Conceptual Model of Health-Related Quality of Life in Schizophrenia

Background:

People with schizophrenia experience devastating symptoms (including hallucinations, emotional withdrawal, and cognitive impairment) as well as comorbidities that lessen their health-related quality of life (HRQoL). Compared to other people, they have a shorter life expectancy and are discriminated against. HRQoL, by focusing on well-being rather than symptoms is a particularly relevant outcome indicator for schizophrenia. Identifying and clarifying determinants of HRQoL in schizophrenia is vital to guide the focus of future research, to investigate alternative and complementary interventions, and to improve the quality of mental health services.

Purpose:

The purpose of this literature review was to develop a conceptual model to describe how the health of people with schizophrenia, including physical, mental, and social domains, influences their HRQoL. Aims were to examine (1) factors influencing HRQoL and (2) key stakeholders affecting HRQoL of persons with schizophrenia.

Methods:

Ferrans et al’s. (2005) HRQoL conceptual model was used as a guiding framework to structure the literature review. English language articles published between 2003 and 2016 and meeting other pre-specified inclusion criteria were reviewed.

Results:

An adapted Ferrans’ model, called the Conceptual Model of HRQoL in Schizophrenia emerged from the literature review. The model (1) describes how biomedical, psychological, and social factors influence each other and shape, over time, a health trajectory; (2) highlights an understanding of health that goes beyond pharmaceutical management of the symptoms of schizophrenia; (3) focuses on pro health behaviors and the management and self-management of health; (3) integrates perspectives and influences from key stakeholders including patients, providers, family, significant others, and society.

Conclusions:

The multifactorial nature of HRQoL in schizophrenia suggests that interventions are possible at many levels including genomics, medicine, nursing, social work, and health policy. Efforts must focus on supporting patients and improving their HRQoL in the community. Mental health nurses are well placed to lead such interdisciplinary work.