Research Article, Int J Ment Health Psychiatry Vol: 9 Issue: 3

Effect of Psychoeducation on Quality of Life of Catha Edulis User Schizophrenia Patients

Abraha Gosh Woldemariam^* and Gloria Thupayagale-Tshweneagae

¹Department of Health Studies, University of South Africa, Pretoria, South Africa

*Corresponding Author:Abraha Gosh Woldemariam,
Department of Health Studies, University of South Africa, Pretoria, South Africa
E-mail: tsadkangg@gmail.com

Received date: 17 August, 2023, Manuscript No. IJMHP-23-110483;

Editor assigned date: 21 August, 2023, PreQC No. IJMHP-23-110483 (PQ);

Reviewed date: 04 September, 2023, QC No. IJMHP-23-110483;

Revised date: 14 September, 2023, Manuscript No. IJMHP-23-110483 (R);

Published date: 22 September, 2023, DOI: 10.4172/2471-4372.1000232

Citation: Woldemariam AG and Tshweneagae GT (2023) Effect of Psychoeducation on Quality of Life of Catha Edulis User Schizophrenia Patients. Int J Ment Health Psychiatry 9:3.

Abstract

Keywords: Quality of life, Schizophrenia, Psychoeducation, Psychoeducational intervention, Quasi-experiment

Introduction

In the treatment of people with schizophrenia, combined treatment is highly advisable to prevent relapse, advance medication adherence and improve patients quality of life [1,2]. Psychoeducation is systematic psychotherapeutic intervention provided for patients with severe mental illness like schizophrenia. For people with schizophrenia psychoeducation has gradually evolved as a treatment since the mid 1970’s and become a promising approach in reducing relapse and rehospitalization, improving treatment non-compliance and quality of life of patients. ‘Patient education’, ‘patient teaching’ and ‘patient instruction’ are some of the terms that can replace Psychoeducation [3-6]. Psychoeducational sessions are highly structured, follow a manual or pre-planned curriculum and provide therapeutic strategies that can increase patients psychosocial functioning, patients knowledge on the course of illness and healing, improve patients cognition and emotion as well as enables patients and their caregiver to cope with the illness [7,8]. Prost et al., found that psychoeducational intervention was helpful in the treatment of people with mental health problems and had increased patients adherence to medication and illness knowledge [9]. Unlikely, a randomized controlled trail conducted in United Kingdom demonstrated that psychoeducational intervention failed to improve participant’s psychological symptoms and quality of life [10].

However, other several literatures suggested that Psychoeducation is a promising approach in improving the lives of patients with schizophrenia [4,11]. For example, Pekkala and Merinder reviewed that provision of psychoeducational interventions as part of the standard treatment was useful for people with schizophrenia and related illnesses [12]. Shin and Lukens also reported that psychoeducation group had showed significant reduction in symptom severity and perceived stigma and developed greater coping skills immediately after the intervention [13]. Walker et al., had also stated that psychoeducation had improved patient’s insight, mental health and quality of life of patients, although these did not reach significance [14]. Similarly, several reviewed literatures have described that psychoeducation has a positive effect in improving quality of life, reducing positive symptoms, increasing illness knowledge, preventing relapse rate, reducing rehospitalization and burden of care when it is provided for schizophrenia patients and their care-givers. Integrated treatment is also helpful for people with comorbid diagnosis of schizophrenia and substance misuse disorders [15-19].

Although psychoeducational interventions have a significant positive effect on improving the lives of individuals with severe mental health problems like schizophrenia, these interventions are poorly implemented in developing countries like Ethiopia due to lack of precise information [20]. Literatures also remain silent about the effect of psychoeducation on quality of life of people with schizophrenia that use catha edulis (chew khat leaves).

Materials and Methods

A quasi-experimental study design that has pre and post intervention tests were used [21]. The study setting was adare general hospital which is found in, Hawassa, the administrative city of Southern Ethiopia.

