Research Paper on Homeless Individuals With Schizophrenia

Introduction

Globally, the number of homeless people is increasing each and every day. Studies conducted showed that most of the homeless individuals suffer mental illness particularly schizophrenia which requires treatment. Lack of treatment of such psychiatric disorders leads to a high mortality rate which mostly is connected with how long one stays in the streets. Additionally, lack of treatment leads to behaviors like delusions and bizarre that makes living alone or with families untenable. Consequently, such people with untreated critical mental illness become homeless and society is forced to bear the cost of that.

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The inspiration behind this research is based on the fact that the rate of homelessness is increasingly becoming visible among individuals living with schizophrenia. A study conducted showed that there were approximately 335 000 people without a home in China and almost half of them were observed to have schizophrenia mental disorder (Folsom & Jeste, 2012). Management of schizophrenia is becoming challenging since the condition is among the most susceptible individuals and the hardest to reach. Consequently, the high mortality rate of such patients with schizophrenia is becoming common and thus there is a need to address the issue so as to improve their living conditions and their physical and mental health.

Qing and his colleagues (2014) observed that cardiovascular disease is one of the major diseases that are prevalent among such homeless patients particularly those with schizophrenia disease and a major cause of death. The disease is caused by deprived diet, lack of exercise and restricted healthcare. Grover and Avasthi (2019) saw that schizophrenia does not only impact the quality of life of individuals but also on the whole family. This is an indication that schizophrenia illness should not be assessed on the patient only, but also on the whole family so as to get a detailed history of all possible sources of the condition. Therefore, treatment of schizophrenia should be taken with caution and sensitivity since it is connected with a great negative psychosocial effect both to the individual and the caregiver.

Research Question

Is there suitability of using Quality of Life (QoL) measurement in examining the issue of the homeless population with schizophrenia mental illness?

Literature Review

The research proposal is a replication of a previous study conducted by various authors in showing interventions that can solve the issue of homelessness among individuals suffering from schizophrenia. Significantly, quality of life is an essential criterion that effectively evaluates an intervention for people living with schizophrenia. Most studies have shown that Lehman Quality of Life Interview (QOLI) is the only scale that authenticated for homeless population with mental illness (Folsom & Jeste, 2012). However, this has not been validated for use among schizophrenia patients who are homeless. Taking into description of the lived occurrence of schizophrenia, most investigator have come up with a scale that is effective for the condition. Girard and his colleagues (2017) used the French version of the Schizophrenia Quality of Life (S-QoL) as a scale for validating homeless people with severe psychiatric disorders. The S-QoL was administered in a two-step process whereby the first one was among two sovereign samples that had long-term schizophrenia and were homeless so as to purposely analyze the S-QoL psychometric properties. The second step involved examining via a qualitative interview with population members so as to get the importance and acceptability of the principle of S-QoL instrument. Girard et al., (2017) found that the S-QoL with psychometric characteristic was globally satisfactory despite its acceptability being poor.

Auquier and his colleagues (2013) used S-QoL 18 measurement to evaluate the acceptability and psychometric properties of a homeless population suffering from schizophrenia and compared it to non-homeless individuals but suffering from schizophrenia. The S-QoL 18 was checked for legitimacy, consistency and change sensitivity among 236 homeless individuals with schizophrenia. Auquier et al., (2013) found there were reasonable acceptability and psychometric properties of the S-QoL 18. This suggests the legitimacy of QoL measurement among the homeless population with schizophrenia since its levels were low. As a result, there is a need for new interventions to eradicate homeless among people suffering from schizophrenia mental illness.

Method

The method that will be used by the research has been selected so as to obtain information and construe conclusions about the issue of homeless people with schizophrenia.

Design

A quantitative research approach will be used to complete the research proposal on studying the issue of homeless patients with schizophrenia. In the study, the proposal will utilize a Causal-comparative research design which is an experimental design. Causal-comparative design also known as quasi-design establishes a relationship of cause-effect linking two or more groups and the surveyor doesn't allocate groups or influence the sovereign variable. Control groups are distinguished and taken to the variable and outcomes are compared with the other group that is not exposed to the variable. Using this research design is important for my research since the design is a natural experiment where the findings in one can be applied to other subjects and settings thus enabling generalizations of the population (Kumar, 2019). Also, the design allows fewer threats to ecological validity and it can be effective in longitudinal research where there is a longer time period in the study.

