Skip to main content
SpringerLink
Log in

Measuring Quality of Life in Patients with Schizophrenia

An Update

  • Leading Article
  • QOL in Patients with Schizophrenia
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

In 1997, we published a review in Pharmaco Economics about quality of life (QOL) measurement in patients with schizophrenia. The objective of this article is to provide an update, as well as to revisit the development of the construct of QOL and its measurement as applied to schizophrenia. Since our previous article, there has been significant growth in the number of publications about QOL in schizophrenia. Unfortunately, alongside this significant increase in research interest, a number of concerns have also risen about the limitations and lack of impact the concept of QOL has on clinical care and health-policy decision making. A number of concerns previously outlined (such as lack of consensus on a uniform definition of QOL) continue to be an issue. However, we believe that a uniform definition may not be possible, and instead, it may be preferable to have several definitions, which may enrich the concept and broaden its usefulness.

Some of the scales we reviewed in 1997 continue to be in use, while others are now rarely or never used. New scales with better psychometrics have been introduced, but most are without theoretical or conceptual foundation. On the other hand, the field of scaling in general has been changing over the past few years and is moving towards a new approach for scale development, based on item response theory, item banks and computer adaptive testing. Unfortunately, this has not extended to QOL in schizophrenia. There continues to be a dearth of theoretical and conceptual models for QOL in schizophrenia, which seems to create the perception that the construct lacks a good theoretical and scientific foundation.

One of the major gaps identified in this review is the recognized lack of impact of QOL measurements on clinical management or policy decision making. The majority of publications continue to focus on measurement rather than what to do with the data. The lack of strategies to integrate QOL data in clinical care, as well as the failure to contribute to policy decisions, particularly in cost analysis or resource allocations, has created the perception that the construct of QOL in schizophrenia is not that useful. It is evident that, for QOL in schizophrenia to regain its promise, researchers must take the ultimate next step beyond measurement: to develop credible strategies for integrating QOL data in clinical practice. Additionally, more focused research is needed to demonstrate the role of QOL, not only as an outcome in itself but also as a contributor to other outcomes, such as adherence to medications, more satisfaction, less resource utilization and so on.

Since self-appraisal of QOL does not happen in a vacuum but relates to the total human experience in all its biological, psychosocial and environmental aspects, particular attention must also be focused on important neurobiological dimensions such as affect and cognition. Both are significantly affected by the illness itself and its treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Awad AG, Voruganti LNP, Heslegrave RJ. Measuring quality of life in patients with schizophrenia. Pharmacoeconomics 1997; 11 (1): 32–47

    Article  PubMed  CAS  Google Scholar 

  2. World Health Organization. The constitution of the World Health Organization. WHO Chron 1947; 1: 29

    Google Scholar 

  3. Awad AG, Voruganti LNP. International research in psychosis: issues related to the assessment of quality of life. Schizophr Bull 2000; 26 (3): 557–64

    Article  PubMed  CAS  Google Scholar 

  4. Lehman A, Ward N, Linn L. Chronic mental patients: the quality of life issue. Am J Psychiatry 1982; 139: 1274–6

    Google Scholar 

  5. Ritsner M. The Distress/Protection vulnerability model of quality of life impairment syndrome. In: Ritsner M, Awad AG, editors. Quality of life impairment in schizophrenia, mood and anxiety disorders. Dordrecht: Springer, 2007: 3–20

    Chapter  Google Scholar 

  6. Narvacz JM, Twamley EW, McKibben CL, et al. Subjective and objective quality of life in schizophrenia. Schizophr Res 2008; 98: 201–8

    Article  Google Scholar 

  7. Eak SM, Newhill CE. Psychiatric symptoms and quality of life in schizophrenia: a meta-analysis. Schizophr Bull 2007; 33: 1225–37

    Article  Google Scholar 

  8. Nadalet L, Kohl FS, Pringuey D, et al. Validation of a subjective quality of life questionnaire (S.QUA.LA) in schizophrenia. Schizophr Res 2005; 76: 73–81

    Article  PubMed  Google Scholar 

  9. Auquier P, Simioni MC, Sapin C, et al. Development and validation of a patient-based health related quality of life questionnaire in schizophrenia: the S-QOL. Schizophr Res 2003; 63: 137–49

    Article  PubMed  CAS  Google Scholar 

  10. Priebe S, Reininghans U, McCabe R, et al. Factors influencing subjective quality of life in patients with schizophrenia and other mental disorders: a pooled analysis. Schizophr Res 2010; 21: 251–8