In this study all patients with schizophrenia who visited the psychiatric outpatient department of the target hospital were source of population and those who had catha edulis exposure were study subjects. Thirty participants, 15 for intervention group and 15 for control group, were selected using purposive sampling method and were assigned nonrandomly to each group. All selected respondents were people with schizophrenia who have catha edulis (khat) exposure; they signed an informed consent and were selected using the following eligibility criteria:

Inclusion criteria

1. Age: 18 to 50 years.

2. Clinical diagnosis of schizophrenia done by clinicians in the target hospital.

3. Motivation for change.

Exclusion criteria

1. Age less than 18 or above 50 years.

2. Axis-I diagnosis other than schizophrenia (Comorbidity).

3. Diagnosis of mental retardation.

Demographic data sheet: That includes age, sex, marital status, education; religion, ethnicity, and occupation were developed by researcher. Short-Form 36v2 questionnaire was used to collect data on Quality of Life at time one (baseline) and time two (outcome). SF-36v2 health survey is standardized questionnaire with 36 items that is translated, adapted and validated in numerous languages. SF-36v2 assess generic health related quality of life that includes physical and mental health concepts in general and the following eight health domains in specific: (1) physical functioning (10 items), (2) role limitation due to physical problems (4 items), (3) bodily pain (2 items), (4) General health (5 items), (5) Vitality (4 items), (6) Social functioning (2 items), (7) Role limitation due to emotional problems (3 items), (8) Mental health (5 items) and one item of the questionnaire asks about the general health of respondents. Scores on each domain-specific scales range from 0 to 100, with higher score representing better health related quality of life. To keep the instrument more valid content validity was done and for the reliability Chronbach’s test was computed. Prior to pilot study psychoeducational intervention guideline was developed by the researcher and then procedures of the intervention, duration of the study, and complexity of methodology and research instruments were tested on a pilot study.

The psychoeducation program was conducted from 11 July to 15 October, 2016. Baseline (pre-test) and outcome (post-test) data on quality of life were collected from both intervention and control groups before (T₁) and after (T₂) the implementation of psychoeducation. To ensure good quality data, two data collectors (one for intervention and one for control group) were used, and data collectors and supervisor were trained in all topics of the questionnaire and research procedure. Collected data were entered to computer software SPSS package version 23. For normally distributed continuous variables mean differences in quality of life within and between groups were analyzed using paired sample t-test and independent sample t-test respectively; while, for skewed continuous variables mann-whitney U test and wilcoxon signed-rank test were used to test score differences in quality of life between and within groups respectively.

Ethical clearance was obtained from University of South Africa (UNISA), Health Studies Higher Degrees Committee (HSHDC) and other necessary approval letters were obtained from responsible bodies like Dilla University Research and Dissemination Office, Southern Nation Nationality and Peoples’ Region (SNNPR) Health Bureau, and officials of Adare General Hospital. Written consent was obtained from all respondents who had participated in the study. Respondents were assured that privacy is well protected through strict confidentiality and were informed that no need to give about their identifying information. This study did not inflict known physical and or psychological harms to respondents due to their participation. However, if needs arise for the emotional feelings of sadness they may encounter when they recall their past exposure, the research team were ready to send them to counselors who works in the target hospital for additional helps. But, no respondents showed adverse emotions in this study.

Components of psychoeducation

There were intervention and control groups that consist of individuals with diagnosis of schizophrenia and catha edulis (khat) exposure. Both groups were under follow-up up to the end of the psychoeducation program for three months. Intervention group received twelve psychoeducational sessions in addition to the usual treatment, while, control group received only pharmacotherapy. Psychoeducational sessions were administered using a guideline developed by the researcher. The psychoeducation program was managed by two professionals, one clinical psychologist and one psychiatry nurse. The clinical psychologist provided psychoeducation on the psychological parts of the program, while the psychiatry nurse provided psychoeducation on the clinical parts.

One psychoeducation session was delivered every week, four sessions per month, and the length of each session lasts between 45 minutes to 1 hours. Issues like; Schizophrenia (causes, symptoms and treatments); Recovery from schizophrenia; Skill training; Relapse prevention; Stress management and effect of substance uses (including catha edulis (khat) use) were covered during the psychoeducational sessions. Under Schizophrenia, points like what schizophrenia is? What are the signs and symptoms of schizophrenia? Treatments of schizophrenia and medication side effect, warning signs of schizophrenia and how to prevent them were covered. In substance use points such as what substance means, use of substances and the effect on schizophrenia, what is khat? Health consequences of khat, Khat and schizophrenia were covered. Teaching strategies like asking questions, role playing, discussions, and explanations were used during sessions. After the implementation of the psychoeducation, post intervention interview were done.

Results

Twenty seven respondents had completed the follow-up, we able to interview 14 respondents from controls and 13 from intervention groups at the end of the psychoeducation program; while three respondents, one from control group and two from intervention group, were lost from the follow up.

Demographic description

Table 1 presents demographic description of respondents in both groups. Respondents in control group were younger (Mdn=34) than respondents in intervention group (Mdn=35), but this difference was not statistically significant, U=84.5, z=-0.317, p=0.756, r=-0.061. All respondents in intervention and control groups were male in gender, and 69.2% of respondents in intervention and 64.3% of respondents in control were single (either unmarried, separated, divorced, or widowed), and 30.8% of respondents in intervention and 28.6% of respondents in control had no formal education. Around 53.8% of interventions and 50% of controls were unemployed and all (100%) of respondents in both groups have history of catha edulis exposure (Table 1).

