Top

Social Psychiatry and Psychiatric Epidemiology

Published in:

01-03-2018 | Original Paper

Health-related quality of life in outpatients with schizophrenia: factors that determine changes over time

Authors: Cristina Domenech, Carlo Altamura, Corrado Bernasconi, Ricardo Corral, Helio Elkis, Jonathan Evans, Ashok Malla, Marie-Odile Krebs, Anna-Lena Nordstroem, Mathias Zink, Josep Maria Haro

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 3/2018

Abstract

Purpose

The objective of this study was to analyze the clinical factors associated with changes in HRQoL in outpatients with schizophrenia using both generic and condition-specific HRQoL scales.

Methods

Adult outpatients with schizophrenia at least 18 years of age who did not have an acute psychotic exacerbation in the 3 months prior to baseline were recruited. PANSS dimensions were calculated based on Lindenmayer et al.’s five factors. HRQoL data were assessed by patients using the Schizophrenia Quality of Life Scale (SQLS), the Short Form-36 (SF-36), and the EuroQol-5 Dimension (EQ-5D) questionnaires.

Results

Out of the 1345 patients included at baseline, 1196 (89%) were evaluated at 12 months. Regression models showed that the factor most consistently associated with HRQoL at endpoint was change in the PANSS negative symptoms score. A decrease in the PANSS negative symptoms score from baseline to 1 year was associated with a decrease in HRQoL during the same period. There were also significant associations of the change in PANSS excitatory factor with all the HRQoL scales except the SF-36 PCS. Female gender was associated with a decrease in all HRQoL ratings. There was also a relationship between years since onset and HRQoL. The longer the time since illness onset, the larger the decrease in HRQoL.

Conclusions

This study has found that, in outpatients with schizophrenia, changes in negative and excitement symptoms may have a greater an association with HRQoL than changes in positive, cognitive and depressive symptoms.

Cella DF (1995) Measuring quality of life in palliative care. Semin Oncol 22:73–81PubMed

Awad AG, Voruganti LNP (2012) Measuring quality of life in patients with schizophrenia: an update. Pharmacoeconomics 30:183–195. https://doi.org/10.2165/11594470 CrossRefPubMed

Boyer L, Baumstarck K, Boucekine M et al (2013) Measuring quality of life in patients with schizophrenia: an overview. Expert Rev Pharmacoecon Outcomes Res 13:343–349. https://doi.org/10.1586/erp.13.15 CrossRefPubMed

Rabin R, Charro F de (2001) EQ-SD: a measure of health status from the EuroQol Group. Ann Med 33:337–343. https://doi.org/10.3109/07853890109002087 CrossRefPubMed

Ware J, Sherbourne C (1992) The MOS 36-ltem Short-Form Health Survey (SF-36): I. Conceptual framework and item selection. Med Care 30:473–483CrossRefPubMed

Brazier J, Connell J, Papaioannou D et al (2014) A systematic review, psychometric analysis and qualitative assessment of generic preference-based measures of health in mental health populations and the estimation of mapping functions from widely used specific measures. Health Technol Assess (Rockv) 18:1–188. https://doi.org/10.3310/hta18340

Papaioannou D, Brazier J, Parry G (2011) How valid and responsive are generic health status measures, such as EQ-5D and SF-36, in Schizophrenia? A systematic review. Value Heal 14:907–920. https://doi.org/10.1016/j.jval.2011.04.006 CrossRef

Haro JM, Altamura C, Corral R et al (2015) Understanding the impact of persistent symptoms in schizophrenia: cross-sectional findings from the pattern study. Schizophr Res 169:234–240. https://doi.org/10.1016/j.schres.2015.09.001 CrossRefPubMed

American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders. Diagnostic Stat Man Ment Disord 4th Ed TR. https://doi.org/10.1016/B978-1-4377-2242-0.00016-X

10.

