1998 - Objective And Subjective Quality Of Life Of First-admitted Women And Men With Schizophrenia

O SfntSe. v€rl,L! 'r )'

E u r A r c h P s y . h r d l t )C I n N e u r o s c(Li 9 9 l ] r ? 1 l j 2 5 0 l j f i

Ut€-Ulrik€ Ritder-Wanner Stefan Prieb€

Obiectiveand subiectivequalityol tife of first'admitledwomenand men with schizophrenia

R e c e r v e2d :J u n e1 9 9 7/ A . c c p t e dl:4 J u l l I 9 9 8

Abstract Empincal sludies hav€ shown thal lher,, r, difterences berween women and men wilh respecr rr) 11.-onser of schizophreniaand lhe developmenl of thetr nre, Lal and social conditions. I! was the.efore the goal ol rh:. 5 t u d y r o a s s e s sr h e o b j e c d v el i f e s i t u a t i o na n d s u b j e c ( i , . quality of life, as well as the differences. similrnriL\ .f.l rntenelatrons,at th€ onset of schizophreniain wonref r, .1 'nen. Ninely schizophrenic patients were jnlerv'escd bl tween lhe second and founh weeks of their firsl hospjl. i \tay using the Berlin Quality of Life Profile, and frl.,l a. ro.ding to the BPRS- Areas of social problems (work. lI, :ng circumstances, safety and drug abuse) had be!on,. manifest wilh several of the panents. parttcularly anro,,l $e yoirng nren, pnor to first admissron. Althotrgh obre, rive conditions, gender and psychopathology have af Ln pact on fie subjective quality of life. ii crnnor be fu11\ e' p l a i n e db y t h e n . M u l t i v a r i a t ea n r l y s e sh a v ed e m o n s r r r t .l Lhat the faclors influencing it are probably differenl t, women and men, and schizophrenjcwomen appraae lhe i life circumstmces in a differeDr manner fr rrue for difterences between the statementsof acutth !rr.1 .hronically ill palients- lr can be concluded from rh. r( s u l t s o f r h i s s r u d y t h a t p s y c h i a r i c s e r v i c e ss h o u l d o l l i , .pecific social suppon measuresbefore or at first hosfrt.Li rdmission and nol after $e illness has b€come chrolr' The subjective conslruct of elobal qualir] of life rff!L .ntly differc from onc sanple to another, and gender'rr , r e oa ' p . c r . . : r m o n g o t h e r ' . h " ! e d r i m p J c .o n i L . Key words Schizophrenra Qualily o{ life . First ,ldmission Cender relared aspectsin schizophrenrr

1 , . U . R i j d e rW a n n e r1 A ) l')ychratric Clini., Emsr lon Ber8nann Klinrkum. Lr der Aue 59-61, D-14480 Potsdan. Ge.m,ny l)epartnrentof PsychologicaiMedi.nte. \r Brdholomew s and lhe Royat London School ol MedrLnrr w e s r S ' n i t h i i e l dL, o n d o nE C I A ? B E , U K

lntroduction N l r i n t a i n i n go f i m p r o v i n gr h eq u a l i t yo f l i f € o f r h e c h ' o n L c nrentally ill has been a staied go.rl of psychiatric carc s r r e s u l t ,m o s t q u a l i t y o f - l i f e s t u d i e si n t h e f i e i d o f p s l . h l dr-a'have thus far focussedon chronrc menlal pattents \: how ro delrnc though there is no general qu.rlity of life, lh€re is broad agreement to utilize srale Dlenls on satisfactionwilh life in eeneral and wirh va,r(tri' in.lividuxl domains ofiife as indicato.s of subjective qurlitl of life. Most authors also collect objecnve data rhoul rhe patienrs' ljf€ circumslancesas critena of objecli!e rrl Lli\idual qualiiy of life. Some imponant lindings h!\. Ihus been made (for review see Lruer 1993) Srud$ rrrred ar underslanding the situalion of ihe persons !o'i . ! r n e d a n d f o m u l a t i n g g u i d e l i n e so f x c t i o n h r v e i n \ e s r L gared mainly the qualily of life in vanous lreatmenl, ,:rJ. rnd service sellings. They have demonsrated Ihe fa\our abL. effect of clozapine lherapy on the qualiry ot lLlc i\lehzer et al. i990i Meltzer 1992). the eftecrivencs! L't p s f c h i a l r i c c o m m u n i l y c a r e p r o g r u m s ,s p e c i . l ' n i e ^ . t oons and specific merhods of case managemenr(Brgclciv er al. 1982: Huxley and Wamer 1992; Mcclary eI rl 1 9 3 9 rS t e i na n d T e s t 1 9 8 0 ) .A d v a n t a g e sa n d d t s a d v a n L r g e r of deinstruljonalization as well as of various living sir!.1 rions have been described in derail (Fiore et al. l'l9l: G i b b o n s a n d B u r l e r 1 9 8 ? rL a u e r l 9 9 l b : L e b m a n e r ! i 1986iMccanhy and Nelson l99li Oliver 1991b:Oliler rn.l Mohamad 1992;Pinkneyer al. 1991).Studics ad drrssing funddrnenlal ilsues around rhe factors infltrenr rr)S lhe qualily of life have eslablishedvarious moderr{o: ! r n a b l e s o f s u b j e c l i v eq u a l i ( y o f l i f e T h e y b a v e s h o $ I ' r h l r o b j e c r i v el i l e c i r c u m s l a n c e sp. s y c h o p a t h o l o g yr P u L i . u l a r l y n o n - s p e c i f i cd e p r e s s i v es y m p t o m s ) , b u t u l \ , ) olhef facton such as self_esteem,have an effect on {rb t e c r i v eq i r a l i t yo f l i f e ( H e i n r i c h se r a l l 9 8 4 r l - a u e r l 9 9 l t ' . b r l - e h m a ni 9 8 3 a , b , I 9 8 8 : L e v n r e 1 a l l 9 9 0 i M e l t z e r l ! r ( l : \ l u e s e r e t a l . 1 9 9 1 ;O l i v e r l 9 9 l a i S i m P s o n e t a l l 9 8 9 r n l l s a t i s i r c t i o nw i t h t h e v a r i o u sd o m a i n so f l i t e a p l . l r s n, be decisivefor global well-being (Lehman l9fl.':

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L e v r r t e r a l 1 9 9 0 i ( ) l l c r t ) r ) l r ! , . N e v e r ( h e l e s sd.r e s u b l e c l i ! c q u a l i l y o f l i l . f i ! h r D i ( I n e n t a lp a t i e n t sc a n n o rb e r e d u c e dt o t h e s ef . r , n , ^ h ! 1 r s u m e a n r n g t u l n d e p e n d e n t c o n s r r u c r( P r i e b ee l . r l , . r ( ) f )l i x w h i c h i t h : r sb e e nP o s s i v rl of deremialnr.. b l Fr o" ' J b l i ' l ' J r o ' . r r . l n t h e s l u d i e sc i r e l , r n , , ! r 0 1 t h e S r o u p sr n v e s l ' g a l e d werc, diagnosticrll,"-stellir!, hct€rogeneousand nor dili' iercntiated in lerms ol sl.tgt ol illnessi gender-relaledas p e c ! s r a r e l y r € c e i v c d d f r r i l c d e o n s i d e r a l r o nH . owever, m l n y s t u d i e sd e s c r i b i n ! d r e d r l l e r c n t m e n t a l a n d s o c ' a l c a r e e r so f s c h r z o p h r . r , cu o n r e n x n d m e n h a ! e s h o w n l h a l gend€r reialed appfod.hes 'na) nrake an essenhalcontrr_ b u t i o n b t h e u n d e , \ t x o d i n ! o l l h e c o u r s eo f t h e i l l D e s s (for review see Rdd.r \lrncr xn,l Priebe 1995). Ir derefore was the objecri\ e of rhj! sludy to assessthe qually of Life of schizophftnic \'1rm.n rnd men at a defined poin! rn . n t h e c o u r s eo f t h e i r i l l d . ! s ( j i r s r h o s p i t a la d m i s s i o n ) A other poinl of inlercst \!us rhc question as to whelher tbe schizophrenic patienr' qurlrt) ol life at this early stageof t h e i ri l l n e s sc o m p a r e dn . t r r i \ e l y t u t h a t o f t h e g e n e r a l p o p u l a t o n , z ' h a r D e e n. . . r ' . r ' r r c d . . y. i c l p d t i e n l ' . The questions to be nrcsligrted by this study were defined as lbllows: L Whal a.e the obj..rile litu siluations of lirst admitted schizophrenic women r.d men l 2- What is the patienri lubj.crr!e quality oflife? Are dif' ferences in the life circurrl(atce! of the women and men interviewed reflected in dilferences in fteir satistaction with the various L;f€ rr.as ar)d $i$ life in general? 3. What are the impacrs .f olrjoclive life circumstances. psychopathology and 8.nder,:'n srtisfaction with the indi vidual domains of liiel 4 . C a n t h e s a m eo b . j c . r i ' e! n ( l \ u b j e d i v e i n d i c a l o r so f q u a l ily of life be used 1o c\plrin glob!L satisfacrionwilh life of both firsi'admiued fernrl. 1..i lirsr-admirtedmale patienls?

