Validity of subjective versus objective quality of life assessment in people with schizophrenia

BMC Psychiatry

Richard J Drake³  Shôn W Lewis³  Graham Dunn²  Jennifer A Massie¹  Karen P Hayhurst³ 

[1]Laureate House Mental Health Unit, Manchester Mental Health & Social Care Trust, Wythenshawe Hospital, Southmoor Road, Manchester, UK

[2]Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, UK

[3]Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester M13 9PL, UK

关键词: Schizophrenia;    Quality of Life;    Depression;    Attitude;    Adverse effects;    Adherence;   

Others  :  1090856
DOI  :  10.1186/s12888-014-0365-x

 received in 2014-08-12, accepted in 2014-12-17,  发布年份 2014

【 摘 要 】

Background

Quality of life (QoL) is considered an important outcome in health research. It can be rated by the patient, or by an external assessor. We wished to identify the predictors of any discrepancies between these two approaches in people with schizophrenia.

Methods

Patients with DSM schizophrenia and related disorders (N = 80) completed both patient-rated (Lancashire Quality of Life Profile; LQOLP) and assessor-rated (Heinrich’s Quality of Life Scale; QLS) measures of QoL.

Results

Patient-rated (LQOLP) and assessor-rated (QLS) measures showed a modest correlation (r = 0.38). In a regression analysis, independent predictors of subjectively-rated QoL being higher than objectively-assessed QoL in the same patient, were low insight score (BIS), negative symptoms (PANSS), absence of depression (CDSS), and less positive attitude toward prescribed treatment (DAI).

Conclusions

In people with schizophrenia, scores on objectively- and subjectively-rated measures of quality of life can differ markedly. When comparing subjective to objective assessments, patients with depressive symptoms will value their QoL lower, and those with low insight will value their QoL higher. This has important implications for the utility and interpretation of QoL measures in schizophrenia.

