Occupational Dysfunction as a Mediator between Recovery Process and Difficulties in Daily Life in Severe and Persistent Mental Illness: A Bayesian Structural Equation Modeling Approach

Abstract

Background. This study is aimed at verifying a hypothetical model of the structural relationship between the recovery process and difficulties in daily life mediated by occupational dysfunction in severe and persistent mental illness (SPMI). Methods. Community-dwelling participants with SPMI were enrolled in this multicenter cross-sectional study. The Recovery Assessment Scale (RAS), the World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0), and the Classification and Assessment of Occupational Dysfunction (CAOD) were used for assessment. Confirmatory factor analysis, multiple regression analysis, and Bayesian structural equation modelling (BSEM) were determined to analyze the hypothesized model. If the mediation model was significant, the path coefficient from difficulty in daily life to recovery and the multiplication of the path coefficients mediated by occupational dysfunction were considered as each the direct effect and the indirect effect. The goodness of fit in the model was determined by the posterior predictive P value (PPP). Each path coefficient was validated with median and 95% confidence interval (CI). Results. The participants comprised 98 individuals with SPMI. The factor structures of RAS, WHODAS 2.0, and CAOD were confirmed by confirmatory factor analysis to be similar to those of their original studies. Multiple regression analysis showed that the independent variables of RAS were WHODAS 2.0 and CAOD, and that of CAOD was WHODAS 2.0. The goodness of fit of the model in the BSEM was satisfactory with a PPP = 0.27 . The standardized path coefficients were, respectively, significant at -0.372 from “difficulty in daily life” to “recovery” as the direct effect and at -0.322 (95% CI: -0.477, -0.171) mediated by “occupational dysfunction” as the indirect effect. Conclusions. An approach for reducing not only difficulty in daily life but also occupational dysfunction may be an additional strategy of person-centered, recovery-oriented practice in SPMI.

Estimation of a Structural Equation Modeling of Quality of Life Mediated by Difficulty in Daily Life in Survivors of Breast Cancer

“…In a study of healthcare workers by Teraoka and Kyougoku [18], the path coefficient between CAOD and Depression was 0.745, which was similar to the path coefficient in the present study. The path coefficient of WHODAS 2.0 and CAOD was 0.598 in the Watanabe et al study [34] of severe and persistent mental illness (SPMI), whereas that in the present study was smaller. The previous studies have used different participants, and to our knowledge, no previous studies have verified these structural relationships in participants with breast cancer, making the present study the first to do so.…”

“…Therefore, we found it necessary to construct a model that can approach survivors' daily life and clarify the extent of the effect. Regarding indirect effects, in a report of the BSEM for SPMI, it was clarified that WHODAS 2.0 was involved in the improvement of recovery of patients with SPMI using CAOD as a mediating variable [34]. This indicates the importance of capturing negative experiences in daily activities as a meaning of difficulty in daily life rather than only the presence or absence of difficulty in daily life.…”