Abstract
Studies and findings regarding the impact of schizophrenia on quality of life (QOL) has been highly variable. This meta-analysis compared QOL between schizophrenia subjects and healthy controls with a focus on standardized measures. A systematic literature search was conducted through Pubmed, PsycINFO, EMBASE, Cochrane Library and Web of Science databases. Only studies using the World Health Organization Quality of Life (WHOQOL) or its brief version or the Short Form-36 Health Survey (SF-36) were included. Fifteen case-control studies with 2195 schizophrenia subjects and 1508 healthy controls were included in this meta-analysis. The WHOQOL/WHOQOL-BREF score was significantly lower in physical health (SMD = -1.80, 95% CI: -2.31 to −1.28, P < 0.001), psychological health (SMD = -1.28, 95% CI: -1.72 to −0.83, P < 0.001), social relationships (SMD = -1.60, 95% CI: -2.05 to −1.15, P < 0.001), and environment domains (SMD = -0.98, 95% CI: -1.38 to −0.59, P < 0.001) in schizophrenia subjects compared to controls. The SF-36 score was significantly lower in both physical (SMD = -1.09, 95% CI: -1.41 to −0.76, P < 0.001 and mental health domains (SMD = -2.08, 95% CI: -3.58 to −0.59, P = 0.006) in schizophrenia subjects than in controls. Subgroup and meta-regression analyses found that age, male gender, illness duration and income have significant moderating effects on QOL. The meta-analysis of studies with standardized measures confirmed that QOL in schizophrenia subjects is significantly lower than healthy controls. Effective interventions should be developed to improve QOL for this population.



Similar content being viewed by others
References
Liddle PF. Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychol. Med. 1987;17(1):49-57.
Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2(5):e141.
Marwaha S, Johnson S. Schizophrenia and employment. Soc Psychiatry Psychiatr Epidemiol. 2004;39(5):337–49.
Karagianis J, Novick D, Pecenak J, Haro JM, Dossenbach M, Treuer T, et al. Worldwide-Schizophrenia outpatient health outcomes (W-SOHO): baseline characteristics of pan-regional observational data from more than 17,000 patients. Int J Clin Pract. 2009;63(11):1578–88.
Awad AG, Voruganti LNP. Measuring quality of life in patients with schizophrenia: an update. Pharmacoeconomics. 2012;30(3):183–95. https://doi.org/10.2165/11594470.
Lysaker P, Yanos P, Outcalt J, Roe D. Association of stigma, self-esteem, and symptoms with concurrent and prospective assessment of social anxiety in schizophrenia. Clin Schizophr Relat Psychoses. 2010;4(1):41–8.
HERT M, Schreurs V, Vancampfort D, Winkel R. Metabolic syndrome in people with schizophrenia: a review. World Psychiatry. 2009;8(1):15–22.
WHO. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL group. Psychol. Med. 1998;28(3):551–8.
San Woon P, Chia MY, Chan WY, Sim K. Neurocognitive, clinical and functional correlates of subjective quality of life in Asian outpatients with schizophrenia. Prog. Neuropsychopharmacol. Bol. Psychiatry. 2010;34(3):463–8.
Xiang Y-T, Hou Y-Z, Yan F, Dixon LB, Ungvari GS, Dickerson F, et al. Quality of life in community-dwelling patients with schizophrenia in China. J Nerv Ment Dis. 2012;200(7):584–7.
Afonso P, Figueira ML, Paiva T. Sleep-wake patterns in schizophrenia patients compared to healthy controls. The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry. 2014;15(7):517–24. https://doi.org/10.3109/15622975.2012.756987.
Alptekin K, Akdede BB, Akvardar Y, Çelikgün S, Dilşen NS, Durak G, et al. Quality of life assessment in Turkish patients with schizophrenia and their relatives. Psychol Rep. 2004;95(1):197–206.
Yen CF, Cheng CP, Huang CF, Yen JY, Ko CH, Chen CS. Quality of life and its association with insight, adverse effects of medication and use of atypical antipsychotics in patients with bipolar disorder and schizophrenia in remission. Bipolar Disord. 2008;10(5):617–24.
Orsel S, Akdemir A, Dag I. The sensitivity of quality-of-life scale WHOQOL-100 to psychopathological measures in schizophrenia. Compr Psychiatry. 2004;45(1):57–61. https://doi.org/10.1016/j.comppsych.2003.09.006.