Methods Thrs srudy was cadred .u: ber.ee'. Varch 1994 and February 1995 in 90 parienrs(60 arrrln rnd lil ne.) wrth a dlagnosis of schizophrenraor schizofh,.nrionn n!ltde.s between ihe second and foudh weeks of the r rL,i ho\prLr slay in one ol erght rndcqards in Berln and Pots pendent.community-cerf,. I r.)rhirl.t dan (cemany). The sa.rPi: . r{ !.t.sPonds to lhe ,ntendedsm ple size wrrh more wonrn i.e'.,u.. qtrLity of lile in lenale schiz' ophrenic prrrents w.s rlk !"!.iri iicus of the study. Pari€nrsaged under i8 and over 60 yeris rs \ tlL .s piriems whose knovledge ot Oeman did nor suffice 1,trIlrt !rre:rie\v, were excluded lrcm lhe iudy. Preliminary sampL:i.!*tr: erleJcd by rhe resPeclve wards upon innialdiagnosis Tlre r,nJL!r:i,qfcis was nade. accord'ngto I C D - t 0 ( F 2 0 8 5 p a r i e n r . r r J I I . l u l m e n i n d I D a n ) ,b y t h e i n vesrigatorwho had oo clLni.ri .e r.,hip with lhe Pltienrs Two pabenlsof the prelimin!, i "rnrtle s. n omi$ed b€causeol differ ences in diagnosrs None oi Ih. ,:,.iLnLng 90 Frients relused lhe inrerliew. and 2 *onen dLa n,! ..f1 eb rt. The assessnBnt'n_ srrume.i employed was rh. ijc: iIr Qr rLily of Life Proiile (Priebe er al. 1995), an adapred\er'rnn i fir Lanclshire Quality of Llte P r o t r l e( O l i ! e r 1 9 9 1 a i O l \ . r . r . r : l 9 . l . r w h i c h h a sp r o v e nu s e f u l rn se!eral srudiescondu.r..l b) rl..iurlrors (Hoffnann el al. 1991. 1 9 9 8 tK a i s e r€ t a l . l 9 9 a l . ' i : P r L e h (e ! ! l 1 9 9 6 ,1 9 9 8 ;R i j d e r W a r n e r e i a l 1 9 9 ? ) ' 1 1 r , , !, i . r ! f n . , r c p e m i $ a n e l a l u a L i o .o l

r h e p x r , e n r \ o b j e c r v ec , r r u , , { J n r r : r l t i r { b i c c I v e \ r r r \ J m t m t w r r h n r n e s D c c r l l cl i k d o r r r , , , rt' r ! . l l , i \ r h e ; g e n e t r l L i l ' s ! ' r \ ' e\tu' inn , 'lrr'r'rdro-- r"llr 'l . po'n .,l..rirgr"; "m i s f i e d .P s v c h o D r t h o l o E! rv\ . ( ! . \ t L i d u n n g l h e o r r i i e , , , 1 r ' . r - , , i d i , R a h n eS c ! l e ( B P R s ) s e s s i o nt i - . i *

Results 1en and womcn L i f e c i r c u m s l a n c eos f l i r \ r r ( l r r r r l l e (m S o ( i o d e n a g r c p h i LL h d t , t t t t t \ ! r . s Slatislical comparisons !.rc dLrneerther wrth chi square tests.Thc n)err lgc of lhe women admit ,)r lchizophrenifbrm drsred to hospnal for schiT{rttrreIiL,r o r d e r si o r l h e f i r s t t i m e \ r s ' 1 : l) c a r s ( 3 2 . 81 1 0 6 . 2 0 5 9 y e a r s ) .C o m p a r e dw i l h i h t n r L c p a l i e n t s m e a n a g e o l 2 5 l , e a r s( 2 5 . 2 1 6 0 , I 8 r . r \ t r r . l . t h c r e w a s a s i g D i f i c a n l diff€r€nce of 8 years (/ < 0.000) T b e w o m e n ' s e d u c a r i o n al l. e l t . n d s t o b e l o w e r t h a n thar of the men who more ofrcn finrshed htgher eductroni however,the differencers no{ nrtistically significant-On the whole, the palien$ edLrtarionappeafsto be aboul fte same a s t h a to f r h e g e n e r a pl o f u l r l r o i A c c o r d i n gt o t h e D a i a R e pon of 1994, approximlrel) 7.:; of aU puPils leave school wrthoul completing low.r 1e!el \e.ondary educalioni in the study sample,87. of thc ronr.n rnd 77oof 'he men had no school-leavingexaminatnrr' Si\r.cn to 26% of lhe general population aged between l0 and 19 years (subdivided inio three age groups) have higher'le\cl secondaryor equ'varenr education. The correspondiDg rltes in our sample were 22% for lhe female and 3.1'; n' rhe male patienb (n.s.) In contrast ro this. thcre \vd\ r narked diilerence be' t w e e n t h e s c h i z o p h r e n r cv o n r e n a n d m e n a t l h i s e a r l y slage of then illness wtll .esl..L lo vocational raintng Whereas morc of the wonrcn ir,l completed an appren_ t i c e s h i po r c o l l e g ee d u . a r l o . ( 6 i v s 4 3 % i p < 0 0 5 ) . t h e r a i e o f d r o p o u l s{ a s h i g h . r l o r r e n ( 1 0 v s 2 0 7 d :n s ) . More women than n)en rend.d to be in paid enplov men! (60 vs 40qo;I < 0 l \\'hef working they eamed as The m u c ha s m e n ( 1 8 0 2 . 51 7 l ' 6 9 \ . 1 E 0 5 i 7 2 5 9 D M ) p r o p u . l r o no l p a r r e n t .r ' I . r ' , ' o b l e s $ 2 ' r h e ' J r r e t " r b o l hp e n , t e r s1. 2 . , ' t r , \ . . - r d n o 2 l q o f r h c m e n : n.s.). Related !o ihe nunrh.r ot rciive persons' lhrs per_ cennge rs 167ofor th€ $or en Llrd 177. for rhe men (p < m e p : r l r et ' d n i m p ' l n . l , n o u i n g . p a n r . u l.:,r r for fte general popluaIhc sr.llislr.i ranr deviaiion from rion of B€rlin (13.a7. \!cJ),rn.ud I2 97. men in 1994i figures by $e Bcrlin Srllc Ltureiu !f Sratistics) ln addl tion to lhe slandardizcd quenL.ns ali Patientswere asked open ended quesrions c,n..min! th.ir work career D'rri n s r h e y e a r p r e c e d i n gL h t ! | r i i r o s P i t aal d n i s s i o n .2 7 9 . o f $ e m e n a n d l s q o f r h e * o t r r . ( n s . ) i n l e r v i e w e dh a d l o s l t h e i r j o b s ( r h i s f i g u . e r l n ' J o n t a i n sp a t i e n t s w h o , r h o u g hj o b l e s s ,h a d n o t ! . r r . g i . r e r e , la s s u c h ) S e v e n t e e n percenr of the men and r'1 oi Ih. $1)rnen(n.s ) had been d i s m i s s e d I. n 1 0 7 , ( m e f l l . 1 r ) rll: ' i ( w o m e n ) o f c a s e st h e p a r i e n t st h e m s e l l e sh a d ( l c . i , l . d t . ' l e a v e( s o m ed u r i n g t h e i r i a l p e r i o d ,s o m es h o . t l ) ! t r n , , i u m i o e m p l o w e n t a f t e r

