Improving quality of life is an important goal in the treatment of schizophrenia. In previous research, quality of life has been reported to be compromised in patients with schizophrenia. The aim of this study was to investigate whether quality of life may be impaired in first-episode schizophrenia patients and to identify the associated factors of quality of life in first-episode schizophrenia.
Forty-eight patients with first-episode schizophrenia and 20 normal controls were recruited. Quality of life was measured by using the Quality of Life scale (QLS). General and social self-efficacy, perceived social support were measured by using the self-report scales. The clinical assessments and comprehensive neurocognitive battery were also administered.
First-episode group showed significantly decreased QLS total and QLS subscale scores compared to normal controls group. The key associated factors of quality of life in patients with first-episode schizophrenia were the negative symptoms and social self-efficacy.
This finding implies that compromised quality of life may be already emerged in schizophrenia in their first-episode and the psychosocial interventions should be targeting the negative symptoms and the psychosocial protective factors including self-efficacy in addition to simply ameliorating the positive symptoms to foster social reintegration and recovery of first-episode patients.
Impairment in quality of life is evident in patients with schizophrenia.
Investigating schizophrenia-related determinants of objective quality of life is a pivotal step in elucidating influential factors associated with quality of life and in guiding the development of future interventions designed to promote social integration.
Additionally, some psychosocial factors have been proposed to be protective factors that serve to optimize quality of life among patients with schizophrenia, and self-efficacy
The aim of this study was to investigate whether quality of life may be impaired in first-episode schizophrenia patients and to identify the associated factors of quality of life in first-episode schizophrenia.
Based on the previous reports,
The present study was part of the Green Program for Recognition and Prevention of Early Psychosis (GRAPE) project; the details of this project have been described elsewhere.
The present study was carried out in accordance with the Declaration of Helsinki. The Institutional Review Boards at Severance Hospital and Severance Mental Health hospital reviewed and approved this study. All participants gave written informed consent.
The Heinrichs-Carpenter quality of life scale (QLS) was used to assess the quality of life. The QLS
Self-efficacy was assessed using the Self-efficacy Scale.
As some of the psychosocial scales and items from the comprehensive neurocognitive battery were not available prior to April 2008, some data of first-episode patients (for Self-efficacy, n=8; for ISEL, n=20; for HAM-D, n=1; for HAM-A, n=1 and for neurocognitive battery, n=12) were not included in the statistical analysis. Some data from the neurocognitive battery were presented elsewhere in order to compare the neurocognitive performance of first-episode groups
The clinical interviews and assessments were administered by a psychiatrist within a week after recruitment into the study. Each participant received a packet of questionnaires, including the Self-efficacy Scale and Interpersonal Support Evaluation List. The neurocognitive batteries were administered within 2 weeks of recruitment by a masters-level psychologist.
All rated scores had acceptable skewness and kurtosis statistics (<1.0). The independent t-tests were done for clinical and socio-demographic variables. Pearson correlations were used to evaluate correlations between QLS scores and the psychopathology, global neurocognitive function, the psychosocial scales. All variables significantly related to QLS total and subdomain scores were analyzed subsequently using a multiple linear regression to evaluate their independent contributions to quality of life. The regression model utilized a stepwise method. The missing data were subjected to pairwise deletion. The criterion for significance was set at p<0.05.
Demographic and clinical characteristics of the normal controls and first-episode schizophrenia group were presented in
First-episode group showed significantly decreased QLS total, and across all subscale scores compared to normal controls group (
The enhanced general self-efficacy, social self-efficacy perceived social support, and neurocognitive performance were correlated to better QLS total and several subdomain scores. Increased severity of modified negative syndrome of PANSS was correlated to poorer QLS total and all subdomain scores (
The modified negative syndrome and social self-efficacy were significant associated factors of QLS total. Modified Negative syndrome was significantly related to the IF subdomain score and social self-efficacy was related to the IPR, IR, COA subdomain scores (
The main findings of this study were that the objective quality of life of individuals with first-episode patients group was poorer than normal controls group and the key associated factors of quality of life among individual with first-episode patients group were negative symptoms and social self-efficacy.
