Predictors of clinically important improvements in occupational and quality of life outcomes among mental health service users after completion and follow-up of a lifestyle intervention: multiple regression modelling based on longitudinal data

Jenny Hultqvist, Kristine Lund, Elisabeth Argentzell, Mona Eklund, Jenny Hultqvist, Kristine Lund, Elisabeth Argentzell, Mona Eklund

Abstract

Background: Balancing Everyday Life (BEL) is a new activity-based lifestyle intervention for mental health service users. An earlier study found BEL to be effective in increasing occupational engagement, occupational balance, activity level, and quality of life scores when compared with a care-as-usual group. However, it is unclear whether care context and socio-demographic, clinical and self-related factors at baseline also influence the results. Thus, the aim of the current study was to explore whether such factors could predict clinically important improvements in occupational and quality of life aspects.

Methods: Participants were interviewed and filled out self-report questionnaires before starting the 16-week intervention (n = 133), upon completion (n = 100), and 6 months following (n = 89). Bi-variate and multi-variate statistical analyses were performed.

Results: Several baseline factors were associated with clinically important improvements, but few predictors were found in the multivariate analyses. Having children was found to be a predictor of improvement in occupational engagement at BEL completion, but reduced the chance of belonging to the group with clinically important improvement in activity level at follow-up. Regarding occupational balance, having a close friend predicted belonging to the group with clinically important improvement in the leisure domain. At BEL completion, other predictors for improvements were female gender for the self-care domain, and self-esteem for the home chores domain. At follow-up, psychosocial functioning and lower education level predicted general balance. None of the factors explored in this study were found to be predictors for improvements in quality of life.

Conclusions: Few of the studied care context, socio-demographic, clinical and self-related factors were found to predict clinically important improvements in occupational engagement, activity level, occupational balance, or QOL. This study, together with previous studies showing positive results, suggests that BEL can be an appropriate intervention in both community and clinical settings, and can support improvement in occupational aspects and QOL for participants with diverse socio-demographic, clinical, and self-related characteristics.

Trial registration: This study is part of a larger research project that is registered at ClinicalTrials.gov. Reg. No. NCT02619318.

Keywords: Mental illness; Occupational balance; Occupational engagement; Occupational therapy; Psychiatric rehabilitation; Quality of life.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
An overview of settings, participants, and quantitative data collection points in the BEL research project

