Quality of life in Chinese patients with schizophrenia: A meta-analysis

Investigating gender differences in quality of life and social support in patients with severe mental illnesses

BACKGROUND

Severe mental illnesses (SMIs), including schizophrenia and bipolar disorder affect patients significantly. Gender has been identified as a key factor influencing the experience of SMIs with notable disparities in prevalence, symptoms, and treatment outcomes. Additionally, the quality of life (QoL) and social support for patients with SMIs can vary based on gender.

AIMS

This study examined gender differences in QoL and social support of patients with SMIs.

METHOD

Participants include 170 outpatients with schizophrenia and bipolar disorder at Shafa Hospital (2021). QoL and social support were assessed using World Health Organization QoL (WHOQOL-BREF) questionnaire and Medical Outcomes Study Social Support Survey (MOS-SSS), respectively. Group differences were analyzed using t-test or Mann-Whitney U test, and two-way multivariate analyses of variance explored the effect of gender and disease type.

RESULTS

It was indicated that females with schizophrenia reported higher QoL than males, but the opposite was observed for bipolar disorder. Gender differences in social support were not significant among schizophrenia patients, nor between the two patient groups. However, women with bipolar disorder and multiple hospitalizations experienced lower social support and QoL compared to men. Additionally, more hospitalizations were associated with decreased QoL in both genders with schizophrenia.

CONCLUSIONS

Findings suggest the need for gender- specific interventions and support policies to enhance QoL and social support in patients with SMI.

Evaluation of quality of life in patients with schizophrenia: An inpatient social welfare institution-based cross-sectional study

Schizophrenia is a chronic mental illness with a poor quality of life (QoL). The main aim of this study was to measure the QoL and factors that affect the QoL of patients with schizophrenia placed in a social welfare institution. This cross-sectional study included 287 patients with schizophrenia who were treated in a long-stay social care institution in which QoL was assessed using five different instruments: the World Health Organization Quality of Life scale, the EuroQoL Five-Dimension-Five-Level scale (including the visual analog scale), the Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form, and the Brief Psychiatric Rating Scale. To determine the impact of patients' characteristics on score values, multiple linear regression using backward elimination was employed. Due to non-normality in the distribution of the dependent variables, a Box-Cox power transformation was applied to each dependent variable prior to conducting multiple linear regression analysis. Results revealed that patients with schizophrenia have lower QoL. Our study revealed that age, level of education, type of accommodation, type of pavilion, age of onset of the disease, number of prescribed antipsychotics, number of psychiatric comorbidities, duration of therapy, and the number of daily doses of antipsychotics are dominant contributors to the QoL in patients with schizophrenia who were treated in social welfare institution.

Dyadic effects of stigma on quality of life in people with schizophrenia and their family caregivers: Mediating role of patients' perception of caregivers' expressed emotion

Schizophrenia, as a stressful diagnosis, profoundly impacts the whole family, especially people with schizophrenia and their caregivers. This study tested the potential mediating role of expressed emotion in the association between mental health stigma and quality of life in caregiver-patient dyads. Using a 2-wave longitudinal design with a 6-month interval between assessments, 161 dyads of patients with schizophrenia and their family caregivers (one patient and one caregiver) completed measures of mental health stigma, expressed emotion, and quality of life. The results showed that patients' self-stigma had no significant actor or partner effect on expressed emotion or quality of life. In contrast, caregivers' stigmatizing attitudes toward patients had a significant partner effect on patients' perception of caregivers' expressed emotion and quality of life. The mediating effect of patients' perception of caregivers' expressed emotion in the association between caregivers' stigmatizing ideas toward patients and patients' quality of life was significant. By focusing on the interdependence of patients and their caregivers, this study highlights the role of caregivers' stigmatizing attitudes toward patients and patients' perception of caregivers' expressed emotion on patients' quality of life. Psychoeducation and interventions should not only aim to reduce the self-stigma of people with schizophrenia but also their caregivers' stigmatizing ideas toward patients. Family interventions targeted at reducing the EE level of caregivers and patients' perception of caregivers' EE would also benefit the adaptation and quality of life of people with schizophrenia and their caregivers.

