Life Events and Hassles, Quality of Life, and Psychopathology among People Suffering from a Severe Mental Illness

Over the last 30 years, objective and subjective quality of life indicators have been used as outcome measures for programs intended to treat persons suffering from a severe mental illness. The current research focuses on measures of subjective and objective quality of life as potential mediating factors between life events and hassles and psychological functioning. The sample consists of 695 individuals admitted to one of 12 psychiatric facilities in Suffolk County New York, between 1989 and 1995. Follow-up interviews were conducted at 6-, 24- and 48-month intervals after baseline. For the current analysis, we focus on the 6-month survey data. Participants were given a consensus diagnosis of 1) schizophrenia, including schizoaffective and schizophreniform disorders; (2) bipolar disorder with psychotic features; (3) major depressive disorder with psychotic features; and (4) other DSM-IV diagnoses. We assess objective and subjective quality of life for the four diagnostic groups, and correlate them with measures of functioning (e.g., SAN, SAP, Hamilton Depression, BPRS, and GHQ). Results show that both subjective and objective quality of life measures are highly correlated with assessments of functioning, controlling for diagnosis, life events, and hassles. Participants with a diagnosis of schizophrenia have lower objective quality of life, whereas individuals with major depression have lower subjective quality of life. Finally, we assess the possible mediation of quality of life between life events and functioning using structural equation modeling. We suggest that helping the severely mentally to address unresolved life events may both improve their quality of life and functioning.