Lecrubier Y, Sheehan DV, Weiller E et al (1997) The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 12:224–231. https://doi.org/10.1016/S0924-9338(97)83296-8 CrossRef

11.

Kay SR, Fiszbein AOL (1987) The positive and negative syndrome scale for schizophrenia. Schizophr Bull 13:261–276. https://doi.org/10.1093/schbul/13.2.261 CrossRefPubMed

12.

Lindenmayer JP, Grochowski S, Hyman RB (1995) Five factor model of schizophrenia: replication across samples. Schizophr Res 14:229–234. https://doi.org/10.1016/0920-9964(94)00041-6 CrossRefPubMed

13.

Wilkinson G, Hesdon B, Wild D et al (2000) Self-report quality of life measure for people with schizophrenia: the SQLS. Br J Psychiatry 177:42–46. https://doi.org/10.1192/bjp.177.1.42 CrossRefPubMed

14.

Jenkinson C, Coulter A, Wright L (1993) Short form 36 (SF 36) health survey questionnaire: normative data for adults of working age. BMJ 306:1437–1440CrossRefPubMedPubMedCentral

15.

Dolan P, Gudex C, Kind P, Williams A (1995) A social tariff for EuroQol: results from a UK general population survey. Work. Paper

16.

Jenkinson C, Wright L, Coulter a (1994) Criterion validity and reliability of the SF-36 in a population sample. Qual Life Res 3:7–12. https://doi.org/10.1007/BF00647843 CrossRefPubMed

17.

Fransen M, Edmonds J (1999) Reliability and validity of the EuroQol in patients with osteoarthritis of the knee. Rheumatol 38:807–813. https://doi.org/10.1093/rheumatology/38.9.807 CrossRef

18.

Linde L, Sørensen J, Ostergaard M et al (2008) Health-related quality of life: validity, reliability, and responsiveness of SF-36, 15D, EQ-5D [corrected] RAQoL, and HAQ in patients with rheumatoid arthritis. J Rheumatol 35:1528–1537 pii]PubMed

19.

Ojeda N, Sánchez P, Peña J et al (2012) An explanatory model of quality of life in schizophrenia: the role of processing speed and negative symptoms. Actas Esp Psiquiatr 40:10–18PubMed

20.

Galuppi A, Turola MC, Nanni MG et al (2010) Schizophrenia and quality of life: how important are symptoms and functioning? Int J Ment Health Syst 4:31. https://doi.org/10.1186/1752-4458-4-31 CrossRefPubMedPubMedCentral

21.

Bystritsky A, Liberman RP, Hwang S et al (2001) Social functioning and quality of life comparisons between obsessive-compulsive and schizophrenic disorders. Depress Anxiety 14:214–218. https://doi.org/10.1002/da.1069 CrossRefPubMed

22.

Browne S, Roe M, Lane A et al (1996) Quality of Life in schizophrenia: relationship to sociodemographic factors, symptomatology and tardive dyskinesia. Acta Psychiatr Scand 94:118–124CrossRefPubMed

23.

Zeng Y, Zhou Y, Lin J et al (2015) Generic and disease-specific quality of life and its predictors among Chinese inpatients with schizophrenia. Psychiatry Res 228:724–728. https://doi.org/10.1016/j.psychres.2015.05.033 CrossRefPubMed

24.

Katschnig H (2000) Schizophrenia and quality of life. Acta Psychiatr Scand Suppl 102:33–37. https://doi.org/10.1034/j.1600-0447.2000.00006.x CrossRef

25.

Cramer J, Rosenheck R, Xu W et al (2000) Quality of life in Schizophrenia: a comparison of instruments. Schizophr Bull 26:659–666. https://doi.org/10.1093/oxfordjournals.schbul.a033484 CrossRefPubMed

26.

Rofail D, Regnault A, le Scouiller S et al (2016) Health-related quality of life in patients with prominent negative symptoms: results from a multicenter randomized Phase II trial on bitopertin. Qual Life Res 25:201–211. https://doi.org/10.1007/s11136-015-1057-9 CrossRefPubMed

27.

