East Asian Arch Psychiatry 2014;24:43-50

Original Article

Quality of Life in People with Mental Illness

in Non-residential Community Mental Health
Services in Hong Kong

P Ng, JY Pan, P Lam, A Leung

A Leung

Abstract
Objective: To identify the subjective quality of life in people with chronic mental health problems who
were in non-residential community mental health services, and to investigate factors affecting their
quality of life after the illness.
Methods: People with mental illness (n = 105) were recruited. They were assessed with the self-rated
Hong Kong Chinese version of the World Health Organization Quality of Life Brief questionnaire.
Results: The participants had lower total quality-of-life and the 4 domain scores of the questionnaire
than the general population. They were particularly dissatisfied with their financial situation. Duration
of illness was positively correlated with subjective quality-of-life variables while age at onset of the
mental illness was negatively correlated with subjective quality of life, in particular the physical health,
psychological health, and environmental domains.
Conclusion: This study highlighted the significance of duration and age at onset of illness in subjective
quality of life of people with mental illness. A longitudinal study to test the causal relationships between
these factors and the quality of life in people with mental illness is recommended.
Key words: Community mental health services; Hong Kong; Mental disorders; Quality of life; Schizophrenia

105

Prof. Petrus Ng, PhD, PsyD, RSW, Department of Social Work, Hong Kong
Baptist University, Hong Kong SAR, China.
Dr Jia-Yan Pan, PhD, RSW, Department of Social Work, Hong Kong Baptist
University, Hong Kong SAR, China.
Dr Paul Lam, PhD, PsyD, Occupational Therapist, Richmond Fellowship of
Hong Kong, Hong Kong SAR, China.
Dr Alex Leung, PhD, California School of Professional Psychology, Alliant
International University, San Francisco, California, United States.
Address for correspondence: Prof. Petrus Ng, Department of Social Work,
Hong Kong Baptist University, Hong Kong SAR, China.
Tel: (852) 3411 5110; Fax: (852) 3411 7145; email: petrus@hkbu.edu.hk
Submitted: 11 July 2013; Accepted: 11 September 2013

2014 Hong Kong College of Psychiatrists

Introduction
Over the past few decades, there has been a change in the
focus of mental health services from eradication of the
disease to the enhancement of quality of life (QOL) of
individuals living in the community with mental illness.
There has also been a shift in the treatment paradigm
from symptom management and relapse prevention to
promotion of QOL.1 With this shift, more emphasis is now
placed on QOL as an outcome measure for treatments and
programmes, as well as for determining resource allocations
43

P Ng, JY Pan, P Lam, et al

in community psychiatric services.2

The concept of QOL has become increasingly popular
as an assessment factor in people with chronic mental
health problems. However, it still remains ambiguous and
controversial.3 In a basic sense, QOL refers to a means
for quantifying ones overall standard of wellbeing.4
It incorporates all aspects of an individuals existence,
including his / her success in obtaining certain expected
or desired circumstances, states, or conditions.5 For people
with chronic mental health problems, it is generally accepted
that QOL is a multidimensional concept that relates to
satisfaction with various aspects of life, including physical,
social, and mental health functioning, as well as general
health perception.6

Objective Versus Subjective Quality of Life

Quality of life comprises both objective and subjective
elements.7 The objective elements of QOL include aspects
external to a persons experiential life, such as general
health and functional and socio-economic status. These
can be assessed objectively in a number of ways: (a) with
biological, material, social, behavioural, and psychological
indicators; (b) by objectively assessing daily activities and
functioning8; (c) by measuring health status and material
resources9; (d) with external life situations, such as social
and economic indicators, behavioural competence, and
role performance measures10; and (e) with biological
factors.4 Chan and Yu3 also added the factors of attainment
of resources and opportunities as an objective QOL
measure.

