Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia

Purpose

Quality of life (QOL) in patients with schizophrenia is influenced by various factors such as depressive symptoms. This study assessed the relationship between depressive symptoms and QOL in outpatients with schizophrenia in Nigeria and evaluated the associated socio-demographic and clinical factors.

Methods

One hundred patients with 10th edition of the International Classification of Diseases diagnosis of schizophrenia participated in this study. Socio-demographic and clinical factors such as depression were assessed with Zung Self-rating Depression Scale and symptoms of schizophrenia with the Positive and Negative Syndrome Scale of schizophrenia (PANSS). The level of functioning was assessed with the Global Assessment of Functioning Scale. QOL was assessed using the brief version of the World Health Organisation Quality of Life Scale.

Results

There were 27 (27.0 %) patients with depression. The depressed patients reported significant lower scores in all QOL domains when compared with the non-depressed group. All QOL domains were significantly negatively correlated with the total PANSS and all its subscales (except for psychological domain with total PANSS and social relationship and environmental domains with PANSS positive). Severity of depressive symptoms was significantly negatively correlated with all QOL domains. Functioning was significantly positively correlated with all QOL domains except in the environmental domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains except the social relationship domain while negative symptoms predicted social relationship and environmental domains.

Conclusion

Depression is a common occurrence during the course of schizophrenia. Depressive and negative symptoms have a significant impact on the QOL of patients with schizophrenia.     

Cortisol response and coping style predict quality of life in schizophrenia

Stress and coping have been found to be strongly associated with quality of life (QOL). Compared to community controls (CC), individuals diagnosed with schizophrenia (SZ) report a lower QOL. Lower QOL in SZ may be explained by patients' tendency to react differently to stress and to use less effective coping strategies than CC, but no studies to date have examined these possible associations. A main goal of this study, therefore, was to examine the roles of stress response and coping style in explaining QOL in SZ and CC, while controlling for potential confounds including personality. Subjects were 30 SZ patients and 29 matched controls who completed the Trier Social Stress Test (TSST). Salivary cortisol was used as an objective measure of stress response. Participants rated their coping strategies with the Brief COPE, judged their QOL with the Satisfaction with Life Scale, and rated their personality using the NEO-Five Factor Inventory. Results indicate that, even when confounds are controlled for, blunted cortisol response predicts better QOL in SZ patients. Additionally, results suggest that more frequent use of coping strategies is associated with better QOL but only in patients with blunted cortisol response; those who showed an increase in cortisol in response to the TSST have better QOL the lower their coping score. Possible explanations and clinical implications of these findings are discussed.     

The influence of neurocognitive deficits and symptoms on quality of life in schizophrenia.

The purpose of the present study was to examine the relationship between neurocognitive deficits and self-reported quality of life in order to examine whether neurocognitive impairment interferes with any aspects of quality of life for patients with schizophrenia. Forty-two outpatients with stable chronic schizophrenia were assessed for neurocognitive deficits using a computerized test battery, and all patients completed a version of the Sickness Impact Profile (SIP) to assess their quality of life across a variety of domains. The neurocognitive assessment tests revealed significant deficits compared with normal control subjects, particularly with respect to impaired iconic memory and frontal functioning. Patients reported that their quality of life was compromised. Despite the substantiation of marked neurocognitive deficits and reduced quality of life, correlations between neurocognitive deficits and quality of life were largely nonsignificant or very weak. Symptom expression, however, particularly with regard to general psychopathology on the Positive and Negative Syndrome Scale (PANSS), was significantly associated with quality of life. These results suggest that neurocognitive deficits in schizophrenia, while often profound, appear to have little direct impact on the patient's perceived quality of life.     

The relation of social support-seeking to quality of life in schizophrenia

Social support-seeking has been shown to improve the outcome of schizophrenia. However, no study to date has documented the impact of social support seeking on self-perceived quality of life in schizophrenia, particularly not on the relation between symptoms and quality of life. The present study explored this issue with a sample of 58 outpatients diagnosed with schizophrenia without comorbidity. Social support seeking, symptoms (positive, negative, and extrapyramidal), and multidimensional self-reported quality of life were assessed cross-sectionally. Negative symptoms were inversely related to the quality of life domain of activities of daily living. Other symptoms and social support-seeking were not related to quality of life, and social support-seeking did not interact with symptoms in their relation to quality of life. Social support-seeking may thus not be beneficial (nor disruptive) as a way of coping with symptoms in schizophrenia. More studies are needed in order to investigate the relation of social support-seeking to symptoms and to quality of life in serious mental illnesses such as schizophrenia, so that interventions with persons suffering from these disorders may be better guided.     

