Longitudinal Change of Domain-Specific Life Satisfaction for Individuals with Schizophrenia Participating in Psychosocial Rehabilitation Services

Background and Purpose: Previous studies have underlined the importance of improving life satisfaction of mental health service consumers (Drake et al., 2006). Limited longitudinal studies reported inconsistencies in change of life satisfaction in people with severe mental illness receiving psychosocial intervention. While some studies report a significant improvement in levels of life satisfaction (i.e., Stein & Test, 1982), others reported marginal to no improvement (Brekke et al., 1999). One of the plausible explanations for the divergent findings may be related to treating life satisfaction as one global construct, despite its multidimensional nature (social relationships, work, independent living). Since changes across different domains are not highly intercorrelated, improvement on one domain does not necessarily related to improvements on other domains (Iyer, et al., 2005; Ritsner, 2003). The purpose of the study was to examine which domains of life satisfaction change over a 1-year period among people with schizophrenia receiving community-based psychosocial rehabilitation services.

Method: The sample consisted of 267 adult individuals diagnosed with schizophrenia spectrum disorders who were recruited upon admission to community-based psychosocial rehabilitation programs. The sample was followed prospectively for twelve months, with psychosocial observations made at baseline and every six months. The Satisfaction with Life is a 18-item self-report instrument that measures life satisfaction in four domains (living situation, work, socialization, and self/present life). These sum score of items in each subscale was used to represent each domain of life satisfaction. Data was analyzed using latent growth curve modeling using Mplus 5.0 software (Muthén & Muthén, 2007).

Results: The total sample size was 267 at baseline, 218 at six months, and 199 at twelve months. All unconditional linear growth models of life satisfaction change fitted well to the data (RMSEA = 0.000). There was a significant rate of change in the mean in the domains of living situation and self/present life (beta=0.354, z=2.507, p<.01; beta=0.495, z=2.846, p<.01). Although there was no significant mean change in the work domain, there was significant rate of change in the variance, suggesting significant individual variation in this domain over time (beta=0.880, z=3.029, p<.01). There was no rate of change in social relationship domain.

Conclusions and Implications: Results from this study demonstrates that life satisfaction domains change at different rates, supporting the necessity to examine each specific domain separately. Vocational rehabilitation is one of the important treatment goals of most psychosocial rehabilitation programs, therefore, it is important to find out whether there are distinct groups of respondents depending on levels of life satisfaction and what are the predictors of this heterogeneity. The finding indicates that there could be different mechanisms of change or predictors for different domains of life satisfaction, which calls for further research. The findings also suggest that psychosocial interventions need to provide target-specific service in order to improve life satisfaction in specific domains where improvement is needed.