Depression and quality of life in first-episode psychosis

doi:10.1016/j.comppsych.2011.07.003

Comprehensive Psychiatry

Volume 53, Issue 5, July 2012, Pages 451-455

https://doi.org/10.1016/j.comppsych.2011.07.003 Get rights and content

Abstract

Aim

Quality of life (QOL) has gained recognition as a valid measure of outcome in first-episode psychosis (FEP). This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL.

Methods

We assessed 208 individuals with first-episode non-affective psychosis using measures of diagnosis (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), symptoms (Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning), insight (Birchwood Scale), duration of untreated psychosis (Beiser Scale), and QOL World Health Organisation Quality of Life Instrument (WHOQOL-Bref). We used multiple regression to determine the contribution of depressive symptoms to QOL domains while controlling for socio-demographic and other clinical characteristics.

Results

There were complete data for 146 individuals with FEP. Quality-of-life domains were consistently predicted by depressive symptoms including depressive mood and hopelessness rather than biological symptoms of depression with those experiencing more depressive symptoms reporting worse QOL. Those who were treated as in-patients reported improved QOL, and hospitalization was an independent predictor of most QOL domains. In-patients displayed greater levels of positive symptoms with those involuntarily detained displaying greater levels of bizarre behavior, thought disorder, and delusions.

Conclusions

These findings suggest that QOL is heavily influenced by depressive symptoms at initial presentation; however, as QOL domains are also influenced by admission status with in-patients being more symptomatic in terms of positive symptoms, subjective QOL assessment may be compromised during the acute phase of illness by both positive and depressive symptom severity.

Introduction

Quality of life (QOL) has gained recognition as a valid measure of outcome in those with first-episode psychosis (FEP) [1]. At first presentation, poorer QOL is seen in those with greater severity of both positive [2], [3] and negative symptoms [4] and is associated with a range of variables indicating an unfavorable course such as male sex [5], being single, comorbid substance misuse [6], and poorer premorbid functioning [7], [8]. In addition, several studies have found that the duration of untreated psychosis (DUP) is linked with QOL; those experiencing lengthier delays before accessing treatment show impaired QOL [6], [8]. Quality of life has also been shown to be worse in those with FEP when compared with healthy controls [9] irrespective of whether the individual has remitted from their first episode of psychotic illness [8].

However, the results of studies of QOL in FEP have been inconsistent [7], [10], [11]. This may reflect the use of different instruments and varying QOL concepts adopted in each study [1], [9]. Furthermore, subjectivity is central to the QOL concept [9], [12]. Quality of life can be broadly separated into 2 opposing paradigms with objective indicators of material living conditions and subjective appraisals of one's own life representing each aspect [1]. It has been consistently shown that QOL is negatively influenced by general psychopathology [6], [13] and, in particular, depressive symptoms [6], [7], [14]. However, it is still unclear which depressive symptoms influence QOL in FEP at first presentation. It is also unknown whether the presence of depressive symptoms affects QOL domains universally or whether their influence can distinguish one domain from another. This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL. In addition, we aimed to evaluate the contribution of possible predictors of QOL such as positive and negative symptoms, DUP, treatment factors, and socio-demographic characteristics.

Section snippets

Participants and setting

Between February 2005 and February 2010, we assessed 338 consecutive individuals presenting with FEP within a geographically defined catchment area (population, 375 000). Of those, 208 (61.9%) had a nonaffective psychosis, and 146 of those had complete data on QOL measures. Non-responders on QOL measures did not differ from responders in terms of age, sex, marital status, treatment status, and diagnosis. Participants were identified from consecutive referrals of FEP to DETECT (Dublin and East

Results

There were complete data for 146 individuals (89 males and 57 females) presenting with first-episode non-affective psychosis. The mean age was 32.7 years (SD, 10.7), and the average DUP was 24.33 (SD, 40.2; Interquartile Range, 1-33.5) months. Most individuals were being treated as inpatients (n = 87, 60%) at the time of assessment. There were complete data for 129 participants on medication status, 105 (72%) of which were being prescribed medication, in most cases with low-dose antipsychotics

Discussion

We examined subjectively appraised QOL of individuals experiencing an FEP for the purpose of understanding the contribution of aspects of depression to QOL domains while controlling for other clinical determinants such as positive and negative symptoms, DUP, treatment status, and sociodemographic characteristics. We have restricted direct comparison of findings with studies also using the WHOQOL-Bref as a measure of QOL in FEP due to the lack of correspondence among QOL measures.