Although objective data can help assess the health
and functional status of an individual, these are considered
inaccurate reflections of an individuals wellbeing.11 It is
argued that measures of QOL assessment should include
a significant subjective component as well.12 The term
subjective implies that the evaluation of QOL depends on
the individual who is living that life. It should be based on
an individuals point of view,13 self-rating,12 or interview.
Thus, any assessment of ones objective life condition
has to take account into the individuals scale of value.
Subjective QOL has become increasingly popular as an
outcome measure to evaluate health services in clinical
practice.14

In general, the subjective QOL experience for any
individual is dynamic and subject to change. Thus, it may
vary with time and with a number of other personal and
environmental factors.15 These factors may include: (a)
age16; (b) gender; (c) ethnicity; (d) culture17; (e) presence of
illness18 and the type of illness; (f) financial status; and (g)
societal influence.19

Quality of life is considered a multidimensional
concept,8 consisting of a number of different dimensions.19
Some researchers have proposed that QOL be divided into
at least 3 major dimensions: physical, psychological, and
social.19 Other researchers have proposed 5 categories for
the assessment of QOL: physical health, mental health,
44

work, social life, and home and family.20 Within these

different proposed models for assessing QOL, there are
overlapping dimensions. A more widely used version of
a 4-dimensional categorisation of QOL was suggested by
the World Health Organization (WHO) in 199821 which
comprised physical health, psychological health, social
relationships, and environmental dimensions.

Efforts to measure QOL were first undertaken in the
US in 1997.22 The measurement of QOL was first applied
in medical practice and was used to prove that cancer
treatment could improve patients sense of wellbeing apart
from improving their survival rate.23 In 1985, researchers in
the UK working in the fields of social and health care started
to adopt QOL measures for their clients.24 Over the past few
decades, various measures of QOL have been developed4
with a complex collection of items, scales, domains, and
instruments.25

Quality of life in People with Mental Illness

Different factors have been reported with regard to the
subjective QOL of people with chronic mental illness.
However, due to the many differences in the study designs,
including selection and size of the samples, characteristics
of the settings, and assessment procedures and instruments
used, there are no conclusive findings regarding the impact
of socio-demographic factors on QOL.14 Nonetheless, a
correlation has been found between QOL of individuals
and clinical factors, such as severity of psychopathology,
duration of illness, and number of hospitalisations.26 In
some studies, participants with mental health problems
were found to be most dissatisfied in the areas of finance
and personal safety, work, contacts with others, money,
and mental health.27 The length of illness and duration of
hospitalisation were also reported to be associated with
subjective QOL.12 Nevertheless, the determinants of QOL
of Chinese people with chronic mental illness might be
different as Chinese culture places more emphasis on the
Confucius values of group harmony and interpersonal
connection. While there are many publications on subjective
QOL in mental illness, those findings might not be relevant
in Chinese societies, particularly in the domain of selfrated social support28 of persons with mental illness who
are living independently in the community and receiving
Community Mental Health Care (CMHC) services in Hong
Kong. The CMHC is a new programme set up in 2005 to
provide support services for people with mental illness after
getting discharged from hospitals or halfway houses, and
who are deemed to be in a stable mental condition. These
services, which are primarily delivered by social workers
from non-governmental organisation (NGO), include:
(a) providing counselling and developing an individual
rehabilitation plan; (b) providing training in social and
communication skills, work skills, and daily living skills
such as budgeting and home management; (c) facilitating
sheltered work / job placement; and (d) making referrals to
other welfare services.29
East Asian Arch Psychiatry 2014, Vol 24, No.2

Quality of Life in People with Mental Illness

Methods
Participants and Procedures

This study attempted to understand the QOL profile of

people with chronic mental illness living in the community
and receiving CMHC services, and identify factors that
affect their QOL. It was hypothesised that demographic
and clinical variables would affect their QOL. Convenience
sampling was used to recruit the participants.30 The
participants had to meet the following inclusion criteria: (a)
diagnoses of mental disorders31; (b) having been discharged
from psychiatric hospitals or halfway houses and were
living in the community; (c) aged between 15 and 70 years;
and (d) were receiving CMHC services. The exclusion
criteria for the participants included: (a) subjects with a
history of violence, or with priority follow-up status (those
in need of intensive medical treatment); and (b) patients
with co-morbid diagnoses of substance abuse, organic brain
syndromes, or mental retardation. This study focused on
QOL of people who were not in acute stage of mental illness.
There are 2 major reasons for excluding people with a history
of violence or priority follow-up. First, these patients were
usually required to attend special services, such as special
halfway houses, or need intensive medical care. Many of
them were not available for this study. Second, such people
usually required more interventions from the mental health
professionals in relation to a history of violence or priority
follow-up when compared with other patients with mental
illness. They may, therefore, have different rehabilitation
experiences that may affect their QOL as compared with
those with mental illness without a history of violence.

