Predictors of quality of life among inpatients in forensic mental health: implications for occupational therapists

Background: Optimising quality of life (QOL) for service users in a forensic hospital is an important treatment objective. The factors which contribute to QOL in this setting are currently unclear. The aim of this study was to analyse the predictors of QOL amongst service users within an inpatient forensic mental health hospital. Methods: This study is a naturalistic, cross-sectional, observational study. Fifty-two male service users with schizophrenia or schizoaffective disorder participated in the study. QOL was measured using the World Health Organisation QOL Bref. We used the Engagement in Meaningful Activity Survey (EMAS), ward atmosphere was measured using the Essen Climate Evaluation Schema (EssenCES), occupational functioning was assessed using the Social and Occupational Functioning Scale (SOFAS). We also collected level of ward security, length of stay and community leave data. Results: Stepwise regression showed that meaningful activity, level of ward security, and therapeutic hold on the EssenCES significantly predicted QOL on a range of specific QOL domains. These variables accounted for 40% of the variance for total QOL score. Engagement in meaningful activity added the largest contribution to total QOL score accounting for 30% of the variance. Conclusions: This study shows that provision of meaningful activities, level of ward security and therapeutic hold may contribute to QOL amongst forensic mental health inpatients.