References

    1. Meyer A. The philosophy of occupation therapy. Reprinted from the Archives of Occupational Therapy, Volume 1, pp. 1-10, 1922. Am J OccupTher. 1976;31(10):639–642.
    1. Chan PS, Krupa T, Lawson JS, Eastabrook S. An outcome in need of clarity: building a predictive model of subjective quality of life for persons with severe mental illness living in the community. Am J Occup Ther. 2005;59(2):181–190. doi: 10.5014/ajot.59.2.181.
    1. The National Psychiatric Coordination . Vad är psykiskt funktionshinder?: Nationell psykiatrisamordning Ger sin definition av begreppet psykiskt funktionshinder [what is psychiatric disability?: the National Psychiatric Inquiry gives their definition of the the concept psychiatricdisability] Stockholm: Nationell psykiatrisamordning; 2006.
    1. Stein MB, Kean YM. Disability and quality of life in social phobia: epidemiologic findings. Am J Psychiatry. 2000;157(10):1606–1613. doi: 10.1176/appi.ajp.157.10.1606.
    1. Connell J, Brazier J, O’Cathain A, Lloyd-Jones M, Paisley S. Quality of life of people with mental health problems: a synthesis of qualitative research. Health Qual Life Outcomes. 2012;10(1):138. doi: 10.1186/1477-7525-10-138.
    1. Davidson L, O'Connell MJ, Tondora J, Lawless M, Evans AC. Recovery in serious mental illness: a new wine or just a new bottle? Prof Psychol Res Pr. 2005;36(5):480–487. doi: 10.1037/0735-7028.36.5.480.
    1. Anthony WA. Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychiatr Rehabil J. 1993;16(4):11–23.
    1. Slade M. Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Serv Res. 2010;10(1):26. doi: 10.1186/1472-6963-10-26.
    1. Le Boutillier C, Leamy M, Bird VJ, Davidson L, Williams J, Slade M. What does recovery mean in practice? A qualitative analysis of international recovery-oriented practice guidance. Psychiatr Serv. 2011;62(12):1470–1476. doi: 10.1176/appi.ps.001312011.
    1. Eklund M, Tjörnstrand C, Sandlund M, Argentzell E. Effectiveness of Balancing Everyday Life (BEL) versus standard occupational therapy for activity engagement and functioning among people with mental illness–a cluster RCT study. BMC Psychiatry. 2017;17(1):363. doi: 10.1186/s12888-017-1524-7.
    1. Bejerholm U, Eklund M. Engagement in occupations among men and women with schizophrenia. Occup Ther Int. 2006;13(2):100–121. doi: 10.1002/oti.210.
    1. Leufstadius C, Eklund M. Time use among individuals with persistent mental illness: identifying risk factors for imbalance in daily activities. Scand J Occup Ther. 2008;15(1):23–33. doi: 10.1080/11038120701253428.
    1. Clark F, Jackson J, Carlson M, Chou C-P, Cherry BJ, Jordan-Marsh M, et al. Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the well elderly 2 randomised controlled trial. J Epidemiol Community Health. 2012;66(9):782–790. doi: 10.1136/jech.2009.099754.
    1. Eklund M, Erlandsson L-K. Return to work outcomes of the redesigning daily occupations (ReDO) program for women with stress-related disorders—a comparative study. Women Health. 2011;51(7):676–692. doi: 10.1080/03630242.2011.618215.
    1. Argentzell E, Eklund M. Vardag i Balans. En manual för kursledare [Balancing Everyday Life. A manual for course leaders.] Lunds: universitet: Hälsa, vård och samhälle; 2012.
    1. Lund K, Hultqvist J, Bejerholm U, Argentzell E, Eklund M. Group leader and participant perceptions of balancing everyday life, a group-based lifestyle intervention for mental health service users. Scand J Occup Ther. 2019.
    1. Hasselkus BR. The meaning of everyday occupation. Thorofare: Slack; 2002.
    1. Christiansen CH, Townsend EA, editors. Introduction to occupation: the art and science of living ; new multidisciplinary perspectives for understanding human occupation as a central feature of individual experience and social organization. 2. Upper Saddle River: Pearson; 2010.
    1. Bejerholm U. Relationships between occupational engagement and status of and satisfaction with sociodemographic factors in a group of people with schizophrenia. Scand J Occup Ther. 2010;17(3):244–254. doi: 10.3109/11038120903254323.
    1. Bejerholm U, Eklund M. Occupational engagement in persons with schizophrenia: relationships to self-related variables, psychopathology, and quality of life. Am J Occup Ther. 2007;61(1):21–32. doi: 10.5014/ajot.61.1.21.
    1. Wilcock AA, Hocking C. An occupational perspective of health. 3. Thorofare: Slack; 2015.
    1. Eklund M, Leufstadius C. Relationships between occupational factors and health and well-being in individuals with persistent mental illness living in the community. Can J Occup Ther. 2007;74(4):303–313. doi: 10.1177/000841740707400403.
    1. Wagman P, Håkansson C, Björklund A. Occupational balance as used in occupational therapy: a concept analysis. Scand J Occup Ther. 2012;19(4):322–327. doi: 10.3109/11038128.2011.596219.