The study protocol was approved by the research
committee of the Hong Kong Baptist University. The study
proposal was also sent to the directors of NGOs and was
approved by their research committees. After obtaining
oral consents from the potential participants and with the
assistance from the social workers of the NGOs, individuals
who met the inclusion criteria were contacted via telephone
and invited to participate in the study. The face-to-face
interviews were conducted in the interview rooms of the
NGOs.

Instruments

Each participant completed 2 questionnaires in face-to-face

interview: the Hong Kong Chinese version of the World
Health Organization Quality of Life Brief questionnaire
(WHOQOL-BREF-HK) and a socio-demographic
questionnaire.

The WHOQOL-BREF-HK is a Hong Kong Chinese
version of the WHOQOL-BREF.31 It was developed in
1998 through the collaboration of the Hospital Authority
of Hong Kong and the WHO. The WHOQOL-BREF-HK
is used to measure the QOL in the subjective sense, and
covers 4 major domains or subscales with respect to QOL:
physical health (DOM1), psychological health (DOM2),
social relationships (DOM3), and environment (DOM4).
Two additional cultural-specific questions were also added
East Asian Arch Psychiatry 2014, Vol 24, No.2

to the questionnaire, including question 27 (To what

extent do you feel other people accept you?) and question
28 (How easy is it for you to eat the food you desire?).
The WHOQOL-BREF-HK has demonstrated satisfactory
psychometric properties with Cronbachs alphas of 0.77
(DOM1), 0.78 (DOM2), 0.59 (DOM3), and 0.76 (DOM4).
The test-retest reliability ranged between 0.80 and 0.91.32

The socio-demographic questionnaire included
questions on gender, employment status (employed or
unemployed), marital status (single, married, divorced,
separated), age, education level, length of mental illness,
onset of mental illness, and number of hospitalisations.
With respect to employment status, vocational rehabilitation
services, such as day hospital, sheltered workshop, or
supported employment were considered equivalent to being
employed.

Results
A total of 105 individuals were recruited for the study.
These individuals were predominantly Cantonese-speaking
Chinese adults who were receiving CMHC services from 2
NGOs in Hong Kong. Among these, 46 (44%) were male and
59 (56%) were female. The majority of participants (71%)
were living with their families and the rest (30%) were
living alone or with friends in apartments or compassionate
housing, a form of housing assistance provided by the
Housing Authority of Hong Kong. The mean age of the
participants was 40 years (range, 18-70 years). The mean
( standard deviation) age of male participants were slightly
younger (39.4 12.1 years) than the female participants
(40.0 12.5 years). The majority of the participants (n = 54;
51%) were in the age-group of 36 to 55 years. Also, 73% of
the participants in this study had had their mental disorder
for a long period of time, with a mean of 10.7 years.

About half (49%) of the participants were single, and
60% (n = 63) had received a secondary level education. The
proportion of participants who had received post-secondary
or university education prior to the onset of mental illness
(12%) was significantly lower than that in the general
population (25%).33 Very few of the participants (6%)
were illiterate. Of note, many of these illiterate participants
were older ( 55 years) and might have been immigrants
from Mainland China who did not have any opportunity to
receive an education.

Less than half of the participants (43%) were
employed in the conventional job market. Using the special
criteria of employment for this study, such as engagement in
different sheltered work or assisted employments like day
hospital, sheltered workshop, and supported employment,
the majority of the participants (85%) could be considered
as being employed at the time of the study. Only 15% of
participants were unemployed or unattached to occupation
training services.

The majority (60%) of the participants reported to
have schizophrenia. Of the remaining participants, 31%
reported to have depression, 2% had personality disorders,
45

P Ng, JY Pan, P Lam, et al

and 7% reported to have other disorders. All participants

had been hospitalised at least once; 74% (n = 78) reported
only 1 hospital admission before the time of the study. Their
mean duration of illness was 10.7 10.3 years, whereas the
duration in males was slightly longer (11.5 9.9 years) than
the females (10.1 10.7 years; p = 0.05).