Depression severity mediates stigma and quality of life in clinically stable people with schizophrenia in rural China

BACKGROUND

Depressive symptoms associated with schizophrenia are closely related to stigma and quality of life(QOL). There is, however, no thorough research on the connection between the three. This study sought to investigate the possible factors influencing depressive symptoms in people with schizophrenia (PWS) in rural Chaohu, China, and to further explore the role of depression severity in stigma and lifestyle quality.

METHODS

Eight hundred twenty-one schizophrenia patients accomplished the entire scale, including the 9-item Patient Health Questionnaire (PHQ-9), the Social Impact Scale (SIS), and the World Health Organization on Quality of Life Brief Scale(WHOQOL-BREF). A straightforward mediation model was employed to determine if the intensity of the depression could act as a mediator between stigma and QOL.

RESULTS

Two hundred seventy-nine schizophrenia patients (34%) had depressive symptoms (PHQ ≥ 10), and 542 patients (66%) did not (PHQ < 10). Logistic regression showed that marital status, job status, physical exercise, standard of living, and stigma contributed to the depressed symptoms of schizophrenia. Depression severity partially mediated the effect between stigma and QOL, with a mediating effect of 48.3%.

CONCLUSIONS

This study discovered a significant incidence of depressed symptoms associated with schizophrenia, with depression severity serving as a mediator variable connecting stigma and QOL and partially moderating the association.

Quality of Life of people with Schizophrenia: A meta-analysis

BACKGROUND

Schizophrenia is a severe, chronic mental disorder that causes many psychosocial problems. In order to reveal these problems, it is necessary to measure the quality of life of people with schizophrenia.

AIM

The aim of this meta-analysis is to compare the quality of life of people with schizophrenia and healthy subjects.

METHODS

Literature search was conducted in the Web of Science Core Collection database including the dates of January 2000 and March 2021. The systematic search provided 464 potentially relevant studies. The final sample consisted of 18 studies.

RESULTS

The results of using a random effects model for analysis indicated that schizophrenia subjects showed considerably lower quality of life scores compared to healthy controls.

CONCLUSION

Determining the quality of people with schizophrenia will help us to create effective psychosocial intervention programs.

The Impact of Health Education on the Quality of Life of Patients Hospitalized in Forensic Psychiatry Wards

PURPOSE

An original health education program, developed for a group of patients of forensic psychiatry wards, was the basis for conducting a study on the impact of educational influences on the quality of life of patients long-term isolated from their natural environment. The main aim of the study was to answer the question: Does health education affect the quality of life of patients in forensic psychiatry wards and is educational activity effective?

METHODS

The study was conducted at the State Hospital for Mental and Nervous Diseases in Rybnik, Poland, in the forensic psychiatry wards, and lasted from December 2019 to May 2020. During the study, patients gained knowledge in the field of broadly understood health education. The study group consisted of 67 men, aged 22-73, diagnosed with schizophrenia. The method of double measurements (before and after the health education cycle) was applied, using the WHOQOL-BREF scale of quality of life and the first author's questionnaire of patients' knowledge, from the educational program used.

RESULTS

Health education does not significantly affect the overall quality of life of patients staying in forensic psychiatry wards, but it does affect their somatic condition. The proprietary health education program is effective because the patients' knowledge has significantly improved.

CONCLUSIONS

The quality of life of interned patients with schizophrenia is not significantly related to educational activities, however, psychiatric rehabilitation through educational activities effectively increases the level of patients' knowledge.

Two-year cohort-up study of clozapine prescription in Chinese patients with schizophrenia treated in rural primary care

Few studies have examined the clozapine in cohort studies of Chinese patients with schizophrenia in rural primary care. The objective of this two-year cohort study was to describe the usage of clozapine and investigate and identify the demographic, clinical correlations and risk variables which affect the use of clozapine in patients with schizophrenia. A random cluster sampling technique was used, and participants were collected from China National Psychiatric Management System (CNPMS). The variables for clozapine use in individuals with schizophrenia who had undergone a two-year follow-up were determined using the generalized estimating equation (GEE). In this study, 742 patients with schizophrenia were invited, and 491 completed the two-year follow-up study. Being married, more years of education, more waist circumference, using mood stabilizer, using anticholinergic, higher ITAQ (Insight and Treatment Attitude Questionnaire) scores were more significantly related to the use of clozapine. Older age of onset, using second-generation antipsychotics (SGAs) except clozapine predicted a lower prevalence of using clozapine. The usage of clozapine was very common in patients with schizophrenia treated by primary care physicians, and was influenced by a variety of factors, including price of drugs, clinical factors, health regulations, and the characteristics of treatment environment. Further examination of the rationale and appropriateness of clozapine in primary care in China is necessary.

