The results of a study of 103 outpatients with residual schizophrenia suggest that spirituality and religiousness might contribute to improved quality of life in patients with this diagnosis and should be considered when caring for these patients, according to the investigators.

"Hence, besides pharmacological and nonpharmacological management for schizophrenia, clinicians should assess the spirituality status and its meaning to an individual patient and should encourage those patients to turn to religion more frequently if they consider it useful to deal with their suffering," concluded Dr. Ruchita Shah and her associates of the psychiatry department at the Postgraduate Institute of Medical Education and Research, Chandigarh (India). The study was published in Psychiatry Research (2011;190:200-5 [doi:10.1016/j.psychres.2011.07.034]).

The study enrolled 103 adults diagnosed with residual schizophrenia who were outpatients at the institute’s psychiatry department. Their mean age was 34 years, the mean age at schizophrenia onset was 23 years, and they had had been diagnosed for a mean of almost 12 years. More than half (62%) were male, 71% were Hindus, and the rest were Sikhs. The mean positive domain score on the Positive and Negative Syndrome Scale (PANSS) was 9, the negative domain score was 17, the general psychopathology score was 23, and the total PANSS score was 49.

Research examining the connections between spirituality and quality of life (QOL) has mainly been in the context of "chronic and life-threatening" diseases such as cancer, HIV infection, heart disease, and spinal cord injury, the investigators wrote. That research has found positive associations between "spiritual well-being" and QOL.

"A gradual consensus appears to be forming that spiritual QOL makes a significant and distinctive contribution to QOL assessment in health, and should be assessed routinely in health care populations," they wrote. But studies looking at the impact of spirituality on QOL in people with chronic mental illnesses are sparse, they noted.

In their study, they used the Hindi translation of the World Health Organization Quality of Life–Spirituality, Religiousness, and Personal Beliefs (WHOQOL-SRPB) Scale to assess these patients. In addition to evaluating the five domains of QOL (physical, psychological, level of independence, social relationships, and environment), this scale includes questions related to spirituality, religiousness, and personal beliefs.

Among the main findings was that the spirituality domain of QOL was significantly related to other QOL domains, including the physical, psychological, and social domains. The results also showed that two facets of the spirituality and religiousness domain of QOL – inner peace and spirituality – significantly contributed to the "variance of all the other domains of QOL." For example, the authors describe inner peace as having "a prominent influence" on other areas of QOL, as well as on general QOL, which "suggests that the most important aspect of the spirituality domain of QOL is inner peace which influences the overall QOL" in people with schizophrenia.

Referring to their results and other studies that also have found an association between spirituality and QOL in patients with other serious diseases, "it can be concluded that spirituality is an important aspect of QOL," they added.

Limitations of the studies included the enrollment of only outpatients with one type of schizophrenia, they said, so the results cannot be applied to other types of patients with schizophrenia, such as those who are hospitalized.

"Our study suggests that the spirituality and religiosity domains of QOL have an important influence on other aspects of QOL of patients with schizophrenia," the authors concluded. In light of this, they advise clinicians to assess the spirituality status and its meaning to each patient and encourage patients to "turn to religion more frequently if they consider it useful in dealing with their suffering."

No disclosures were listed in the study.