    1. Eklund M, Orban K, Argentzell E, Bejerholm U, Tjörnstrand C, Erlandsson L-K, et al. The linkage between patterns of daily occupations and occupational balance: applications within occupational science and occupational therapy practice. Scand J Occup Ther. 2017;24(1):41–56. doi: 10.1080/11038128.2016.1224271.
    1. Eklund M, Leufstadius C, Bejerholm U. Time use among people with psychiatric disabilities: implications for practice. Psychiatr Rehabil J. 2009;32(3):177–191. doi: 10.2975/32.3.2009.177.191.
    1. Bejerholm U. Occupational balance in people with schizophrenia. Occup Ther Ment Health. 2010;26(1):1–17. doi: 10.1080/01642120802642197.
    1. Eklund M, Argentzell E. Perception of occupational balance by people with mental illness: a new methodology / perception of occupational balance by people with mental illness: a new methodology. Scand J Occup Ther. 2016;23(4):304–313. doi: 10.3109/11038128.2016.1143529.
    1. Browne S, Roe M, Lane A, Gervin M, Morris M, Kinsella A, et al. Quality of life in schizophrenia: relationship to sociodemographic factors, symptomatology and tardive dyskinesia. Acta Psychiatr Scand. 1996;94(2):118–124. doi: 10.1111/j.1600-0447.1996.tb09835.x.
    1. Johanson S, Bejerholm U. The role of empowerment and quality of life in depression severity among unemployed people with affective disorders receiving mental healthcare. Disabil Rehabil. 2017;39(18):1807–1813. doi: 10.1080/09638288.2016.1211758.
    1. Hansson L. Determinants of quality of life in people with severe mental illness. Acta Psychiatr Scand. 2006;113(Suppl. 429):46–50. doi: 10.1111/j.1600-0447.2005.00717.x.
    1. Bjorkman T, Hansson L. Predictors of improvement in quality of life of long-term mentally ill individuals receiving case management. Eur Psychiatry. 2002;17(1):33–40. doi: 10.1016/S0924-9338(02)00621-1.
    1. Eklund M, Bäckström M. A model of subjective quality of life for outpatients with schizophrenia and other psychoses. Qual Life Res. 2005;14(4):1157–1168. doi: 10.1007/s11136-004-2960-7.
    1. Eklund M, Bäckström M, Hansson L. Psychometric evaluation of the Swedish version of Rosenberg’s self-esteem scale. Nord J Psychiatry. 2018;72(5):1–7. doi: 10.1080/08039488.2018.1457177.
    1. Argentzell E, Tjörnstrand C, Eklund M. Quality of life among people with psychiatric disabilities: does day Centre attendance make a difference? Community Ment Health J. 2017;53(8):984–990. doi: 10.1007/s10597-017-0084-0.
    1. Eklund M, Sandlund M. The life situation of people with persistent mental illness visiting day centers: a comparative study. Community Ment Health J. 2012;48(5):592–597. doi: 10.1007/s10597-011-9410-0.
    1. Endicott J, Spitzer RL, Fleiss JL, Cohen J. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976;33(6):766–771. doi: 10.1001/archpsyc.1976.01770060086012.
    1. Startup M, Jackson MC, Bendix S. The concurrent validity of the global assessment of functioning (GAF) Br J Clin Psychol. 2002;41(4):417–422. doi: 10.1348/014466502760387533.
    1. Mann MM, Hosman CM, Schaalma HP, De Vries NK. Self-esteem in a broad-spectrum approach for mental health promotion. Health Educ Res. 2004;19(4):357–372. doi: 10.1093/her/cyg041.
    1. Eklund M, Bäckström M. The role of perceived control for the perception of health by patients with persistent mental illness. Scand J Occup Ther. 2006;13(4):249–256. doi: 10.1080/11038120600928823.
    1. Rosenberg M. Society and the adolescent self-image. Princeton: Princeton Univ Press; 1965.
    1. Pearlin LI, Lieberman MA, Menaghan EG, Mullan JT. The stress process. J Health Soc Behav. 1981;22(4):337–356. doi: 10.2307/2136676.
    1. Oliver J, Huxley P, Bridges K, Mohamad H. Quality of life and mental health services. London: Routledge; 1996.
    1. Eklund M, Erlandsson L-K, Hagell P. Psychometric properties of a Swedish version of the Pearlin mastery scale in people with mental illness and healthy people. Nord J Psychiatry. 2012;66(6):380–388. doi: 10.3109/08039488.2012.656701.
    1. Bejerholm U. The profiles of occupational engagement in people with severe mental Ilness - self rating version: Lund University: Department of Health Sciences/Work and Mental Health; 2011.
    1. Bejerholm U, Lundgren-Nilsson Å. Rasch analysis of the profiles of occupational engagement in people with severe mental illness (POES) instrument. Health Qual Life Outcomes. 2015;13(1):130. doi: 10.1186/s12955-015-0327-0.
    1. Bejerholm U, Hansson L, Eklund M. Profiles of occupational engagement in people with schizophrenia (POES): the development of a new instrument based on time-use diaries. Br J Occup Ther. 2006;69(2):58–68. doi: 10.1177/030802260606900203.
    1. Priebe S, Huxley P, Knight S, Evans S. Application and results of the Manchester short assessment of quality of life (MANSA) Int J Soc Psychiatry. 1999;45(1):7–12. doi: 10.1177/002076409904500102.
    1. Bjorkman T, Svensson B. Quality of life in people with severe mental illness. Reliability and validity of the Manchester short assessment of quality of life (MANSA) Nord J Psychiatry. 2005;59(4):302–306. doi: 10.1080/08039480500213733.