Reported

Statement of funding and ethical approval

The early psychosis service is funded by the Health Service Executive and formerly St John of God Hospitaller Services. The first author is funded by a fellowship from the Health Research Board of Ireland. The project was granted ethical approval by St John of God Provincial Ethics Committee, Elm Mount Services Ethics Committee, and Newcastle Hospital Ethics Committee.

Acknowledgments

The authors thank all of the people, both clients and clinicians, who participated in this study for generously giving their time.

References (23)

S.M. Cotton et al.
Quality of life in patients who have remitted from their first episode of psychosis
Schizophr Res
(2010)
A. Thorup et al.
The quality of life among first-episode psychotic patients in the OPUS trial
Schizophr Res
(2010)
I. Melle et al.
Measuring quality of life in first-episode psychosis
Eur Psychiatry
(2005)
P. Rocca et al.
Quality of life and psychopathology during the course of schizophrenia
Compr Psychiatry
(2009)
K. Sim et al.
Subjective quality of life in first episode schizophrenia spectrum disorders with comorbid depression
Psychiatry Res
(2004)
D. Addington et al.
A depression rating scale for schizophrenics
Schizophr Res
(1990)
C.C. Bow-Thomas et al.
Predicting quality of life from symptomatology in schizophrenia at exacerbation and stabilization
Psychiatry Res
(1999)
A. Malla et al.
First-episode psychosis: psychopathology, quality of life, and functional outcome
Schizophr Bull
(2005)
K.Y. Chee
Determinants of subjective quality of life in first-episode schizophrenia: perspective from Malaysia
Early Interv Psychiatry
(2010)
U.U. Roder-Wanner et al.
Objective and subjective quality of life of first-admitted women and men with schizophrenia
Eur Arch Psychiatry Clin Neurosci
(1998)

A.K. Malla et al.

Determinants of quality of life in first-episode psychosis

Acta Psychiatr Scand

(2004)

Cited by (40)