The majority (70%) of participants reported having
the illness for < 10 years; 18% reported having the illness
for 10 to 20 years, 11% reported having the illness for >
20 years, and another participant (1%) had the illness for
< 1 year. The age at onset of the illness ranged from 11 to
66 years, with a mean of 29.6 12.1 years. The mean age
at onset of illness in male participants (28.4 12.9 years)
was lower than that of the female participants (30.6 11.4
years; p = 0.05). The duration of illness was closely related
to the chronicity and severity of the illness, a factor that
could affect the QOL of the participants.

Data from the WHOQOL-BREF-HK were analysed
for each of the 4 QOL domains to give the following
Cronbachs alphas: DOM1 (0.43), DOM2 (0.70), DOM3
(0.63), and DOM4 (0.78). The mean ratings of the 4
domains were: DOM1 (12.7 2.4), DOM2 (11.5 3.2),
DOM3 (12.2 2.7), and DOM4 (12.3 2.5).

Table 1 shows the findings from one-way analysis of
variance (ANOVA) comparing the types of mental illnesses
with the QOL of participants. There were significant

differences among the participants based on their diagnoses

and the total QOL (F = 4.44, p = 0.01). Furthermore, there
were significant differences between the mean scores of
subjects with different types of mental illnesses (DOM1 [F
= 4.94, p < 0.001], DOM2 [F = 4.84, p < 0.001], and DOM4
[F = 2.79, p = 0.04]).

Correlational Analysis

The correlations between socio-demographic and clinical

variables and QOL are shown in Table 2. The duration of
illness was found to have a significant positive correlation
with total QOL (r = 0.25, p = 0.02) and in particular with the
3 domains of DOM1 (r = 0.20, p = 0.04), DOM2 (r = 0.27,
p = 0.01), and DOM4 (r = 0.28, p = 0.01).

The age at onset of illness was significantly correlated
with total QOL (r = 0.24, p = 0.02) as well as the 3 domains:
DOM1 (r = 0.25, p = 0.01), DOM2 (r = 0.23, p = 0.02),
and DOM4 (r = 0.25, p = 0.01).

The one-way ANOVA indicated that there was
significant difference between type of mental illness and the
participants overall QOL (F = 4.44, p = 0.01). Tukeys HSD
test was used to test for group differences, and it was found
that the outcome of participants within the schizophrenia
and psychotic disorder group was different from that in
the mood disorder group (p = 0.01). Participants with
schizophrenia and psychotic disorders had significantly

Table 1. Analysis of variance for quality of life by type of illness.

Score

WHOQOL-BREF-HK total score

Between groups
Within groups
Total
Physical health (DOM1)
Between groups
Within groups
Total

Psychological health (DOM2)

Between groups
Within groups
Total
Social relationships (DOM3)
Between groups
Within groups
Total
Environment (DOM4)
Between groups
Within groups
Total

df

SS

MS

p Value

3
90
93

2395.90
16184.95
18580.85

798.64
179.83

4.44

0.01

3
100
103

78.16
526.97
605.13

26.05
5.27

4.94

< 0.001

3
100
103

129.45
892.02
1021.47

43.15
8.92

4.84

< 0.001

3
100
103

30.46
717.98
748.44

10.16
7.18

1.41

0.24

3
100
103

51.24
612.14
663.38

17.08
6.12

2.79

0.04

Abbreviations: df = degrees of freedom; SS = sums of squares; MS = mean squares; WHOQOL-BREF-HK = The Hong Kong Chinese
version of the World Health Organization Quality of Life Brief questionnaire.
46

East Asian Arch Psychiatry 2014, Vol 24, No.2

Quality of Life in People with Mental Illness

better QOL than participants with mood disorders (Table 3).

The one-way ANOVA was conducted with each
domain of the QOL. There was significant difference in the
mean scores between types of mental disorders for DOM1
(F = 4.94, p = 0.003) and DOM2 (F = 4.84, p = 0.003).
Post-hoc tests were conducted to test the group differences
for the 2 domains. For DOM1, significant difference was
found between the schizophrenia / psychotic disorder group
and mood disorder group (p = 0.05), the mean score of the

former was higher (13.0 2.2) than the latter group (11.7
2.4). Moreover, the DOM1 score in personality disorder
group was significantly lower (9.3 4.6) than the other
disorder group (14.3 2.5; p = 0.04). Regarding DOM2
scores, significant difference was only found between the
schizophrenia / psychotic disorder group (12.1 2.9) and
the mood disorder group (10.3 3.0; p = 0.04).