Participants

Ideally, one would like to survey the whole population. However, this is not possible or feasible as one must resolve for a sample. A sample is an element portion that is taken from an inhabitant that is seen to be a delegate of the populace (Kumar, 2019). Thus, to gather the primary data, the survey technique of questionnaire will be used that will utilize the random probability sampling and as Silverman stated: "sample sizes larger than 30 and less than 500 are appropriate for most research" (2016). With this in mind, the size of the sample for the research will be 236 homeless individuals with schizophrenia conscripted over a long period of over 12-month period. This will be compared with other 236 individuals who are non-homeless but with schizophrenia.

Procedures

Patients will be recruited by outreach mobile teams of mental health for an over 12-month period. The team will involve a psychiatrist, a nurse and a social worker in regions of France including Lille, Marseille, Paris, and Toulouse so as to ensure the homeless population with schizophrenia is reached. The team will recognize and assist such individuals roughly sleeping in the streets of the four regions by providing aid with instant needs like food and admittance to health care. Also, they will give ongoing support by addressing needs like mental health and drug substance problems. A questionnaire survey will be used to gather information about interest variables in an analysis.

For this research, closed-ended queries will be used so as to call for answers that will narrow down the inquiry ground since most participants tend to give fixed responses. Also, they assist the investigator in analyzing the data easier as the answers can be easily contrasted and motivated (Kumar, 2019). They are also flexible hence analysis can be used among individuals of all ages. Also, they can be simulated from one matter to another and queries can be answered within a short time period. However, it is good to note that most close-ended questions lead to biases since many respondents are given limited alternative replies.

Data Analysis

Statistical analysis will be carried out to investigate the internal structure, dependability, external legitimacy and change sensitivity of the S-QoL. Sample descriptive statistics will involve frequencies, definite variables percentages, means and standard deviations of incessant variables. The root means square error of approximation (RMSEA) will be <0.08 if suitable and <0.05 if satisfactory. Rasch analysis assessed the uni-dimensionality of every measurement and Pearson's correlation coefficient, r, was used in assessing item-internal consistency and relating each item with its scale. Basically, Pearson tends to draw a line of the best fit in data of two variables. If the value is 0, it is an indication that there is no connection between the two variables. However, if the value is below 0, then the association is negative and if the value is above 0, the association is usually positive (Silverman, 2016). If the value of r is closer to 0, then the variation around the line of best fit will be greater. Differential item functioning (DIF) analysis was also carried out from the sample validation of the S-QoL to glimpse if all items were behaving in a similar manner in homeless and non-homeless population.

Ethical Issues

In research, confidentiality issue may arise hence bringing the conflict to between participants and the researchers. It is important that all information gathered in the field from the participants be kept a secret unless when the interests of the society are important. To solve this, it is important that the researcher not to reveal any information to anybody including the research team. Also, the researcher can search for advice from ethics committees so as to obtain endorsement for broadcasting the results including on the account of what happened. Informed consent is another ethical issue especially when it entails individuals with moderate autonomy like children, aged and mentally ill (Kumar, 2019). It is upon the researcher to safeguard the decorum and confidentiality of such people who are susceptible to privacy loss. Other ethical issues include deception and conflict of interest and researchers must develop an awareness so as to create an effective framework that can deal with each ethical issue that may arise.

Conclusion

The rapid economic growth of most developing nations is linked with an increasing in the number of homeless population especially those suffering from schizophrenia. Due to this, there is need of coming up with ways of solving the underlying problem so as the homeless mentally ill patients can obtain the needed health care services, food and other care that they may require. In the study, S-QoL measurement is the only reliable and valid measure of studying the health status of individuals who are homeless. This is because the measurement evaluates the acceptability and psychometric properties of a homeless population suffering from schizophrenia. By highlighting some of the challenges of homeless patients with schizophrenia, the S-QoL measurement remains to be a relevant and crucial method of examining the issue of homelessness and possible solutions that can be used.

References

Auquier, P., Tinland, A., Fortanier, C., Loundou, A., Baumstarck, K., Lancon, C., & Boyer, L. (2013). Toward meeting the needs of homeless people with schizophrenia: the validity of quality of life measurement. PLoS One, 8(10), e79677. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808288/

Folsom, D., & Jeste, D. V. (2012). Schizophrenia in homeless persons: a systematic review of the literature. Acta Psychiatrica Scandinavica, 105(6), 404-413.

Girard, V., Tinland, A., Bonin, J. P., Olive, F., Poule, J., Lancon, C., ... & Simeoni, M. C. (2017). The relevance of a subjective quality of life questionnaire for long-term homeless persons with schizophrenia. BMC Psychiatry, 17(1), 72. https://sci-hub.tw/10.1186/s12888-017-1227-0

Grover, S., & Avasthi, A. (2019). Clinical pr...