Patients with first-episode schizophrenia were found to have poorer quality of life and subdomains of quality of life such as intrapsychic foundation, interpersonal relations, instrumental role and common objects and activities and this is consistent with those of previous studies.
Negative symptoms were found to be independently contributed to the decreased quality of life total and intrapsychic foundation subdomain in the first-episode patients group. In previous studies, this association was argued to partly reflect some redundancy of common variance between negative symptoms and quality of life for individuals experiencing schizophrenia.
In addition to negative symptoms, social self-efficacy was also independent contributing factor of better quality of life total and across all subdomins in first-episode patients. As a human, intrinsic need such as esteem and self-actualization,
Contrary to our hypothesis, global neurocognitive function and perceived social support were not independent factors of quality of life in first-episode schizophrenia patients. In regard of global neurocognitive function, first, there may be only a modest relationship, which may have gone undetected due to the small sample size of this study. Second, neurocognitive function may not translate into real-world function due to the influence of psychopathology, lack of opportunity, or other factors, which was offered by Narvaez et al.
In regard of affective psychopathology in present study, depression and anxiety was not independent contributing factor of objective quality of life in first-episode schizophrenia patients, although there were significant correlations between QLS and HAM-D, and HAM-A. It may be explained that the affective symptoms in schizophrenia may be nonspecific symptoms since these depression and anxiety symptoms were found to be closely related with the positive (p<0.010) and negative symptoms (p<0.12) and self-efficacy (p<0.005).
The limitations of this study should be addressed. First one was the small sample sized and cross-sectional nature, which precludes conclusions regarding causality. In addition, some data including ISEL and global neurocognitive function were not included into statistical analysis. In the near future, longitudinal follow-up studies with larger samples with full data set will be needed to elucidate the key determinants of quality of life among individuals with first-episode schizophrenia. Second, in present study, there was no measurement of subjective quality of life. It was reported that in schizophrenia patients, the subjective rating of quality of life may be valid and informative on the point of life satisfaction.
In conclusion, the present study found that quality of life may be already compromised in schizophrenia patients in their early phase. More importantly, the key independent contributing factors of objective quality of life may be negative symptoms and psychosocial protective factors of social self-efficacy in individuals with first-episode schizophrenia. This finding implies that for social reintegration and recovery, psychosocial interventions should be comprehensive, targeting negative symptoms and self-efficacy in addition to simply ameliorating the positive symptoms.
This study was supported by a grant of the Korea Healthcare technology R&D project, Ministry for Health, Welfare and Family Affairs, Republic of Korea (A090096).
Clinical and demographic characteristics
*p<0.05. aSome data of first-episode persons (for Self-efficacy, n=8; for ISEL, n=20; for HAM-D, n=1; for HAM_A, n=1 and for neurocognitive battery, n=12) were not included in the statistical analysis. ISEL
Comparison of quality of life between normal controls and first-episode schizophrenia patients
*p<0.05. QLS
Correlations of quality of life with psychosocial variables, psychopathologies, and neurocognitive function in first-episode patients
*p<0.05, **p<0.01. aSome data of first-episode persons (for Self-efficacy, n=8; for ISEL, n=20; for HAM-D, n=1; for HAM_A, n=1 and for neurocognitive battery, n=12) were not included in the statistical analysis. ISEL
Stepwise multiple regression analyses of significant factors associated with quality of life in first-episode schizophrenia patients
All VIF <1.5, all condition index <10.1. aStandardized coefficient, bChanged variance, ΔR2, cAdjusted R2, Explained variance by model, dSome data of first-episode persons (for Self-efficacy, n=8 and for ISEL, n=20) were not included in the statistical analysis. IF: Intrapsychic Foundations, IPR: Interpersonal Relations, IR: Instrumental Role, COA: Common Objects and Activities. Modified Negative syndrome: scores were recalculated by omitting three items, including emotional withdrawal, passive/apathetic withdrawal, and difficulty in abstract thinking of PANSS