A stepwise regression on the 4 domains of QOL
showed that duration of illness and age at onset accounted

Table 2. Correlations between socio-demographic and clinical variables and quality of life.
Characteristics

Age Age Duration WHOQOL- Physical Psychological Social Environment

of of illness BREF-HK health
health
relationonset
total score
ships

Age

Age of onset

Duration of illness

0.67*
-

0.41*

0.39

WHOQOL-BREF-HK total
score
Physical health (DOM1)

-0.08
-0.24

-0.10

0.25
-

-0.25

0.20
0.89*
-

Psychological health (DOM2)

-0.01

0.15

-0.23

-0.06

0.01

-0.25*

0.27*

0.15

0.69*

0.87*

0.79*

0.49*

0.68*

0.59*

0.90

Social relationships (DOM3)

0.57*

Environment (DOM4)

0.28*

0.68*
-

Abbreviation: WHOQOL-BREF-HK = The Hong Kong Chinese version of the World Health Organization Quality of Life Brief
questionnaire.
*
p < 0.01 (2-tailed).

p < 0.05 (2-tailed).

Table 3. Tukeys post-hoc analysis pairwise comparison of participants types of illness with quality of life.
Score

Item 1

Item 2

WHOQOL-BREF-HK
total score

Schizophrenia and psychotic disorder Mood disorder

Psychological health

Schizophrenia and psychotic disorder Mood disorder

Physical health

Mean
difference*

Schizophrenia and psychotic disorder Mood disorder

Personality disorder
Other

SE

p Value

8.06

3.01

0.04

1.30
-5.04

0.50
1.84

0.05
0.04

1.77

0.65

0.04

Abbreviations: WHOQOL-BREF-HK = The Hong Kong Chinese version of the World Health Organization Quality of Life Brief
questionnaire; SE = standard error.
*
Mean difference is equal to item 1 minus item 2.

Table 4. Stepwise multiple regression analysis.*

Dependent valuable

WHOQOL-BREF-HK total score

Physical health

Psychological health

Adjusted R2

Predictor

0.06

Duration of illness

0.09

Duration of illness

0.05

Onset age

p Value

-0.24

0.02

0.24
0.29

0.02

0.003

Abbreviation: WHOQOL-BREF-HK = The Hong Kong Chinese version of the World Health Organization Quality of Life Brief
questionnaire.
*
Only statistically significant predictors are reported.
East Asian Arch Psychiatry 2014, Vol 24, No.2

47

P Ng, JY Pan, P Lam, et al

for a small portion of variance in QOL (Table 4). Duration

of illness accounted for only 6% of the variance in the total
QOL (F = 5.77, p = 0.02) and only 5% of the variance in
physical health (F = 6.08, p = 0.02). In addition, duration
of illness only accounted for only 9% of the variance in
psychological health (F = 9.31, p = 0.003).

Discussion
We found a higher proportion of unmarried male (65%) in
this study. In Hong Kong, many men with chronic mental
illness, who have few financial and social abilities and
resources, find it difficult than women to find a life partner.
Many men with mental illness are forced by society to remain
single because they cannot financially support a family.
However, women with a mental illness in Hong Kong have
better prognosis than men with mental illness,34 and one
could argue that better prognosis will likely increase ones
chances to marry. The employment rate of the participants
was highly consistent with the findings from another study
on hospital and community-based care for patients with
chronic schizophrenia in Hong Kong.1

Many of the participants in this study worked in
sheltered workshops or in assisted employment with
relatively low pay. This finding that people with chronic
mental health problems live on the margin of society
has been corroborated from studies conducted in other
countries35 as well as in Hong Kong.3 For many people with
chronic mental illness working in assisted employment,
the earnings are not sufficient to cover their subsistence
needs. Thus, many live in poverty and cannot afford social
activities.3

In general, the participants had a lower level of total
QOL as well as lower scores on each of the 4 domains than
the general population and psychiatric patients of Hong
Kong.36 These findings, which are consistent with data from
studies in other countries37 and local studies,3,14 suggested
that people with chronic mental illness are generally less
satisfied with their QOL than the general population.