Guajardo VD, Terroni L, Sobreiro MDFM. et al (2015) The influence of depressive symptoms on quality of life after stroke: a prospective study. J Stroke Cerebrovasc Dis 24:201–209. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.08.020 CrossRefPubMed

28.

Schram MT, Baan CA, Pouwer F (2009) Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev 5:112–119. https://doi.org/10.2174/157339909788166828 CrossRefPubMedPubMedCentral

29.

Mulhern B, Mukuria C, Barkham M et al (2014) Using generic preference-based measures in mental health: psychometric validity of the EQ-5D and SF-6D. Br J Psychiatry 205:236–243. https://doi.org/10.1192/bjp.bp.112.122283 CrossRefPubMed

30.

Rouillon F, Eriksson L, Burba B et al (2013) Functional recovery results from the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE). Acta Neuropsychiatr 25:297–306. https://doi.org/10.1017/neu.2013.7 CrossRefPubMed

31.

Payakachat N, Ali MM, Tilford JM (2015) Can the EQ-5D detect meaningful change? A systematic review. Pharmacoeconomics 33:1137–1154. https://doi.org/10.1007/s40273-015-0295-6 CrossRefPubMedPubMedCentral

32.

Sonntag M, König H-H, Konnopka A (2015) The responsiveness of the EQ-5D and time trade-off scores in schizophrenia, affective disorders, and alcohol addiction. Health Qual Life Outcomes 13:114. https://doi.org/10.1186/s12955-015-0315-4 CrossRefPubMedPubMedCentral

33.

McCrone P, Patel A, Knapp M et al (2009) A comparison of SF-6D and EQ-5D utility scores in a study of patients with schizophrenia. J Ment Health Policy Econ 12:27–31PubMed

34.

Awad AG, Voruganti LN, Heslegrave RJ (1997) Measuring quality of life in patients with schizophrenia. Pharmacoeconomics 11:32–47. https://doi.org/10.2165/11594470-000000000-00000 CrossRefPubMed

35.

Hsiao C-Y, Hsieh M-H, Tseng C-J et al (2012) Quality of life of individuals with schizophrenia living in the community: relationship to socio-demographic, clinical and psychosocial characteristics. J Clin Nurs 21:2367–2376. https://doi.org/10.1111/j.1365-2702.2012.04067.x CrossRefPubMed

36.

Xiang Y-T, Weng Y-Z, Leung C-M et al (2010) Gender differences in sociodemographic and clinical characteristic and the quality of life of Chinese schizophrenia patients. Aust N Z J Psychiatry 44:450–455. https://doi.org/10.3109/00048670903489858 CrossRefPubMed

37.

Narvaez JM, Twamley EW, McKibbin CL et al (2008) Subjective and objective quality of life in schizophrenia. Schizophr Res 98:201–208. https://doi.org/10.1016/j.schres.2007.09.001 CrossRefPubMed

38.

Dimitriou P, Anthony D, Dyson S (2009) Quality of life for patients with schizophrenia living in the community in Greece. J Psychiatr Ment Health Nurs 16:546–552. https://doi.org/10.1111/j.1365-2850.2009.01413.x CrossRefPubMed

39.

Hermes Ed, Sokoloff D, Stroup S, T., & Rosenheck RA (2012) Minimum clinically important difference in the positive and negative syndrome scale with data from the clinical antipsychotic trials of intervention effectiveness (CATIE). J Clin Psychiatry 73:526–532. https://doi.org/10.4088/JCP.11m07162.Minimum CrossRefPubMedPubMedCentral

40.

Coretti S, Ruggeri M, McNamee P (2014) The minimum clinically important difference for EQ-5D index: a critical review. Expert Rev Pharmacoecon Outcomes Res 14:221–233. https://doi.org/10.1586/14737167.2014.894462 CrossRefPubMed

41.