Meta-analysis of the effect of psychosocial skills training on the quality of life of people with schizophrenia

PURPOSE

The purpose of this study was to synthesize the studies examining the effects of psychosocial skills training (PSST) on the quality of life of people with schizophrenia using a meta-analysis.

DESIGN AND METHODS

Fifteen studies were included in the meta-analysis according to the inclusion and exclusion criteria.

FINDINGS

PSST was found to have a moderate effect on the overall score of quality of life of individuals with schizophrenia, a moderate effect on the psychological dimension, and a low effect on the physical dimension.

PRACTICE IMPLICATIONS

It can be said that psychosocial skills training is an effective intervention that can be used to improve the quality of life of people with schizophrenia.

Quality of life in patients with schizophrenia: A 2-year cohort study in primary mental health care in rural China

Objective

Quality of life (QoL) has been always an important way to evaluate the outcomes of schizophrenia, but there have been few previous longitudinal studies and few in middle-income countries. This study aimed to explore the QoL in Chinese patients with schizophrenia treated in primary mental health care and the risk factors of QoL over time.

Methods

Patients with schizophrenia treated in primary mental health care in rural/regional areas in Luoding, Guangdong, PR China, were evaluated with an extended questionnaire including the Chinese version of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and 2-year follow-up. Bivariate and multivariate analyses were conducted including Generalized Estimated Equation analyses (GEE).

Results

Four hundred and ninety-one patients with schizophrenia in primary care completed the 2-year follow up evaluation. The QoL physical, environmental, and social relationships domains showed improvement after the 2-year period, but the psychological domain did not. GEE results showed that earlier age of onset, older age, being employed, being unmarried, the thicker waist circumference, less use of clozapine or other SGAs, fewer hospitalizations, more frequent insomnia, more severe depressive and negative symptoms as well as worse treatment insight were independently associated with poor QoL in patients with schizophrenia.

Conclusion

According to our results, to improve the quality of life of patients with schizophrenia in primary care, we should pay more attention to the treatment of depression, negative and insomnia symptoms of schizophrenia, the choice and dosage of antipsychotic medication and improvement in the treatment compliance. The combined use of educational and behavioral strategies may improve treatment adherence.

How psychosocial stress profile influences the subsequent occurrence of neuropsychiatric comorbidities: A longitudinal population-based cohort study

BACKGROUND

The role of psychosocial stressors in psychiatric disorders and executive dysfunction has been reported, separately. The literature has also suggested the involvement of social support and coping strategies in these relationships. However, there is a lack of research conducted to examine the relationships among multiple stressors and neuropsychiatric comorbidities while considering the presence of social support and coping strategies. This study aims to articulate the roles of multiple psychosocial stressors, social support, and coping strategies in the subsequent occurrence of neuropsychiatric comorbidities.

METHODS

Data analyzed were from the 6th data collection of a large-scale, longitudinal population-based cohort from Southwest Montreal in Canada. The cumulative effects of multiple stressors were separately examined by a composite score and latent profile analysis. Multinomial logistic regression models were used to test the relationship between cumulative stressors and neuropsychiatric comorbidities.

RESULTS

A total of 210 participants were included in the analyses. The LPA identified a 2-class model for psychosocial stressors (low and high) and executive function (executive dysfunction and no executive dysfunction), respectively. There were 11.8% of participants with neuropsychiatric comorbidities. Both the composite stress score (RR = 1.08, 95%CI = 1.01-1.15) and latent stress groups (RR = 3.65, 95%CI = 1.15-11.57) were associated with neuropsychiatric comorbidities after adjusting for social support and coping strategies. The risk of developing neuropsychiatric comorbidities decreased when the level of social support was high (P < 0.05).

CONCLUSIONS

Exposures to multiple stressors increased the risk of subsequent neuropsychiatric comorbidities, but the risk can be modified by a higher level of social support.