With regard to the areas of dissatisfaction, the
participants in this study were most dissatisfied with their
financial situation, possibly as a result of their low-paying
jobs or limited general financial resources. Their financial
hardships may well have affected their physical and social
lives and impacted their overall enjoyment of life and
attitude towards the meaning of life.

Another dissatisfaction reported was pain and
discomfort, and this may possibly be related to the
side-effects of antipsychotic medications. Subjects on
antipsychotic medication often need to tolerate pain and
discomfort associated with these medications over a long
period of time. These side-effects which may include
extrapyramidal, anticholinergic, antiadrenergic, tardive
dyskinesia, and antihistaminergic symptoms negatively
influence their subjective QOL.26

There was no conclusion drawn regarding the effect
of family support on QOL. However, family could also
48

have a negative effect on individuals with mental illnesses

because of a negative emotional climate in the family. The
quality of relationships within the family could influence an
individuals social and emotional functions. The quality of
family relationships was negatively influenced by the length
of mental illness of the patient. In this study, the mean length
of illness of the participants was 10.7 years, indicating that
many families of the participants had been coping with the
illness for a long period of time. Consequently, they may
have become weary of the caregiving tasks.

With regard to clinical variables, participants with
schizophrenia or psychotic disorders were found to have
significantly higher QOL, particularly in physical and
psychological domains than those with mood disorders and
other disorders. Although the symptoms of schizophrenia,
such as hallucinations and paranoid ideas, could affect
ones sense of security and various aspects of daily living
and social functioning, people with depressed mood might
report a relatively lower subjective QOL score as they
are affected by their pessimistic view about themselves.
However, the causal association between type of illness
and QOL could not be inferred from this study, and, thus,
deserves further investigation.

Stepwise regression showed that duration of
illness predicted the total QOL and psychological health.
Participants with longer duration of illness were found
to have a significantly higher total QOL score, and in
particular, psychological health. Quality of life is often
related to the prognosis of the illness, and long duration
of illness is often regarded to have negative effects on the
prognosis. Thus, our finding is in contrast with the widely
accepted view that the longer the duration, the poorer the
prognosis of the illness.31 Perhaps this discrepancy might be
due to an inherent qualitative difference between the QOL
of a patient and the prognosis of the illness.

In this study, QOL refers to subjective experience and
how an individual evaluates his / her own ability to cope
with living with the illness. This subjective attitude may be
completely unrelated to the objective evaluation of prognosis
of illness by a psychiatrist. Individuals with chronic mental
health problems, regardless of the prognosis, might maintain
a subjectively high QOL. Moreover, some might become
more content with their lives after suffering from the illness
for many years. Early in the illness, the effects of both the
positive and negative symptoms may have a strong impact
on the individuals social functioning. However, over time,
they may adapt to their symptoms as well as living with the
illness. In this study, many of the participants might have
ceased to be defined by their illness, seldom refer to it, and
do not show any particular dissatisfaction with their lives.

Age at onset of the illness is another clinical variable
correlated with physical health, and stepwise regression
showed that the age at onset was predictive of physical health.
Improved physical health was significantly correlated with
early onset of mental illness. However, age at onset was
the least significant contributing factor relating to chronic
mental health problems. This finding was inconsistent with
East Asian Arch Psychiatry 2014, Vol 24, No.2

Quality of Life in People with Mental Illness

data from previous studies1,3 which showed that people

with chronic mental health problems living independently
in their community were most satisfied with their physical
health and, in particular, their mobility.

This study also has some limitations. First, the sample
size of the study was quite small. Second, the researchers had
to adopt a convenience sampling based on the availability
of the participants as they were invited voluntarily for the
interview. Thus, the sampling was not exactly random in
nature.

The third limitation was related to the participants
of this study. This study excluded those with a history of
violent behaviour or priority follow-up status. Thus, the
study might not be truly representative of the people with
mental illnesses in Hong Kong.

