EFFECT OF RELIGION ON THE QUALITY OF LIFE OF SCHIZOPHRENICS IN KINSHASA. [Original Research]
Kaswa. KJ , MD1, Mampunza MS, PhD1, Yassa P, PhD2, NGOMA M, PhD1, Human D, MD3
[emedpub – Psychiatry and Mental Health: Vol 1:3] [Date of Publication: 07.12.2013]
ISSN 2231-6019

July 12, 2013 at 12:28 AM

Correspondence : Dr Jean KASIAMA KASWA

University of Kinshasa, Department of Psychiatry CNPP,  Kinshasa, DRCONGO.

Contact : 243 99 71 36 894, E-mail : doctakaswak@gmail.com, Web  site: http://kaswa.blog.com,

www.scibd.com/doctakaswa

RESUME:

Contexte. De nombreux patients s’appuient sur leurs ressources spirituelles pour faire face à leur maladie. Les schizophrènes semblent très religieux en RDC. L’étude consiste à faire une enquête sur l’évaluation de la qualité de vie des schizophrènes dans le domaine de la religion au C.N.P.P. en vue d’améliorer leur prise en charge et la qualité de soins.

Objectif. Connaitre la qualité de vie des schizophrènes dans le domaine de la spiritualité pour une meilleure prise en charge.

Méthode. Dans une étude clinique ouverte avec 3 schizophrènes, nous allons   évaluer la qualité de vie des schizophrènes dans le domaine de la religion à l’aide de l’échelle EQVS. Ce nombre étant insuffisant, pour plus de précision, nous allons recourir aux données de l’échelle WHOQOL-26 d’une étude sur 432 sujets afin de mieux faire la comparaison.

Résultats. Dans le domaine de la religion et de tout ce qui a aspect aux croyances, les deux échelles se rapprochent avec 77% pour l’EQVS, malgré le petit nombre et 76,69% pour le WHOQOL-26 alors que la qualité de vie dans sa globalité est mauvaise (au tour de 60%). Dans le domaine de vie “Religion”, une proportion de 65% des schizophrènes a, au moins, une bonne qualité de vie (plus de 75%).

Conclusion. Si les schizophrènes n’ont pas une bonne qualité de vie, dans le domaine de la religion, cependant, il n’y a pas de déficit ; la qualité de vie pour la plupart d’entre eux est bonne. Il est donc souhaitable, dans la démarche thérapeutique, d’intégrer la dimension spirituelle et de faire l’évaluation de la qualité de vie par rapport à la religion pour améliorer la qualité des soins.

ABSTRACT

Context. Many patients lean on their spiritual resources to face their illness. The schizophrenics seem very religious in DR Congo. The study consists of an investigation on the assessment of the quality of life of the schizophrenics in the domain of religion in order to improve their coping and the quality of care.

Objective. To determine the quality of life of schizophrenics using religion/spirituality for a better coping.

Methods. In a clinical study conducted on 3 schizophrenics, the quality of life  was validated using the religion with the help of the EQVS scale. This study used small number of patients, but it also used database of WHOQOL-26 of 432 subjects in order to support this study.

Results. Using the effect of religion and everything that is associated with beliefs, the two scales come closer;  77% for the EQVS, and 76,7% for the WHOQOL-26. However, the quality of life in its totality was bad (60%). With the effect of religion, 65% of the schizophrenics had a good quality of life.

Conclusion. It is desirable to integrate the dimension of religion with the therapeutics to improve the quality of care.

INTRODUCTION:

The schizophrenics feel enormous difficulties to return to their community because of their precarious situation and the devastating effects of their illness (1). Because of the stigma associated to this illness, the families accept them with difficulty. Hence, many call on their religious resources in order to face their illness (2). Often they resort to religion and spirituality that not only influences their relative decisions to the treatment but also to become evolutionary (3). The quality of life (QL) of these patients is not good. It touches a good part of the world’s population, all disconcerted races, and even the Democratic Republic of Congo is not an exception.  This illness stays heterogeneous, marked by a clinical polymorphism, a prognosis classically reserved, with an evolution often synonymous of chronicity. So the character potentially showing a deficit of the evolution classifies this affection among the invalidating psychiatric unrests (1).

