The central role of self-esteem in the quality of life of patients with mental disorders

Abstract

In psychiatry, recent years have seen a change of focus from a clinician- to a patient-centered perspective that emphasizes quality of life as a treatment target. As a complex construct, quality of life is composed of multiple dimensions that interact with one-another (e.g. physical and psychological well-being, relationships, autonomy, self-esteem). Here, we used data from the REHABase cohort, which includes N = 2180 patients from 15 psychosocial rehabilitation centers in France, to explore networks of quality-of-life dimensions among six psychiatric disorders: schizophrenia, neurodevelopmental, bipolar, depressive, anxiety, and personality disorders. Stronger connections (edges) involved the Self-Esteem dimension, such as Self-Esteem-Physical Well-Being, Self-Esteem-Autonomy, Self-Esteem-Psychological Well-Being, and Self-Esteem-Resilience. Self-esteem was also consistently retrieved as the most central node (the dimension with the most connections within each network). Between-group tests did not reveal any differences regarding network structure, overall connectivity, edge-weights, and nodes' centrality. Despite presenting with different symptom profiles, various psychiatric disorders may demonstrate similar inter-relationships among quality-of-life dimensions. In particular, self-esteem may have a crucial inter-connecting role in patients' quality of life. Our findings could support treatment programmes that specifically target self-esteem to improve patients' quality of life in a cost-effective way.

Figure 1

Estimated network structure of quality of life dimensions for the six diagnosis groups. For each diagnosis group (A–F), the network is a Gaussian graphical model, i.e. a network of partial correlation coefficients, in which glasso regularization is applied. Quality of life dimensions: SEL self-esteem, ROM romantic life, RES resilience, PSY psychological well-being, PHY physical well-being, FRI relationships with friends, FAM family relationships, AUT autonomy.

Figure 2

Centrality indices (node strength) of the eight quality of life dimensions obtained for the six diagnosis groups. For each diagnosis group (A–F), each node strength is shown as a standardized z-score (X axis). Quality of life dimensions (Y axis): SEL self-esteem, ROM romantic life, RES resilience, PSY psychological well-being, PHY physical well-being, FRI relationships with friends, FAM family relationships, AUT autonomy.

Figure 3

Relative importance of edges connecting quality of life dimensions among the six diagnosis groups. For each diagnosis group (X axis), each tile represents the number of times each edge (Y axis) shows significantly greater weight than other edges. Quality of life dimensions: SEL self-esteem, ROM romantic life, RES resilience, PSY psychological well-being, PHY physical well-being, FRI relationships with friends, FAM family relationships, AUT autonomy.

Figure 4

Relative importance of quality of life dimensions (nodes) among the six diagnosis groups. For each diagnosis group (X axis), each tile represents the number of times each node (Y axis) shows significantly greater strength than other nodes. Nodes (Quality of life dimensions; Y axis): SEL self-esteem, ROM romantic life, RES resilience, PSY psychological well-being, PHY physical well-being, FRI relationships with friends, FAM family relationships, AUT autonomy.