Multilevel model of quality of life among United States veterans with serious mental illness.

Abstract

This study is principally concerned with the social conditions of U.S. Veterans with serious mental illness discharged from inpatient psychiatric institutions. The study specifically investigates the relative impact of social structural characteristics (for example, case management exposure and treatment program orientation) and client attributes (for example, psychiatric, socio-demographic and socio-economic profiles) on the quality of life of U.S. veterans with serious mental illness. Quality of life can be defined as a product of the fit between attributes of the person and characteristics of higher environment. Accordingly, an ecological framework is adopted in this study to assess this notion of fitness. The proposed study utilizes data provided by the U.S. Department of Veterans Affairs Serious Mental Illness Treatment Research and Evaluation Center (SMITREC). The dependent variable incorporates Anthony Lehman's objective and subjective multidimensional scales of quality of life specifically designed for the SMI population. The independent variables include individual socio-demographic and psychiatric profile measures, the individual patient's case management exposure during program participation and treatment program type. This study employs Hierarchical Linear Modeling (HLM) to appropriately assess three levels of data; time points nested within individuals nested within treatment programs. Overall, during the course of treatment program participation, these clients obtain access to greater resources, engage in social and leisure activities to a greater extent and are more satisfied across a wide range of life domains. The results of this study indicate that case management has measurable effects on several domains of quality of life, particularly in relation to social and leisure activities. The general improvement in quality of life over time is particularly important in light of the highly dysfunctional population studied. Additionally, this study highlights some potential target areas for policy-makers, managers and researchers: aging clients with SMI, poor functioning clients and economically-disadvantaged clients within the U.S. veteran health care system. These sub-population groups appear to have the lowest level of quality of life across the sample. Future studies should investigate other aspects of the treatment environment in addition to such factors as access to good housing, safe neighborhoods and social support.