼慢性疾病患者的激活干预措施的开发提供理论基础, 可帮助改善相关人群的生活质量。 影响: 多种并存病可能导致严重精神疾病患者的生活质量下降。我们发现, 患者激活度在慢性病的治疗中起着重要的作用, 帮助提高患者的生活质量, 然而, 其可能受到内耻感的负面影响。此类发现可以帮助精神卫生专业人员制定针对性的干预策略, 提高患者的积极性, 减少严重精神疾病兼慢性病患者的内耻感、精神症状和并存病严重程度, 提高其生活质量。.
Keywords: chronic disease; comorbidity; internalized stigma; mental illness; nursing; patient participation; quality of life; structural equation model.
© 2020 John Wiley & Sons Ltd.