t5l r p f o l o n g e dp e r o d o f j o b l e s s n e s so r a l e m r t ! l e a ! . . I r ! h r J d a i l y o r w e e k l ) ,c o n l a c r w i t h l h € i r l a m i l y o f o r : r r r w o f k s r r u . r r r conf 3 5 f . o f r h e u o m e n a n d 3 3 ? t o r L r r c; r L , o r l y l e w h n d l c s s t h a n m o n l h l y c o n t : r c l x, n d t h e ) rh t r t L, , r h . t d c h ! n 8 e d d u r i n g r h r y e ! r p r e c e d u r gh o s p r t . r lr , l f r . ' r e r ,d e s r r e de v e n c l o s c r c o n t a c tw i l h t h e i r l , n r i l y o l o , i ! j r l s i o n . T h e y h a d e i t h c f l o s t r h e i r j o b s o r c h a n g c , l 1 l r d l , l n g r h e y e a r p r e c e d i n gh o s p i r a la d n i s s i o n . H o \ ! , r r , . w o f k p h c c . T w e n r y - s r xp e r c e n to f t h e w o m c n i n d r / i f r ) \ i r h L \ h a d n o l b e e n p o s s i b l e .l n c o n L r a stlo o t h e r l i l t r r e i . r r h i r d ( 3 0 % ) o l r h e m e n w e r e c o n v i n c e dl h a l d i i l i ( r l r i . . 5 u r i n k e e p i r g w i l h d r e s t a t e m e n rosn l h e i r w o r k s i i u r l i o r r . r f l s r n gl r r h e i rw o r k p l n c ew e r ea s s o c i a r ew d i r h r h e i rr l n . . r 5 0 ( h w o m e n ( 2 4 7 . ) . r n d m e n ( 3 3 7 . i n . 5 . )o t r e n m e n l r { r . d F i r s l a d m i t t e dw o m e n o n a v e r a g eh a d m o r e r r n i n ( hr r h r r d i f i i c u t l i e s a s s o c i a t c dw i t h l h e i r i l l n e s s h a d r r i s c r r s p e n d i n gm o n e yt h a nr h e m e n ( l 6 l l 1 7 2 5 v s l 2 2 r 1 S . ll w i r h t h e i r l i n r r l y o r t h e r rp a r h e . A s n t a y b e e x p e c l e ( ri .t D M . t < 0 . 0 5 ) .N e v e r t h e l e s sm, o . e r h a na t h i r d o f h ) r h t l ! r a ' F p r r i e n r sh . u d . i r e r e r l r o . e . n r h . i ' e n ! i ' o r r . ) n d l h e m a l e i n t c r v i e w e e s( 3 ? 9 . ) s r a r c Jr l r . L r l . o m t h e m e n . W h c n l i v i n g t o g e f t e . w i t h o t h e r p e ^ o n l l e m a i c( , 1 0 9 .a ( h e r eh r d b e e n p e r i o d sd u . i n g r h e p r e l i o u s y e a r d r r i r r ! r h t y m o r e o i l e n c a r i e d f u l l r e s p o n s i b i l i l yf b r I h e h o ! \ . ' w h i c h r h e y h a d n o t h r d e n o u g hm o n e y t o g e t b y r n L l r r I h o i d ( 6 6 v s 5 7 o :p < 0 . 0 0 1 ) a n d . i n c o m p a r i s o nw i t h r h c d a i l y l i v e s .E i g h t a n d l 3 E , . e s p e c l i v e l y( n . s . ) ,o i l i r e p r L . 'nen, there was a higher number of women Gking ca,. or rent sample received stale benefits (social sccurit\ be.( . h i l d r e n l i v i n g i n l h e i f h o u s e h o l d s( 6 1 v s o q . i p < 0 . 1 ) 5 1 I l l l ! o r r € n t s u b s i d i e sb) e c a u s eo f t h e i r f i n , r n c i a ls j r u J l r o r l , u , , l r J r yl o e \ p e L r J l r u n .l .- , . q F ' e r .r h e s u m e n i I l o w e v e r . t h i s p e f c e n u g e d o € s n o t c o m p a r e n e l r r i \ c L r \ iewees lended to experiencc less role conflic1, and il tht] with rhalof the g€nernp l o p u L a l i o no f B e r l i n i n w h i . h 9 ' ; ,iid. fiey did nol ieel as adversely affecled by il as lhe Inen of women and 89. of men collected social securit\ lrcrlt 1 1 o ol i f t l e t i m c f o r i a m i l y b e c a u s eo i j o b : 5 5 v s 6 7 E o ,n \ l f i r s i n 1 9 9 : , a n d a p p r o x i m r t e l yl l S z o f a l l B e r l i n h o u s . . e s u l r i n gh i g h s r . e s s : 2 2 v s 8 3 % ; p < 0 . 0 1 i t o o l i t i l e h o l d s ( 1 9 8 . 7 1 8o f I , 8 4 2 , 1 0 0 )r e c e i v e dr e n t s u b s i d r e s( l i ! rrnrc/energyforjob becauseof lamily: 6 vs :3ol,, p < U 05l r c s u l l i n gh j g h s t r e s s : 3 3v s 5 0 7 . . n . s . ) .T h e s e s t a r e m e . l s ures by rhe Berlin State Bur€au of Statisrics). Most patients lived in a rented flaI (937, of the sonrcn h,r!c to be considered with two points in mind. The re aDd 867, of the men). As many as 7ol. oi the womer lnLl spective subgroups (panicularty the m€n) ofren tend ro 1 4 % o f t h e m e n w e r e h o m e l e s so r l i v e d i n a b o d d r n ! l ecome very small, and for male palients the advenc cl house or residenlial home provided by the Social Seeu.irl lccts of conflicling roles in the family and work s'lual|on Office. Discounring those living in residential home!. rht $ill concern majnly their family of origin and thus thc,r percen(age of homeless persons came down io 3t til rolc as son. ln conlrast. for female patienls such efi.cl\ $omen but remained unchangeda. l47o for men (p < {r.l Loncem mainly their role as a panne. or mother. The figures issuedby the Be.lin State Bureau ofSttllrlrjcs Firsr-admitted patienrsstill had most of their social ret o r 1 9 9 3 s h o w 1 1 . 6 0 3h o m e l e s sp e r s o n si n t h e $ e \ I i f l l!tionsbips with friends or acquaintances.More than th.e. paft of rhe crty who tumed to facitilies for homeless pco luxners of both women and men had a close friend oi ei plet the number of unknown cases is estimated to rrng. rher gender (78 vs 70q.. n.s.) and also a reliable friencl r,) from 2000 to 4000 persons. Based on a number ol q h o m t h e y c o u l d t u m f o r h e l p ( 7 5 v s 8 0 7 . i n . s . ) .P r i o t r , ) 1 . 1 7 6 , , 1 7 i. n1 h a b i l a n t sr e g i s t e r e di n W e s t B e r l i n i n l L ) { ) r . hostital admission.rhey were used to seeingtireDds or tc this is equal !o a totrl percenlage of homeless peoplr ol' q u a r n t a n c eosn a v e r a g eo n c eo r t w i c e w e e k l y ( 1 . 6 v s 1 . 6 . 0 5 ro 0.7E . By comparison, the propodion of persons The percentageof p€rsons in th€ general population h!\ t r r l h o u l d o m i c i l e i s c o n s p i c u o u s l yh i g h a m o n g f i ' ! 1 ' ! d ii8 ! circle of friends is approxlmateiy the same (69.1i m i t t e d p a t i e n t s .A m o n g r h e s u b j e c | s ; n t e r v i e w e d I. n , ) r r \oelle-Neumann 1993).Neirherwomen nor men frequerrll women than men lived alone (49 vs 287.: p < 0. l) o, s irh p . n e n .e J d r f i r c u l r e . q i r h I h e i r f r i e n d 5o r J c q u ! i n r r l L h e i ro w n f a m i i y ( 4 0 v s 1 7 9 . i p < 0 . 0 5 ) , w h e r e a sr r o r . \ h i c h w e r ea s s o c i a t ew d i r h t h e i r i l l n e s s( 1 2 v s l 7 c . ; n ! ' en srill liv€d wilh their family of origin (12 vs 3l'i: Ho\ever- more men than women fell thal their rolc in th. t fihe women and40E ofrhcnr.l lrnrily was advers€lyaffecredby relations with friends r..i i r < 0 . 0 1 ) .S i x r y p e r c e n o i / < 0 . 1 ) h a d w i s h e dt o m o v e o r m a k e s o m ef u n d a r r e r u . r ; .r.quaintances(ioo little lime for farnily becauseoffriend-(: c h a n g ei n t h e i r l i v i n g s i l u a t i o nd u r i n g t h e y e a rb e f o r cl i r s r r , r ! i I 5 q . , p < 0 . I : r e s u l t i n gh i g h s t r e s s5: 0 v s 0 9 ' . p < 0 I \ \ r t h r e s p c |( r o l e r . u r c r c i ! i l i e . . t h e p J l i e n r ' q admrssionbut had nol been successful. rskcd if during the monfi preceding hospiral admissrin. rhcr had engag.d in some spott. had been to a bar fr t ial )eldtions and l.isure aLtivities restlrurant,to the cinema, the theare or a conccn or h!\l Srnc shopping. if they hnd gone on ca.. bus or train nd.\ hnd walched TV or listened to lhe radio. Bolh female rna Compared wirh m.rle parienis. more first-admirled f€fri,ir p l t i e n r s c u r e n d y h a d o r h a d h a d a p a d n e r ( t 0 v s l r r ' t : nrele interviewees reported havine eogaged in tour io i !l , < 0 . 0 0 1 )a n d / o rc h i l d r e n( 4 1 v s 1 0 7 . ip < 0 . 0 1 ) .T h r si s f o r . r i d r es i r l e i s u r ea c t i l i t i e ss u g g e s r e(d4 . 3 t l . l v s 4 . 4 1 I L r \) Ninety to 957. of them replied in rhe affirmahle !urprisnrg becausefirst-admitted women were on av.rr!. p.rst dre mean marriage age of wom€n jn Geman\ 116 r ! ' q u e s l i o n sc o n c e m i n gT V o r m d i o . s h o p p i n gc, a r , b u s o r ! e a r s ) , w h e r e a sm a l e p a t i e n t so n a ! e r a g e w e r e y o u n ! . 1 Ir.,in rides. Two thirds recalled having been to a bar nr thrn the mean maniage age for lrlen (29 yearsi Datr It. reshurant during !his peiod, and lirrle more than half had p o r r o f 1 9 9 4 ) .D e s p i t eh a v i n g t h e i r o w n f a m i l y , . l n h 5 r f.rdr.ipated in a cultural evenl. The aclivity least engalea r w o t h i . d s o t t h c w o m e n a n d m e n ( 6 5 v s 6 0 q " : n . s . 1 l \ ! ' rr (ooe third of the men and a quarter of ihe women) $r.