    Article  Google Scholar 

  11. Norman RH, Malla AK, McLean T, et al. The relationship of symptoms and level of functioning in schizophrenia to general wellbeing and the Quality of Life Scale. Acta Psychiatr Scand 2000; 102: 303–9

    Article  PubMed  CAS  Google Scholar 

  12. Skantze K, Malm U, Denker SJ, et al. Comparison of quality of life with standard of living in schizophrenic outpatients. Br J Psychiatry 1992; 161: 797–801

    Article  PubMed  CAS  Google Scholar 

  13. Awad AG, Voruganti LNP. Antipsychotics, schizophrenia and the issue of quality of life. In: Ritsner M, Awad AG, editors. Quality of life impairment in schizophrenia, mood and anxiety disorders. Dordrecht: Springer, 2007: 307–19

    Chapter  Google Scholar 

  14. Voruganti LNP, Heselgrave RJ, Awad AG, et al. Quality of life measurement in schizophrenia: reconciling the question of subjectivity with question of reliability. Psychol Med 1998; 28: 165–72

    Article  PubMed  CAS  Google Scholar 

  15. Awad AG, Voruganti LNP, Heselgrave RJ. The aim of antipsychotic medications: what are they and are they being achieved? CNS Drugs 1995; 4: 8–16

    Article  Google Scholar 

  16. Calman KC. Quality of life in cancer patients: an hypothesis. J Med Ethics 1984; 10: 124–7

    Article  PubMed  CAS  Google Scholar 

  17. Ware Jr JE. The SF-36 health survey in quality of life and pharmacoeconomics in clinical trials. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia (PA): Lippincott-Raven, 1996: 337–45

    Google Scholar 

  18. Wood S, William JI. Reintegration to normal living as a proxy to quality of life. J Chronic Dis 1987; 40: 497–9

    Google Scholar 

  19. Awad AG, Voruganti LNP, Heslegrave RJ. Preliminary validation of a conceptual model to assess quality of life in schizophrenia. Qual Life Res 1997; 6: 21–6

    Article  PubMed  CAS  Google Scholar 

  20. Zissi A, Barry MU, Cochrane R. A meditational model of quality of life for individuals with severe mental health problems. Psychol Med 1998; 28: 1221–30

    Article  PubMed  CAS  Google Scholar 

  21. Voruganti LNP, Awad AG, Parker G, et al. Cognition, functioning and quality of life in schizophrenia treatment: results of a one year randomized controlled trial of olanzepine and quetiapine. Schizophr Res 2007; 96: 146–55

    Article  PubMed  CAS  Google Scholar 

  22. Skantze K, Malm U. A new approach to facilitation of working alliances based on patients’ quality of life goals. Nord J Psychiatry 1994; 48: 37–55

    Article  Google Scholar 

  23. Lehman AF. A quality of life interview for the chronically mentally ill. Eval Program Plan 1988; 11: 51–62

    Article  Google Scholar 

  24. Sainfort F, Becker M, Diamond R. Judgements of quality of life of individuals with severe mental disorders: patient selfreport versus provider perspectives. Am J Psychiatry 1996; 153: 497–502

    PubMed  CAS  Google Scholar 

  25. Skantze K. Subjective quality of life and standard of living: a 10-year follow-up of outpatients with schizophrenia. Acta Psychiatr Scand 1998; 98 (5): 390–9

    Article  PubMed  CAS  Google Scholar 

  26. Ritsner M, Gibel A, Ratner Y, et al. Determinants of changes in perceived quality of life in the course of schizophrenia. Qual Life Res 2006; 15: 515–26

    Article  PubMed  Google Scholar 

  27. Gorna K, Jaracz K, Rybakowski F, et al. Determinants of objective and subjective quality of life in first time admission schizophrenic patients in Poland: a longitudinal study. Qual Life Res 2008; 17 (2): 237–47

    Article  PubMed  Google Scholar 

  28. Bengtsson-Tops A, Hansson L, Sandlunds M, et al. 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: 221–9

    Article  PubMed  Google Scholar 

  29. Ruggeri M, Bisoffi G, Fontecedro L, et al. Subjective and objective dimensions of quality of life in psychiatric patients–a factor analytical approach: the South Verona Outcome Project 4. Br J Psychiatry 2001; 178: 268–75

    Article  PubMed  CAS  Google Scholar 

  30. Wehmeier PM, Kluge M, Schacht A, et al. Correlation of physician and patient related quality of life during antipsychotic treatment in outpatients with schizophrenia. Schizophr Res 2007; 91: 178–86

