Exploring Quality of Life and Mental Health Related Concerns among Adults with Disabilities

11 Applied Psychology, September 2014

Applied Psychology

Citation this paper:

Yaqoob, A., Naz, S. (2014). Exploring Quality of Life and Mental Health Related Concerns

among Adults with Disabilities.Applied Psychology, 9, 11-22.

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12 Exploring Quality of Life and Mental Health Related Concerns among Adults with …

Exploring Quality of Life and Mental Health Related

Concerns among Adults with Disabilities

Ayesha Yaqoob

M.Phil Scholar, Department of Behavioral Sciences, Fatima Jinnah Women University

[email protected]

Sajida Naz

PhD, Assistant Professor, Department of Behavioral Sciences, Fatima Jinnah Women University,

[email protected]

Received: 7 Jul, 2014

Accepted: 19 Aug, 2014

Abstract

Objective: To explore the Quality of life and mental health of adults with

disabilities. Method: Exploratory research including 66 participants with

physical disabilities. The data was collected through qualitative (interviews)

and quantitative (questionnaire) methods. Results: It was shown by the

results that there is a strong association between quality of life and mental

health (r = -.59, p <0.01) indicating that better quality of life was associated

with better mental health. Quality of life is a strong indicator of mental

health in persons with disabilities (beta = 35.42, p<0.01).

Conclusion: It has been concluded that the relationship between quality of

life and mental health is inverse but significant and Quality of life affects

mental health of adults with disabilities which indicate lower the quality of

life of person with disabilities higher will be their mental health problems.

Key words: Physical disability, Persons with physical disabilities, Quality of

Life, Mental Health.

Applied Psychology

Vol. 2(9), pp. 11-22, September 2014

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mailto:[email protected]


Introduction

Disability effect more than one billion people around of the world and amongst them 200 million

are living with functional disabilities (WHO, 2001). It is estimated that in developing world 80%

person with disabilities live and 20% of person with disabilities are living in under poverty

(Lang, 2009). The factors that are involved in poor quality of life among person with disabilities

in these countries are generally low level of development, insufficient health and social welfare

services (Hosain, Atkinson, & Underwood, 2011).

According to an estimated population of 180.7 million (as of July 2012), Pakistan is 6th most

densely inhabited country in the world (Awan, 2012).

Individual are considered physically normal when they are able to participate in a wide range of

human activities on equal terms with others, without requiring special consideration or undue

help. Most people acquire competence in the basic skills needed for daily living and, with

increasing maturity, they become independent and able to contribute to the common good,

whether in the family setting or in the community. However, few individuals who are prevented

from acquiring this natural adaptability because of a defect result in a disability. This disability

leads to handicap when it retards, distorts or adversely affects the normal development and

adjustment to life (Hunzai, 1993).

Disability is defined as a concept and experience which arise from the health conditions and the

environment interaction (WHO, 2001). There are various definitions of disability but currently

best practice definitions are used in the International Classification of Functioning, Disability

and Health (ICF) And the UN Convention on the Right of Person with Disabilities (UNRPD).

Person with disabilities are defined as those “who due to the improper long term physical,

mental, intellectual or sensory condition might come across several obstacles which may stop

them from participating in society on equal basis as compared to those who are not disable

(Officer and Groce 2009; United Nations 2006; World Health Organization 2001 as cited by

Honey, Emerson, Llewellyn, & Kariuki).

Quality of life (QOL) of person with disability may reduce by their physical disability. Primary

functional capacities and overall quality of life is restricted and affected by physical limitations

of person with disabilities. Physical health, social relationship and life in realms of family,

friends and neighbors, psychological state and level of independence all are affected by their

disability. Person with disability age at which disabling condition occurred influence their life

satisfaction. Women with disabilities are more disadvantage than men with disabilities and may

be at greater risk for excessive stress. Discrimination within family is faced by women with

disabilities and they have less access to health services and very limited educational and

employment opportunities (Deepika, Fungladda, Kaewkengwal, Jalayondeja, &Tornee).

Like general population person with disabilities (i.e. physical impairments for instance cerebral

palsy, multiple sclerosis, muscular dystrophy, spinal cord injury, paralysis, polio etc.)

experience mental health problem. The need of mental health related services may be even more

than the general population. The high rate of poverty and unemployment are associated with

poor mental health of person with disabilities (Unit, 2005). The vulnerability to poor mental

health increases by chronic medical conditions and sensory disability(Friedli, Stansfield, &

O’Hara, 2011).

