Skip to main content
SpringerLink
Log in

Does the Psychiatrist’s Use of Subjective Well-Being Measurement in People with Schizophrenia Provide a Better Alignment with the Patient’s Well-Being Perception than Clinical Judgement Alone?

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

To examine the agreement between patient and psychiatrist ratings of subjective well-being in people with schizophrenia using three well-being measurements: Satisfaction with Life, Subjective Happiness, and Subjective Well-being under Neuroleptic Treatment (SWN), including the SWN-subscale, and to investigate whether the psychiatrist’s judgement or the psychiatrist-rated SWN is better at defining patient well-being. Patients with schizophrenia (n = 150) completed the three well-being measurements, then met psychiatrists, and their well-being was judged as either ‘poor’ or ‘adequate’ via the usual clinical assessment before being assessed again by the psychiatrist using the same measurements. Intra-class correlation was used to analyze the absolute agreement between ‘patient-rated’ and ‘psychiatrist-rated’ scores. Agreements on ‘adequate’ well-being status between patient-rated SWN (≥ 80; gold standard), psychiatrist-rated SWN, and psychiatrist’s judgement were calculated using Kappa coefficients. We also calculated the sensitivity and specificity of the psychiatrist’s judgement and the psychiatrist-rated SWN to define adequate well-being. SWN showed the strongest absolute agreement between patient-psychiatrist ratings (ICC = 0.7, p = 0.005), with physical functioning yielding the highest and self-control the lowest coefficients. The psychiatrist-rated SWN showed a better Kappa coefficient (0.4, p < 0.001) than the psychiatrist’s judgement. Clinical judgement showed a 67% sensitivity and a 64% specificity, whereas the psychiatrist-rated SWN (score 93, AUC 81.4%) showed a 74% sensitivity and a 74% specificity for well-being prediction. The use of SWN by psychiatrists yielded a better alignment of well-being than the psychiatrist’s judgement alone. The SWN subscale could help fill the gap between clinician and patient views on well-being. Psychiatrists should upskill in assessing patient wellbeing for appropriate treatment provision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the corresponding author, WA, upon reasonable request.

References

  • Acosta, F. J., Hernandez, J. L., Pereira, J., Herrera, J., & Rodriguez, C. J. (2012). Medication adherence in schizophrenia. World Journal of Psychiatry, 2(5), 74–82. https://doi.org/10.5498/wjp.v2.i5.74

    Article  PubMed  PubMed Central  Google Scholar 

  • Agid, O., McDonald, K., Siu, C., Tsoutsoulas, C., Wass, C., Zipursky, R. B.,…Remington, G. (2012). Happiness in first-episode schizophrenia. Schizophrenia research, 141(1), 98–103.https://doi.org/10.1016/j.schres.2012.07.012

  • Aunjitsakul, W., & Pitanupong, J. (2018). Schizophrenias’ quality of life and emotional intelligence in Songklanagarind Hospital. Journal of Health Science and Medical Research, 36(1), 61–71.

    Google Scholar 

  • Aunjitsakul, W., Teetharatkul, T., Vitayanont, A., & Liabsuetrakul, T. (2019). Correlations between self-reported and psychiatrist assessments of well-being among patients with schizophrenia. General Hospital Psychiatry, 56, 52–53. https://doi.org/10.1016/j.genhosppsych.2018.11.001

    Article  PubMed  Google Scholar 

  • Chue, P. (2006). The relationship between patient satisfaction and treatment outcomes in schizophrenia. Journal of Psychopharmacology, 20(6 Suppl), 38–56. https://doi.org/10.1177/1359786806071246

    Article  PubMed  Google Scholar 

  • de Haan, L., Weisfelt, M., Dingemans, P. M., Linszen, D. H., & Wouters, L. (2002). Psychometric properties of the subjective well-being under neuroleptics scale and the subjective deficit syndrome scale. Psychopharmacology (Berl), 162(1), 24–28. https://doi.org/10.1007/s00213-002-1054-x

    Article  CAS  Google Scholar 

  • Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75. https://doi.org/10.1207/s15327752jpa4901_13

    Article  CAS  Google Scholar 

  • Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. L. (1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125(2), 276–302.

    Article  Google Scholar 

  • Eack, S. M., & Newhill, C. E. (2007). Psychiatric symptoms and quality of life in schizophrenia: A meta-analysis. Schizophrenia Bulletin, 33(5), 1225–1237. https://doi.org/10.1093/schbul/sbl071

    Article  PubMed  PubMed Central  Google Scholar 

  • Fervaha, G., Agid, O., Takeuchi, H., Foussias, G., & Remington, G. (2016). Life satisfaction and happiness among young adults with schizophrenia. Psychiatry Research, 242, 174–179. https://doi.org/10.1016/j.psychres.2016.05.046