    Article  PubMed  Google Scholar 

  31. Awad AG, Voruganti LNP. The subjective/objective dichotomy: relevance to nosology, research and management. In: Gaebel W, editor. Zukunftsperspekiven in psychiatries und psychotherapie. Darnstadt: Stienkopff verlog, 2002: 21–7

    Chapter  Google Scholar 

  32. Najman JM, Levine S. Evaluating the impact of medical care and technologies on the quality of life: a review and critique. Soc Sci Med 1981; 15: 107–15

    CAS  Google Scholar 

  33. Awad AG, Voruganti LNP. Impact of atypical antipsychotics on quality of life in patients with schizophrenia. CNS Drugs 2004; 18: 877–93

    Article  PubMed  CAS  Google Scholar 

  34. Stein LT, Test MA. Alternative to mental health treatment: I. Conceptual model, treatment program and clinical evaluation. Arch Gen Psychiatry 1980; 37: 392-197

    Article  PubMed  CAS  Google Scholar 

  35. Malm U, May PRA, Deneker SJ. Evaluation of the quality of life of the schizophrenic outpatient: a checklist. Schizophr Bull 1981; 7: 477–87

    Article  PubMed  CAS  Google Scholar 

  36. Baker F, Intagliata J. Quality of life in the evaluation of community support systems. Eval Program Plann 1982; 5: 69–79

    Article  PubMed  CAS  Google Scholar 

  37. Bigelow DA, Brodsky G, Steward L, et al. The concept and measurement of quality of life as a dependent variable in evaluation of mental health services. In: Stahler GJ, Tash WR, editors. Innovative approaches to mental health evaluation. New York: Academic Press, 1982: 345–66

    Google Scholar 

  38. Awad AG. Subjective response to neuroleptics in schizophrenia. Schizophr Bull 1993; 19: 609–18

    Article  PubMed  CAS  Google Scholar 

  39. Hogan TP, Awad AG. Subjective response to neuroleptics and outcomes in schizophrenia: a re-examination comparing two measures. Psychol Med 1992; 22: 347–52

    Article  PubMed  CAS  Google Scholar 

  40. Rosen A, Pavlovic H, Parker G. The life skills profile: a measure assessing function and disability in schizophrenia. Schizophr Bull 1989; 325–34

    Google Scholar 

  41. Heinrichs DW, Hanlon TE, Carpenter WT. The quality of life scale: an instrument for rating the schizophrenic deficit symptoms. Schizophr Bull 1984; 388–98

    Google Scholar 

  42. Stuart E, Wykes T. Assessment schedules for chronic psychiatric patients. Psychol Med 1987; 17: 485–93

    Article  Google Scholar 

  43. Becker M, Diamond R, Sainfort F. A new patient focused index for measuring quality of life in persons with severe and persistent mental illness. Qual Life Res 1993; 2: 239–51

    Article  PubMed  CAS  Google Scholar 

  44. Endicott J, Spitzer Rl, Fleiss JL, et al. The Global Assessment Scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 1976; 33: 766–71

    Article  PubMed  CAS  Google Scholar 

  45. McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. New York: Oxford University Press, 1987

    Google Scholar 

  46. Bergner M, Bobbit RA, Carter WB, et al. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981; 19: 787–805

    Article  PubMed  CAS  Google Scholar 

  47. McHorney CA, Ware Jr JE, Lu R, et al. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions and reliability across diverse patient groups. Med Care 1994; 32: 40–66

    Article  PubMed  CAS  Google Scholar 

  48. Chambers LW. The McMaster health index questionnaire. In: Spilker B, editor. Quality of life and pharmacoeconomics in clinical trials. Philadelphia (PA): Lippincott-Raven, 1996: 267–79

    Google Scholar 

  49. Kawata A, Revicki D. Reliability and validity of the social integration survey (SIS) in patients with schizophrenia. Qual Life Res 2008; 17: 123–35

    Article  PubMed  Google Scholar 

  50. Boyer L, Simeoni MC, Loundou A, et al. The development of the S-QOL 18: a shortened quality of life questionnaire for patients with schizophrenia. Schizophr Res 2010; 121: 241–50

    Article  PubMed  Google Scholar 

  51. Voruganti LNP, Awad AG. Personal evaluation of transition in treatment (PETiT): a scale to measure subjective aspects of antipsychotic drug therapy in schizophrenia. Schizophr Res 2002; 56: 37–46