Psychiatric symptoms and quality of life in schizophrenia: a meta-analysis

Quality of life (QoL) has been recognized as an important outcome of schizophrenia treatment, yet the determinants of QoL for individuals with schizophrenia are not well known. Research has consistently found psychiatric symptoms to be negatively related to QoL, however, findings concerning the strength of these relationships have been mixed, making it difficult to determine the degree to which such symptoms are related to poor QoL. This research presents a systematic meta-analysis of studies examining the relationship between psychiatric symptoms and QoL in schizophrenia, in an effort to elucidate the determinants of QoL for this population. A total of 56 studies were extracted from literature searches of relevant databases for empirical reports published between 1966 and 2005 examining the relationship between positive, negative, and/or general psychiatric symptoms and QoL. Weighted effect size analyses revealed small relationships between psychiatric symptoms and QoL, with general psychopathology showing the strongest negative associations across all QoL indicators. Moderator analyses indicated that variation in effect sizes could be accounted for by differing operationalizations of QoL, study design, sample, and participant treatment setting. In particular, positive and negative symptoms were more strongly related to poor QoL among studies of schizophrenia outpatients, whereas general psychopathology showed a consistent negative relationship with QoL across all study samples and treatment settings. Implications for future research and treatment development are discussed.     

The impact of the interviewer-interviewee relationship on subjective quality of life ratings in schizophrenia patients

Subjective quality of life (SQOL) ratings are usually based on interviews. This study examined in which way patients' ratings differ depending on whom they are interviewed by. SQOL was assessed in 78 schizophrenia patients in an out patient clinic and in sheltered living arrangements. Using patients randomly allocated to two interview situations: one group was interviewed by external researchers, the other group by their case managers. On average, more favourable ratings were elicited by case managers. Some of the differences were statistically significant and substantial in size. Yet, opposing differences were also found regarding some life domains in one group. It may be concluded that a significant impact of the interviewer-interviewee relationship on SQOL ratings may exist, but that it is not consistent, unidirectional and uniform regarding life domains and across different settings and samples.     

The impact of work-related rehabilitation on the quality of life of patients with schizophrenia

In a cross-sectional study of 60 outpatients with schizophrenia (mean age 36.3 ± 11.1) the effect of a work-related rehabilitation programme on the patients' quality of life was investigated. A group of patients with the same diagnosis, but without rehabilitation, served as controls. Patients of the rehabilitation group had been attending the programme for a mean duration of 15.0 months. The programme focuses on occupational and everyday skills and also involves social aspects. The patients' quality of life was assessed using two self-administered questionnaires: the Munich List of Life Dimensions (MLDL, Heinisch et al. 1991) and the Everyday Life Questionnaire (Bullinger et al. 1993). Life satisfaction as well as functional quality of life were higher in the rehabilitation group in the majority of domains assessed. Difference between groups was highest for satisfaction with work, followed by leisure-time activities, independence and friendships/acquaintances. Results indicate that the rehabilitation programme acts like a “lever” which, applied to one point (work, day structuring), subsequently affects most domains of daily living. Accepted: 26 February 1998     

The impact of weight gain on quality of life among persons with schizophrenia

Weight gain has been associated with the use of antipsychotic medications, and research has linked obesity with reduced quality of life. This study sought to assess the impact of weight gain on persons with schizophrenia who are taking antipsychotic medications. The Psychological Well-Being Index, a measure of quality of life, was distributed to individuals with schizophrenia who belonged to mental health associations. Among 286 respondents, 56 percent gained no weight over a six-month period while taking antipsychotic medications, 19 percent gained one to ten pounds, 12 percent gained 11 to 20 pounds, and 14 percent gained more than 20 pounds. When gender and use of antipsychotics were controlled for, weight gain was related to poorer quality of life and reduced well-being and vitality. Clinicians should consider the effect of weight gain on quality of life when prescribing antipsychotics and should help patients adopt weight maintenance behaviors.     

氨磺必利治疗晚发性分裂症的疗效及对生活质量的影响

目的 了解氨磺必利治疗晚发性分裂症的疗效和对生活质量的影响.方法 选择80例晚发性分裂症的患者作为研究对象,分别应用氨磺必利和利培酮,进行为期12周疗效、不良反应以及生活质量变化的观察.结果 治疗前氨磺必利组和利培酮组PANSS总分及各因子分差异均无统计学意义(P＞0.05).治疗后第2,4,12周末,两组PANSS量表总分、阳性症状量表分、阴性症状量表分及一般病理量表分逐渐降低,差异有统计学意义(P＜0.05);但在治疗第12周末,两组阴性症状量表分差异有统计学意义(P＜0.05);在治疗12周末,氨磺必利组躯体功能和社会功能的改善优于利培酮组(P＜0.05);氨磺必利组较利培酮组不良反应轻微(P＜0.05).结论 氨磺必利有助于晚发性分裂症提高长期疗效和生活质量的改善.     