The physicians do not perform systematic investigations for patients with schizophrenia, essentially due to the lack of information and tools of assessment. To undertake an assessment of this original dimension of banal appearance that is in general the daily life, the English-speaking methodologists, suggest various synthetic indicators under the generic term of “quality of life” (4). The goal is to provide help to the therapeutic decision, to appreciate the response/effect of therapeutics, and to value the quality of care and handling of schizophrenics (Table 1).

To determine the value of religion towards the quality of life of schizophrenics, a study was conducted at our psychiatric services in the Center Psyco-Pathological Neuro of Kinshasa (CNPP). The subjective QL constitutes an essential dimension of the psychic handicap (5). The interest, in psychiatry, for QL of patients affected with chronic pathologies is bound historically to the development of the psychosocial rehabilitation techniques.

Table 1: Correspondence of Score/Réponse/QL/Percentage

Score Answer Quality of life Percentage
0 Ever Bad 0%
1 Rarely Enough pain 25%
2 Sometimes Good enough 50%
3 Often Good 75%
4 Still Excellent 100%

PATIENTS AND METHODS:

The quality of life study was undertaken on three patients by internees in December, 2010 at the Neuro-Psycho-Pathological Center of Kinshasa. Three patients are insufficient for this study. So we were obliged to resort to data of a survey of the assessment of the QL among 432 subjects with the WHOQOL-26 scale for comparison. For these 3 cases we used an auto-questionnaire (EQVS), in way of validation that consists of 44 items left in 11 domains of life domains: 1.Health, 2.Symptômes psychic, 3.Esteem of oneself / well-being, 4.Relation of the family, 5.Rapports in social and in love, 6.Loisirs / creativeness, 7.Participation in the communal life / productivity,  8.Religion, 9.Financial situation, 10. Conditions of nbso online casino life, and 11. Autonomy.

The use of EQVS in clinic permits to get profiles of the subject’s quality of life. Every domain treats to four items, each having four modes of answers (6). The questionnaire resorts to a conventional segmentation of the daily life and the topic values the importance that every dimension has for it and its degree of present satisfaction in every domain. The appreciation of satisfaction and the importance of the domain is considered for the topic in question and produces for every patient a profile of scores by each domain. For our study, only the domain of the religion interests us. The items of this domain are: D8. RELIGION

Items:

D8.1 I believe in God.

D8.2 I read the Bible, the Koran, God”s Speech.

D8.3 I go to the cult / to the Mass.

D8.4 The prayer brings me something in my life.

To every answer a very specific judgment value, Score, quality of life and percentage is obtained.

Procedure. We conducted an open clinical study; the intervening party (the researcher) and the patient knew what was going to be done and also the merit and the progress of the investigation. After their consent, the participants were asked to read the questionnaire and to tick the answer only one time for every question. The time of the beginning and the end was noted in order to value the necessary time put by the patient for the assessment (6).

Evaluation

While adding all answers of the questionnaire, the middle score corresponds to the level of the life quality in the domain of “ Religion .” The ratings of 0-74 are ‘negative answers, rarely, sometimes) and indicate bad quality of life; the ratings of 75-100 (often, always) correspond to a casino good quality of life (Table I).

RESULTS:

The three patients in the study were admitted 1-2 times in CNPP wards. Their last admission lasted between 2-4 weeks. Their self-assessment (EQVS) lasted for 3-5 minutes. Table 2 presents the scores of each item of Domain 8 (Figures 1-2).

Table 2: Scores by item for every patient.

Items Patient 1 Patient 2 Patient 3
D8.1 100% 75% 100%
D8.2 100% 0% 75%
D8.3 75% 25% 100%
D8.4 100% 75% 100%

Figure 1 : Score of patients

Figure 2 : Average score by items.

