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Living with Serious Mental Illness: the Role of Personal Loss in Recovery and Quality of Life

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Living with Serious Mental Illness: the Role of Personal Loss in Recovery and Quality of Life LIVING WITH SERIOUS MENTAL ILLNESS: THE ROLE OF PERSONAL LOSS IN RECOVERY AND QUALITY OF LIFE Danielle Nicole Potokar A Dissertation Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of: DOCTOR OF PHILOSOPHY December 2008 Committee: Catherine Stein, Ph.D., Advisor Alexander Goberman, Ph.D., Graduate Faculty Representative Dryw Dworsky, Ph.D. Jennifer Gillespie, Ph.D. © 2008 Danielle Nicole Potokar All Rights Reserved iii ABSTRACT Catherine Stein, Ph.D., Advisor As the mental health field is moving towards a recovery based model of serious mental illness for both conceptualization and treatment, further research into the factors which may impact recovery and quality of life are needed. Currently, there are no studies which examine how personal loss due to mental illness or cognitive insight relate to factors such as quality of life and recovery. The purpose of the present study was to investigate the relative contribution of demographic factors, self-reports of psychiatric symptoms, and individual factors of cognitive insight and personal loss in describing variation in reports of quality of life and recovery from mental illness. It was hypothesized that cognitive insight and personal loss would each predict a significant portion of the variance in scores of quality of life and recovery from mental illness. A sample of 65 veterans with serious mental illness from the Minneapolis Veterans Affairs Medical Center completed structured interviews regarding psychiatric symptomotology and quality of life and completed questionnaires related to demographics, cognitive insight, personal loss due to mental illness, and recovery. Thirteen significant hierarchical regression models emerged. Results indicate that personal loss is the strongest predictor of facets of quality of life and recovery from serious mental illness, explaining incremental variance in ten of the regression models. Cognitive insight, however, was found to only explain incremental variance in one aspect of quality of life. Additionally, psychiatric symptoms and demographic variables such as diagnosis and living arrangement were also found to be significant predictors of aspects of quality of life and recovery. These findings highlight the importance of personal loss due to mental illness as a construct for further investigation and which has powerful implications for clinical intervention. Additionally, these results suggest the need for further examination of iv cognitive insight. The implications of these findings for future research and clinical practice, as well as the limitations of the study are discussed. v To the woman who taught me, mostly through her own actions, the importance of kindness, compassion, and humility And To the man who inspired me with his own drive and intellectual curiosity… Mom and Dad this is dedicated to you. vi ACKNOWLEDGMENTS I would first like to thank my advisor, Dr. Catherine Stein, who took me under her wing when I was an orphaned graduate student. She inspired me with her passion for working with people with serious mental illness, and without this exposure, I may never have found my true calling. Thank you. I also thank my dedicated committee members, Drs. Dryw Dworsky, Jennifer Gillespie, and Alex Goberman for their feedback on this project. To my many colleagues at the Minneapolis VA Medical Center, thank you for your referrals, support, and encouragement throughout this process. Special thanks to my VA mentor, Dr. Bridget Hegeman for her input on this project and her commitment to the recovery of people with SMI. I would also like to thank my friends, especially “The VA Girls”, for fun times and much needed breaks from the writing. Special thanks to my good friend and stats guru, Dr. Melissa Cohen, for her statistical guidance and her humor. To my dear friend, Meghan Kahn, thank you for reminding me how much I have learned on this journey when I started to get discouraged. We have come so far and I wouldn’t trade my experiences over these long years for anything! To my family, thank you for always believing in me and supporting me every step of the way. I am proud to be a member of this family, where love and understanding really are the guiding principles. To my husband, John, words cannot express what you mean to me. Thank you for your patience and dedication to me throughout this very long journey. I promised you it would work out in the end, and here we are. Now we can start the next chapter of our lives together. I love you. Finally, I thank the veterans who participated in this study. I am truly awestruck by your courage and your perseverance. You have taught me more about myself and the personal strength of people than I could have learned anywhere else. You have also taught me that recovery is not just a theoretical concept but a reality. I feel truly honored to serve you. vii TABLE OF CONTENTS Page INTRODUCTION ..........................................................................................................................1 CHAPTER I: SERIOUS MENTAL ILLNESS: AN OVERVIEW…………………………….....3 Definitions............................................................................................................................3 Recovery in Serious Mental Illness ...................................................................................5 Approaches to Recovery......................................................................................................7 “Objective” Scientific Definitions...........................................................................7 “Subjective” Consumer Definitions.........................................................................9 Recovery and the Present Study…………………………………………………………13 CHAPTER II: THE STUDY OF QUALITY OF LIFE: AN OVERVIEW……………………...15 Definitions......................................................................................................................... 15 Objective Indicators of Quality of Life..................................................................16 Subjective Indicators of Quality of Life................................................................16 Measuring Quality of Life ................................................................................................17 Quality of Life and Serious Mental Illness .......................................................................20 Psychopathology and Quality of Life....................................................................22 Protective Factors...................................................................................................23 Medication Side-effects.........................................................................................24 Insight....................................................................................................................24 Recovery................................................................................................................27 Quality of Life and the Present Study................................................................................28 CHAPTER III: THE STUDY OF PERSONAL LOSS: AN OVERVIEW ………….……….....32 Definitions………………………………………………………………………………..32 viii Personal Loss and Serious Mental Illness .........................................................................33 Personal Loss and Present Study.......................................................................................35 CHAPTER IV: SUMMARY & CRITIQUE...…………………………………………….…….38 Present Study.....................................................................................................................40 CHAPTER V: METHODS............................................................................................................41 Recruitment of Participants...........................................................................................….41 Participant Characteristics............................................................................................….41 Procedure...........................................................................................................................42 Measures ...........................................................................................................................43 Beck Cognitive Insight Scale (BCIS)……………………………………………43 Brief Psychiatric Rating Scale (BPRS), Expanded Version……………………..44 Demographics Questionnaire ................................................................................44 Personal Loss due to Mental Illness Scale (PLMI)……………………………....44 Quality of Life Interview (QOLI)..........................................................................45 Recovery Assessment Scale (RAS).......................................................................46 CHAPTER VI: RESULTS.............................................................................................................47 Analytic Procedures......................................................................................................….47 Descriptives........................................................................................................................47 Cognitive Insight…………………………………………………………………48 Personal Loss……………….................................................................................48 Quality of Life……………………………………………………………………49 Recovery………………………............................................................................50 Analysis of Variance
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