Finally, this study was a cross-sectional analysis to
evaluate the QOL of people with chronic mental illness
living in the community. It did not test the causal linkage
between different socio-demographic and clinical factors
and QOL in patients whose treatments changed and who
underwent rehabilitation. There is a need to develop
longitudinal studies to test the causal relationships between
these factors and the QOL of patients who are recovering.

Implications for Services and Future Research

The concept of QOL has become an important consideration

in the rehabilitation of patients, as it is regarded as an
important indicator of good health status and positive
rehabilitation.6 Is it important to find new ways to enhance
the QOL of people with chronic mental illness?

The ability to obtain gainful employment with
reasonable pay is necessary for all individuals, including
those with mental illness, as it paves the way for other life
pleasures and the ability to live a normal life. In view of the
relatively high proportion of people with mental illness who
attained secondary education level, it would be helpful for
mental health professionals to become more knowledgeable
about skill-based vocational training programmes to
prepare their patients for gainful employment in the future,
independent of social services. However, those who cannot
be gainfully employed could get help from mental health
professionals to develop meaning of life from non-paid
activities, such as leisure and voluntary work.

In this study, clinical factors, such as duration of illness
and age of onset, played a more important role in QOL than
socio-demographic factors. Despite this, the clinical factors
explained only 5% to 9% of the variance. Clearly, there
must be other predicting factors for QOL, such as the social
network of the patient, leisure, and spiritual support that
deserve further investigation.

In practice, there is a need to identify ways to enhance
social and supportive network for people with mental
illness. Mental health professionals could organise selfhelp or support groups to assist their patients in developing
a good social support network to sustain their living in
the community. Family members also need assistance
to help them cope with caring for their family members
East Asian Arch Psychiatry 2014, Vol 24, No.2

with mental illnesses. Family education in conjunction

with a mutual supportive network should be organised to
foster supportive attitudes and enhance a pro-social family
attitude as part of rehabilitation programmes for people
with mental illnesses.

References
1. Chan GW, Ungvari GS, Shek DT, Leung Dagger JJ. Hospital and
community-based care for patients with chronic schizophrenia in Hong
Kong quality of life and its correlates. Soc Psychiatry Psychiatr
Epidemiol 2003;34:196-203.
2. Awad AG, Voruganti LN. Intervention research in psychosis: issues
related to the assessment of quality of life. Schizophr Bull 2000;26:55764.
3. Chan S, Yu IW. Quality of life of clients with schizophrenia. J Adv
Nurs 2004;45:72-83.
4. Blenkiron P, Hammill CA. What determines patients satisfaction
with their mental health care and quality of life? Postgrad Med J
2003;79:337-40.
5. Wu CF, Mak WW, Wan DL. Quality of life of mental health consumers
in Hong Kong: analysis of service perceptions. Qual Life Res
2007;16:31-40.
6. Chan SW, Chiu HF, Chien WT, Thompson DR, Lam L. Quality of
life in Chinese elderly people with depression. Int J Geriatr Psychiatry
2006;21:312-8.
7. Tomotake M. Quality of life and its predictors in people with
schizophrenia. J Med Invest 2011;58:167-74.
8. Young KW. Factors predicting overall life satisfaction for people with
long-term mental illness. Int J Psychosoc Rehabil 2004;9:23-35.
9. Heydari J, Khani S, Shahhosseini Z. Health-related quality of life
of elderly living in nursing home and homes in a district of Iran:
implications for policy makers. Indian J Sci Technology 2012;5:2782-7.
10. Dimens ES, Dahlf CG, Jern SC, Wiklund IK. Defining quality of life
in medicine. Scand J Prim Health Care Suppl 1990;1:7-10.
11. Kusel Y, Laugharne R, Perrington S, McKendrick J, Stephenson
D, Stockton-Henderson J, et al. Measurement of quality of life in
schizophrenia: a comparison of two scales. Soc Psychiatry Psychiatr
Epidemiol 2007;42:819-23.
12. Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Quality of
life of Chinese schizophrenia outpatients in Hong Kong: relationship to
sociodemographic factors and symptomatology. Aust N Z J Psychiatry
2007;41:442-9.
13. Katschnig H. Quality of life in mental disorders: challenges for
research and clinical practice. World Psychiatry 2006;5:139-45.
14. Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS. Subjective
quality of life in outpatients with schizophrenia in Hong Kong and
Beijing: relationship to socio-demographic and clinical factors. Qual
Life Res 2008;17:27-36.
15. Taylor RM, Gibson F, Franck LS. A concept analysis of health-related
quality of life in young people with chronic illness. J Clin Nurs
2008;17:1823-33.
16. Diefenbach GJ, Tolin DF, Gilliam CM. Impairments in life quality
among clients in geriatric home care: associations with depressive and
anxiety symptoms. Int J Geriatr Psychiatry 2012;27:828-35.
17. King CR. Overview of quality of life and controversial issues. In:
King CR, Hinds PS, editors. Quality of life: from nursing and patient
perspectives. 2nd ed. Sudbury, MA: Jones and Bartlett Publishers;
2003: 29-44.
18. Bowling A. Measuring disease: a review of disease-specific quality
of life measurement scales. 2nd ed. Buckingham, Philadelphia: Open
University Press; 2001.
19. The World Health Organization Quality of Life assessment
(WHOQOL): position paper from the World Health Organization. Soc
Sci Med 1995;41:1403-9.
20. Olatunji BO, Cisler JM, Tolin DF. Quality of life in the anxiety
disorders: a meta-analytic review. Clin Psychol Rev 2007;27:572-81.