Prediction of quality of life in schizophrenia using machine learning models on data from Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial

While research focus remains mainly on psychotic symptoms, it is questionable whether we are placing enough emphasis on improving the quality of life (QoL) of schizophrenia patients. To date, the predictive power of QoL remained limited. Therefore, this study aimed to accurately predict the QoL within schizophrenia using supervised learning methods. The authors report findings from participants of a large randomized, double-blind clinical trial for schizophrenia treatment. Potential predictors of QoL included all available and non-redundant variables from the dataset. By optimizing parameters, three linear LASSO regressions were calculated (N = 697, 692, and 786), including 44, 47, and 41 variables, with adjusted R-squares ranging from 0.31 to 0.36. Best predictors included social and emotion-related symptoms, neurocognition (processing speed), education, female gender, treatment attitudes, and mental, emotional, and physical health. These results demonstrate that machine learning is an excellent predictive tool to process clinical data. It appears that the patient’s perception of their treatment has an important impact on patients’ QoL and that interventions should consider this aspect.

Trial registration: ClinicalTrials.gov Identifier: NCT00014001.

Caregivers' burden and schizophrenia patients' quality of life: Sequential mediating effects of expressed emotion and perceived expressed emotion

BACKGROUND

Increasing attention has been paid to the role of caregivers' burden in affecting quality of life (QoL) of schizophrenic patients. However, less is known about potential mediation mechanisms underlying this relationship. The current study aimed to explore the sequential mediating effect of expressed emotion and perceived expressed emotion on the relationship between care burden and QoL among people with schizophrenia.

METHODS

135 Chinese families (one patient and one caregiver) participated in this study. Caregivers reported their care burden and expressed emotion, patients reported their perceived expressed emotion and QoL.

RESULTS

The results of the correlation analysis showed that care burden was negatively related to patients' QoL, including physical, psychological, and social relationships domains, with patients' sex, age, educational level, employment status, and medication-taking as covariates. The sequential mediating effects of criticism and perceived criticism between care burden and QoL were not significant. However, the sequential mediating effects of emotional over-involvement and perceived emotional over-involvement (EOI) between care burden and QoL (including physical and psychological domain) were significant.

CONCLUSION

The results indicated that reducing the burden and expressed emotion of caregivers could be helpful to improve schizophrenia patients' QoL.

Gender differences in socio-demographics, clinical characteristic and quality of life in patients with schizophrenia: A community-based study in Shenzhen

INTRODUCTION

The objective of this study was to explore the gender differences of community-dwelling patients with schizophrenia in terms of socio-demographics, clinical characteristic and quality of life (QOL).

METHODS

A total of 433 community-dwelling patients with schizophrenia were recruited in Shenzhen city, China. Data were obtained from a face-to-face interview with standard research questionnaire. The QOL and insight were assessed using the WHOQOL-BREF and the Chinese version of the insight and treatment attitude questionnaire, respectively.

RESULTS

This cross-sectional study included 206 male and 227 female patients. Male patients were more likely to be educated, employed, smoking cigarettes and drinking alcohol, and have an early age of illness onset. In contrast, female patients were more likely to be married/cohabitating and have drug side effects. There was no significant difference between genders across all QOL domain. Multiple regression analyzes showed that mental symptoms were negatively associated with all QOL domains, whereas frequency of exercise in the past year was positively associated with all QOL domains. Higher education levels, household per capita annual income in past year (≥100 000 RMB), employment status, IATQ score, drug side effects, marital status, and number of hospitalization were also significantly associated with specific QOL domains.

DISCUSSION

There was significant gender difference in socio-demographics and clinical characteristics among community schizophrenia patients in Shenzhen city. Gender-specific intervention measures are needed to improve the functioning and QOL in patients with schizophrenia.

Relationships of Family Emotional Support and Negative Family Interactions with the Quality of Life among Chinese People with Mental Illness and the Mediating Effect of Internalized Stigma

This study aimed to investigate the relationships of family emotional support and negative family interactions with the quality of life among Chinese people with mental illness. Furthermore, it examined the mediating role of internalized stigma in these relationships. One hundred and twenty-five Chinese adults with mental illness were recruited from community mental health service centers in Hong Kong. The results show that both family emotional support and negative family interactions were related to the quality of life. Negative family interactions had a stronger effect on the quality of life compared to family emotional support. Internalized stigma partially mediated the relationship between negative family interactions and the quality of life. These findings suggest that, for Chinese people with mental illness, interventions aimed at promoting quality of life should consider enhancing family emotional support and reducing negative family interactions. In addition, mental health service providers could consider using family approaches to address internalized stigma in the effort of improving the quality of life for their service users.