Examining the influence of self-referential thinking on aberrant salience and jumping to conclusions bias in individuals with schizophrenia-spectrum disorders
2024, Journal of Behavior Therapy and Experimental Psychiatry
Cognitive processes such as aberrant salience and the jumping to conclusions (JTC) bias are implicated in the development of delusions. Self-referential thinking is implicated in this process; however, it is unknown how it may interact with aberrant salience and JTC bias in individuals with schizophrenia-spectrum disorders (SSDs). This study examined associations of self-referential thinking with aberrant salience, JTC bias, and delusion severity, and whether self-referential stimuli led to an increase in aberrant salience and JTC bias in SSDs (n = 20) relative to psychiatrically healthy controls (n = 20).
To assess aberrant salience and JTC bias, participants were asked to complete both self-referential and neutral versions of the Salience Attribution Test (SAT) and the Beads Task, as well as self-report measures of aberrant salience and JTC bias.
Self-referential task condition interacted with clinical group to predict JTC beads task scores, such that participants with SSDs exhibited greater levels of JTC bias than psychiatrically healthy controls during the neutral task condition, when controlling for levels of motivation, cognitive insight, and functioning. Self-referential thinking was significantly associated with aberrant salience, JTC bias, and delusion severity.
This experiment examined trait-level relationships between variables, so does not provide information about state-level interrelationships and would benefit from replication using more dynamic methods such as ecological momentary assessment.
These findings highlight the interrelationships between self-referential thinking, JTC bias, aberrant salience, and delusion severity, in individuals with SSDs, and support the interactive role of self-referential thinking in predicting JTC bias.
Altered resting-state functional connectivity of the right precuneus and cognition between depressed and non-depressed schizophrenia
2021, Psychiatry Research - Neuroimaging
The study investigated the resting-state functional connectivity (FC) and cognitive changes in patients with depressed schizophrenia(DS) and non-depressed schizophrenia(NDS). Eighty patients with first-episode schizophrenia and 50 healthy controls (HC) were included to conduct resting-state fMRI. All participants completed MATRICS Consensus Cognitive Battery (MCCB). The right precuneus was selected as the seed in whole-brain FC analysis. Our results showed the cognitive function (All MCCB dimensions) of all schizophrenia patients were worse than HC, but no differences were found between DS and NDS. The DS had decreased FC than NDS between the right precuneus and left middle cingulate gyrus, left cerebellum, right cerebellum. The DS had increased FC than HC between the right precuneus and temporal lobe, occipital lobe, and decreased FC between the right precuneus and left cerebellum. However, the NDS had increased FC than HC between the right precuneus and left cerebellum, right cerebellum, temporal lobe, occipital lobe, left superior parietal lobule. Correlation analysis showed that FC between the right precuneus and occipital lobe was negatively correlated with visual learning in DS and with social cognition in NDS. Our results suggest DS and NDS patients have different patterns of FC, and their FC changes correlate with different domains of cognition.
Relationship between subjective quality of life and perceptions of recovery orientation of treatment service in patients with schizophrenia and major depressive disorder
2021, Asian Journal of Psychiatry
This study aimed to investigate the relationship between subjective quality of life (QOL) and the specific domains of perceptions of recovery orientation of treatment services in patients with schizophrenia and major depressive disorder (MDD).
One hundred and seventy-nine patients with schizophrenia spectrum disorders and fifty-seven patients with MDD were recruited. Patients were assessed on subjective QOL, self-reported depressive symptoms, illness severity, functioning, and perception of recovery orientation of the service environment (RSA). A multiple linear regression model was used to assess the relationship between QOL and RSA score, controlling for all other factors. Spearman correlation analysis was used to examine the relationship between RSA domains and total QOL in each diagnostic group separately.
The regression model explained 47.4 % of the variance observed in total QOL. Depressive symptoms, functioning and RSA were significantly associated with total QOL in the model. Domains one (life goals) and five (individually tailored services) of the RSA were associated with QOL in both groups. Domains two (patient involvement) and three (diversity of treatment options) were associated with total QOL only in patients with schizophrenia.
Our findings highlight that perceptions of recovery orientation of service, depressive symptoms and functioning significantly affected the subjective QOL of patients with serious mental illness. The differential relationship observed between QOL and domains of RSA in patients with MDD and schizophrenia suggests that targeted interventions meeting the needs of different patient groups may be crucial to improve QOL of patients.
Relationships Between Depressive Symptoms, Other Psychological Symptoms, and Quality of Life
2020, Psychiatry Research