The results of database WHOQOL-26 on 432 patients is presented in Table 3.  Among the 26 items of WHOQOL-26, most items scored <75% indicating bad quality of life. However, item 6.26 i.e beliefs and personal convictions had the score of 76.7% indicating good quality of life (Table 4).

Table 3: WHOQOL-26 : Median score of global QV and domains

QV D1 D2 D3 D4 D5 D6
N 432 432 432 438 432 432 432
6 6 6 6 6 6 6
Average 60,86 74,20 65,35 73,26 71,33 63,09 54,53
Median 63,00 83,00 66,00 33,00 75,00 66,00 55,00
Standard deviation 12,98 20,89 21,70 29,03 22,37 19,97 20,48
Minimum 11 8 8 6 6 16 0
Maximum 99 100 100 100 100 100 100

Table 4: WHOQOL-26 : Average Score by each item.

N Average Standard deviation Mistake standard average
11 432 75,23 26,49 1,27
12 432 72,92 25,06 1,21
13 432 75,00 31,59 1,52
2.4 432 78,01 24,26 1,17
2.5 432 52,08 33,22 1,60
2.6 432 67,82 33,55 1,61
3.7 432 74,54 31,21 1,50
3.8 432 67,36 32,03 1,54
3.9 432 69,91 29,25 1,41
3.10 432 81,25 23,63 1,14
4.11 432 81,25 28,52 1,37
4.12 432 77,78 30,72 1,48
4.13 432 61,81 34,48 1,66
4.14 432 65,05 32,48 1,56
5.15 432 73,84 28,57 1,37
5.16 432 77,31 29,60 1,42
5.17 432 38,89 39,62 1,91
6.18 432 37,04 39,79 1,91
6.19 432 71,93 32,32 1,56
6.20 432 39,24 39,35 1,89
6.21 432 70,60 32,33 1,56
6.22 432 71,49 37,36 1,80
6.24 432 38,37 33,40 1,61
6.25 432 50,98 35,53 1,71
6.26 432 76,69 28,19 1,36

DISCUSSION:

This study was conducted at the pavilion 3 of the service of psychiatry of the Center Pathological Neuro-Psycho of Kinshasa. Among the patients confined to the pavilion 3 of the CNPP, three cases suffering from schizophrenia were recruited. The technique used for collection of data was the auto assessment (EQVS). The condition required was the stability of patients because any disruptions of the cognitive faculties could interfere in the assessment of their quality of life (QL).

With the EQVS scale, patients 1 and 3, had better level of QL probably because they integrated “Religion ”dimension better in their treatment, leading to a better psychological restoration. With regard to the question “ Do you believe in God ” (D8.1) and “ My prayer brings me something in life ” (D8.4), their score is high because persons who are sick, poor and miserable, get comfort from faith in God. For patient 2 with regard to the D.8.3 item, “You go to the cultural gatherings / in the Mass”, score was 25%, and D.8.2 “ You read the Bible, the Koran, God”s Speech,’ the score was 0%. Notwithstanding this, patient 2 had low scores for every other item possibly because of his low belief in religion and therefore, took longer (4 weeks) to stabilize.

With the WHOQOL-26 scale, and the database of 432 schizophrenics, most of 26 items had score of <75% indicating bad quality of life, except of the item 6.26, (beliefs and personal convictions) that had the score of 76.7% indicating good quality of life. Beyond that, other scores indicated bad quality of life in its totality.

In the domain of the religion and everything that is connected with beliefs, the two scales, namely EQVS and WHOQOL-26, both came closer to scores of 77%. In our another publication on assessment and improvement of quality of life of schizophrenics by psycho-education (accepted), at least 65% of the schizophrenics had good quality of life in the domain of religion. By comparison, religion in another study had positive effects on 71% of the cases and the negative effects on 29% (3). For some, religion is the basis for psychological restoration; for others it is the source of suffering and despair.