    Article  PubMed  Google Scholar 

  • Frosch, D. L., May, S. G., Rendle, K. A., Tietbohl, C., & Elwyn, G. (2012). Authoritarian physicians and patients’ fear of being labeled ‘difficult’ among key obstacles to shared decision making. Health Affairs (Project Hope), 31(5), 1030–1038. https://doi.org/10.1377/hlthaff.2011.0576

    Article  Google Scholar 

  • Gunnmo, P., & Bergman, H. F. (2011). What do individuals with schizophrenia need to increase their well-being. International Journal of Qualitative Studies on Health and Well-Being. https://doi.org/10.3402/qhw.v6i1.5412

    Article  PubMed  PubMed Central  Google Scholar 

  • Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: An overview and tutorial. Tutorials in Quantitative Methods for Psychology, 8(1), 23–34. https://doi.org/10.20982/tqmp.08.1.p023

    Article  PubMed  PubMed Central  Google Scholar 

  • Hamm, J. A., Buck, K. D., Leonhardt, B. L., Luther, L., & Lysaker, P. H. (2018). Self-directed recovery in schizophrenia: Attending to clients’ agendas in psychotherapy. Journal of Psychotherapy Integration, 28(2), 188–201. https://doi.org/10.1037/int0000070

    Article  Google Scholar 

  • Higashi, K., Medic, G., Littlewood, K. J., Diez, T., Granstrom, O., & De Hert, M. (2013). Medication adherence in schizophrenia: Factors influencing adherence and consequences of nonadherence, a systematic literature review. Therapeutic Advances in Psychopharmacology, 3(4), 200–218. https://doi.org/10.1177/2045125312474019

    Article  PubMed  PubMed Central  Google Scholar 

  • Kahneman, D., & Tversky, A. (1984). Choices, values, and frames. American Psychologist, 39(4), 341–350.

    Article  Google Scholar 

  • Kim-Prieto, C., Diener, E., Tamir, M., Scollon, C., & Diener, M. (2005). Integrating the diverse definitions of happiness: A time-sequential framework of subjective well-being. Journal of Happiness Studies, 6(3), 261–300.

    Article  Google Scholar 

  • Lambert, M., Schimmelmann, B. G., Naber, D., Schacht, A., Karow, A., Wagner, T., & Czekalla, J. (2006). Prediction of remission as a combination of symptomatic and functional remission and adequate subjective well-being in 2960 patients with schizophrenia. The Journal of Clinical Psychiatry, 67(11), 1690–1697. https://doi.org/10.4088/jcp.v67n1104

    Article  PubMed  Google Scholar 

  • Langdon, R., Coltheart, M., Ward, P. B., & Catts, S. V. (2002). Disturbed communication in schizophrenia: The role of poor pragmatics and poor mind-reading. Psychological Medicine, 32(7), 1273–1284.

    Article  CAS  Google Scholar 

  • Lehman, A. F. (1988). A quality of life interview for the chronically mentally ill. Evaluation and Program Planning, 11(1), 51–62. https://doi.org/10.1016/0149-7189(88)90033-X

    Article  Google Scholar 

  • Leonhardt, B. L., Huling, K., Hamm, J. A., Roe, D., Hasson-Ohayon, I., McLeod, H. J., & Lysaker, P. H. (2017). Recovery and serious mental illness: A review of current clinical and research paradigms and future directions. Expert Review of Neurotherapeutics, 17(11), 1117–1130. https://doi.org/10.1080/14737175.2017.1378099

    Article  CAS  PubMed  Google Scholar 

  • Lindstrom, E., Jedenius, E., & Levander, S. (2009). A symptom self-rating scale for schizophrenia (4S): Psychometric properties, reliability and validity. Nordic Journal of Psychiatry, 63(5), 368–374.

    Article  Google Scholar 

  • Lyubomirsky, S., & Lepper, H. S. (1999). A measure of subjective happiness: Preliminary reliability and construct validation. Social Indicators Research, 46(2), 137–155.

    Article  Google Scholar 

  • McHugh, M. L. (2012). Interrater reliability: The kappa statistic. Biochemical Medicine (Zagreb), 22(3), 276–282.

    Article  Google Scholar 

  • Myers, D. G., & Diener, E. (2018). The scientific pursuit of happiness. Perspectives on Psychological Science: A Journal of the Association for Psychological Science, 13(2), 218–225. https://doi.org/10.1177/1745691618765171

    Article  PubMed  Google Scholar 

  • Naber, D. (1995). A self-rating to measure subjective effects of neuroleptic drugs, relationships to objective psychopathology, quality of life, compliance and other clinical variables. International Clinical Psychopharmacology, 10(Suppl 3), 133–138.

    PubMed  Google Scholar 

  • Naber, D., Karow, A., & Lambert, M. (2005). Subjective well-being under the neuroleptic treatment and its relevance for compliance. Acta Psychiatrica Scandinavica. Supplementum, 427, 29–34.

    Article  Google Scholar 

  • Naber, D., Moritz, S., Lambert, M., Pajonk, F. G., Holzbach, R., Mass, R., & Andresen, B. (2001). Improvement of schizophrenic patients’ subjective well-being under atypical antipsychotic drugs. Schizophrenia Research, 50(1–2), 79–88.