l5i p h v s r c a te x e r c r s eo r s t ! . \ 4 o f e f i r s l a d m i | e d w o m e n T r b l . : M c r f \ r r r n r c r i , , l t l r a n f i r s r . i d m i e d r ) . n . . ( ) ! i t h a l e l ; k e d r o h r v e h . r d l r e r l sR i r hl r l ! d o o r r i s n l o r e l c i s u r ea c t i v i r r . s i 5 , . I r J l r y c a r ( 8 0 v s 5 ? 9 i ; / < 0 . 0 5 ) . F e m : t l ep a r i e n r \J r . ! c d l . L s u r ea c l i v i r i e sr o b e l h e d o r n a r nr n w h i c h l h e \ r x . r e n . ( . dr h c t c a s td i f f i c u t r i c sa s L o c r d r r Jq ' h ' h e i r , ' , r ' . . m : . 1

Saf?ry ahd tesat asl,ts

. .,Lrfilled s.hr2olhrenic P!_

:r - l.l

O e r u n go n w r r ho r h e 6

D u r i n g $ e 1 2 m o n r h sp r I l o r h e i r a d m r s s l o nr, n e m a r e p a l e n r s l r v e d i n ] e s ss i r l e r r u n r s r a n c ersh a nl h e w o m e n . I n c o m p a r i s o nw i t h t h e r i t r . l h r y w e r e m o r e o r t e n a s - ' l a b l e I P e r c e n r ! g oe f s a l i \ 1 L 1 : s a u l t e do r b e a r e n( 4 0 ! s ' : ; . , < 0 . 1 . o r a c c u s e do f h a v i n g c o r n m i l l e da l e g a lo j l i , , r c . r l l v s 8 % i p < 0 . 0 1 ) .t n r h e gen€ral populatrcn. 1oo.s . (rnresmore men rhan women come rntoconflicrwirh rlr lrs illata Repon of 1994). 5 { r( r

Health and drug abus. There was no differenc. .i IIPRS rolat score belween lhe first-admjtted womc. I : nrcr: n€ither was nerc anv rn r h e " u b . r o ' e r u r l h r h . \ - i , i . " r r h e c a r e g o r yo t a n e r _ g r a . w h e r em e n h a d a h i ' r h , m e r n v a l u e( s e eT a b t e l ) . The proportion of firsr rlmnred women using medical services is higher rban rhr t mcn. whrch coincides with I h e p r o p o n i o n s i n t h e g ( , r r r t p o p u l a t j o n( E l k e l e sa n d S e i f e n 1 9 9 2 ) :h o w e v e r .i r . r o w s s i g n i f i c a n t t yo n l y i n f t e trearment of physical fr,rl. , ' ln rhe year b€fore hospi tal admission more womdr t r!. mcn had seena doctor for ': \ . 2'-,: p h \ - i c d l d r r m e n r .o ' r l , p < 0 0t , F r I | ) - r n r e ep e r l e n ro n,rn but only one *oman l2Ea: p < O.OOO)r€poreL nrshish abuse over periods fron I to 10 years (mern I r:iod .1years). More lhan hall o l r h e n . e p u l J r l ). o n " n u: j g dd ty ^cordrngro I n e ' r o $ n \ l J l e m e n t \ .\ ' r' rr||o\pc!r ln morelhdn h a l f o f r h e h a s h i s hu s e r i f i r n d r u s a b u s eo c c u r e d s o m e t i m e b e f o r e r h e r u b r . r i ! e t ) p e r c e i v e dc h a n g e si n b e h a v i o u r( i n m o s t c a s e !: , . i x l r e t r e a t )o r e m o r l o n a le x p e n e n c e . ( T h e r w o q u c s ri , r s \ r r e p o s e d a r d i f t t r e n r porn'..n rhr intenie\ .. L,.'\ord Jn\ \4ore rnen thdn bor " rl r rodr. ar.ohot abu,e ( r 3 v s 3 o / , ip < 0 . I ) .

t - ai . -_r l

3ll

78 7t

3L 69

89 8? 89

88 8i 89

"Satisfied:scoresof 5 7 ((th€r . .L.li:.1.salisfiedo. conPleteiv \!rt i, r \cale satisfied)on rheseven-poinr hRarhersarisfiedor co;plercl] . t ."-l EMNID Jan/"Feb.1994 *p < 0.05

S u b j e c t i v eq u a l i t y - o f - l i f ci n , r . , r , , J s Clobal ltfe sdtislactian ant ' iith specLficlife domains

si ttton

T b e p a i i e n t sw e r e l e a s l\ a t , s l - . 1 r i t h t h e i r l i f e i n g e n e r a l ' a n d f i D a n c i a lc i r w i t h t h e i r m e n t a l h e a l l h .$ . r . r r , L a l i o n cumstances.The domains ol , ilr'r -iluaton and personal safet), were judged somewhr ' (,r. llvourably. espec'arrv b y n r e n .T h e g r e a i e s ts n ( r s f r ' J r $ . 1 s s 6 t e d i b f t h e d o m a i n s o f l e i s u r ea c t i v i t i e s -l i r l \ r h e w a y o f g e i t r n go n 'i.nd\ and acquarntances w i t h o i h e r s a n d r e l a t i o n s$ i r ( s e eT a b l e 2 ) . j l.r circumstances' first Despite their more fa!oirr T r b l e I B P R S r o r J l\ ! o r . t r , t r j .,-.or.\ rn tirst !dni ed panenrs admiued women did nor rr. !:trter satisfaciion tnxn " r r h l i f e i n g c n e r a ln o r t h e i r m a l e c o u n r e r p a n sn. c i r 1 l:. domain of personal a r e ! . wirh any specific life ( a n d , . . i u . \ t i o n w a s a s k e d ,f o r u h e f s a l e t y a n d i a n i l y ! l L ! . \ , : c r d . d t o b e l e s ss a t i s f i e d t l e ) c o u p i e r e l a r i o n s h i p s ) : l l l . i t 0 . 8t 3 . 2 ( s e eT r l ' 1 . \ , r " i l a r l y , i r e s p e c l i v eo l t h a n m a l e p a l r e n t s 1 1 . 9 1 3 . 3 | )< 0 0 5 t h e ; b e u e r s i r u a t i o ni n s o r r r r ' j r n r 3 i n s ,t h e p r c P o n t o n o f s a t i s f i e dw o m e n w a s n o r l . Lr i H r n y l i f e d o m a i n .w r t h r e i d n o o b j e _ r ie r h e e \ . e p r r n no r _ r n r n c e H o s r r l es u \ p i c l o u s n e s r difference (see Table 3).

ti; 'lxble,l

S a ' s h c r m f w , r h o n e l , ' c d o n ' . i . : e f l e c 'o l M o b i ( r \ ! lndepcndenroble.lrve

Elrcr

il.lc Ind or -lender(age !s . courirle enretedtrAl ', Jhlr Erltr otEcnLjcr

r

Ha!rnE ! close iflend\hip

< 0.1

15.8 t0

< ll.0rxl <0.t

0 l

1.5 1.6

5 l

0l 0.5

N u n b e r o f l e r \ u r er c h ! r l r e s |li

0.7 0.5

Frequencyoi conracrs 5 l .-110l

EPRS roral scofe (separated

00

o.1 a.i 0l

Bosrle susprclousness

2l

The patients' global lif€ satisfaction and salisfaclior) \\rrh all specific life domains were less than lhose ol women and men in the general population. At the tin'c ol ljrst admission the proponion of satisfied persons was !l ready clearly lower ihan in the general poputarion in a'rr life domain (see Table 3).