Ulas H, Akdede BB, Ozbay D, Alptekin K. Effect of thought disorders on quality of life in patients with schizophrenia. Prog. Neuropsychopharmacol. Bol. Psychiatry. 2008;32(2):332–5. https://doi.org/10.1016/j.pnpbp.2007.08.033.
Xiang YT, Chiu HF, Ungvari GS. Quality of life and mental health in Chinese culture. Curr Opin Psychiatry. 2010;23(1):43–7.
WHO. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403–9.
Stewart AL, Hays RD, Ware JE Jr. The MOS short-form general health survey. Reliability and validity in a patient population. Med Care. 1988;26(7):724–35.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
APA. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington: American Psychiatric Association; 1994.
World Health Organization. Manual of the international classification of diseases, tenth revision (ICD-10). Geneva: WHO; 1992.
Chen YF. Chinese classification of mental disorders (CCMD-3): towards integration in international classification. Psychopathology. 2002;35(2–3):171–5 65140.
Ware JE, Kosinski M, Dewey JE, Gandek B. SF-36 health survey: manual and interpretation guide: quality metric Inc.; 2000.
Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2011.
Zhou F-C, Wang Y-Y, Zheng W, Zhang Q, Ungvari GS, Ng CH, et al. Prospective memory deficits in patients with depression: a meta-analysis. J Affect Disord. 2017;220:79–85.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ: British Medical Journal. 2003;327(7414):557–60.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.
Worldbank. New country classifications by income level: 2017-2018. databank.worldbank.org/data/download/site-content/CLASS.xls. Accessed 01 June 2018.
Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63.
Awad AG, Voruganti LN. Quality of life and new antipsychotics in schizophrenia are patients better off? Int J Soc Psychiatry. 1999;45(4):268–75.
Xiang YT, Wang CY, Wang Y, Chiu HF, Zhao JP, Chen Q, et al. Socio-demographic and clinical determinants of quality of life in Chinese patients with schizophrenia: a prospective study. Qual Life Res. 2010;19(3):317–22.
Teasdale SB, Ward PB, Rosenbaum S, Samaras K, Stubbs B. Solving a weighty problem: systematic review and meta-analysis of nutrition interventions in severe mental illness. Br J Psychiatry 2016:bjp. bp. 115.177139.
Stubbs B, Firth J, Berry A, Schuch FB, Rosenbaum S, Gaughran F, et al. How much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression. Schizophr Res. 2016;176(2):431–40.
Stubbs B, Williams J, Gaughran F, Craig T. How sedentary are people with psychosis? A systematic review and meta-analysis. Schizophr Res. 2016;171(1):103–9.
Vancampfort D, Correll CU, Galling B, Probst M, De Hert M, Ward PB, et al. Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis. World Psychiatry. 2016;15(2):166–74.
Alexandratos K, Barnett F, Thomas Y. The impact of exercise on the mental health and quality of life of people with severe mental illness: a critical review. Br J Occup Ther. 2012;75(2):48–60.
Sibitz I, Amering M, Unger A, Seyringer M, Bachmann A, Schrank B, et al. The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. Eur Psychiatry. 2011;26(1):28–33.
Rosenheck R, Leslie D, Keefe R, McEvoy J, Swartz M, Perkins D, et al. Barriers to employment for people with schizophrenia. A. J Psychiatry. 2006;163(3):411–7.
Alptekin K, Akvardar Y, Akdede BBK, Dumlu K, Isik D, Pirincci F, et al. Is quality of life associated with cognitive impairment in schizophrenia? Prog Neuropsychopharmacol Bol Psychiatry. 2005;29(2):239–44. https://doi.org/10.1016/j.pnpbp.2004.11.006.
Caron J, Mercier C, Diaz P, Martin A. Socio-demographic and clinical predictors of quality of life in patients with schizophrenia or schizo-affective disorder. Psychiatry Res. 2005;137(3):203–13.
Folsom DP, Depp C, Palmer BW, Mausbach BT, Golshan S, Fellows I, et al. Physical and mental health-related quality of life among older people with schizophrenia. Schizophr Res. 2009;108(1):207–13.
Narvaez JM, Twamley EW, McKibbin CL, Heaton RK, Patterson TL. Subjective and objective quality of life in schizophrenia. Schizophr Res. 2008;98(1–3):201–8. https://doi.org/10.1016/j.schres.2007.09.001.
