Severely mentally ill individuals in the community: Needs for care, quality of life and social network

Abstract: This 18-month follow-up study investigated needs for care and support, quality of life and social network in individuals with schizophrenia or a schizoaffective disorder living in the community and in contact with psychiatric services. The validity of Antonovsky's sense of coherence (SOC) measure was also examined. At baseline 120 patients were interviewed and 94 of these participated in the follow-up. The majority were unmarried, unemployed and living alone in own apartments. A majority of the patients had comprehensive needs for care and support, which to a great extent were unmet regarding company, daytime activity, physical health, psychological distress, psychotic symptoms, intimate relationship and sexual expression. In need domains such as information, sexual expression, intimate relationship, safety to self and benefits a great proportion of the patients did not received any formal or informal help. Subjective quality of life was most poor in the areas of finances and work. Objective life conditions and subjective quality of life were only weakly associated while sense of coherence, aspects of the social network, psychopathology and severity of needs showed at stronger association to quality of life. Compared to a healthy sample the patients reported a worse social network. Relatives were stated as main supportive contacts and played a vital role in providing help and support in both social and clinical domain of need. Quality of life improved, and symptoms and needs were reduced during follow-up for patients included in a new psychosis team. Patients only in contact with a psychiatrist in the team in some aspects showed a better outcome compared to patients with more extensive contacts with the team. Support was found for a construct and predictive validity of the SOC measure. The results are discussed in relation to a holistic perspective of quality of life and evidence-based community-based psychiatric services.