Person with physical disabilities report high apparent stress scores found by studies (Hughes,

Taylor, Robinson-Whelen, &Nosek, 2005). Impact of stress on person with disabilities who have

vulnerable health status, less recourses and sufficient social support is more sever (Hughes et al.,


2005). Stress in person with disabilities has been associated with poor mental health (Aikens,

Fischer, Namey, &Rudick, 1997; Gilchrist & Creed, 1994;Hughes, Swedlund, Petersen, &Nosek,

2001).

In Pakistan disability is a stigma, person with disabilities face obstruction in mixing up into the

community because of cultural norms. The lack of reliable disability epidemiological data,

inadequate funding, poor health care infrastructure and workforce shortages are other barriers to

addressing the need of the person with disabilities. In Pakistan 4 to 6 % population has a

disability, indicated by the last national census 1998. The epidemiology of common diseases and

cause of disability related information are very limited. The main causes of disability reported

by studies carried out in targeted population are physically disability (19%) followed by visually

impaired, mental retarded and speech impaired. Mental retardation prevalence ranges from 19 to

24.3 per 1000 children and range of impaired vision in adult is 2.2 to 5.2%. There is no data

available on prevalence of stroke, spinal cord injury, limb confiscation, chronic pain or other

causes of disability (Rathore, New, &Iftikhar, 2011).

Method

The present study was carried out to explore the quality of life and mental health of adults with

physical disabilities and is generally described as an exploratory research including 66

participants. It is a mixed method research because the data was collected through qualitative

(interviews) and quantitative (questionnaire) methods. It is an exploratory-descriptive research

which refers to the provision of a rich and accurate description of quality of life and mental

health of person with disabilities with the help of questionnaires and interviews, which provides

an in-depth understanding of their life experiences in term of mental health and life quality.

Instruments

The following measures were used to collect the data for the variables:

2.1.1 World Health Organization Quality Of Life (WHOQOL) Scale:

Quality of life was assessed with the help of WHOQOL- BREF. In this present study quality of

life was operationally defined on the scores of WHOQOL- BREF in terms of physical,

psychological, social and environmental dimensions. It is brief version of the WHOQOL- 100,

and had four domains scores. The WHOQOL- BREF consisted of 26 items and comprised of

four dimensions physical functioning (items 3,4,10,15,16,17 and 25), psychological functioning

(items 5,6,7,11,18 and 26), social dimensions (items 19, 20, 21) and environment (items 8,9,12,

13, 14, 22, 23 and 24). Items no 1 and 2of WHOQOL- BREF examined separately, i.e. and

individual’s overall perception of quality of life and health(Organization, 1996). The scale was

originally developed by WHO where as it was adapted and translated in Urdu language in 2003

by Khan, Akhter, Ayub, Alam and Laghari(Khan, Akhter, Ayub, Alam, & Laghari, 2003).

The World Health Organization Quality Of Life (WHOQOL) is cross-culturally comparable

quality of life assessment scale. WHOQOL- BREF comprised of 26 items divided in four

dimensions. The domains scores are scaled in positive direction i.e. higher scores denote higher

quality of life. The mean scores are then used to calculate the domain scores. The overall scores

on the scale can also be taken as an indicator of overall quality of life of the person reflecting

that higher the score better would be the quality of life(Organization, 1993).


The alpha reliability of WHOQOL and its subscales was computed to assess the reliability of the

scale. The alpha reliability of the scale was found to be .91 which indicated that it is a reliable

scale for assessing quality of life of adults with disabilities.

2.1.2 General Health Question (GHQ12)

The General Health questionnaire was developed by Goldberg in 1978, and has been used as

screening questionnaire across different settings. It is self-administering. The concept in GHQ 12

included: depression and unhappiness, anxiety and felt psychological disturbance and social

impairment. The respondent rated themselves on a four point severity. According to how they

have recently experienced each GHQ item: better than usual, same as usual, worse than usual,

or much worse than usual. Normally, each item is scored on 0 to 3, depending upon which

severity choice is selected(Hankins, 2008; Montazeri et al., 2003). A total score is composed by

adding the scores of each individual item. Items number 3, 4, 5, 6, 8, & 9 are containing reverse

scoring and cut off of score of GHQ12 is 15 to screen out psychologically healthy and distressed

people.

In present study, Urdu version translated by Farid and Mubasher(Minhas & Mubbashar, 1996) of

GHQ12 was used. All the items of GHQ12 have shown high internal consistency as having

Cornbach’s alpha value more than 0.80. GHQ12 is widely used in Pakistan.