49

P Ng, JY Pan, P Lam, et al

21. Development of the World Health Organization WHOQOL-BREF
quality of life assessment. The WHOQOL Group. Psychol Med
1998;28:551-8.
22. Awad AG, Voruganti LN. Measuring quality of life in patients with
schizophrenia: an update. Pharmacoeconomics 2012;30:183-95.
23. Mendlowicz MV, Stein MB. Quality of life in individual with anxiety
disorders. Am J Psychiatry 2000;157:669-82.
24. Selby P. Measurement of the quality of life after cancer treatment. Br J
Hosp Med 1985;33:266-71.
25. Hewitt J. Critical evaluation of the use of research tools in evaluating
quality of life for people with schizophrenia. Int J Ment Health Nurs
2007;16:2-14.
26. Yamauchi K, Aki H, Tomotake M, Iga J, Numata S, Motoki I, et al.
Predictors of subjective and objective quality of life in outpatients with
schizophrenia. Psychiatry Clin Neurosci 2008;62:404-11.
27. Skantze K, Malm U, Dencker SJ, May PR, Corrigan P. Comparison of
quality of life with standard of living in schizophrenic out-patients. Br
J Psychiatry 1992;161:797-801.
28. Hong Kong Project Team. Hong Kong Chinese Version World Health
Organization Quality of Life Measure abbreviated version. Hong
Kong Hospital Authority; 1997.
29. Social Welfare Department, Hong Kong SAR Government. Aftercare
service for discharges of halfway houses. Handbook on rehabilitation

50

services. Hong Kong: Social Welfare Department; 2004.

30. Huck SW. Reading statistics and research. 3rd ed. New York:
Longman; 2000.
31. American Psychiatric Association Division of Research. Psychiatric
research report; 2005.
32. Leung KF, Wong WW, Tay MS, Chu MM, Ng SS. Development
and validation of the interview version of the Hong Kong Chinese
WHOQOL-BREF. Qual Life Res 2005;14:1413-9.
33. Census and Statistics Department, Hong Kong SAR Government.
Hong Kong Census 2010.
34. Lo WH, Lo T. A ten-year follow-up study of Chinese schizophrenics in
Hong Kong. Br J Psychiatry 1977;131:63-6.
35. Mas-Expsito L, Amador-Campos JA, Gmez-Benito J, Lalucat-Jo
L; Research Group on Severe Mental Disorder. The World Health
Organization Quality of Life Scale Brief version: a validation study in
patients with schizophrenia. Qual Life Res 2011;20:1079-89.
36. Hong Kong Chinese version of the World Health Organization Quality
of Life Measure, abbreviated version. Hong Kong: Hospital Authority,
Hong Kong SAR Government; 1997.
37. Ritsner M, Modai I, Endicott J, Rivkin O, Nechamkin Y, Barak P,
et al. Differences in quality of life domains and psychopathologic
and psychosocial factors in psychiatric patients. J Clin Psychiatry
2000;61:880-9.

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