【 授权许可】

   
2014 Hayhurst et al.; licensee BioMed Central.

【 参考文献 】

• [1]Jones PB, Barnes TRE, Davies L, Dunn G, Lloyd H, Hayhurst KP, Murray RM, Markwick A, Lewis SW: Randomized controlled trial of the effect on quality of life of second- vs first-generation antipsychotic drugs in schizophrenia. Arch Gen Psychiatry 2006, 63:1079-1087.
• [2]Lewis SW, Barnes TRE, Davies L, Murray RM, Dunn G, Hayhurst KP, Markwick A, Lloyd H, Jones PB: Randomized controlled trial of effect of prescription of clozapine versus other second-generation antipsychotic drugs in resistant schizophrenia. Schizophr Bull 2006, 32:715-723.
• [3]Lewis SW, Davies L, Jones PB, Barnes TRE, Murray RM, Kerwin R, Taylor D, Hayhurst KP, Markwick A, Lloyd H, Dunn G: Randomised controlled trials of conventional antipsychotic versus new atypical drugs, and new atypical drugs versus clozapine, in people with schizophrenia responding poorly to, or intolerant of, current drug treatment. Health Technol Assess 2006, 10 (17).
• [4]Awad AG, Voruganti LP: Cost-utility analysis in schizophrenia. J Clin Psychiatry 1999, 60:22-26.
• [5]Browne S, Clarke M, Gervin M, Waddington JL, Larkin C, O’Callaghan E: Determinants of quality of life at first presentation with schizophrenia. Br J Psychiatry 2000, 176:173-176.
• [6]Doyle M, Flanagan S, Browne S, Clarke M, Lydon D, Larkin E, O'Callaghan C: Subjective and external assessments of quality of life in schizophrenia: relationship to insight. Acta Psychiatr Scand 1999, 99:466-472.
• [7]Bengtsson-Tops A, Hansson L, Sandlund M, Bjarnason O, Korkeila J, Merinder L, Nilsson L, Sørgaard KW, Vinding HR, Middelboe T: Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: a Nordic multicentre study. Qual Life Res 2005, 14:221-229.
• [8]Kusel Y, Laugharne R, Perrington S, McKendrick J, Stephenson D, Stockton-Henderson J, Barley M, McCaul R, Burns T: Measurement of quality of life in schizophrenia: a comparison of two scales. Soc Psychiatry Psychiatr Epidemiol 2007, 42:819-823.
• [9]Sainfort F, Becker M, Diamond R: Judgments of quality of life of individuals with severe mental disorders: patient self-report versus provider perspectives. Am J Psychiatry 1996, 153:497-502.
• [10]Ruggeri M, Warner R, Bisoffi G, Fontecedro L: Subjective and objective dimensions of quality of life in psychiatric patients: a factor analytical approach. Br J Psychiatry 2001, 178:268-275.
• [11]Narvaez JM, Twamley EW, McKibbin CL, Heaton RK, Patterson TL: Subjective and objective quality of life in schizophrenia. Schizophr Res 2008, 98:201-208.
• [12]Tomotake M, Kaneda Y, Iga J, Kinouchi S, Tayoshi S, Motoki I, Sumitani S, Yamauchi K, Taniguchi T, Ishimoto Y, Ueno S, Ohmori T: Subjective and objective measures of quality of life have different predictors for people with schizophrenia. Psychol Rep 2006, 99:477-487.
• [13]Yamauchi K, Aki H, Tomotake M, Iga J-I, Numata S, Motoki I, Izaki Y, Tayoshi S, Kinouchi S, Sumitani S, Tayoshi S, Takikawa Y, Kaneda Y, Taniguchi T, Ishimoto Y, Ueno S-I, Ohmori T: Predictors of subjective and objective quality of life in outpatients with schizophrenia. Psychiatry Clin Neurosci 2008, 62:404-411.
• [14]Tomotake M: Quality of life and its predictors in people with schizophrenia. J Med Invest 2011, 58:167-174.
• [15]Awad AG, Voruganti LN: Measuring quality of life in patients with schizophrenia: an update. Pharmacoeconomics 2012, 30:183-195.
• [16]Heinrichs DW, Hanlon TE, Carpenter WT: The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984, 10:388-398.
• [17]Oliver JPJ: The social care directive: development of a quality of life profile for use in community services for the mentally ill. Soc Work Soc Sci Rev 1991, 3:5-45.
• [18]Wehmeier PM, Kluge M, Schacht A, Helsberg K, Schreiber W: Correlation of physician and patient rated quality of life during antipsychotic treatment in outpatients with schizophrenia. Schizophr Res 2007, 91:178-186.
• [19]Naber D: A self-rating to measure subjective effects of neuroleptic drugs. Relationships to objective psychopathology, quality of life, compliance and other clinical variables. Int J Clin Psychopharmacol 1995, 10:133-138.
• [20]Skantze K, Malm U, Dencker SJ, May PRA, Corrigan P: Comparison of quality of life with standard of living in schizophrenic out-patients. Br J Psychiatry 1992, 161:797-801.
• [21]Whitty P, Browne S, Clarke M, McTigue O, Waddington J, Kinsella T, Larkin C, O'Callaghan E: Systematic comparison of subjective and objective measures of quality of life at 4-year follow-up subsequent to a first episode of psychosis. J Nerv Ment Dis 2004, 192:805-809.
• [22]Group WHOQOL: Measuring quality of life: the development of the World Health Organization Quality of Life Instrument (WHOQOL). WHO, Geneva; 1993.
• [23]Kay SR, Fiszbein A, Opler LA: The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987, 13:261-276.
• [24]Addington D, Addington J, Schissel B: A depression rating scale for schizophrenics. Schizophr Res 1990, 3:247-251.
• [25]Hogan TP, Awad AG, Eastwood R: A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983, 13:177-183.
• [26]Hayward P, Chan N, Kemp R, Youle S, David A: Medication self-management: a preliminary report on an intervention to improve medication compliance. J Ment Health 1995, 4:511-517.
• [27]Simpson GM, Angus JWS: A rating scale for extrapyramidal side effects. Acta Psychiatr Scand 1970, 45:11-19.
• [28]Barnes TRE: A rating scale for drug-induced akathisia. Br J Psychiatry 1989, 154:672-676.
• [29]Guy W: ECDEU Assessment Manual for Psychopharmacology. US Govt. Printing Office, Washington; 1976.
• [30]Yusufi BZ, Mukherjee S, Aitchison K, Dunn G, Page E, Barnes TR: Inter-rater reliability of the antipsychotic non-neurological side effects scale (ANNSERS) [Abstract]. Schizophr Bull 2005, 31:574.