Result

The present study was designed to explore the Quality of life (QOL) and mental health of adults

with disabilities. Quality of life and mental health were assessed with WHOQOL-Bref 26 and

GHQ 12 (General health Questionnaire). Data was analyzed with the help of SPSS software 21

version for windows. In order to fulfill the objectives of the study and to test the basic

hypothesis following statistical analysis were performed. Internal consistency of both the scales

was determined. For analysis, correlations were used to see relationship between scales and

subscales. T-test analysis was used to compare the differences between the scores of quality of

life and general health between genders. For prediction that how much quality of life influence

mental health of person with disabilities regression analysis was used. Following tables indicated

the results obtained from data analysis:


Table 1- Demographic characteristics of research participants (n=66)

Variable

F

Percentage (%)

Gender

Male 39 59.1

Female 27 40.9

Age

18-27 32 48

28-37 31 47

38-47 3 4.5

Marital Status

Single 47 71.2

Married 17 25.8

Widowed 2 3

Education

uneducated 15 22.7

Elementary 10 15.2

Secondary 18 27.3

Intermediate 7 10.6

Graduate

16 24.2

Occupation

Unemployed 40 60.6

Employed 26 39.4

Table 1 shows the demographic information and details of the participants in terms of gender,

age, marital status, education and occupation.


Table 2: Cornbach’s Alpha reliability index of General health Questionnaire (GHQ12) and WHO -

Quality of life Scale (WHOQOL- 26) and its subscales

Table shows the value of Cornbach’s alpha reliability coefficient of GHQ12 and Quality of life

scale and subscales. Results showed that GHQ12 Scale has alpha reliability coefficient (α = .89)

indicating that GHQ12 Scale is internally consistent tool for assessing the Mental health of adults

with disabilities and Quality of life scales (WHOQOL-Bref 26) questionnaire has alpha

reliability coefficient (α = .91) .Results also show the alpha reliability of WHOQOL subscales

alpha reliability of “Physical health” is .82, “Psychological” is .88, “Social relationships” is .76

and “environment” is .85 representing that Quality of life scales (WHOQOL-Bref 26) is

internally consistent tool for assessing the Quality of life scales of adults with physical

disabilities (on present sample).

Table 3: Pearson product moment correlation (r) between GHQ-12, WHOQOL and its subscales

Scale WHOQOL PHY-D PSY-D SR-D ENV-D GHQ

WHOQOL -- . 832** .932** .701** .853** -.596**

Physical -- -- .756** .407** .522** .496**

Psychological -- -- -- .634** .727** -.686**

Social Relation -- -- -- -- .565** .427**

Environment -- -- -- -- -- .477**

GHQ -- -- -- -- -- --

Scale and subscales n M S.D α

WHOQOL 26 85.7 18.6 .91

-Physical 4 22.8 5.92 .82

-Psychological 4 19.9 6.31 .88

-Social 4 9.22 3.01 .76

-Environment 10 27.4 7.44 .85

GHQ12 12 15.7 7.18 .89


There was a significant relationship between the WHOQOL and GHQ12, r = -.59, p< .01.Table

indicated the Pearson correlation between General health questionnaire (GHQ12), Quality of life

scale and its subscales. Pearson Correlation was significant between GHQ12, WHOQOL and its

subscales.

Table 4: Independent Sample t-test, comparing gender differences in WHOQOL and GHQ-12

This table shows that there was no significant gender difference of mental health and quality of

life, which means for both males and female effect of quality of life on mental health is

perceived same as Value of t= -.001,-.72 and differences were not significant.

The value of R² is .35, which tells us that quality of life can account for 35% of the variation in

Mental Health. In other words, there might be many factors that can explain this variation, but

our model, which includes only Quality of Life, can explain approximately 35% of it, which

means that 65% of the variation in mental health cannot be explained by Quality of Life alone.

Therefore, there must be other variables that have an influence also. In other words, 1 unit

change in quality of life will change .23 unit changes in mental health.

Table5: Simple regression analysis on determining prediction effect of QOL on Mental Health

Scales Females (n=27) Males (n=39) t p

M(SD) M(SD)

WHOQOL 85.74(19.91) 85.74(18.02) -.001 n.s

GHQ-12 15(7.14) 16(7.25) -.72 n.s

Parameters

β

R²

f

t

Quality Of Life

(Predictor)

35.42

.35

35.2

10.46

Mental Health

(dependant)

-.23


Conclusion

Current study was aim to study the effect of quality of life on mental health of person’s with

disability, with a mixed method approach. To carry out the research, SAYYA Association of

people with disability, Leonard Cheshire Disability & Development Program (LCDDP)

Islamabad, Special Talent Exchange program (STEP) and Holy Family Hospital Rawalpindi was

approached to get access to person with disabled. The sample comprised of adults of age range

18-47years. The demographics of the sample were taken in terms of gender, age, marital status,

education and occupation. The hypothesis of the study was that Quality of life affects mental

health of person with disabilities.

The scale used in the study to assess quality of life was WHOQOL-BREF 26 and to assess

mental health, GHQ12 was used. The psychometric properties of the scales show good reliability

and validity of the scales. The alpha reliability coefficient of WHOQOL-BREF scale and

GHQ12 scale was found to be .91 and .89 respectively.