Liu W, Zeng PX, Du ZH. Quality of life of 128 outpatients with schizophrenia. Medical Journal of Chinese People's Health. 2011;23(5):570–1.
Sum MY, Ho NF, Sim K. Cross diagnostic comparisons of quality of life deficits in remitted and unremitted patients with schizophrenia and bipolar disorder. Schizophr Res. 2015;168(1–2):191–6. https://doi.org/10.1016/j.schres.2015.08.030.
Mercier C, Peladeau N, Tempier R. Age, gender and quality of life. Community Ment Health J. 1998;34(5):487–500.
van Os J, Schizophrenia KS. Lancet. 2009;374(9690):635–45.
Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. Int Rev Psychiatry. 2010;22(5):417–28. https://doi.org/10.3109/09540261.2010.515205.
Angermeyer MC, Kuhn L, Goldstein JM. Gender and the course of schizophrenia: differences in treated outcomes. Schizophr Bull. 1990;16(2):293–307.
Xiang YT, Weng YZ, Leung CM, Tang WK, Chan SS, Wang CY, et al. Gender differences in sociodemographic and clinical characteristic and the quality of life of Chinese schizophrenia patients. Aust N Z J Psychiatry. 2010;44(5):450–5.
Picardi A, Rucci P, de Girolamo G, Santone G, Borsetti G, Morosini P. The quality of life of the mentally ill living in residential facilities - findings from a national survey in Italy. Eur Arch Psychiatry Clin Neurosci. 2006;256(6):372–81. https://doi.org/10.1007/s00406-006-0647-5.
Ali A, Kujur N, Jahan M, Verma AN, Singh AR. Quality of life in schizophrenia and its relationship with age of onset and duration of illness. Journal of Projective Psychology & Mental Health. 2009;16(1):62–5.
Franz M, Meyer T, Reber T, Gallhofer B. The importance of social comparisons for high levels of subjective quality of life in chronic schizophrenic patients. Qual Life Res. 2000;9(5):481–9.
McCabe R, Röder-Wanner U-U, Hoffmann K, Priebe S. Therapeutic relationships and quality of life: association of two subjective constructs in schizophrenia patients. Int J Soc Psychiatry. 1999;45(4):276–83.
Ritsner MS, Blumenkrantz H. Predicting domain-specific insight of schizophrenia patients from symptomatology, multiple neurocognitive functions, and personality related traits. Psychiatry Res. 2007;149(1):59–69.
Xiang Y-T, Wang Y, Wang C-Y, Chiu HF, Chen Q, Chan SS, et al. Association of insight with sociodemographic and clinical factors, quality of life, and cognition in Chinese patients with schizophrenia. Compr Psychiatry. 2012;53(2):140–4.
Karow A, Pajonk F-G, Reimer J, Hirdes F, Osterwald C, Naber D, et al. The dilemma of insight into illness in schizophrenia: self-and expert-rated insight and quality of life. Eur Arch Psychiatry Clin Neurosci. 2008;258(3):152–9.
Staring A, Van der Gaag M, Van den Berge M, Duivenvoorden H, Mulder C. Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophr Res. 2009;115(2):363–9.
Nuechterlein KH. Dawson ME. A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull. 1984;10(2):300–12.
Ulas H, Polat S, Akdede BB, Alptekin K. Impact of panic attacks on quality of life among patients with schizophrenia. Prog. Neuropsychopharmacol. Bol. Psychiatry. 2010;34(7):1300–5. https://doi.org/10.1016/j.pnpbp.2010.07.014.
Fitzgerald PB, Williams C, Corteling N, Filia S, Brewer K, Adams A, et al. Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand. 2001;103(5):387–92.
Acknowledgements
The study was supported by the University of Macau (MYRG2015-00230-FHS; MYRG2016-00005-FHS), the National Key Research & Development Program of China (No. 2016YFC1307200), the Beijing Municipal Administration of Hospitals Incubating Program (No. PX2016028) and the Beijing Municipal Administration of Hospitals’ Ascent Plan (No. DFL20151801).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of Interest
All authors have no conflicts of interest to declare.
Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
NA.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Dong, M., Lu, L., Zhang, L. et al. Quality of Life in Schizophrenia: A Meta-Analysis of Comparative Studies. Psychiatr Q 90, 519–532 (2019). https://doi.org/10.1007/s11126-019-09633-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11126-019-09633-4