F,].tots inftuencins satisfa.tion t

h speLifk tle domattr\

0? o1

l. The D.oponion of the varixnce of the satislaclron wtlh .Decrtic domains explained by lhe respecdveobjective it ,iicaror is low; r! ranges between 2 and 109. for lhe speL wrlh the obrective condition kept constml' gender plavs a role in the domain of social relations and tends lo inlluence lhe living situalion Schizophrenrcwomen evcn rn rhe same obieciive circumstances feel more saiisfied q,rh frieDds an; less satisfied wilh th€ living situation ln rc.rclions were found in the areasol social relations and nf leisure activities. The impac! ofthe objective condrl'on nn sarisfaclion with thes€ areas is slronger in lhe lenaie

To establish the influencing factors, analyses of variln.. $ere performed using satisfaction wi$ a specific life do main as dependent variable, and objecdve circumst.rnccs in rhe same life domain and gender as independent !.rrl explr rbles. In two differenl procedures.age and rhe BPRS t(n!l - A1reas a covariate made no contflbutlon to tne samplc. in this life domains wnh rxrio; of th€ satisfaction score were taken as covariates.The results ol analysis oi .\cefl on satisfaction with personai salely. wnere orocr \arLance were as follows (seeTable 4): .rgr nreant less satisfaclion. I With only one excepiion. the respective objeclive s'trl alion in each life domain was shown to contnb re lo cx_ i T h e B P R S t o l a l s c o r e ,i . e . ,i h e e x t e n ro f o v e r a l l c u n e n i : \ c j J D , r h o l o e v .e n ' e e d a s d c o ! 3 t i r l e . a r . o p l J ) e d n plrrning sarisfaction.Only the sarisfacrion of frrst-admlr ' . t i r i r o l " i n i n e r h e I a r ' a n te o l ' a L r ( r r c t i u n$ r L nr n \ l ' r led patients with their financial silualton was iDdependtnl u h e r e r t ' r m p : ! rrJ,n e\c€pr ihat ot menr"l heJlrh oj the rmount of lheir monthly spending rnoney. Ho\ o . l ( i d l \ o b e s h o q n * h e n l o r d l' o r e o r ' u b ' ! o r P w e r ' e!er. this is not surprising in vrew of the lact that th€ ti .eparxred according Io fie mean. licnts wer€ asked how mucb monlhly spending none\ l r \ . ( j r h e t h a d . I n r h e c a s eo f l h e y o u n g m e n w h o o i t e n !irh rheir family of origiD, for instance. this amounl rr\ af Slohal ltfe satisJaLtion not have met lheir aclual financial reqtriremenls,and nr(i!L luetninant! prohably the same applied for mosl manied women. ()rrc mrf thus suspeci rhal in lhis domain the objective aJrd Thrce steDwisemultrDl€ reeression'nalyses were camed s f global lile , ' , r r , ' e s i a b l i s ht t r e i s s e n t l a td e t e . m r n a n t o subtective qualily-oi-life indicarors do not ref€r ro exi.rll Indr variables with was conducted The first !!Irsirction. Ihe iame lhing, and consequently the objecrive indicllor and symplomatoloS\ circumslances life \ u ' .alin! obiective i l o c s n o t s i g n i f i c a n d yc o n t r i b u t . l o e x p l a i n i n g t h e 1)b c:rive indicarors covered each of the inleresring lile rnce of rhe sub.jectiveindicaro. .lcmains: ase. monlhly spending monev, number of leisur'

155

7

u( \,! r^r," rlJe,enn,,!n,soie,ob.LL

cighr subiecrive qualily ol l,lr Ir|.r1ors: sarisfaclion w i l h l i n a n c i x l s r r u r l i o n . l j v j n ! r , r . : u n r r t e n c e sp-e n o n a l O b . i r . t i v ev , r i r b l € s ( I t P R S i n . h ! d ( ' i s a i e r y ,l e i s u r ca c ! r v n r e st ,h e s r t 1 ' l ! . r l i n g o n w r l h o r h e r s . r e l a r i o n sw i l h l i i c n d s a n d a c q u ! i n l r n l e s . f a m i l y . m e n l a i \ , , . l l c r s u r ea c ! ! i r i e \ h c . r l r h a n d B P R S r o t a ls c o r e .i n , r l h , f d r c l r e s s r o na n a l y _ N o . o l l c i s u r ea c r v l r e s s i s , t h € i m p a c l o i r h o s e o b j e c l r \ f v . r . r r f ' l e sw h i c h h a d s h o w n l o b e o f a s i g n i f i c a n lr n i l l e n i t i n r h e i l r s r t e g r e s 'n!lriple rq = 0.45 s i o n a n a l y s i sa n d s u b j e c t i v e\ . f i r b l c \ ( ! i l o g e t h e rr e n p r e . h e f c s u l r \ a r c E i v c n i n T a b l e5 . d i c l o r s )w a s e x a m i n e d T C o m p a r e dw i l h o t h e r s t u d i c so . r i e n r : r lp a t i e n t s{ L e h m a n l 9 8 l a ) a n d t h e a u t h o r s \ t u d r e 5o n p o p u l a t i o n so f Satisilcrion wtrh nenlal htdlrJl ! ! , ' r r c r i o nw n h w . " _o f m a i n l y c h r o n i c s c h i z o p h r e n i cp t r r i e n r s( H o f l m a n n e r a l !.ti, g on wirholhers I 9 9 7 , 1 9 9 8 ,K a i s e re t a l 1 9 9 6 .l 9 r ) 7 .R i i d e r - W a n n eer t a l . SJrr:r.rion wnh memal 1 9 9 ? , P r i e b e e ( a L . 1 9 9 8 ) ,f i e e \ f h n a r o r v v a l u e o f r h e objective vanables is reLatively hrgh at 20 and 29%. rc speclively Onty for firsGadmrtte'l nren were lhe subjec nulr,pleA=050 r i v e v a r i r b l e sa l o n ec l e a r l ya b c r t e rp f e d i . r o ro f l i f e s a i i s O b j r c l i r € , n d s u b j e c t i v ev , r i r b l t s faclion than lhe objeclive variable! rk,ne For this group. tbe considerarion of borh subjecr;verrrd objective indicalors of life qualily results in a slrll belter prediclion Sarisfac on wnh mental hcrhh S . ' L j . i c r i o nw n h w a y o i wrth on orher E whereas for lhe women's group tht subleclrve detemr_ lctrr S.rr:rxcLronwnh menral nants alon€ already reach lhe highest expldnabry value The predicrors of globai lif€ larisla.lion diffef slightlv \o, i leisuredctrvllies b€lween female and male paiienls. lhc BPRS tolal score r, = 25q. Dlavs a roi€ onlv for women; howcvcr. it comes Io noughl in ui"* of rl" puta*ounl importarce of rhe; sarislaclion with menlal healrh (which evidenll) lunclrons as an 'noep € n d e r r f a . r o r ' w h e n . r n a d J r r i u r ' r h o b j e c t i v et a r i ables. the subjective ones are t.rkcn inro consideradon ln (out sug!isred) in lhe month leisure rlems activities of six the given situation of thei first hosfital slay. the female prior to admission and BPRS rol.ri s.rre. The following subjects rated rheir globai life slli.lacuon with respect to items were entered as dumnry va,rrblc.: enployment. liv ing wirh the family, existence oi r trmershrp, extstence their satisfaction with mental herlLh. and neglected all ob(cri!e (rrcum of close friendships, contacl wilh rhe l.rmily of origin, in- o r h e r l i r e d o m a r n ' . \ & n e n r n . volvemenl in physical violence ,, ch\hes wift lhe iaw, slanceswer€ evalualed.the numbcr oi leisure acuvrtreswas contacr with the medical care s) stem prior to admiss'on decisive for the nale subjects rarin-Qot global life satisitogether ll objec- faclion, whereas having a panncr rarked second and wa5 because of psychological problcnl' tive indicators enlered in th. firil re:'ession analysis. A much less imponanl With regard n) rlr subjeciive predtcgreater second anatysis was made raki.! rs iidependent factors tors, the men, uniike the womcn. rrlrihuted much

Table 6 Dnnensions of s!lis

0.86 0.19

f:

( r . 1 1i ! o n w i r h o r h e s

Cening on *ilh others

0.t8 015

0.r

o7J 0.68 {.4?

lrlr

4.13 4.12 060

r , , | ( ! r r n c e t o s r l i s i a c l i o nw i l h l h e w a y t h e y g o t o n w ' t h , , : nr \ r h r | r o s ! l i s f r c t i o r r\ \ ' i l h m c n l a l h e ! l t h . T h e l o n n e r , , r t L d { ) r r c r , r i n e di l s d e c i s i v cw e i g h l e v e nw h € n b o t h s u b r . r i \ . i r n do b j e c r i v ev a r i a b l e sw e r ee v n l u a r e dA c o m m o n ..,ruir n firsr admitted ttmale and mal€ palienrs wu! rhe 1 r r h r r d u r i n g t h e i r f i r s r h o s p i r a ls r a y .o n l y f e w l i f e d o ' r . , r n . r e f e i m p o n a n lf o r $ e i t - q l o b a ll i f e s a l i s f a c r t o n \ . . , n l r k c r h , . s a m p l , . , r l r r ' r d , l m r r t e dp u r i c n r ' .J p o p t,iiLrL(o Df m o s t l y c h r o n i c s c h i z o p h r e n i cp a l r c n $ r n v e s l r _ ' , , r . r lh ! t h e a u r h o r si n a n o $ e r s l u d y ( R o d e f ' w , n n e r e r a l l , i i ' r : r t e d t h e i . B l o b a l I i f e s a t i s l a c l r o nm a i n l y w i l h r e , r , l r r i r h es u b J e c l i v cer i t e . i a ,i . c . s a t i s f a c t i o nw i t h I i t e d o ' .I H o $ e v e r , $ h , r e a . l h e f i r . l - r d m r l r c J p d r i e n t t. o n i , j c J . dt u s r o n e o r o n l y f e w a s p e c t so f $ e i r l i f e c i r c u m r , n . . i i m p o n a n t f o r a p p r a i s i n gl h € i r q u a l i l y o i l i f e . r h e !!orL. rnent.tl parrenlslook a broader view and included r , , s rL ) ll h e a f o r e m € n t i o n eldi f e d o n a m s i n t h e i r . r i i n g s o f - 1 , ) b ! lb l a s a l i s f a c t i o n .