    Article  PubMed  Google Scholar 

  52. Oliver JPJ, Huxley PJ, Priebe S, et al. 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

    Article  PubMed  CAS  Google Scholar 

  53. Oliver JPJ. How to use quality of life measures in individual care. In: Priebe S, Oliver JPJ, Kaiser W, editors. Quality of life and mental health care. Petersfield: Wrightson Biomedical Publishing, 1999: 81–105

    Google Scholar 

  54. Kusel Y, Laugharne R, Perrington S, et al. Measurement of quality of life in schizophrenia: a comparison of two scales. Soc Psychiatry Psychiatr Epidemiol 2007; 42: 819–23

    Article  PubMed  Google Scholar 

  55. Priebe S, Huxley P, Knight S, et al. Application and results of the Manchester Short Assessment quality of life (MANSA). In: Priebe S, Oliver J, Kaiser W, editors. Quality of life and mental health care. Petersfield: Wrightson Biomedical Publishing, 1999: 155–7

    Google Scholar 

  56. Wilkinson G, Hesdon B, Wild D, et al. Self-report quality of life measure for people with schizophrenia: SQLS. Br J Psychiatry 2000; 177: 42–6

    Article  PubMed  CAS  Google Scholar 

  57. Kaneda Y, Imakura A, Fujii A, et al. Schizophrenia quality of life: validation of the Japanese version. Psychiatry Res 2001; 113: 107–13

    Article  Google Scholar 

  58. Luo N, Seng BK, Xie F, et al. Psychometric evaluation of the schizophrenia quality of life scale (SQLS) in English and Chinese speaking patients in Singapore. Qual Life Res 2008; 17: 115–22

    Article  PubMed  Google Scholar 

  59. Kolotkin RL, Crosby RD, Corey-Lisle PK, et al. Performance of weight-related measure of quality of life in a psychiatric sample. Qual life Res 2006; 15: 587–96

    Article  PubMed  Google Scholar 

  60. Awad AG, Voruganti LNP. Body weight, image and selfesteem evaluation questionnaire development and validation of a new scale. Schizophr Res 2004; 70: 63–7

    Article  PubMed  Google Scholar 

  61. Atkinson M, Zibin S, Chuang H. Characterising quality of life among patients with chronic mental illness: a critical examination of self-report methodology. Am J Psychiatry 1997; 154: 99–105

    PubMed  CAS  Google Scholar 

  62. National Institutes of Health. Patient Reported Outcomes Measurement Information System (PROMIS) [online]. Available from URL: http://www.nihpromis.org [Accessed 2008 Feb 1]

    Google Scholar 

  63. Greenhalgh J, Long AF, Flynn R. The use of patient reported outcome measures in routine clinical practice: lack of impact or lack of theory? Soc Sci Med 2005; 60: 833–43

    Article  PubMed  Google Scholar 

  64. Lauer G. Concepts of quality of life in mental health care. In: Priebe S, Oliver J, Kaiser W, editors. Quality of life and mental health care. Petersfield: Wrightson Biomedical Publishing Ltd, 1999: 1–18

    Google Scholar 

  65. Revicki D. Pharmacoeconomic studies of atypical antipsychotics drugs for the treatment of schizophrenia. Schizophr Res 1999; 35 Suppl.: S101–9

    Article  Google Scholar 

  66. Luo N, Seng BK, Thumboo J, et al. A study of the construct validity of the Health Utilities Index Mark 3 (HUI3) in patients with schizophrenia. Qual Life Res 2006; 15 (5): 889–98

    Article  PubMed  Google Scholar 

  67. Petrou S, Johnson S, Wolke D, et al. Economic costs and preference-based health-related quality of life outcomes associated with childhood psychiatric disorders. Br J Psychiatry 2010; 197: 395–404

    Article  PubMed  Google Scholar 

  68. Awad AG, Voruganti LNP. Cost-utility analysis in schizophrenia. J Clin Psychiatry 1999; 60 Suppl. 3: 22–6

    PubMed  Google Scholar 

  69. Voruganti LNP, Awad AG, Oyewumi LK, et al. Assessing health utilities in schizophrenia: a feasibility study. Pharmacoeconomics 2000; 17 (3): 273–86

    Article  PubMed  CAS  Google Scholar 

  70. Hooker C, Park S. Emotion processing and its relationship to social functioning in schizophrenic patients. Psychiatry Res 2002; 112: 41–50

