Quality of life in patients with comorbid serious mental illness and chronic diseases: A structural equation model

Aims To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases. Design Descriptive, cross‐sectional study design. Methods In total, 204 patients with serious mental illness were recruited from two hospitals. Self‐reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 – January 2019. The structural equation model was applied to examine the associations among the study variables. Results Internalized stigma (β = −0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = −0.207, p = .002) and psychiatric symptoms (β = −0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life. Conclusion The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population. Impact Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases. 摘要 目的 探讨影响成年严重精神病兼慢性病患者生活质量的因素。 设计 描述性横断面研究设计。 方法 两所医院共计招募204名严重精神疾病患者。可通过简明精神病评定量表、精神病患者病耻感评估量表、患者激活措施和世界卫生组织生活质量量表的简要版本收集自我报告数据。数据收集时间为2018年7月至2019年1月。结构方程模型可用于检验不同变量之间的相关性。 结果 内耻感 (β = −0.479, p = .002) 对生活质量的直接影响最大, 其次是患者激活度(β = 0.238, p = .002) 、并存病严重程度(β = −0.207, p = .002) 和精神症状 (β = −0.186, p = .006) 。此外, 精神症状直接影响并存病严重程度, 进而影响内耻感和患者的积极性, 最终影响其生活质量。 结论 内耻感和生活质量的相关性可通过患者激活度来确定。这一发现为针对精神疾病兼慢性疾病患者的激活干预措施的开