Numerous studies demonstrated positive effects between the religion and the physical and mental health. In a study of Borras et al (6), 82% of the patients had a religious affiliation: to Catholic or Protestant churches (52%), to evangelical or Pentecostal churches (9%), to other big religions (Judaism, Islam, Buddhism (9%), and to minority religious movements (12%). Eighteen percent of the patients are without religious affiliation. The spiritual beliefs of most patients are not pathological (74%); some don”t have any spiritual belief (12%), whereas others present spiritual beliefs mixed with their positive psychotic symptoms (14%). For close to the half of the patients, the religion holds a central place in their life. The patients lean extensively on the religion to face their difficulties (5). For 14% of the patients, the religion is source of suffering and despair (picture of oneself negative) (5).

To measure the quality of life of the chronic psychotic patients, several scales have been developed among which the one achieved by A. Lehman, in “ Quality of Life Interview ” (7), by Oliver and collaborators in “ Lancashire Quality of Life Profile »(8) and the one (EQVS) that Kaswa and colleagues are using in the CNPP in “ Assessment and the improvement of the quality of life of the schizophrenics by the psycho education” (9). Yet, in the literature, a lot of questionnaires exist concerning the religion and the spiritual strategies to face the illness among psychotic patients, however, none is validated (10-11).

Finally, the choice of the study is important for two reasons :one, the theoretical and scientific interest, because the study puts, at the disposal of the psychiatrists, a referential setting for their research, notably for those bound to the field of schizophrenia and the religion; two, the convenient interest, because conclusions and the recommendations will influence the practices to improve the management of schizophrenia.

CONCLUSION AND RECOMMENDATION:

We conclude from the study that if the domains of daily life do not offer good quality of life to the schizophrenics, yet,  in the domain of religion, however, there is no deficit . The subjective quality of life for most patients remained good. Unfortunately, this subject has remained less studied and is not systematically valued by the psychiatrists. It is therefore desirable in the therapeutic field to integrate the religious/spiritual dimension and to make assessment of quality of life in relation to the religion so as to improve the quality of management.

REFERENCES:

  1. Kaswa K.J., Mapunza M.S., Kinsala Y.B.S. –Santé reproductive et santé mentale. Kinshasa, République Démocratique du Congo, septembre 2007, pp. 6-7.
  2. Mohr S. et coll.-Les rôles de la religion et de la spiritualité pour faire face à la schizophrénie et se rétablir. Congrès Colloque William James, Lausanne, Suisse, mai 2006.
  3. Mohr S. Borras L. Gillieron C.  Brandt P.-Y. Huguelet P. - Spiritualité, pratiques religieuses et schizophrénie : mise au point pour le praticien. Revue Médicale Suisse N° 79 publiée le 2006.
  4. Zannotti M., Pringuey D. A method for quality of life assessment in psychiatry: the subjective quality of life analysis. Quality of life News Letter,1992.
  5. Prouteau Antoinette – Qualité de vie des personnes souffrant de schizophrénie : une étude en vie quotidienne Revue Médicale Suisse, 2006.
  6. Borras L. et al. Spirituality and religious practices in outpatients with schizophrenia or schizo-affective disorders and their clinicians. Psychiatric service, Geneva, Switzerland, 2006; 57:366-72.
  7. Lehman A.F. Well-being of chronic mental patients: assessing their quality of life Arch. Gen. Psychiatry 1983, 40, 369-373.
  8. American Psychiatric Association. –Diagnostic and Statistical Manual of mental disorders: DSM-IV. 4th edition Washington: American Psychiatric Association, 1994.
  9. Kaswa K.J., Mapunza M.S., Aworth A., Odimba B.F.K. –Mise en forme d’une échelle d’évaluation de la qualité de vie du schizophrène au CNPP. Lusaka, Zambie, octobre 2007, 6 pages.
  10. Heinrichs D.W., Hanlon T.E., Carpenter W.T. The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenic. Bull. 1984, 10, 388-398.
  11. WHO-Report from the meeting on the assessment of quality of life in health care. World Health Organization, Geneva, 1991.

Comments are currently closed, but you can trackback from your own site.

Subscribe to Newsletter

Loading...Loading...


<