Severe may indicate that adults with lower cognitive

Severe mental illness
(SMI), affecting about 6% of the adult U.S. population, is a persistent mental
health condition that significantly impacts functioning in multiple life
domains (Dunn, Wewiorski, & Rogers, 2010; National Institute of Mental
Health NIHM, 2013). People with severe mental illness experience a broad
array of functional limitations in areas such as physical, psychological, and
social functioning (Tschopp & Frain, 2009). Functional limitations have the
potential to significantly hinder an individual’s ability to successfully and
meaningfully participate in important activities linked to life satisfaction,
well-being, and quality of life (Tschopp & Frain, 2009; Sánchez, Chan et al., 2016). In addition to
functional limitations, several psychosocial factors have been shown to
correlate with community participation and life satisfaction (Tschopp &
Frain, 2009; Sánchez, Chan et al., 2016; Sánchez,
Rosenthal, Tansey, Frain, & Bezyak, 2016).

            Individuals with SMI experience
varying levels of psychiatric symptoms due to the natural progression of the
disease (Brown et al., 1996). Psychiatric symptoms affect a person’s mental
health functioning and have been linked to community participation and life
satisfaction (Tschopp & Frain, 2009; Sánchez,
Chan et al., 2016; Sánchez, Rosenthal et al., 2016). There is extensive
empirical evidence that severity of psychiatric symptoms in SMI have been found
to be negatively correlated with community participation, life satisfaction,
and quality of life (Browne et al., 1996; Huang et al., 2012; Naber et al.,
2001; Purvis, Ohlsen, O’Toole, Pilowsky, & Brown, 2004; Sánchez, 2014; Sánchez, Rosenthal et al., 2016). Surprisingly,
cognitive functioning as a psychiatric symptom is inversely related to quality
of life, which may indicate that adults with lower cognitive functioning may
become acclimated to their deficits and thus may rate their quality of life
higher, or greater awareness of cognitive deficits may lead to rating their
quality of life lower (Narvaez et al., 2008; Sidlova et al., 2011).

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Poor
insight into individuals’ mental health status is linked to impairment in
social skills and lack of empathy (Dickerson, Boronow, Ringel, & Parente,
1997; Francis & Penn, 2001; Lysaker, Bell, Bryson, & Kaplan, 1998;
Smith et al., 1999; White, Bebbington, Pearson, Johnson, & Ellis, 2000). As
a personal factor, empathy is a requisite skill for developing social skills,
and it plays an important role in the development and maintenance of
interpersonal relationships and social support (Di Giunta et al., 2010; Loeb et
al., 2016). A recent study conducted by Sánchez, Pfaller, and colleagues (2016)
revealed that low empathy levels and social functioning pose significant
challenges related to community participation and life satisfaction among
individuals with SMI, suggesting that empathy and social functioning are
necessary enhancing community participation and life satisfaction among those
with SMI. In addition, empathy and social skills increase an individual’s
opportunity to expand their social network and support (Dilk & Bond, 1996;
Heinssen, Liberman, & Kopelowicz, 2000; Mueser, 1998; Smith, Bellack, &
Liberman, 1996).

            Despite their desire to have social support,
individuals with SMI has lack of social support related to severity of
psychiatric symptoms and lack of social skills and empathy (Bengtsson-Tops
& Hansson, 1999; Pinfold, 2000; Sánchez, 2014; Sánchez, Pfaller et al.,
2016; Sánchez, Rosenthal et al., 2016). As an environmental factor, social
support from family members, friends, and community facilitates recovery,
increases social functioning, and improves life satisfaction and quality of
life for people with SMI (Aldersey & Whitley, 2015; Klein, Cnaan,
, 1998; Pang et al., 2015; Sánchez, Rosenthal et al., 2016; van
Vugt, Kroon, Delespaul, & Mulder, 2012). However, persons with SMI are more
socially isolated and have greater difficulty participating in community
activities than those without a mental illness, which is linked to decreased
community participation and life satisfaction among individuals with SMI
(Lemay, 2006; Sánchez, Rosenthal et al., 2016).  

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