( , 1 | t r l r c n I S : w o r k , l i v i n g s r t u a l r o n ss. a f e l y a n d l e g . r 1 . d - r . . r r d d r u g a b u s c .T h c p a r r e n t s( p a r r ' c u l a r l ym e n ) , ) i , ] n ! e n o o f i n c o m p l € l ev o c l l i o n a l t r u i n i n g ,a h i 8 h e r f , , . . . r . r g c o f r h e mr r e j o b l e s sl h a n i n t h e g e n e r u l p o p u l a d chrnge r , r n f ) h l d o f l e n l o s l t h e i r J o b so t e x p e r i e n c e a w o r k d u n n g l h e y € a r p r i o r i o h o s pitll !d situation ri r :r w i th lhcir p r o b l e m s a t w o r k a s s o c i a l e d , , n h a d fr. anri , ul ,il,r ' A \mall numbet oi prtienls were homelessb r h , , t , r r . e n r a g ei s d i s p r o p o n i o n a t e lhyi g h c o m p a r e dw ' t h r l r . i ! r h € g e n e r a l p o p u i a l b n . A p p r o x i m a r e l yh a l f o f r l r , , i ! . i q i s h e d i n v a i n t o r a s u b s t a n t i , cr lh a n g er n r h e r a d m i s s i o nD u r d u r i n 8t h € y e a rP r e c e d i n g lr i ! .iiruarjon been involved in i.! lre \anre pe.iod, they had often v i c l i n o r a g g r e s s o rH' a l f o f i r a s a p l r . . r r L v i o l e n c e .b e ha\hish were regular ..un! palients, moreover, mal€ rh. ! ! . r . J n d a m a r k e d l yl o w e r b u t c l i n i c a l l ys t i 1 lr e m a r k a b l e n ' r . r . . r o f r h e m p e r i o d i c a l l ya b u s e da l c o h o l T h e s ec o n d ' t r t , n $ h i c h a r e e s s e n t i a l l yu n f a v o u r a b l cf o r f u r u r es o c i a l Jc., Lrpnrenrhad already evolved before the f;sr hospital

I . donrains of family of origin, social relarions with f,rr..1' and acquaintancesand leisure activities. on the ii, prolre funh€r inro the questionof possiblegenderrelated o1|r haod, appeared al first sighl to pose no problems .LrLcLurrldifferencesin statedsatisfaction,the investrgators Il,,n :, e.. difficulties in these domains were relalively ofarisen in associalion$ith the illness I'eJibn)reda faclor anaiysis (principal componen! analysts ren , porred Io have I c ditTerencesbetween female and male palients with .,rLh \afimax rotation) of satisfaction wiih the specilic re.t,, rr ro health or previous visits lo lhe doctor, aggres_ lrlJ dornains and global life sarisfaction(see Table 6). . o ' si.. ,',countcrs and drug abuseare compa.able to those in l ' r l z { r u a c . n b F d r s c e m e d .p e r s o n J l p ' i \ d r e . lh. '.rieral populalion, with women consuhing a doctor factor' , r,'srrucruralfactors and a social relations nr,r, often. having fewer aggressiveencountersand abuscoincides global life satisfaction O\t'!ll appraisal of . !|d al.oho. le.\ rhanmen. Concem;n! vocd I, " irh (he 'personal factoi'. ti,j,i rrlining. work sirualion, money and living ctrcum Thc $omen and men hardly differ on these dimen .,.ns lhere are slight differences within lhe four lactors strl..-\. the women investigated in this sludy had a more ,. hrrir. however, do not affect the diff€renliation between lJ\,, ,rblc srtualion and canied more responsibilily than r.,.r.r\ The men grouped (heir satisfaction wilh the way th. r tn. Ar rhis Pornt in life, fewer men were rndependent r.i.) -!or on with o$ers togelher with ihe personal factor, rn r r, lreas ,rf work, money and private life The men had ..j1rrlr.(ion wirh leisure aclivities wilh the privarc one ancl lcs. ,r\ponsrbility to cany for others. more and somet'mes , l.a.rion of it with lhe petsonal faclor, lvhereas women d \L.r chanles in their social roles and subjectivel)' exPe, , t l . d b o r h m o r e i n c o n n e c t i o nw i l h t h e i r s o c i a l r e l a l i o n s . ricrr il Nr. stressin connection wilh their different so Ihi drscrete negalive loading of saiisfaclion with work c r r l ' , l e \ . l h e c o m p a r a t i v e l yl e s s f a v o u r a b l es o c i a l c i r ' l e s c r i b e dt n c en in generad ' lrxrLor on the social-relalions faclor demonstraled lbr r r i r . l . f r c c s o f s c h i z o p h r e n im a l r e a d y at tbeir first rh( l..r.uure crn lhus be perceived | lle 'lbjecrs and the less clear loading of female sub p s y c h i a t r i c h o s p i t a l . sit' c o i r r , , . rw i t h a ., .r. srrsfaction with safety might reflecl the" specific clique" bur t , ' r h i s r e a s o n i, t w o u l d e v i d e n l l yb e b e n e f i c i a lt o o f L . r l , o Jor 1 r h e y o u n g m e n ( w h o b e l o D gt o a ' ,:al !.rvice and suppon measures at firsl hospilal ( w h o f.r d r a w t h e i rs u b l e c r i v e l ' . r \ . r c i o b ) a n d o f r h ew o m e n . . i r r c . i s a f e t ym o r e f r o m t h e p r i v a l e a r e a ) .I n a n o v e r a l l {clf .Lon and nol dler the illness has become chronic. A t r - l . d m r l l e om e nd n de \ e n m o r e$ o m e n u e r e i n :.r,sI].'.u!e, however, there are mo.e similarilies th.n d'i_ l r . r r.n..\ in the sructure of satisfaction wrth relpecl to lhe t s \ . 1 , ! I r i c l r e a h e D t d u r i n g l h e y e a r b e f o r e f i r s r a d n l s s n d p r r c t i c i n gp s y c h i a t r i s tssh o u l d 5 r) ir sr,. arnily physiciana , , - d m a l e ' u b F c r ' . T h e ' l . g h r d i r r e r F r r c em , , e d i s p o s aw l aysand mea.s of offer h r l e a t t h e ; r h c r . t .ill b. leen as contingent on gend€r related role aspecls r n : , r l l e r s t .o f h e l p i n gt h e i r p a t i e n t st o o b t a i n s u p p o r t Lhr,. rlr frmily therapy. supporting services in dailv lif€. . l l ' , , i . x n d w i l h l i v i n g s i l u a t i o n sa, n d f i n a n c i a la i d F a m _ Discussion i]) Lr r.tpt could take into account rhe described spccific c o n r e na n d m e n i n r h e i f o w n 1 3 m ' r o l t . , i s c h i z o p h r e n iw I i)i o.Lertive situalion of first-adrnitted schizophren'c To counter.rcrdeveloping soci.rl runril\ ol origin. il\ I n . f r \ i n d p o s s i b l ec l i n i c . r l c o n s e q u e n c e s . , . \ , l m ! ) b e a d \ a n l r g r o u ' l o g i \ e r n o r ei m p o r ,! socral work and offer more work lherapy rn hosI , r c l r l r c a l p r a c l i c ei r i s . a b o v e a l l . i m p o n a n l l h a t t h e r e rin.. ,,. dxlcare lacilities fo. firsl adn1rrledschizophrenjc , ; l r , i ! \ e r y c r i t i c a l l i f e d o n r a i n se v e n a t l r r s l a d m r s s t o n ftlr ijrntn wns af satisfaction

lir p a t i e n l s .T h e e x i s t i n gs o c i a l p r o h l c r r ) sn c t d 1 o b c c o n s t d ' ered as ad!erse factors fof lhe lurrher roru\c oJ the rllncss. n o m a ( e r w h e t h e rl h c y r e s u l l 1 r , ) n l h . c o u r s eo f l h e i l l n e s s p n o r r o f i r s r r d m i s s i o n o r i r L ' I n { l e p e . d e n to i l h e s c h i z o p h r e n i cc o n d i r i o n ,a n d l h c ! \ I ! i u l d b e r e l r c v e da s earty as possible by m€ans of lhe nreir\ure\ mcntroned previ{)usly or other specific measures