The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia

Objective

The quality of life (QOL) of patients with schizophrenia has been found to be positively correlated with the social network and empowerment, and negatively correlated with stigma and depression. However, little is known about the way these variables impact on the QOL. The study aims to test the hypothesis that the social network, stigma and empowerment directly and indirectly by contributing to depression influence the QOL in patients with schizophrenia and schizoaffective disorders.

Method

Data were collected on demographic and clinical variables, internalized stigma, perceived devaluation and discrimination, empowerment, control convictions, depression and QOL. Structural equation modelling (SEM) was applied to examine the impact of the above-mentioned constructs on QOL.

Results

The influences of the social network, stigma, empowerment and depression on QOL were supported by the SEM. A poor social network contributed to a lack of empowerment and stigma, which resulted in depression and, in turn, in poor QOL. Interestingly, however, the social network and stigma did not show a direct effect on QOL.

Conclusion

Following a recovery approach in mental health services by focusing on the improvement of the social network, stigma reduction and especially on the development of personal strength has the potential to reduce depression in patients with psychosis and improving their QOL.     

团队封闭式训练对精神分裂症康复期患者应对方式 与生活质量的影响

目的 探究团队封闭式训练对精神分裂症康复期患者应对方式与生活质量的影响。方法 选 择2014 年7 月—2017 年7 月经武汉市精神卫生中心治疗后病情稳定的精神分裂症患者100 例,按照随 机数字表法分为两组,各50例。对照组患者进行常规护理,观察组在对照组基础上进行团队封闭式训练, 比较两组Morningside 康复状态量表（MRSS）评分、应对方式（CSQ）评分、家庭关怀度指数（APGAR）以及 生活质量综合评定（GQOLI-74）评分。结果 观察组MRSS 的依赖、活动能力缺乏、症状行为异常以及社 交评分均显著低于对照组（P＜0.05）。训练前两组的CSQ 、APGAR、GQOLI-74评分差异无统计学意义（P ＞ 0.05）,训练后均显著改善,并且观察组各项评分均显著高于对照组（P＜ 0.05）。结论 团队封闭式训练 可有效提高精神分裂症康复期患者应对方式以及生活质量。     

Anxiety disorders in outpatients with schizophrenia: prevalence and impact on the subjective quality of life

OBJECTIVE: To describe the prevalence of comorbid lifetime anxiety disorders in outpatients with schizophrenia and to compare the subjective quality of life of patients with and without comorbid anxiety disorders. METHODS: Fifty-three outpatients were recruited. They were interviewed with the Anxiety Disorders section of the SCID for DSM-IV. Quality of life was assessed with the Sheehan disability scale (SDS). RESULTS: Specific prevalences of anxiety comorbidity were: social phobia (17%), OCD (15.1%), GAD (9.4%), anxiety disorder NOS (7.5%), panic disorder (5.7%), specific phobia (5.7%), PTSD (3.8%), and agoraphobia (1.9%). Schizophrenic patients with comorbid anxiety disorder (41.5%) showed significantly higher scores in global scale (p=0.005), work subscale (p=0.007), and social life subscale (p=0.003) of the SDS than their counterparts without comorbid conditions. CONCLUSIONS: Anxiety disorders may impose an additional burden to patients with schizophrenia, resulting in further decline in their subjective quality of life.     

The impact of cognitive remediation on psychiatric symptoms of schizophrenia

OBJECTIVE: The relationship between psychopathology and cognitive functioning in schizophrenia is of interest, both for an understanding of the nature of the disease, and for comprehensive treatment planning. The aim of this study was to investigate how psychiatric symptoms affect, and are affected by, cognitive remediation. METHOD: Fifty-four psychiatric inpatients received either cognitive remediation exercises (remediation group) or no cognitive intervention (control group). The subjects' scores on tests of cognition and on the Positive and Negative Symptoms Scale (PANSS) were measured before, after the 10 session treatment, and again 4 weeks post treatment. RESULTS: Only the remediation group showed significant and persistent improvement on all three PANSS Subscales as well as on the Positive Symptoms and Depression Factors. There were no significant between-group differences on any PANSS pre/posttreatment change scores. Baseline measures of psychopathology did not correlate meaningfully with amount of change made on cognitive measures after rehabilitation. CONCLUSIONS: A brief 10-session course of cognitive remediation is sufficient to benefit cognition and has some positive effects on psychopathology as measured by the PANSS, but does not add significantly to the effects of standard psychiatric treatment on psychopathology. Furthermore, psychiatric symptom profile is not predictive of the degree to which cognitive symptoms respond to cognitive remediation. The differential impact of cognitive remediation on cognition and psychopathology may imply that psychopathology and cognitive functioning follow fairly independent treatment courses.