    Article  PubMed  Google Scholar 

  71. Wise RA. Neurobiology of addiction. Curr Opin Neurobiol 1996; 6: 243–51

    Article  PubMed  CAS  Google Scholar 

  72. Adinoff B. Neurobiologic processes in drug reward and addiction. Harv Rev Psychiatry 2004; 12 (6): 305–20

    Article  PubMed  Google Scholar 

  73. Goff DC. New insight into clinical response in schizophrenia: fromdopamine D2 receptor occupancy to patients’ quality of life. Am J Psychiatry 2008; 165: 940–3

    Article  PubMed  Google Scholar 

  74. Awad AG, Voruganti LNP. Neuroleptic dysphoria, comorbid drug abuse in schizophrenia and the emerging science of subjective tolerability. J Dual Diagnosis 2005; 2: 83–94

    Article  Google Scholar 

  75. Thornicroft G, Tansella M, Becker T, et al. The personal impact of schizophrenia in Europe. Schizophr Res 2004; 69: 125–32

    Article  PubMed  Google Scholar 

  76. Voruganti LNP, Awad AG. Subjective and behavioural consequences of striatal dopamine depletion in schizophrenia: findings from an in vivo SPECT study. Schizophr Res 2006; 88: 179–86

    Article  PubMed  Google Scholar 

  77. de Haan L, Lavalaye J, Linszen D, et al. Subjective experiences and striatal dopamine D2 receptor occupancy in patients with schizophrenia stabilized by olanzepine or risperidal. Am J Psychiatry 2000; 157: 1019–20

    Article  PubMed  Google Scholar 

  78. Bowie C, Reichenberg A, Patterson T, et al. Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity and symptoms. Am J Psychiatry 2006; 163: 418–25

    Article  PubMed  Google Scholar 

  79. Yamauchi K, Hirofumi A, Masahito T, et al. Predictors of subjective and objective quality of life in patients with schizophrenia. Psychiatr Clin Neurosci 2008; 62: 404–11

    Article  Google Scholar 

  80. Hwang S, Lee JY, Cho SJ, et al. The model of the relationships among the predictors of quality of life in chronic stage of schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2009; 33 (7): 1113–8

    Article  PubMed  Google Scholar 

  81. Heselgrave RJ, Awad AG, Voruganti LNP. The influence of neurocognitive deficits and symptoms on quality of life in schizophrenia. J Psychiatry Neurosci 1997; 22: 235–43

    Google Scholar 

  82. Moritz S, Ferhali S, Naber D. Memory and attention performance in psychiatric patients: lack of correspondence between clinician-rated and patient-rated functioning with neuropsychological test results. J Int Neuropsychol Soc 2004; 10: 623–33

    Article  PubMed  Google Scholar 

  83. Alptekin K, Akvardar Y, Akdede B, et al. Is quality of life associated with cognitive impairment in schizophrenia? Prog Neuropsychopharmacol Biol Psychiatry 2005; 29: 239–44

    Article  PubMed  Google Scholar 

  84. Tomotake M, Kaneda Y, Iga J, et al. Subjective and objective measures of quality of life have different predictors for people with schizophrenia. Psychol Rep 2006; 99: 477–87

    PubMed  Google Scholar 

  85. Huppert JD, Weiss KA, Lim R, et al. Quality of life in schizophrenia: contributions of anxiety and depression. Schizophr Res 2001; 51: 171–80

    Article  PubMed  CAS  Google Scholar 

  86. Test MA, Greenberg JS, Long JD, et al. Construct validity of a measure of subjective satisfaction with life of adults with serious mental illness. Psychiatr Serv 2005; 56: 292–300

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to conduct this study or prepare the manuscript. The authors have no conflicts of interest that are directly relevant to the content of this review. The opinions expressed in this review are the authors’ own.

Author information

Authors and Affiliations

  1. Department of Psychiatry and the Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    A. George Awad (Chief of Psychiatry)

  2. International Society for CNS Clinical Trials & Methodology (ISCTM), Nashville, TN, USA

    A. George Awad (Chief of Psychiatry)

  3. Department of Psychiatry, Humber River Regional Hospital, 2175 Keele Street, Room 243A, Toronto, ON, M6M 3Z4, Canada

    A. George Awad (Chief of Psychiatry)

  4. Department of Psychiatry, Oakville General Hospital, Oakville, ON, Canada

    Lakshmi N.P. Voruganti

Authors
  1. A. George Awad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lakshmi N.P. Voruganti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. George Awad.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Awad, A.G., Voruganti, L.N. Measuring Quality of Life in Patients with Schizophrenia. PharmacoEconomics 30, 183–195 (2012). https://doi.org/10.2165/11594470-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11594470-000000000-00000

Keywords

Search

Navigation