Obesity increases the risk of depression in children and adolescents: Results from a systematic review and meta-analysis

BACKGROUND

Clinical depression (including major depression, dysthymia, and unspecified depression) is common in children and adolescents with obesity and overweight. The objective of this systematic review and meta-analysis was to examine prevalence of clinical depression among overweight and obese children.

METHODS

PubMed, EMBASE, Web of Science, Medline, Cochrane library, and PsycINFO databases were systematically and independently searched by three researchers from the inception dates to April 01, 2019. The fixed-effects model was used to perform meta-analysis. Data analyses were performed with STATA Version 12.0.

RESULTS

Eleven studies with 69,893 subjects were included; 5 studies examined major depressive disorder (MDD), while the remaining 6 studies examined other types of clinical depression. In the overweight and obese group, the prevalence of clinical depression ranged from 1.7% to 26.7% in obese subjects and from 4.0% to 16.9% in overweight subjects. In studies on MDD, prevalence ranged from 10.1% to 26.7% in obese subjects and from 9.0% to 16.9% in overweight subjects. The odd ratios (ORs) of clinical depression ranged from 0.92 to 4.39 between obese subjects and healthy controls (i.e., normal-weight controls), and ranged from 0.96 to 1.67 between overweight subjects and controls. Compared to healthy controls, obese (OR = 1.851, 95% CI: 1.410-2.429) but not overweight (OR = 1.068, 95% CI: 0.889-1.283) children and adolescents were more likely to have MDD.

CONCLUSION

Obese children and adolescents had a significantly higher risk for MDD compared with healthy controls. Considering the negative health outcomes of depression, regular screening and effective treatments should be implemented for obese children and adolescents.

Prevalence of depressive symptoms in overweight and obese children and adolescents in mainland China: A meta-analysis of comparative studies and epidemiological surveys

BACKGROUND

Obesity is associated with a higher risk of depression in children and adolescents. This is a meta-analysis of studies examining depressive symptoms in overweight and obese children and adolescents in China.

METHODS

A systematic literature search was performed independently in both English (PubMed, EMBASE, Web of Science and Medline Complete) and Chinese (China National Knowledge Internet, WANFANG Data and WeiPu VIP) databases from their commencement date to December 31, 2018. The pooled prevalence of depressive symptoms was calculated using a random-effects model. Data analyses were performed with STATA Version 12.0, R Version 3.3.0 and R Studio Version 0.99.903.

RESULTS

Twenty-two epidemiological and 18 comparative studies were included in the meta-analysis. The overall prevalence of depressive symptoms was 24.02% (95% CI: 15.92%-33.16%) in obese children and adolescents and 22.61% (95% CI: 14.87%-31.34%) in overweigh children and adolescents. Obese children and adolescents were more likely to suffer from depressive symptoms (OR = 1.877, 95% CI: 1.459-2.415, P < 0.001) than their non-obese counterparts. The use of different screening scales for depressive symptoms was significantly associated with the prevalence of depressive symptoms.

CONCLUSIONS

Depressive symptoms are common in overweight and obese children and adolescents in China. Obese, but not overweight children and adolescents had higher risk of depressive symptoms. In order to lessen the risk of depressive symptoms, regular screening and effective interventions should be implemented to reduce obesity and overweight in this population.

Clarifying pathways to poor psychological health: The mediating role of psychosocial factors in the relationship between general psychopathology and quality of life impairment in patients diagnosed with schizophrenia

Objectives

The present study examines the latent factor structure of general psychopathology and investigates the mediating role of unmet psychosocial concerns, motivation, and medication side effects in the relationship between general psychopathology and quality of life (QOL) impairment in patients with schizophrenia.

Methods

A total of 251 patients completed self‐report measures of unmet psychosocial concerns, motivation, medication side effects, and physical/mental QOL impairment. The severity of schizophrenia was assessed on the Positive and Negative Syndrome Scale.

Results

Exploratory factor analysis revealed one latent factor (emotional distress) of general psychopathology. Mediation path analyses controlling for confounding variables revealed significant indirect effects of unmet psychosocial concerns, motivation, and medication side effects on emotional distress and physical/mental QOL impairment.

Conclusions

Our findings suggest that identifying optimal methods of managing co‐occurring emotional distress as well as secondary psychosocial factors on psychological health may improve QOL among patients diagnosed with schizophrenia.