Depressive disorders are common, heterogeneous conditions involving physical and psychological symptoms, and substantial impairment in quality of life (QoL). However, relationships between depressive symptoms and QoL are poorly understood, and little research has directly compared relationships between subtypes of depressive symptoms, other psychological symptoms and QoL. This research aimed to examine how symptoms of depression and other mental health conditions are related to QoL. Participants (N=559) completed the World Health Organization Quality of Life - BREF questionnaire, demographic information, the Brief Symptom Inventory, the Beck Depression Inventory II, and the Depression, Anxiety and Stress Scales. Relationships between psychological symptoms and QoL were assessed using correlations and linear multiple regressions. QoL was inversely related to all types of psychopathology. Depressive symptoms were the strongest predictors of lower overall QoL. Both somatic and psychological depressive symptoms negatively predicted QoL, with somatic symptoms being stronger predictors. Conclusions: While many types of psychological symptoms were negatively correlated with QoL, depressive symptoms, particularly somatic symptoms, were the strongest predictors of impaired QoL. These findings provide new information about specific relationships between symptom profiles and QoL which may lead to greater understanding of the underlying mechanisms and to improved interventions.
Longitudinal evidence for a relation between depressive symptoms and quality of life in schizophrenia using structural equation modeling
2019, Schizophrenia Research
Citation Excerpt :
For example, depressive symptoms may influence social functioning and through this pathway influence QoL or they may have a direct effect on QoL. Former studies used mixed – effects regression analysis or analysis of variance to investigate the association between different variables influencing QoL (Conley et al., 2007; Reine et al., 2003; Renwick et al., 2012). Here we use structural equation modeling (SEM) that offers advantages since it is possible to perform longitudinal analyses and to include latent constructs.
Patients diagnosed with schizophrenia often report a low quality of life (QoL). The purpose of this study was to investigate whether we could replicate a cross-sectional model by Alessandrini et al. (2016, n = 271) and whether this model predicts QoL later in life. This model showed strong associations between schizophrenia spectrum symptoms and depressive symptoms on QoL, but lacked follow-up assessment. This model was adapted in the current study and the robustness was investigated by using a longitudinal design in which the association between baseline variables (including IQ, depression, schizophrenia spectrum symptoms as well as social functioning) and QoL during 3-years of follow-up was investigated. We included patients with a non-affective psychotic disorder (n = 744) from a prospective naturalistic cohort-study. In the cross-sectional model, with good measure of fit, both depression as well as social functioning was associated with QoL (direct path coefficient −0.28 and 0.41, respectively). Additionally, the severity of schizophrenia spectrum symptoms was highly associated with social functioning (direct path coefficient −0.70). Importantly, the longitudinal model showed good measures of fit, which strengthens the validity of the initial model and highlights that depression prospectively affect QoL while schizophrenia spectrum symptoms prospectively influence QoL via social functioning. The negative, longitudinal impact of a depression on QoL highlights the need to focus on treatment of this co-morbidity.
A meta-analysis of factors associated with quality of life in first episode psychosis
2018, Schizophrenia Research
Improving quality of life for people with first episode psychosis is an important aspect of recovery. Our objective was to review the associative factors on quality of life in first episode psychosis. A meta-analysis was conducted on the associations between quality of life, symptom severity, and duration of untreated psychosis.
Fifty-one articles were identified (published through 08/29/2016) that provided data on the relationship between quality of life and at least one other outcome measure of interest in first episode psychosis. Of those studies, 21 were included in a meta-analysis (n = 3992) of the relationship between quality of life, severity of psychosis, and duration of untreated psychosis.
Meta-analysis identified significant negative correlations between quality of life and severity of symptoms (total symptom scores: r = −0.32, p < 0.001) and quality of life and duration of untreated psychosis (r = −0.21, p < 0.001). Heinrich's quality of life scale emerged as being more sensitive to the presence of psychotic symptoms than other measures of quality of life.
Associations were found between certain disease specific variables and quality of life in first episode psychosis, highlighting the relationship between symptom presentation and quality of life and the need for early intervention. Proper assessment of quality of life is important to promote improved quality of life in patients with first episode psychosis. Future research is needed to examine the interacting effects of symptom presentation, duration of untreated psychosis, and other variables, such as neurocognition, on quality of life.

View all citing articles on Scopus

View full text

Depression and quality of life in first-episode psychosis

Abstract

Aim

Methods

Results

Conclusions

Introduction

Section snippets

Participants and setting

Results

Discussion

Statement of funding and ethical approval

Acknowledgments

Schizophr Res

Schizophr Res

Eur Psychiatry

Compr Psychiatry

Psychiatry Res

Schizophr Res

Psychiatry Res

First-episode psychosis: psychopathology, quality of life, and functional outcome

Schizophr Bull

Determinants of subjective quality of life in first-episode schizophrenia: perspective from Malaysia

Early Interv Psychiatry

Objective and subjective quality of life of first-admitted women and men with schizophrenia

Eur Arch Psychiatry Clin Neurosci

Determinants of quality of life in first-episode psychosis

Acta Psychiatr Scand