Insight into illness, marital status, and employment were the most important factors associated with higher quality of life in patients with schizophrenia, according to a study in Progress in Neuro-Psychopharmacology and Biological Psychology. Neurocognition, however, had no apparent influence on quality of life.

Quality of life (QoL) measurements – including psychological, economic, and vocational status; functional abilities; social interaction; and physical health – help clinicians evaluate whether their treatments and care of patients who have schizophrenia are effective. The factors that predict quality of life, however, remain unclear, and numerous studies show conflicting results.

So, Dr. Laurent Boyer of University of the Mediterranean Aix-Marseille II in Marseille, France, and colleagues undertook a cross-sectional study to determine how insight into illness affects patients’ self-reported quality of life. Insight into illness, including the need to comply with treatment, might help predict outcomes and possibly reduce the risk of relapse and rehospitalization, they say.

"This study highlights the need for clinicians to pay more attention to the personal impact of schizophrenia, especially upon family life and work."

The study took place in the psychiatric department of a French public university teaching hospital (Prog. Neuropsychopharmacol. Biol. Psychiatry 2012;36:271-6). Dr. Boyer and colleagues enrolled 113 outpatients (79 men, 34 women) with a mean age of 38.6 years and a diagnosis of schizophrenia. Also, 8 subjects (7.1%) were married, 51 (45.1%) had 12 or more years of education, 16 (14.2%) were employed, and 54 (47.8%) lived independently.

Besides this sociodemographic information, the researchers gathered information about clinical characteristics, which medications patients used, and cognitive performance on a standardized battery of tests. They interviewed patients using a shortened version of SUMD (Scale to Assess Unawareness of Mental Disease) to determine whether patients understood that they have a mental disease and whether they were aware of its symptoms. Last, they administered the S-QoL 18 questionnaire, which explores 18 items that describe eight dimensions of well-being, including physical and psychological well-being, self-esteem, relationships with family and friends, resilience, autonomy, and sentimental life.

The mean scores on the shortened SUMD were 4.81 for awareness of their mental disorder, 3.42 for level of awareness of positive symptoms, and 3.79 for level of awareness of negative symptoms. Meanwhile, the average index score on the S-QoL 18 was 59.43, with all dimension scores higher than 60, except for scores tied to relationships with friends, physical well-being, and sentimental life.

Univariate and multivariate analysis showed that marital status and employment were associated with a higher quality of life. This finding was consistent with other studies that found a lower quality of life among those who were unemployed, had no reliable friend or daily contact with family, and had few leisure activities, reported Dr. Boyer, who also is affiliated with the department of public health at Hôpital de la Timone in Marseille.

Awareness of symptoms (both positive and negative) also was associated with a higher quality of life. However, better awareness of the disease – including having a mental disorder, needing to take medicine, being restricted in daily living, facing barriers to rehabilitation, and being stigmatized – was associated with a lower quality of life, the researchers found.

"One explanation for the discrepancy with awareness of mental disorders could be that identifying symptoms may require a different form of [judgment] that is unrelated to beliefs about people or minds," the researchers wrote. "A better awareness of symptoms may help to develop personal care skills that mitigate or reduce these symptoms and also help to apply adapted skills necessary for [everyday life], thus enabling success across a variety of domains of QoL."

The analyses showed no direct relationship between neurocognition and quality of life. "Our findings suggest that insight might be a mediator of the relationship between neurocognition and QoL," the researchers said.

Some potential limitations of the study exist. For example, the sample might not represent the entire population of patients who have schizophrenia. Also, the study used just one type of QoL instrument. A study on a larger, more diverse group of patients is needed, as are further studies to investigate the discrepancies in mental awareness of the disease and how that awareness relates to symptoms and quality of life.

Even so, the researchers say, clinicians must consider several facets of a patient’s insight into his or her illness when developing specific interventions to improve quality of life for patients with schizophrenia. "Moreover," they add, "this study highlights the need for clinicians to pay more attention to the personal impact of schizophrenia, especially upon family life and work."

The authors reported no conflicts of interest. The French Ministry of Health provided a national grant for this study.