Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modelling analysis.

OBJECTIVE: The Substance Abuse and Mental Health Services Administration (SAMHSA) National Consensus Statement on Mental Health Recovery proposed 10 recovery components as guiding principles for fostering recovery among people with severe mental illness. Although researchers have recognized a close association between patient-oriented recovery and health-related quality of life (HRQOL), the relation between the recovery components and patients' self-reported HRQOL is still unknown. The purpose of the present study was therefore to use structural equation modelling to predict HRQOL of schizophrenia outpatients from the recovery components proposed by SAMHSA. METHODS: The recovery status of 201 outpatients with schizophrenia, schizophreniform, or schizoaffective disorder was measured using 12 variables that indicate the outcome of 10 recovery components. Canonical correlation analysis was applied to screen variables that are highly correlated with HRQOL. Valid variables were then used to build a structural model that predicted individuals' HRQOL as indicated by the World Health Organization Quality of Life Measure Abbreviated (WHOQOL-BREF (HK)). RESULTS: The bestfit model was able to explain 80.7% of the variance in WHOQOL-BREF outcome. The model demonstrated significant direct and indirect effects of five recovery components on HRQOL. The effect of psychosocial symptoms on HRQOL was highest (total beta = -0.64), followed by sense of personal agency (total beta = 0.58), sense of optimism (total beta = 0.54), perceived support (total beta = 0.47), and internal stigma (total beta = -0.42). CONCLUSION: The recovery components proposed by the SAMHSA consensus statement provided a useful framework to explain HRQOL of outpatients with schizophrenia. The present model indicated a moderate to large effect of five major recovery components on HRQOL. It showed that patients' perceptions of support, optimism, and personal agency were influenced by psychosocial symptoms and internal stigma. This empirical study supported the use of recovery principles, such as resilience building or mastery-based intervention to improve the QOL of community dwellers with schizophrenia.

Operationalization of the SAMHSA model of recovery: a quality of life perspective.

PURPOSE: To test empirically the Substance Abuse and Mental Health Services Administration (SAMHSA) recovery model. METHODS: Two hundred and four attendants aged 18-60, with schizophrenia spectrum disorder, from two participating outpatient clinics were interviewed with a number of inventories, including health-related quality of life measure (WHOQOL-BREF (HK)). Canonical correlation analysis was performed on two sets of variables (SAMHSA recovery components and QoL domain scores). RESULTS: There were significant correlations between most recovery components proposed in the SAMHSA recovery statement and the health-related quality of life measure. Age, duration of untreated psychosis, the degree of social support, the interaction of singlehood and the number of confidants, engagement in competitive careers, and the duration of participation in community support services were all found to be important predictors. CONCLUSIONS: The SAMHSA consensus statement appeared to contain valid concepts for Chinese subjects. It presented new challenges for psychiatric rehabilitation and reminded the policy makers that there is much more psychiatric rehabilitation can achieve beyond symptom control and patient management. It also demonstrated that resolve and the commitment of resources to combat stigma, develop resilience, and foster patient empowerment were very much needed in Hong Kong and perhaps in Asia and elsewhere.

Intent to remarry among Chinese elderly widowers: an oasis or an abyss?

To investigate the intent to remarry and the predictors for such intent with psychosocial variables, this study used male interviewers to interview 180 Chinese elderly widowers. A structured questionnaire on singlehood and intent to remarry, which developed out of a pilot in-depth focus-group study, was used. Data were analyzed with nonparametric tests and logistic regression. The intent to remarry was predicted by younger age, inability to meet sexual needs, and dissatisfaction with widowhood. A total of 40% of these widowers who wanted a partner considered finding one from Mainland China. The sex-related findings were very different from previous studies on Chinese men. They showed that there should be professional support to help them to better adjust to late-life marriage. In addition, the study uncovered the need to expand the scope and enhance the sensitivity of current general practitioners and geriatric services to address issues beyond medical concerns.

Effectiveness of a mobile smoking cessation service in reaching elderly smokers and predictors of quitting.