T h f p r o c e s so f a p p r a i s aol l l i l a c r r c u m s t . r n c e ! a n d s o m e c o n c l u s i o n sf b r f u r t h e rr e t . r r c h The patients drfficulr circumstancestfe rlso r'flected in t h e i re m o r r o n a € l x p e r i e n c eN. o t u n l i k e c h r o n i c a l l vi l l P e r ' sons, firsFadmifted schizophrenir patic.ts are less satis i i e d w i l h a l l l i f e d o m a i n sa n d w i r l t l i i e i t g e n e . a lt h a nt h e general popularion. The mein value for rhe gkrbal life sat isfaction of rhe female and male sublecls wrs Just below .1,r.e. in the undecidedrange and lo$er rhrn llre mean lift salisfaction generally slated Such l.w vaLue! have thus far been demonslrated neither for lhe gencral Populalron nor for chronic schizophJenicpatients lt may be assumed Ihar they express either the special circumstancesand life cnsis leading lo lhe first tr€ameni irr a Pslchiaric hospi ral, or lhe stress$r'ithwhich the ircatnrent situalion itself is associatedfor many patienis. This finding is remarkable becauseir conlradicts the general beliel that the comparatively low subJeclive quality oi liie of chronic schizo phrenic patients (when compared wirh that of the general popularion) resuits nainly from a grldual deteriorat;on over a long period of lime. The firsl rd ilred Pauentsare mosi dissatisfied wilh th€ir life in ecneml. wirh ther health. work and financial siturtions Their subjective qualry of life is besi in th€ domans ol familv, social relarions and leisure activilies. Contrary to erPecrairons ancl despite lheir objectively more fa!oufrble life circumnances, Ihe first admitted worner wcrc no more satisfied wrth life in general nor with any life donlrin rhdn the men. ln facr, rhey were even less salisfied wrth the (objeclively more favourable) domains of peAonal srfclv and familv Nevedheless,a significanl though qulntiralrvely mrnor re lation of objective life circumstancesro s{tisfaction with rhe specific iife domains can be demonnrated- It is sur p r i s i n g t h a l t h e o v e r a l l d e g . e e o f p s \ c h o p a t h o l o g ya f fected only salisfaction with metrlal herlth bur nol w*n other life domains. However, indrvidu^l aspects of psy_ chopathology, and above all non'spccili. anxious depress i v e s y m p t o m s .d o h , r v ea r e l a r i ( n rl o s d r i s f a c r i o nw i l h a few life areas.Cender'related asp.cts are sho$n !o phy a r c l e i n s u b l e c t i v es a r i s f a c t i o nl .h . u g h o n l ) w r t h f e w l i t e d o m a i n s .T h e r e l a l i o no f o b j e c r i ! ec f : r i ' a o f l i i e c r r c u m s l a n c e st o s a t i s f a c t i o nw i t h s p c . i f i c l i f e d o m a r n s a l s o seems to be gender related.This I|ay indrciLlelial lhe ap_ praisal processesof women and nrin in Lheselife domains drffeI1 W h e n a p p r a i s i n ga l l I i l e c i r c u m s : . 1 r r c et:h, € p a t r e n l s v r e w . u p o n f i r s r h o s p i t a la d m i s s r n . L sc l e a r l ! l i m r l e d r o t h e i r c u r e n t s i l u a t i o n( r n c o n t r a s l o r h e ! r e $ o l c h t o n r c p a r i e n l s l .A l t h o u g h t h e s i m i l a r i t i c !p . e \ t i , l . t h c r ea r e a g a i n

i n d i c a t i o n sl h 3 l l h e p r o c e s so f a p p f u: . r l s c h i r o p h r c n r cw o n e n . r n d n r e n a ' r ( l ! r i L f \ r l \ o b c r s r ' . f a c u l e l ys i c l r n d c h i o n i c p a l i e n l s .l h r \ r ' r r ! r l L r h o r hI h . r a r i n g t o f g l o b a l l i L s a t i s l a c r i o n. L n d: l ' . : ( ) u p r r ! \ o l t h o s eI i l e d o m a i n sw h r c h . r n v r € w o i ( h . r c s u l r ! o l l l c r o r a n a l y s i s .a r e r a l € d f r o n l l h c 5 r m e p t A p f c l r \ e s o n r e c o . . a ) b e d I i L $ nl i o l n r h e s c c l u s i o n s ,a h h o u g hs p e c u l a t i v em .esuhs for funher rcsearch E v e n w i r h a c u l € l yi 1 lp a L i e n t ss.a l r ! l a e r i t nwr r l h s p e c r l i c l i f e d o m a i n s .w h i c h a r e l h e e s s e n t i . lr n d r c r r o r \o i s u b l e c r i l e l i t e q u a l i l y , c a n n o lb e r e d u c e d1 o a r e i l . f l i o n o i c u r r e n r p s y c h o p a r h o l o goyr o b F c t i v e l r i € c r r ' r m \ t a n c e s S i r n i l a r i r i e si n t h e s c o r e so f s u b j ' c L r v cq u r l r r v - o f - l r i e indicarors sometimes seem ro obscure qu'LrLrtive differ e n c e s .T h e a p p r a i s a lp r o c e s s e sf o r s p e L r l r ' l L l e d o m a r n s a n d l i f c r n s e n e r a l .a n d l h e s u b j e c t i ! eg r o u p r n go l l i l e d o m a i n s ,a r e ; o t i d e n l i c a li n s c h i z o p h l c n i c$ o ' n e n a n d m e n The consirucl of global life satisfacrion do'\ nd meln lhe . d m e r h r n g' , d L L , l e l yl l D e ' \ o n \d n l ' l r ' r r ' . p a r r P n r " " n" tor Iu_ W h a r r o l l ; $ ' l l o n l h e s eh y p o l h e l t Jr i ' n ture srud;esis fie realization lhat conrprfinrn5 of the sub iective oualitY of life of differen! groups carlrot be msoe '* itt .ut ieseruations. Comparisons of mcan values of sat isfacrion therefore have onlv limited lilLre !s evidence' and the appraisal processesin different Sroups should be specially investigated A l t h o u s h t h i i s t u d v h a s y i e l d e d c o r s r r u c r i r er e s u h s ' t h e e r o l a n " r r o no l s d r r s l a . l r o n$ r t h r l r " - t " I i l e d o Jl. ed i\ not m d i n ' a c h r e \ e db ) m € a n \ o r I n e \ a r J r n ' possible bccn indced hai it While altosether salisfaatory' rd e;Dlain a relativelv hish Percentlge of the lariance of slob;l lif€ satisfaction bv the examined !3'irhles as com" no8eneir) ; a r e d w r r h o r h e r' r u o i e s .p o " r b r ) d " r ' r ' r L d : e \r o r r r r ' o r d e ' r r a h l $ o u r d b e iirle.,mpl.. rr d broader ba ofobtlinilrg obiectrve with the be conducted of t i(l deterrninants csse n Furlher conclusions sis forvalid ' r - ' r ' r ' r o r d P rl o \ u b j e c r i v eq u J l r l ) o l l r l e s n o J l d b e r r ' d , a ; \ t i l l m o r e r o n c l e t eJ n d s p e c r l r ' r " ' ' ' \ r ' l o L I - c psychiatric care ofdefined krget groups ln\'stigations of comDararive processes such as sLrbleeLr\ecompanson wilh friends a;d acquaintances(which con\titLrreessential "- r"DU Jl'on. 'ee d e t e r m r r d n r \o f . a l r . ' b r r o r I n ( h e P r Glalzer and Zapf 1984) qualitalive apProachcsand process I n ' e n ri n I e a n a l \ . e .m r y U " . o n , - f r . ' ' . l o l J n h e rJ ' I search and clinical care Acl'nosleds(menr\'hF

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."rr' i.i ir'"' '"oi-' r''', on de Pn'n -Kr ' i l' Rnnr r . r - - " " . . ' ' i , i . r . . , * - t " * v o " b r ' \ e r ' ' '' d1 r3ur" '' K' rp' n I l e r n d u \ e r r o e l ' \ r ' J o \ e P r ' Kx l i P r h " oP r r L ' l ' l e r o ' V ' " t . , 1 . " o"."J"t ' i h e B e r l ' n P u b L r rH e i t h R e s e a r c hA i o c r ' 1

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Refelences "B i -e"e; l;o wD A . B r o d s k yC . S t e w l n L O l s o f \ 4 ' i ' ) S l r I h e' c o n c ei p l br( ' ";",. " ".",-., q, 'r"r o r re ' o r - ' 1$ R "."...i.""'.*"t 'i.-.i\eGn"'r 5 n d "d "J. i .- -,'..,pp,- t'" ' -*'m ' . P r e \ \ \ r u Y o r r .P Pl ' 1 5 - 1 6 6