Table 1: Demographic descriptions of respondents in psychoeducation and control groups in phase-two (quasi-experimental study) at Adare Hospital, SNNPR, Ethiopia (N=27).

Effect of psychoeducation on quality of life

Evidences presented that provision of psychoeducational intervention for schizophrenia patients and their caregivers had improved Health Related Quality of Life [18]. For example, a study conducted in Vietnam had reported that significant improvement was found on the Quality of Life of respondents in psychoeducation group than respondents in control group [22]. Similarly, findings of the present study have demonstrated a positive effect on improving the quality of life of schizophrenia patients in psychoeducation group. Results have been discussed in the following paragraphs.

Baseline (T₁) analysis

On this study, respondents in intervention and control groups did not show significant differences in scores of quality of life at baseline analysis. Table 2 presents the comparison of pre-test median scores of quality of life between respondents in intervention and control groups. From this table we can understand that respondents in both intervention and control groups did not have significant differences in scores of quality of life of Physical and mental component summaries at baseline analysis. Similarly, there were no significant differences in scores of quality of life between intervention and control groups on Physical Functioning (PF), Role Physical (RP), Body Pain (BP), Vitality (VT), Social Functioning (SF) and Role Emotion (RE) health domains at baseline analysis (Table 2).

Table 2: Comparison of pre-test scores of quality of life for the two component summaries and for PF, RP, BP & RE health domains between groups at Adare Hospital, SNNPR, Ethiopia (N=27).

For example, respondents in control group (Mdn=56.25) seems to have larger scores of quality of life than respondents in intervention group (Mdn=48.25) on Mental Component Summary, however, the difference was not statistically significant, U=91.0, z=0.024, p=0.981, r=.005. In the same way, scores of Physical Functioning domain in intervention group (Mdn=30) looks superior to control group (Mdn=23.5); whereas, the difference in scores of quality of life was not significant, U=98.0, z=.344, p=.731, r=.066, (Table 2).

Table 3 demonstrates comparison of mean scores in general health, vitality, social functioning and mental health domains between intervention and control groups. There was no significant mean score differences between the two groups in all the four domains (Table 3).

Table 3: Comparison of mean scores for general health, vitality, social functioning and mental health domains between the two groups at baseline in Adare hospital, SNNPR, Ethiopia (N=27).

Outcome (T₂) analysis

At this time, scores of quality of life of respondents in both intervention and control groups were positively augmented at the posttest measurement when compared to the pre-test.

Comparisons of pre and post scores of quality of life of the two physical and mental component summaries and six other sub-scales (PF, RP, BP, VT, SF & RE scales) among respondents in intervention group is presented in Table 4. At this point, scores of quality of life showed significant increase from pre-test to post-test in the two component summaries and six domains. For example, physical functioning and role emotion had significant improvement in scores of quality of life at the post-test measurement than the pre-test. This indicates that respondents in Intervention group had significantly large scores of quality of life of role emotion after the intervention (Mdn=47.0) when compared to baseline (Mdn=25.0), T=91.0, z=3.182, p=0.001, r=0.881. Similarly, respondents showed significantly large scores of quality of life of physical functioning after the intervention (Mdn=70) than baseline (Mdn=30), U=55, z=2.807, p=.005, r=.778 (Table 4).

Table 4: Pre and Post-test median score comparison for two component summaries and six health domains within intervention group at Adare Hospital, SNNPR, Ethiopia (N=27).

Table 5 also presents comparisons of pre and post test scores of quality of life of general and mental health domains among respondents in Intervention group. There were significant differences in scores of quality of life of the two domains among respondents in intervention group at outcome analysis than before baseline. As it can be seen in Table 5 scores of quality of life of respondents in intervention group had significantly higher mean score in mental health domain at the post test (M=57.02, SE=3.92) than the pretest mean score (M=35.0, SE=5.58). The difference in mean score, 22.02, BCa 95%CI (17.53, 25.83), was significant t (12)=10.3, p<.001, and represented largesized effect, r=.899 (Table 5).

Table 5: Pre and Post-test mean scores comparison for General and Mental Health domains within intervention group at Adare Hospital, SNNPR, Ethiopia (N=27).

