Alemu Wondale Getinet, Mwanri Lillian, Due Clemence, Azale Telake, Ziersch Anna
College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia.
Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Front Psychiatry. 2024 Aug 12;15:1407588. doi: 10.3389/fpsyt.2024.1407588. eCollection 2024.
Mental illness is one of the most severe, chronic, and disabling public health problems that affects patients' Quality of life (QoL). Improving the QoL for people with mental illness is one of the most critical steps in stopping disease progression and avoiding complications of mental illness. Therefore, we aimed to assess the QoL and its determinants in patients with mental illness in outpatient clinics in Northwest Ethiopia in 2023.
A facility-based cross-sectional study was conducted among people with mental illness in an outpatient clinic in Ethiopia. The sampling interval was decided by dividing the total study participants who had a follow-up appointment during the data collection period (2400), by the total sample size 638, with the starting point selected by lottery method. The interviewer-administered WHOQOL BREF-26 tool was used to measure the quality of life (QoL) of people with mental illness. The domains of QoL were identified, and indirect and direct effects of variables were calculated using structural equation modelling with SPSS-28 and Amos-28 software. A p-value of < 0.05 and a 95% CI were used to evaluate statistical significance.
A total of 636 (99.7%) participants agreed to participate and completed the data collection. The mean score of overall QoL of people with mental illness in the outpatient clinic was 49.6 ± 10 Sd. The highest QoL was found in the physical health domain (50.67 9.5 Sd), and the lowest mean QoL was found in the psychological health domain (48.41 ± 10 Sd). Rural residence, drug nonadherence, suicidal ideation, not getting counselling, moderate or severe subjective severity, family does not participate in patient care and a family history of mental illness had an indirect negative effect on QoL. Alcohol use and psychological health domain had direct positive effect on QoL. Furthermore, objective severity of illness, having low self-esteem, and having history of mental illness in the family had both direct and indirect effect on QoL. Furthermore, sociodemographic factors (rural residence, illiterate educational status, not married marital status), social support-related factors (poor self-esteem, family not participating in patient care), substance use factors (alcohol use, tobacco use) and clinical factors (high objective and subjective severity of illness, not getting counselling, suicidal ideation, higher number of episodes, comorbid illness, family history of mental illness, poor drug adherence) directly and indirectly affected QoL.
In this study, the QoL of people with mental illness was poor, with the psychological health domain the most affected. Sociodemographic factors, social support-related factors, drug use factors, and clinical factors, directly and indirectly affected QoL through the mediator variables of physical health domains, psychological health domains, social relation health domains, and environmental health domains. In order to improve the QoL of people with mental illnesses, we recommend that emphasis be given to addressing the QoL of those with mental illness, including the development of policy and practice responses that address the above identified factors.
精神疾病是最严重、最慢性且致残的公共卫生问题之一，会影响患者的生活质量（QoL）。提高精神疾病患者的生活质量是阻止疾病进展和避免精神疾病并发症的关键步骤之一。因此，我们旨在评估2023年埃塞俄比亚西北部门诊精神疾病患者的生活质量及其决定因素。
在埃塞俄比亚的一家门诊对精神疾病患者进行了一项基于机构的横断面研究。抽样间隔通过将数据收集期间有随访预约的总研究参与者（2400人）除以总样本量638来确定，起始点通过抽签法选择。采用访谈式的世界卫生组织生活质量简表（WHOQOL BREF - 26）工具来测量精神疾病患者的生活质量。确定了生活质量的领域，并使用SPSS - 28和Amos - 28软件通过结构方程模型计算变量的间接和直接效应。使用p值<0.05和95%置信区间来评估统计学意义。
共有636名（99.7%）参与者同意参与并完成了数据收集。门诊精神疾病患者的总体生活质量平均得分为49.6±10标准差。身体健康领域的生活质量得分最高（50.67±9.5标准差），心理健康领域的平均生活质量得分最低（48.41±10标准差）。农村居住、药物不依从、自杀意念、未接受咨询、中度或重度主观严重程度、家庭不参与患者护理以及精神疾病家族史对生活质量有间接负面影响。饮酒和心理健康领域对生活质量有直接正面影响。此外，疾病的客观严重程度、自卑以及家族精神疾病史对生活质量既有直接影响也有间接影响。此外，社会人口学因素（农村居住、文盲教育程度、未婚婚姻状况）、社会支持相关因素（自卑、家庭不参与患者护理）、物质使用因素（饮酒、吸烟）和临床因素（疾病的高客观和主观严重程度、未接受咨询、自杀意念、发作次数较多、共病、精神疾病家族史、药物依从性差）直接或间接影响生活质量。
在本研究中，精神疾病患者的生活质量较差，心理健康领域受影响最大。社会人口学因素、社会支持相关因素、药物使用因素和临床因素通过身体健康领域、心理健康领域、社会关系健康领域和环境健康领域的中介变量直接或间接影响生活质量。为了提高精神疾病患者的生活质量，我们建议重视解决精神疾病患者的生活质量问题，包括制定应对上述已确定因素的政策和实践措施。