The main objective of the study was to find out the relationship between quality of life and

mental health of adults with disabilities. The results showed strong and significant relationship

between the two variables .There was a significant relationship between the WHOQOL and

GHQ12, r = -.59, p< .01. But the relationship was found to be inverse. It indicates that low level

of quality of life leads to high level of mental health problems and vice versa.

It was found by another study that disability has a considerable impact on quality of life and

level of disability is affecting by mental health conditions(Verbunt, Pernot, & Smeets, 2008).

Negative mental health risk is greater in person with disabilities as a population group then for

the general population (Emerson et al., 2008; Honey et al., 2011; Miauton et al., 2003;Wolman et

al., 1994). Person with physical disabilities report high apparent stress scores found by studies

(Hughes et al., 2005).

Results of the study indicate a statistically significant relationship between mental health and

quality of life which can also be seen in previous studies. However regression shows that quality

of life only contribute 35% in mental health which means that there may be many other variables

which contributes rest of 65%. In other words, there might be many factors that can explain this

variation, but our model, which includes only Quality of Life, can explain approximately 35% of

it, which means that 65% of the variation in mental health cannot be explained by Quality of Life

alone. Therefore, there must be other variables that have an influence also.

Previous studies have also shown the contribution of many other psychosocial variables in

mental health and quality of life. According to a study person with disabilities have lower quality

of life than those without disabilities. For depressive symptoms person with disabilities are a

particular target population. The quality of life of person with disabilities can be influenced by

support from family and from significant others outside the home (Edwards et al., 2003).

The results of the present study also showed the mean differences between quality of life and

mental health among male and female and it showed that there was not a significant gender

difference of mental health and quality of life, which means for both males and female effect of

quality of life on mental health is perceived same as Value of t= -.001,-.72 (p≠0.5).

In order to see mean differences in quality of life between person with better mental health and

person with poor mental health independent sample t-test was calculated. Results of the t-test

showed that person with better mental health and person with poor mental health in WHOQOL

Sub-scale Physical domain, Psychological domain, Social relationship domain, and environment

domain had significant differences Value of t= 3.05, 5.35, 2.98, 2.74. Differences in Physical


QOL were significant at the level of .003, Psychological QOL was significant at the level of

.000, Social QOL was significant at the level of .004 and environmental QOL was significant at

the level of .008. So as to shows that for person with better mental health and person with poor

mental health quality of life scores in four domains were different.

In all four domains of the WHOQOL Scores of person with better mental health were high then

person with poor mental health. High scores in WHOQOL-BREF indicate high quality of life.

Hence it was proved that relationship between quality of life and mental health exists and those

suffers from mental health problems also had low quality of life. Results of the study showed

that out of the 66 participants, 27(41%) had better mental health and 39(59%) had poor mental

health.

So it can be seen that with reference to disability there is statistically significant relationship with

a quality of life and mental health in quantitative study and at the same time in qualitative study

it has been found that effect of quality life is immensely affecting mental health of person’s with

disability, because of social stigmas associated with disabilities, family support, educational and

occupational discrimination and many other social and psychological factor.

These findings extend previous work in clinical and community samples that noted an

association between quality of life and mental health but also demonstrate the unique association

of this co morbidity with poor quality of life and disability. Although there have been improved

efforts to identify and take care of disability in the medically unwell, our findings underline the

need to form related programs to recognize and take care of mental disorders and need of

counseling.

In contrast to preceding studies, this study was not limited by sampling biases initiate in

treatment-seeking samples and a lesser amount of recall biases of the public surveys that have

used self-report measures to evaluate physical illnesses. The use of the reliable and well

established quality of life and mental health measures for various types of disabilities were

particular strength of the research.

The association between mental health, quality of life and disability was statistically significant

in both quantitative and qualitative. In qualitative phase of study different reasons have been

found those are affecting quality of life and mental health of persons with disability. Further, the

length of time since the onset of the disability was a risk factor for the person's feeling of

satisfaction. The qualitative analyses of the interviews confirmed the results of the quantitative

analyses but giving different dimensions of their lives which are leading to dissatisfaction with

their lives and different mental health problems.

3.2 Summary

Current study aimed to study the affect of quality of life on mental health of person’s with

disability. It has been concluded that the relationship between quality of life and mental health is

inverse but significant and Quality of life affects mental health of adults with disabilities which

indicate lower the quality of life of person with disabilities higher will be their mental health

problems.

Acknowledgment

We thank that cooperated in this research earnestly.


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Exploring Quality of Life and Mental Health Related Concerns among Adults with Disabilities

Healthcare

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