2)! E . ! . r f \ T . S e L r r nw ( 1 9 9 2 ) A r b c n s l o s eu n d i h r e C c s u n d h e i r , M c ( a r r 5 . l . ! J i n B , E ! a t \ C l( 1 9 8 9 )E v a l u i r , o i o , a c o m ' n u n r r ] L p r{lre L.!n!zer!n!l!scr. Verofienrlichungsrerhedcr For r i 0 x r , ) . n rp r o S r r mf o t y o u n ! r i l u i l s c h i 2 o p h r c n r cI sC l i n P s y \ f u r ! ! \ ! r u ! r n e G c s u n d h c r r s n s i k eunn d P r l i ! e n l i o n s p o L i r i k . \\ rssrn\rhnrrszenrrunrBerlin fiir So2ralforschune M e l r r e r F Y l r ) 9 l i D r m e n s i o i s o l o u i c o m e * l l h c l o T a p r n eB r J F o L V C ! l ! . r . S , H i l 1 c rM . l n g h i l l e r i C l l 9 9 l ) D i eD e h o s p r r . P \ y . r l . i r N l a , 0l S u p p l l: a G 5 . l , . R r n n e z L R ( 1 9 9 0 )E i e c t s o f l!'.er!nB de: psychiahschen KrankenhausesSa. Cleme.re 'n M e l u e r H Y . t s u n ! r r 5 , B a s t a nB \ , d . ( | g P s J c h r a lPr r a x l 8 : 3 0 - 3 5 si! ntrr:r1r\ ol tlozapine lrealmem on lhc qualrty oi lite of C r b b r n : l S . B u i i c rJ P ( l 9 t ! 7 ) Q u a h r o f l i f e f o i " n e w l o n e s t a y chio.i. schuofhrenic p,nens HosP Conrdunily Psychratry r \ \ r r i ' i r r c i , ; p a l e n a T h e e l f e . t s o t n o v i n g r o a h o s r c l .B r . l P\v.hink! li l: l:17 354 M u c ' . r K l . D . . 8 1 ! s M S . B e l l c c kA S . M o r i s o n R L ( 1 9 9 1 ) A s CLrr;, r W. ZJFI W ( 1984) Lebensquihiit in der Eundesrepublik sssnreirr .i .ndurinC dencn and negalle svnrpton subllpes in ()tjclir!r l-(bcnrbedrngunAenund subjekrivesWohlbcinden s h i z o t ) t d r ' J S c h r z o p hBr u l l 1 ? 5 6 5 5 l l 2 a.!nfd\. Frrrilun NoelLc N.nnrdn F, (1993) AllensbacherJahrbuch der Denrosko_ H r i r . , . l r \ D W , H a o ' o nT E . C a . p e n t eW r T ( 1 9 8 4 )T h e q u a l t y o f . 1 . l ( ) 8 + . l 9 t r 2 S a u r .M u n r c h lLrr s.rlc rn insrtumenr for nring rhe schizophrenic deficil O l i i e r i ' ' J { l 9 9 l , l T h e s € r a l c a r e d i r e c l i v e :d e v e l o p m e not l a \ \ i d n n r . S . h i z o p h rA u U l 0 : 3 8 8 - 1 9 8 qualry ol lre lrofile for use in commonrlv sewi.es tbr rhe Horiii J.n (. P..be S. Isemann M. Kaiser w (1997) Lebensquali n r e n u l l l r l l S o r w o . * S o cS c i R e v 3 : 5 - 4 5 rrLl.tselurlnL*e und Behandlungsbewenunglanazenhosprtali- O l r l e r J P Ji l 9 9 L b ) T h € q u a l i t y o f l i f e i n c o m m u n n yc a r e :a c o n rr!:1., F.nicrx€nr Teil ll der Berline. Enrhospitalisie.ungs siderrlo. ol horrel vards pronpted by a su cv of resde.t'al ! r r i n - P \ l c h L l r rP r a x2 4 : 2 2 1 - 2 2 6 f r . i l i ! c r I n : Y o u n e R ( e d ) R e s i d e n r a l n e e . lt so r s e v e r e l vd l s Hollnun K. Kriser W, lsemann M, Priebe S (1998) Wie leriinaL,ledpry.hi!rn. p;tienc: lhe casefor hospilal hosLels HMsO. dtn sich di. Lebensqualll.t kngzeilhospiralisiencr psychraI ondorl pp 5l- 60 ti\.h.. I,rrie en nach rhrer E.tlassun8 j. die Cemejnde ce Olivc. JPJ Nlohatrad H (1992) The quality of lile in rhe chroni' s u ' n l h e i s w e $ n6 0 : 2 3 2 - 2 1 8 cllly inrnrally ill: a comparisonof Public. pnva€ and volun HuxLr't P. wamer R (1992) Cae nataeeoent, quality of life and l c . y r c \ i d e n l i aFl r o v i s i o n sB. . J S o c W o r k 2 2 r 3 9 1 4 0 4 s!hs!!cr n wltlr seflrc€s ot long tem psychiatnc patients. OIi'eaJ, H,xley P, B.idges K. Mohamad H (1996) Qualitv oflile tlrF CoJnmunilyPsychiatry.ll:799j02 ard menraLlr.ahbsenices Roudedge.London Ka,n': \\. Priebe S, Hoffmann K. kemann M (1996) Subjekr,ve Pink.cy AA. Gerbcr GJ, Lafare HG (1991) Quality of liie aher psvchix(1. rehabililation.Acb PsycbrarrScand El:86 91 L,:L.ensquahrt bei Patienten nn chonischer Scbizophrcnie. N r a e n n r z t6 l : 5 7 2 5 8 2 P.i;he s aii!\te6 T. Heinze M- Hoifmann C..lbkel A (1995) Sub Kars., W. Prebe S. Bar W, Hoffmann K, Isemann M, R6der iekdLe Ev;l!alionskn!erien in der Psy.hlatrischenversorgung: \\ rind L U. Huxley P (1997) Profiles of subjecri!e quahy of Erhebungst,cth.den ft. Fo6chlng und Praxis. PsychiatrP.ax lilr ii schLzothrenicin- and ourparientsamptes.Psychialr Res 2: 140 11.1 Priebe S, Kiser w. Huxley P (1996) Lebensqualitiiials Planune! Laud C I l99l ai Lebensquah?itund Selbsrkonzeptbei ch.onisch und Evr ualionskrirenumpsychiarischerversorgung Cesu.d' p\].h,\ch Kranke.. Paper presentedar L DeutscherPsy.hoto h e r s r e r n 5 5 l s o n d e r h e f ltl : 8 G 9 0 gcfrae. Dresden.19 22 September1991 P.ieb. S. Kai\e. w. Huxley PJ, Rdde.wanner UU. Rudolf H (1998, Do diiferenr subjective evaluation cnreria reflecr dis_ Lluer li ( 1991b)The quaLly of life issuein chronic menral illness. I'rllr pre\entedat the 5rh Europed liealrh PsycholoCySdiety r i n . l . o . r t r u c L s ?J N e r y M e n t D i s 1 8 6 : 1 8 5 3 9 2 C.nieren.e, Psychology and Pronotion of Eealrh. Lausanne. Rbdcr Wrnrer LU. Pnebe S (1995) SchizoPhrenieund tfbe.n Aspekle Fonschr Neurol Pst21, l0 Augu$ l99l qurlitir Seschlecxlsspezifische Lr!er (j rl99l) E.eebnisseder Lebensqualir;itsfoBchunE b€i chro, c h L ! t r6 . :: 1 9 r 4 0 l n lrh pstchisch Kranken Psychiaf P.ax 20:88-90 Rdder \,\'r.ne. LU. Oliver JPJ. P.iebe S (1997) Does quahv ot Ler,E.,1 AF il98la) The well-berng ol chronic me.ral parienrs. liic d,lt.r rn schrzophrenicwonfn and men? An empincal {f. i (jen Ps).hralry 40:369 373 s t l d ! I J S o c J ' s y c h i a t r4y3 : i 2 9 - l 4 l Le|n.,i AF (1981b) Tlle elfects olpsychialic synptoms on qual- Simpson aJ Ily.le CE. FaragherEB (1989) Tbe chronicallv men ir) .f li[ :$c$m€ms anong the chronically menlatly ill. Eval rall\, 'lL n .onrm0nity facilnies A slud! oi quahv of life. Br J P r , : r x P L a n6 : 1 4 3 - 1 5 1 P s \ c b r , r r vI 5 . 1 : i 7 - € 2 Le|dr.rr Ali. ',osndenteS. Hawker F (1986) The quaLty ol lite of Starisrisch.' Bundesanl (1994) DabnrcPofl 1994. Bundesze.hale ch,,!!c nre.ralparie.ts in a srarehospitaland communrry rcsi fijr pol rrichc Bildung. Bonn. Gemany d . r . e s H o s pC o m n u n n yP s y c h i a i r y3 7 : 9 0 1 - 9 0 1 Srein LJ. Tr,t \4,\ (1980) Alremalive to nenulhospital trea'nenr' Le\ lf ,\J. Holan TP. Bucosky CM (1990) Quahr of tife rn chron I Conrep(ulL sr.del, trearmenl Program atu1clini.'l evalua,c.,il! menrallr.'iU parrentsrn day lreareent. Psychol Med 20: ti.f Ar.h C.n hy.hiatry l7rl92 397 M r C i i r ] r ! l . N e l s o nG ( 1 9 9 1 ) A ne v a l u a l o no l s u p p o n i v eh o u s i o g 1. ru,Je.r and fomef psychiaric parie.rs. Hosp Communny Pr.:h rtrv 42:1254 1256