Caregiver's quality of life and its positive impact on symptomatology and quality of life of patients with schizophrenia

Alejandra Caqueo-Urízar, Marine Alessandrini, Alfonso Urzúa, Xavier Zendjidjian, Laurent Boyer, David R Williams, Alejandra Caqueo-Urízar, Marine Alessandrini, Alfonso Urzúa, Xavier Zendjidjian, Laurent Boyer, David R Williams

Abstract

Background: Although the quality of life (QoL) experienced by patients with schizophrenia has been recognized, few studies have assessed the relationship between the caregivers' QoL and patients' QoL.

Methods: The study included 253 stabilized outpatients with schizophrenia and their caregivers from 3 Mental Health Services in Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Caregivers' and patients' QoL were respectively assessed using two specific QoL questionnaires (S-CGQoL and S-QoL 18). We collected socio-demographic information and clinical data. Multiple linear regressions were performed to determine which variables were associated with patient's QoL. We tested the following hypothesis using structural equation modeling (SEM): caregivers' QoL may have an indirect effect on patients' QoL mediated by their influence of the severity of psychotic symptoms.

Results: In the multivariate analysis, the caregivers' QoL was not significantly associated with the patients' QoL, except for one QoL dimension about relationship with family (Beta = 0.23). Among patients' characteristics, being a woman and Aymara, having lower educational level, unemployment and severity of symptoms was significantly associated to a lower QoL. The SEM revealed a moderate significant association between caregivers' QoL and psychotic symptoms severity (path coefficient = -0.32) and a significant association between psychotic symptoms severity and patients QoL (path coefficient = -0.40). The indirect effect of caregivers' QoL on patients' QoL was significant (mediated effect coefficient = 0.13).

Conclusion: Improvement of caregiver's QoL may have a direct impact on the psychotic symptoms of patients and indirectly on patient's QoL, confirming the need for ongoing family interventions in these regions.

Keywords: Caregiver; Quality of life; Schizophrenia; Structural equation modeling.

Figures

Fig. 1
Fig. 1
Hypothetical sequential process. QoL: Quality of Life
Fig. 2
Fig. 2
Structural equation model (SEM) with fitted coefficients. SEM goodness of fit: chi square = 384.39 DF = 231 normed chi square = 1.66 CFI = 0.88 RMSEA = 0.05 and SRMR = 0.05. Patients’ QoL, symptoms severity and patients’ QoL are latent variables (with arrows pointing to their respective indicators). The patients’ QoL is composed of the 8 dimensions of the S-QoL 18: Schizophrenia Quality of Life 18 items; PsW: Psychological Well-being dimension of the S-QoL 18; SE: Self-Esteem; RFa: Family Relationships; RFr: Relationships with Friends; RE: Resilience; PhW: Physical Well-being; AU: Autonomy; and SL: Sentimental Life. The psychotic symptoms severity is composed of the 5 factors of the PANSS (Positive and Negative Syndrome Scale): negative, positive, excitation, anxiety/depression and cognitive factors. The caregivers’ QoL is composed of the 7 dimensions of the S-CGQoL (Schizophrenia Caregiver Quality of Life questionnaire): PsPhW (Psychological and Physical Well-being); PsBDL (Psychological Burden and Daily Life); RS (Relationships with Spouse); RPT: Relationships with Psychiatric Team; RFa: Relationships with Family; RFr: Relationships with Friends; MB: Material Burden. Educational level, ethnicity, gender and employment status are independent factors (observed variables)

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