title: Structural equation model of factors related to quality of life for community-dwelling schizophrenic patients in Japan.
abstract: BACKGROUND
  This study aimed to clarify how community mental healthcare systems can be improved.
  
  
  METHODS
  We included 79 schizophrenic patients, aged 20 to 80 years, residing in the Tokyo metropolitan area who regularly visited rehabilitation facilities offering assistance to psychiatric patients and were receiving treatment on an outpatient basis. No subjects had severe cognitive disorders or were taking medication with side effects that could prevent the completion of questionnaires. Questionnaires included items related to quality of life, self-efficacy, self-esteem, psychosis based on the Behavior and Symptom Identification Scale, health locus of control, and socio-demographic factors. We performed multiple linear regression analysis with quality of life as the dependent variable and, based on covariance structural analysis, evaluated the goodness of fit of the resulting structural equations models.
  
  
  RESULTS
  Self-efficacy, self-esteem, and degree of psychosis significantly impacted quality of life. Marital status, age, and types of medications also influenced quality of life. Multiple linear regression analysis revealed psychiatric symptoms (Behavior and Symptom Identification Scale-32 [daily living and role functioning] (Beta = -0.537, p < 0.001) and self-efficacy (Beta = 0.249, p < 0.05) to be predictors of total quality of life score. Based on covariance structural analysis, the resulting model was found to exhibit reasonable goodness of fit.
  
  
  CONCLUSIONS
  Self-efficacy had an especially strong and direct impact on QOL. Therefore, it is important to provide more positive feedback to patients, provide social skills training based on cognitive behavioral therapy, and engage patients in role playing to improve self-efficacy and self-concept.
authors.affiliation: Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan ; Faculty of Nursing, Department of Nursing, Josai International University, 283-8555 1 Gumyo, Togane-City, Chiba, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ami-machi, 300-0394 Inashiki-gun, Ibaraki, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Matsushima
keywords: Quality of life; Regression analysis; Schizophrenia; Self-efficacy; Self-esteem; Structured equation modeling
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