    1. Cohen J. A power primer. In: Kazdin AE, editor. Methodological issues and strategies in clinical research. 4. Washington, DC: American Psychological Association; 2016. pp. 279–284.
    1. Cohen J. Statistical power analysis for the behavioral sciences. 2. Hillsdale: L. Erlbaum Associates; 1988.
    1. Lund Kristine, Argentzell Elisabeth, Leufstadius Christel, Tjörnstrand Carina, Eklund Mona. Joining, belonging, and re-valuing: A process of meaning-making through group participation in a mental health lifestyle intervention. Scandinavian Journal of Occupational Therapy. 2017;26(1):55–68. doi: 10.1080/11038128.2017.1409266.
    1. Lund K, Argentzell E, Bejerholm U, Eklund M. Breaking a cycle of perceived failure: the process of making changes toward a more balanced lifestyle. Aust Occup Ther J. 2019;66(5):627–636. doi: 10.1111/1440-1630.12604.
    1. Onken SJ, Craig CM, Ridgway P, Ralph RO, Cook JA. An analysis of the definitions and elements of recovery: a review of the literature. Psychiatr Rehabil J. 2007;31(1):9–22. doi: 10.2975/31.1.2007.9.22.
    1. Ikiugu MN, Hoyme AK, Mueller B, Reinke RR. Difference between meaningful and psychologically rewarding occupations: Findings from two pilot studies. J Occup Sci. 2016;23(2):266–277. doi: 10.1080/14427591.2015.1085431.
    1. Hultqvist J, Markström U, Tjörnstrand C, Eklund M. Social networks and social interaction among people with psychiatric disabilities: comparison of users of day centres and clubhouses. Glob J Health Sci. 2017;9(6):107–120. doi: 10.5539/gjhs.v9n6p107.
    1. Kuehner C, Buerger C. Determinants of subjective quality of life in depressed patients: the role of self-esteem, response styles, and social support. J Affect Disord. 2005;86(2–3):205–213. doi: 10.1016/j.jad.2005.01.014.
    1. Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry. 2011;199(6):445–452. doi: 10.1192/bjp.bp.110.083733.
    1. Eklund M, Bäckström M, Hansson L. Personality and self-variables: important determinants of subjective quality of life in schizophrenia out-patients. Acta Psychiatr Scand. 2003;108(2):134–143. doi: 10.1034/j.1600-0447.2003.00103.x.
    1. Lam JA, Rosenheck RA. Correlates of improvement in quality of life among homeless persons with serious mental illness. Psychiatr Serv. 2000;51(1):116–118. doi: 10.1176/ps.51.1.116.
    1. Yanos PT, Rosenfield S, Horwitz AV. Negative and supportive social interactions and quality of life among persons diagnosed with severe mental illness. Community Ment Health J. 2001;37(5):405–419. doi: 10.1023/A:1017528029127.
    1. Håkansson C, Ahlborg G., Jr Perceptions of employment, domestic work, and leisure as predictors of health among women and men. J Occup Sci. 2010;17(3):150–157. doi: 10.1080/14427591.2010.9686689.
    1. Eek F, Axmon A. Gender inequality at home is associated with poorer health for women. Scand J Public Health. 2015;43(2):176–182. doi: 10.1177/1403494814562598.
    1. Lundberg U. Stress hormones in health and illness: the roles of work and gender. Psychoneuroendocrinology. 2005;30(10):1017–1021. doi: 10.1016/j.psyneuen.2005.03.014.
    1. Larivière N, Denis C, Payeur A, Ferron A, Lévesque S, Rivard G. Comparison of objective and subjective life balance between women with and without a personality disorder. Psychiatry Q. 2016;87(4):663–673. doi: 10.1007/s11126-016-9417-3.
    1. Eklund M, Wästberg BA, Erlandsson LK. Work outcomes and their predictors in the redesigning daily occupations (ReDO) rehabilitation programme for women with stress-related disorders. Aust Occup Ther J. 2013;60(2):85–92. doi: 10.1111/1440-1630.12019.
    1. Goldberg B, Brintnell ES, Goldberg J. The relationship between engagement in meaningful activities and quality of life in persons disabled by mental illness. Occup Ther Ment Health. 2002;18(2):17–44. doi: 10.1300/J004v18n02_03.
    1. Priebe S, Reininghaus U, McCabe R, Burns T, Eklund M, Hansson L, et al. Factors influencing subjective quality of life in patients with schizophrenia and other mental disorders: a pooled analysis. Schizophr Res. 2010;121(1–3):251–258. doi: 10.1016/j.schres.2009.12.020.
    1. Norman RM, Malla AK, McLean T, Voruganti LPN, Cortese L, McIntosh E, et al. The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the quality of life scale. Acta Psychiatr Scand. 2000;102(4):303–309. doi: 10.1034/j.1600-0447.2000.102004303.x.
    1. Ventegodt S, Thegler S, Andreasen T, Struve F, Enevoldsen L, Bassaine L, et al. Self-reported low self-esteem. Intervention and follow-up in a clinical setting. ScientificWorldJournal. 2007;7:299–305. doi: 10.1100/tsw.2007.88.
    1. Norman GR, Wyrwich KW, Patrick DL. The mathematical relationship among different forms of responsiveness coefficients. Qual Life Res. 2007;16(5):815–822. doi: 10.1007/s11136-007-9180-x.
    1. Ostelo RW, de Vet HC. Clinically important outcomes in low back pain. Best Pract Res Clin Rheumatol. 2005;19(4):593–607. doi: 10.1016/j.berh.2005.03.003.

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