Dual Change Model of Life-Satisfaction and Psychosocial Functioning for Individuals with Schizophrenia Receiving Community-Based Psychosocial Services

Purpose: Psychosocial functioning outcomes and subjective life satisfaction are critical to recovery-oriented psychosocial services. This study examined the relationship between life satisfaction and psychosocial functioning over time in individuals with schizophrenia receiving community-based services. Despite the prevailing notion that increases in functioning should be associated with increases in life satisfaction, previous studies have generally found no association between the two. Most studies use life satisfaction only as a global score. Since changes across different life satisfaction domains are not highly correlated, improvement in one domain does not necessarily relate to improvements in the other domains. Consequently, treating life satisfaction as a unidimensional construct may contribute to the lack of association between change in life satisfaction and change in psychosocial functioning over time. This study was the first to examine: 1) global and domain specific associations between life satisfaction and psychosocial functioning over time; and 2) the simultaneous change in life satisfaction and functional variables over time – hence called a ‘dual change model'.

Method: The sample of 145 individuals diagnosed with schizophrenia was followed prospectively for twelve months during psychosocial rehabilitation, with three observation points (baseline, 6 months, 12 months). The Satisfaction with Life Scale was used to measure global life satisfaction as well as life satisfaction in the following domains: living situation, work, socialization, self/present life. The Role Functioning Scale was used to measure global psychosocial functioning and functioning in the following domains: work, social, and independent living. Data were analyzed using latent growth curve modeling. Results: There were statistically significant improvements in global functioning and global life satisfaction over time, and in the domain specific psychosocial functioning and life satisfaction domains over time. Turning to the global dual change model, improvement in global life-satisfaction was significantly associated with improvement in global functioning over time (β=0.125, p<0.05; χ²=6.21, df=7, p=0.52; CFI= 1.00, RMSEA=0.00). Concerning dual change in the specific domains, satisfaction with living situation improved as independent living functioning improved (β=0.015, p<0.001; χ²=13.36, df=7, p=0.03, CFI=0.96, RMSEA=0.09), similarly satisfaction with social relationships improved as social functioning improved (β=0.02, p<0.001; χ²=11.37, df=7, p=0.12, CFI=0.98, RMSEA=0.07); however, satisfaction with work did not improve as work functioning improved over time (β=0.003, p>0.15).

Conclusions and Implications: This is the first study to find that improvements in global life satisfaction and global functioning are linked over time. The domain specific linkage varied based on the specific outcome and satisfaction domains tested. This suggests that psychosocial interventions should provide outcome-specific services in order to improve life satisfaction in specific domains. The conditions related to improvements in satisfaction with work need further exploration. Understanding the linkages between the functional outcomes and subjective life satisfaction contributes to a recovery-based orientation to rehabilitative interventions for schizophrenia.