• [31]Ohlsen RI, Williamson R, Yusufi B, Mullan J, Irving D, Mukherjee S, Page E, Aitchison KJ, Barnes TRE: Interrater reliability of the Antipsychotic Non-Neurological Side-Effects Rating Scale measured in patients treated with clozapine. J Psychopharmacol 2008, 22:323-329.
• [32]Lehman AF: Measures of quality of life among persons with severe and persistent mental disorders. Soc Psychiatry Psychiatr Epidemiol 1996, 31:78-88.
• [33]Cramer JA, Rosenheck R, Xu W, Thomas J, Henderson W, Charney DS: Quality of life in schizophrenia: a comparison of instruments. Schizophr Bull 2000, 26:659-666.
• [34]Birchwood M, Smith J, Drury V, Healy J, MacMillan F, Slade M: A self-report Insight Scale for psychosis: reliability, validity, and sensitivity to change. Acta Psychiatr Scand 1994, 89:62-67.
• [35]Lehman AF: The well-being of chronic mental patients. Assessing their quality of life. Arch Gen Psychiatry 1983, 40:369-373.
• [36]Meijer CJ, Schene AH, Koeter MWJ: Quality of life in schizophrenia measured by the MOS SF-36 and the Lancashire Quality of Life Profile: a comparison. Acta Psychiatr Scand 2002, 105:293-300.
• [37]Oliver JPJ, Huxley PJ, Priebe S, Kaiser W: Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Soc Psychiatry Psychiatr Epidemiol 1997, 32:76-83.
• [38]Flanagan S, Doyle M, Browne S, Larkin C, O’Callaghan E: A survey of the self-rated quality of life of individuals with schizophrenia in community residential settings. Ir J Psychol Med 2000, 17:22-24.
• [39]Fitzgerald PB, Williams CL, Corteling N, Filia SL, Brewer K, Adams A, de Castella RA, Rolfe T, Davey P, Kulkarni J: Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand 2001, 103:387-392.
• [40]Aki H, Tomotake M, Kaneda Y, Iga J, Kinouchi S, Shibuya-Tayoshi S, Tayoshi S-Y, Motoki I, Moriguchi K, Sumitani S, Yamauchi K, Taniguchi T, Ishimoto Y, Ueno S, Ohmori T: Subjective and objective quality of life, levels of life skills, and their clinical determinants in outpatients with schizophrenia. Psychiatry Res 2008, 158:19-25.
• [41]Bechdolf A, Klosterkötter J, Hambrecht M, Knost B, Kuntermann C, Schiller S, Pukrop R: Determinants of subjective quality of life in post acute patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2003, 253:228-235.
• [42]Drake RJ: Insight into illness: impact on diagnosis and outcome of nonaffective psychosis. Curr Psychiatry Rep 2008, 10:210-216.
• [43]Hasson-Ohayon I, Kravetz S, Roe D, David AS, Weiser M: Insight into psychosis and quality of life. Compr Psychiatry 2006, 47:265-269.
• [44]Karow A, Pajonk F-G, Reimer J, Hirdes F, Osterwald C, Naber D, Moritz S: The dilemma of insight into illness in schizophrenia: self- and expert-rated insight and quality of life. Eur Arch Psychiatry Clin Neurosci 2008, 258:152-159.
• [45]Kurtz MM, Tolman A: Neurocognition, insight into illness and subjective quality-of-life in schizophrenia: what is their relationship? Schizophr Res 2011, 127:157-162.
• [46]Priebe S, McCabe R, Junghan U, Kallert T, Ruggeri M, Slade M, Reininghaus U: Association between symptoms and quality of life in patients with schizophrenia: a pooled analysis of changes over time. Schizophr Res 2011, 133:17-21.
• [47]Drake RJ, Pickles A, Bentall RP, Kinderman P, Haddock G, Tarrier N, Lewis SW: The evolution of insight, paranoia and depression during early schizophrenia. Psychol Med 2004, 34:285-292.
• [48]Lysaker PH, Roe D, Yanos PT: Toward understanding the insight paradox: internalised stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull 2007, 33:192-199.
• [49]Lysaker PH, Vohs J, Hillis JD, Kukla M, Popolo R, Salvatore G, Dimaggio G: Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches. Expert Rev Neurother 2013, 13:785-793.
• [50]Edmondson M, Pahwa R, Lee KK, Hoe M, Brekke JS: A dual change model of life satisfaction and functioning for individuals with schizophrenia. Schizophr Res 2012, 139:110-115.
• [51]Zissi A, Barry MM: Well-being and life satisfaction as components of quality of life in mental disorders. In Quality of life in mental disorders. Edited by Katschnig H, Freeman H, Sartorius N. New York: John Wiley & Sons Ltd. 2006
• [52]Puschner B, Born A, Giebler A, Helm H, Leese M, Bindman JP, Gray RJ, Schene A, Kikkert M, Burti L, Marrella G, Becker T: Adherence to medication and quality of life in people with schizophrenia. J Nerv Ment Dis 2006, 194:746-752.
• [53]Puschner B, Angermeyer MC, Leese M, Thornicroft G, Schene A, Kikkert M, Burti L, Tansella M, Becker T: Course of adherence to medication and quality of life in people with schizophrenia. Psychiatry Res 2009, 165:224-233.
• [54]Warner R: The emics and etics of quality of life assessment. Soc Psychiatry Psychiatr Epidemiol 1999, 34:117-121.
• [55]Fitzgerald PB, de Castella ARA, Filia K, Collins J, Brewer K, Williams CL, Davey P, Kulkarni J: A longitudinal study of patient- and observer-rated quality of life in schizophrenia. Psychiatry Res 2003, 119:55-62.
• [56]Angermeyer MC, Holzinger A, Kilian R, Matschinger H: Quality of life – as defined by schizophrenic patients and psychiatrists. Int J Soc Psychiatry 2001, 47:34-42.
• [57]Beck AT, Grant PM, Huh GA, Perivoliotis D, Chang NA: Dysfunctional attitudes and expectancies in deficit syndrome schizophrenia. Schizophr Bull 2013, 39:43-51.
• [58]Awad AG, Voruganti LNP, Heslegrave RJ: A conceptual model of quality of life in schizophrenia: description and preliminary clinical validation. Qual Life Res 1997, 6:21-26.
• [59]Gourevitch R, Abbadi S, Guelfi JD: Quality of life in schizophrenics with and without the deficit syndrome. Eur Psychiatry 2004, 19:172-174.
• [60]Eack SM, Newhill CE: Psychiatric symptoms and quality of life in schizophrenia: A meta-analysis. Schizophr Bull 2007, 33:1225-1237.