مدل تغییر دوگانه رضایت از زندگی و عملکرد برای افراد مبتلا به اسکیزوفرنی

Despite the notion that increases in functioning should be associated with increases in life satisfaction in schizophrenia, research has often found no association between the two. Dual change models of global and domain-specific life satisfaction and functioning were examined in 145 individuals with schizophrenia receiving community-based services over 12 months. Functioning and satisfaction were measured using the Role Functioning Scale and Satisfaction with Life Scale. Data were analyzed using latent growth curve modeling. Improvement in global life satisfaction was associated with improvement in overall functioning over time. Satisfaction with living situation also improved as independent functioning improved. Work satisfaction did not improve as work functioning improved. Although social functioning improved, satisfaction with social relationships did not. The link between overall functioning and global life satisfaction provides support for a recovery-based orientation to community based psychosocial rehabilitation services. When examining sub-domains, the link between outcomes and subjective experience suggests a more complex picture than previously found. These findings are crucial to interventions and programs aimed at improving functioning and the subjective experiences of consumers recovering from mental illness. Interventions that show improvements in functional outcomes can assume that they will show concurrent improvements in global life satisfaction as well and in satisfaction with independent living. Interventions geared toward improving social functioning will need to consider the complexity of social relationships and how they affect satisfaction associated with personal relationships. Interventions geared towards improving work functioning will need to consider how the quality and level of work affect satisfaction with employment.

Psychosocial functioning and satisfaction with life are widely recognized as important treatment goals and components of recovery in people with severe mental illness (SMI) (Lasalvia et al., 2005, Xie et al., 2005, Bellack, 2006 and Yanos and Moos, 2007). While alleviating psychiatric symptoms remains a primary treatment outcome, broadening treatment goals to encompass psychosocial functioning and life satisfaction incorporates multiple stakeholder perspectives on mental health recovery (Resnick et al., 2004 and Lasalvia et al., 2005). Further, it has been argued that psychosocial functioning is a more accurate benchmark to measure treatment outcomes and recovery than clinical outcomes for individuals with SMI (Liberman et al., 2002) and has been widely used to measure outcomes in SMIs like schizophrenia (Brekke et al., 2002 and Peer et al., 2007). Numerous studies have underlined the importance of subjective quality of life as a treatment outcome for individuals with schizophrenia (Bobes and García-Portilla, 2006). As an indicator of subjective quality of life, studies assessing changes in life satisfaction in treatment have reported mixed findings. While some studies reported a significant improvement in life satisfaction levels (Stein and Test, 1982 and Rosenheck et al., 1998), other studies reported marginal to no improvement (Tempier et al., 1997 and Brekke et al., 1999). Part of this discrepancy may be due to various demographic and clinical factors that affect life satisfaction including age, gender, illness insight, depression, and psychotic symptoms (Karow and Pajonk, 2006 and Zissi and Barry, 2006). Another explanation for these divergent findings concerns treating life satisfaction as a global construct. Most measures assessing life satisfaction use global scores or include multiple domains of life satisfaction (i.e., social/family relationships, work, independent living) but use a composite score for analysis. However, improvements in one domain may not necessarily relate to improvements in other domains, as has been found for functional outcomes (Brekke and Long, 2000). Life satisfaction in different domains may change at different rates or times. Consequently, treating life satisfaction as a unidimensional construct measured by global or composite scores may result in the failure to capture important changes in levels of life satisfaction. Concerning life satisfaction and functioning, there is an underlying assumption that psychosocial interventions improving consumer functioning will also improve life satisfaction. Some studies have found a positive relationship between life satisfaction and social or work functioning (Kemmler et al., 1997, Mueser et al., 1997 and Bradshaw and Brekke, 1999). However, the relationship between objective indicators of functioning and subjective indicators of life satisfaction is complex. Perceptions of satisfaction with life may be affected by an appraisal process that includes re-evaluating expectations and aspirations as functioning changes (Zissi and Barry, 2006) thus accounting for studies that find no relationships between the two (Arns and Linney, 1995 and Narvaez et al., 2008). Additionally, most studies examining the association between functioning and life satisfaction are cross sectional and may not fully capture the dynamic covarying changes occurring between functioning and life satisfaction over time. One longitudinal study examined the relationship between specific objective indicators of functioning and specific subjective quality of life domains (Heider et al., 2007). A relationship was found between daily activities, family relations, social relations over a two-year period and corresponding subjective quality of life domains. However, the extent to which specific functioning domains and specific quality of life domains changed together over time was not examined. To address this gap, we sought to build upon the Heider et al. (2007) study in three ways. First, we examined concurrent changes in overall functioning and global life satisfaction for individuals with schizophrenia receiving psychosocial rehabilitation services that target functional improvement. Second, we examined concurrent changes in specific domains of functioning and corresponding life satisfaction domains using distinct measures of functioning and life satisfaction. Finally, we used latent curve modeling which allowed us to analyze covarying change between these variables over time. From previous analyses on this sample we knew that global and domain-specific functioning would improve over time (Brekke et al., 2007), and we expected that there would be improvement in global satisfaction and specific satisfaction domains over time. Specifically, we hypothesized that (1) overall functioning and global life satisfaction would improve together over time, and (2) domain‐specific functioning and corresponding domain-specific life satisfaction would improve together over time.