Subjective and objective quality of life in schizophrenia

Abstract

Objective: Quality of life (QOL) is considered an important outcome in the treatment of schizophrenia, but the determinants of QOL are poorly understood in this population. Furthermore, previous studies have relied on combined measures of subjective QOL (usually defined as life satisfaction) and objective QOL (usually defined as participation in activities and relationships). We examined separately the clinical, functional, and cognitive predictors of subjective and objective QOL in outpatients with schizophrenia. We hypothesized that better subjective QOL would be associated with less severe negative and depressive symptoms, better objective QOL, and greater everyday functioning capacity, and that better objective QOL would be associated with less severe negative and depressive symptoms, better cognitive performance, and greater functional capacity.

Method: Participants included 88 outpatients with schizophrenia or schizoaffective disorder who completed a comprehensive series of assessments, including measures of positive, negative, and depressive symptoms; performance-based functional skills; a neuropsychological battery; and an interview measure of subjective and objective QOL.

Results: In the context of multiple predictor variables, more severe depressive symptoms and better neuropsychological functioning were independent predictors of worse subjective QOL. More severe negative symptoms predicted worse objective QOL. Functional capacity variables were not associated with subjective or objective QOL.

Conclusion: Treatments to improve QOL in schizophrenia should focus on negative symptoms and depressive symptoms.

Figure 1

Relationships between Symptom Severity, Functional Capacity, and Cognitive Performance. Note. Dashed arrows represent hypothesized relationships that were not supported in the multivariate analyses. Solid arrows represent hypothesized relationships that were supported in the multivariate analyses. The dotted arrow represents an unexpected significant relationship (worse cognitive performance was associated with better subjective QOL). Note that although the arrows depict hypothesized causative relationships, many relationships may be bidirectional.