Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: As newer atyptical antipsychotic medications are allowing many individuals with schizophrenia some control over the cardinal symptoms of the illness, treatment approaches have increasingly focused on improving functional outcomes among this population. One outcome of particular importance to both researchers and individuals with schizophrenia is quality of life. Unfortunately, surprisingly little is known about the psychosocial determinants of quality of life among this population, as research focusing on quality of life has overwhelmingly emphasized the impact of psychiatric symptomatology. In particular, few studies have assessed the degree to which psychosocial factors contribute to quality of life in schizophrenia, beyond the influence of symptoms. The purpose of this research was to examine the relative contribution, above and beyond psychiatric symptomatology, of unmet need and perceived social support to quality of life in schizophrenia. Such psychosocial factors have previously been documented to exert an importance influence on quality of life, however their contribution beyond symptomatology is not clear.

Methods: A sample of 32 individuals with schizophrenia or schizoaffective disorder living in the community was collected as part of a clinical trial of a novel online psychoeducation program for patients with schizophrenia and their family members. Participants were assessed using the Lehman Quality of Life Interview, the Brief Psychiatric Rating Scale, the Medical Outcomes Study Perceived Social Support Scale, and a new comprehensive measure of need for individuals with schizophrenia. Hierarchical multiple regression was used to cross-sectionally analyze the independent contribution, above and beyond psychiatric symptomatology, of perceived social support and unmet need to objective and subjective indicators of quality of life.

Results: Findings indicate that quality of life in schizophrenia is markedly influenced by both perceived social support and unmet need. Psychiatric symptoms were of little influence to objective measures of quality of life (ß = -.08), although perceived social support and unmet need together made a significant contribution to objective quality of life, ΔR² = .19, F(2, 28) = 3.39, p < .05. Findings concerning subjective evaluations of quality of life indicated that although psychiatric symptoms explained a significant amount of variance in subjective quality of life, R² = .23, F(1, 30) = 9.16, p < .01, both perceived social support and unmet need continued to explain another 30% of the variance beyond psychiatric symptoms in subjective quality of life, ΔR² = .30, F(2, 28) = 9.01, p < .01.

Implications: These findings highlight the importance of two psychosocial determinants, perceived social support and unmet need, to the quality of life in individuals with schizophrenia. Such findings suggest that psychosocial treatment development for schizophrenia needs to continue to remain a priority among researchers and federal funders, and that treatment developers aiming to improve the quality of life of these individuals need to look beyond reducing symptomatology, and focus on helping clients to build social support networks and meet their needs. Social work researchers and practitioners are in a unique position to contribute to such treatment development efforts.