Cohen J (1988) Statistical power analysis for the behavioral sciences. Stat Power Anal Behav Sci 2:567. https://doi.org/10.1234/12345678

42.

Bobes J, A-Portilla PG (2005) Quality of life measures in schizophrenia. Eur 20 (Suppl 3):S313–S317. https://doi.org/10.1016/S0924-9338(05)80182-8

43.

Gandek B, Ware JE, Aaronson NK et al (1998) Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: results from the IQOLA project. J Clin Epidemiol 51:1171–1178. https://doi.org/10.1016/S0895-4356(98)00109-7 CrossRefPubMed

44.

Ware JE, Gandek B, Kosinski M et al (1998) The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. J Clin Epidemiol 51:1167–1170. https://doi.org/10.1016/S0895-4356(98)00108-5 CrossRefPubMed

45.

Ciconelli RM, Ferraz MB, Santos W et al (1999) Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF-36). Rev Bras Reumatol 39:143–150

46.

Augustovski FA, Lewin G, Elorrio EG, Rubinstein A (2008) The Argentine-Spanish SF-36 Health Survey was successfully validated for local outcome research. J Clin Epidemiol. https://doi.org/10.1016/j.jclinepi.2008.05.004 PubMed

47.

Devlin NJ, Brooks R (2017) EQ-5D and the EuroQol group: past, present and future. Appl Health Econ Health Policy 15:127–137. https://doi.org/10.1007/s40258-017-0310-5 CrossRefPubMedPubMedCentral

48.

Jenkinson C (1999) Comparison of UK and US methods for weighting and scoring the SF-36 summary measures. J Public Health Med 21:372–376. https://doi.org/10.1093/pubmed/21.4.372 CrossRefPubMed

49.

Janssen MF, Pickard AS, Golicki D et al (2013) Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study. Qual Life Res 22:1717–1727. https://doi.org/10.1007/s11136-012-0322-4 CrossRefPubMed

50.

Cordoba R, Cano JF, Arango-Davila CA et al (2012) Study of flexible doses of paliperidone ER in patients with schizophrenia who have undergone inefficient treatment with other antipsychotics. Rev Colomb Psiquiatr 41:340–356. https://doi.org/10.1016/S0034-7450(14)60009-3 CrossRefPubMed

51.

Stefanovics EA, Elkis H, Zhening L et al (2014) A cross-national factor analytic comparison of three models of PANSS symptoms in schizophrenia. Psychiatry Res 219:283–289. https://doi.org/10.1016/j.psychres.2014.04.041 CrossRefPubMed

52.

Ruggeri M, Nosè M, Bonetto C et al (2005) Changes and predictors of change in objective and subjective quality of life: multiwave follow-up study in community psychiatric practice. Br J Psychiatry 187:121–130. https://doi.org/10.1192/bjp.187.2.121 CrossRefPubMed

Title: Health-related quality of life in outpatients with schizophrenia: factors that determine changes over time
Authors: Cristina Domenech
Carlo Altamura
Corrado Bernasconi
Ricardo Corral
Helio Elkis
Jonathan Evans
Ashok Malla
Marie-Odile Krebs
Anna-Lena Nordstroem
Mathias Zink
Josep Maria Haro
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 3/2018
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-018-1483-4

At a glance: The STEP trials

Springer Medicine

Health-related quality of life in outpatients with schizophrenia: factors that determine changes over time

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Involuntary hospitalization, stigma stress and suicidality: a longitudinal study

Suicidal thoughts and behaviors among college students and same-aged peers: results from the World Health Organization World Mental Health Surveys

Effects of contact-based mental illness stigma reduction programs: age, gender, and Asian, Latino, and White American differences

Self-reported discriminatory and positive behaviours towards people with mental health problems: findings from an Australian national survey

Trends and socio-economic determinants of suicide in India: 2001–2013

Loneliness in psychosis: a systematic review