    Article  CAS  Google Scholar 

  • Pavot, W., Diener, E., Colvin, C. R., & Sandvik, E. (1991). Further validation of the satisfaction with life scale: Evidence for the cross-method convergence of well-being measures. Journal of Personality Assessment, 57(1), 149–161. https://doi.org/10.1207/s15327752jpa5701_17

    Article  CAS  PubMed  Google Scholar 

  • Polit, D. F. (2014). Getting serious about test-retest reliability: A critique of retest research and some recommendations. Quality of Life Research, 23(6), 1713–1720. https://doi.org/10.1007/s11136-014-0632-9

    Article  PubMed  Google Scholar 

  • Rettenbacher, M. A., Hofer, A., Eder, U., Hummer, M., Kemmler, G., Weiss, E. M., & Fleischhacker, W. W. (2004). Compliance in schizophrenia: Psychopathology, side effects, and patients’ attitudes toward the illness and medication. Journal of Clinical Psychiatry, 65(9), 1211–1218.

    Article  Google Scholar 

  • Ritsner, M. S., Lisker, A., & Arbitman, M. (2012). Ten-year quality of life outcomes among patients with schizophrenia and schizoaffective disorders: I. Predictive value of disorder-related factors. Quality of Life Research, 21(5), 837–847. https://doi.org/10.1007/s11136-011-9988-2

    Article  PubMed  Google Scholar 

  • Seale, C., Chaplin, R., Lelliott, P., & Quirk, A. (2007). Antipsychotic medication, sedation and mental clouding: An observational study of psychiatric consultations. Social Science & Medicine, 65(4), 698–711. https://doi.org/10.1016/j.socscimed.2007.03.047

    Article  Google Scholar 

  • Strassnig, M., Kotov, R., Fochtmann, L., Kalin, M., Bromet, E. J., & Harvey, P. D. (2018). Associations of independent living and labor force participation with impairment indicators in schizophrenia and bipolar disorder at 20-year follow-up. Schizophrenia Research, 197, 150–155. https://doi.org/10.1016/j.schres.2018.02.009

    Article  CAS  PubMed  Google Scholar 

  • Tolman, A. W., & Kurtz, M. M. (2012). Neurocognitive predictors of objective and subjective quality of life in individuals with schizophrenia: A meta-analytic investigation. Schizophrenia Bulletin, 38(2), 304–315. https://doi.org/10.1093/schbul/sbq077

    Article  PubMed  Google Scholar 

  • Vothknecht, S., Schoevers, R. A., & de Haan, L. (2011). Subjective well-being in schizophrenia as measured with the subjective well-being under neuroleptic treatment scale: A review. Australian and New Zealand Journal of Psychiatry, 45(3), 182–192. https://doi.org/10.3109/00048674.2010.545984

    Article  Google Scholar 

  • Vothknecht, S., Meijer, C., Zwinderman, A., Kikkert, M., Dekker, J., van Beveren, N.,...For, Group. (2013). Psychometric evaluation of the Subjective Well-being Under Neuroleptic Treatment Scale (SWN) in patients with schizophrenia, their relatives and controls. Psychiatry Research, 206(1), 62–67.https://doi.org/10.1016/j.psychres.2012.09.004

  • Wehmeier, P. M., Kluge, M., Schacht, A., Helsberg, K., & Schreiber, W. (2007). Correlation of physician and patient rated quality of life during antipsychotic treatment in outpatients with schizophrenia. Schizophrenia Research, 91(1–3), 178–186. https://doi.org/10.1016/j.schres.2006.12.017

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank all patients, caregivers, research assistants, and nurses for their availability and ready cooperation in this research.

Funding

This research was supported by funding from the Faculty of Medicine, Prince of Songkla University, Thailand.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand

    Warut Aunjitsakul, Teerapat Teetharatkul & Arnont Vitayanont

  2. Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand

    Tippawan Liabsuetrakul

Authors
  1. Warut Aunjitsakul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Teerapat Teetharatkul
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arnont Vitayanont
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tippawan Liabsuetrakul
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Warut Aunjitsakul.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Consent for Publication

All authors agreed to submit this study for publication.

Ethical Approval

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation as well as the Helsinki Declaration of 1975, as revised in 2008. This study was approved by the Ethics Committee of the Faculty of Medicine, Prince of Songkla University (REC: 60-197-03-1).

Informed Consent

All the participants gave their informed consent before being interviewed.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 119 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aunjitsakul, W., Teetharatkul, T., Vitayanont, A. et al. Does the Psychiatrist’s Use of Subjective Well-Being Measurement in People with Schizophrenia Provide a Better Alignment with the Patient’s Well-Being Perception than Clinical Judgement Alone?. Adm Policy Ment Health 48, 768–779 (2021). https://doi.org/10.1007/s10488-021-01127-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-021-01127-5

Keywords

Search

Navigation