BACKGROUND: Different smoking cessation programmes have been developed in the last decade but utilization by the elderly is low. We evaluated a pilot mobile smoking cessation service for the Chinese elderly in Hong Kong and identified predictors of quitting. METHODS: The Mobile Smoking Cessation Programme (MSCP) targeted elderly smokers (aged 60 or above) and provided service in a place that was convenient to the elderly. Trained counsellors provided individual counselling and 4 week's free supply of nicotine replacement therapy (NRT). Follow up was arranged at 1 month by face-to-face and at 3 and 6 months by telephone plus urinary cotinine validation. A structured record sheet was used for data collection. The service was evaluated in terms of process, outcome and cost. RESULTS: 102 governmental and non-governmental social service units and private residential homes for the elderly participated in the MSCP. We held 90 health talks with 3266 elderly (1140 smokers and 2126 non-smokers) attended. Of the 1140 smokers, 365 (32%) received intensive smoking cessation service. By intention-to-treat, the validated 7 day point prevalence quit rate was 20.3% (95% confidence interval: 16.2%-24.8%). Smoking less than 11 cigarettes per day and being adherent to NRT for 4 weeks or more were significant predictors of quitting. The average cost per contact was US$54 (smokers only); per smoker with counselling: US$168; per self-reported quitter: US$594; and per cotinine validated quitter: US$827. CONCLUSION: This mobile smoking cessation programme was acceptable to elderly Chinese smokers, with quit rate comparable to other comprehensive programmes in the West. A mobile clinic is a promising model to reach the elderly and probably other hard to reach smokers.

What Chinese adolescents think about quitting smoking: a qualitative study.

The aim of this study was to investigate the attitudes of Chinese adolescents toward smoking, giving up smoking, and smoking cessation programs presently available. The study was a qualitative study carried out in 2002 by focus groups of 32 male secondary school students in Hong Kong who were either current smokers or had recently given up smoking. Subjects were students (grades 8-10) attending two full-day secondary schools in Hong Kong. Participants did not feel the need to make any serious psychological preparation for quitting. They underestimated the addictive nature of cigarette smoking and felt that they could choose to quit smoking at any time with little difficulty. Several barriers to quitting were reported, including boredom, peer influence, the urge to smoke, school work pressure, the wish to do something with their hands, difficulty in concentrating, and the ready availability of free cigarettes from peers. Those who had attempted to quit smoking (26/32) reported that peer influence and boredom were the main reasons why they started smoking and insisted that willpower and determination could have helped them in their quitting attempt. Participants were unanimous that pressure or encouragement from teachers, parents, or girlfriends did not help them to stay off cigarettes. Most (24/32) of the current smokers knew that smoking cessation services were available in Hong Kong, only 50% (12/24) of those who knew had made use of such services. None of the participants were able to identify any effective way of quitting smoking, though some suggested that the best practical measure was to avoid friends who smoked. The study suggests that attempts to persuade young people to quit smoking might benefit if they were framed to address issues such as the strong influence of their peers, the ease with which tobacco products can be obtained, the casual attitudes of young people toward smoking cessation, the perceived pros and cons of quitting, and (given that underage smoking is frowned upon by many parents and teachers) the need to respect confidentiality when offering support.

Establishment and evaluation of a smoking cessation clinic in Hong Kong: a model for the future service provider.

BACKGROUND: In the West, the effectiveness of smoking cessation programmes is well established. Smoking cessation programmes in the East are rare. We evaluated a pilot smoking cessation health centre (SCHC) of the Hong Kong Council on Smoking and Health (COSH). METHODS: The clinic operated 3 days a week from 6 to 9 pm. Smokers were recruited mainly by low cost publicity. Trained counsellors provided individual counselling and a 1 week free supply of nicotine replacement therapy (NRT). The programme was evaluated in terms of process, outcome and cost. RESULTS: During August 2000 to January 2002, 2212 calls were received through the clinic hotline and 1203 smokers attended the clinic. Eight hundred and forty-one were successfully followed up at 12 months. Based on intention-to-treat analysis, the 7 day point prevalence quit rate at 12 months (not smoking any cigarette during the past 7 days at the 12 month follow-up) was 27 per cent (95 per cent confidence interval, CI 25-30 per cent). The average cost per quitter was USD 339 (USD 440 including NRT cost for a 1 week free supply). Other benefits included training of healthcare workers and medical students, organization of seminars, health talks and self-help groups, and promotion of research and training. CONCLUSION: This first evaluation of a clinic-based smoking cessation service in Asia showed that the service was acceptable to Chinese smokers. The quit rate in this pilot part-time clinic is comparable to those of full-time and better funded clinics in the West. A part-time smoking cessation clinic is a promising model for piloting smoking cessation services in the East.