Comparison of pre and post test scores of physical and mental component summaries and six other health domains (PF, RP, BP, VT, SF, & RE domains) among respondents in control group are illustrated in Table 6. Except for body pain, scores of quality of life of the two component summaries and five health domains (PF, RP, VT, SF and RE) were significantly higher in the post test analysis than in the pretest one. For instance, in mental component summary, we can see that respondents in control group had significantly larger scores of quality of life at outcome analysis (Mdn=60.9) than scores of the baseline analysis (Mdn=56.25), T=105, z=3.296, p=0.001, r=0.881 (Table 6).

Table 6: Pre and post-test median score comparison for two component summaries and six health domains within controls at Adare Hospital, SNNPR, Ethiopia (N=27).

Table 7 also presents comparison of pre and post-test mean scores of general health and mental health domains among respondents in control group. Scores of quality of life of controls were amplified at the post-test measurement than in the pre-test. Scores of quality of life in mental health domain for example were higher in the post-test (M=36.86, SE=4.93) than scores in pre-test (M=32.5, SE=5.95), and the difference in mean scores, 4.36, BCa95%CI (1.86, 7.35), was significant, t(13)=2.86, p=0.013 (Table 7).

Table 7: Pre and Post-test mean score comparison for general and mental health domains within control group at Adare Hospital, SNNPR, Ethiopia (N=27).

Table 8 shows comparison of post-test scores of quality of life of the two component summaries and six health domains among respondents in intervention and control groups.

Table 8: Post-test score comparison for two component summaries and six health domains between intervention and control groups at Adare Hospital, SNNPR, Ethiopia (N=27).

Results of the present study found that there was difference in posttest scores of quality of life between respondents in intervention and control groups. Except for body pain and physical functioning domains, respondents in intervention group had magnificently large post-test scores of quality of life in all scales than respondents in control group after the intervention. For example, scores of quality of life in role physical domain were significantly larger among respondents in intervention group (Mean rank=16.31) than respondents in control group (Mean Rank=11.86), U=142.5, z=2.502, p=.012, r=.481. Similarly, scores of quality of life in social functioning domain were also significantly larger for respondents in intervention group (Mean Rank=17.69) when compared to respondents in control group (Mean rank=10.57), U=139.0, z=2.336, p=0.020, r=0.449 (Table 8).

Table 9 presents comparison of scores of quality of life for general and mental health domains between respondents in intervention and control group. Scores of quality of life in both health domains were significantly higher among respondents in intervention group when compared to control group. For instance, scores of general health domain was significantly higher among respondents in intervention group (M=69.96, SE=3.31) than control group (Mdn=56.57, SE=4.21). The difference, 13.39, BCa 95%CI (2.75, 24.13), was significant t (25)=2.47, p=0.021, and represented medium sized effect, r=0.443 (Table 9).

Table 9: Post-test mean scores comparison for general and mental health domains between intervention and control groups at Adare Hospital, SNNPR, Ethiopia (N=27).

Discussion

In this study demonstrated that respondents in control group (schizophrenia patients that received psychotropic medication alone) had higher scores of quality of life at the end of the psychoeducational intervention when compared to the pre-test measurement. Similarly, scores of quality of life of respondents in intervention group (respondents that received psychoeducation and medication) were also higher at post-test than in the pre-test measurement. Higher post-test scores of quality of life among respondents in control group prove that treating schizophrenia patients with standard treatments alone can improve the quality of life of patients with schizophrenia. Likewise, larger post-test scores of quality of life among respondents in intervention group also verifies that providing combined treatments of psychoeducation and medications had improved the quality of life of schizophrenia patients.

However, outcome analysis revealed that schizophrenia patients who received psychoeducational and medication had larger post-test scores than respondents in control group. These higher post-test scores of quality of life of respondents in intervention group demonstrates that providing combined therapy (psychoeducation and psychotropic medications) had better effect on improving the quality of life of patients with schizophrenia over psychotropic medication alone. The effect of psychoeducation on quality of life was stronger and significant. Schizophrenia patients with high scores of quality of life did more benefits from participating in the psychoeducation program in addition to the pharmacotherapy. Results of the present study are consistent with studies done in Uganda, Scotland, Jordan, Egypt, Vietnam and in India [9,14,16,18,22,23].

Conclusion

Results of the present study demonstrated that post-test scores of quality of life in both control and intervention group were higher. This shows that chemotherapy alone and combination of chemotherapy and psychoeducation have improved the quality of life of respondents. However, scores of quality of life in intervention group were significantly higher than in control group, which means that respondents who received both psychoeducation and psychotropic medications made superior benefits in their quality of life than respondents in control group. However, since this study is an initial study and is small sample sized farther studies are recommended to duplicate findings.

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