Quality of life in Chinese patients with schizophrenia treated in primary care

Highlights

• This study examined quality of life (QOL) in community-dwelling schizophrenia patients treated in primary care in China.

• QOL was significantly associated with certain demographic and clinical characteristics.

• Compared to the general population, lower physical and mental QOL domains were found in schizophrenia patients.

Abstract

In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. This study examined the quality of life (QOL) in patients with schizophrenia treated in primary care and explored the demographic and clinical characteristics associated with QOL. Altogether, 612 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. QOL, psychotic and depressive symptoms, extra-pyramidal symptoms and insight were assessed using standardized instruments. Data analyses were conducted with the one sample t-test and multiple linear regression analyses. Compared with the normative data for the Chinese general population, significantly lower scores in physical and mental QOL domains were found in the patient group. Older age, being unemployed, major medical conditions, no smoking, more severe depressive and negative symptoms, more frequent insomnia, and suicidality were independently associated with poor physical QOL. Male gender, more severe depressive and anxiety symptoms, more frequent insomnia, and suicidality were independently associated with poor mental QOL. Patients with schizophrenia treated in primary care had lower level of QOL in comparison with general population. Effective measures need to be implemented to improve their QOL.

Introduction

During the past decades, quality of life (QOL) has been an important outcome measure in psychiatry because it can comprehensively reflect the effectiveness of psychosocial interventions and/or pharmacotherapy; in addition, QOL could reflect a more holistic view of a person beyond symptom reduction alone (Xiang et al., 2010a; Boyer et al., 2013; Caqueo-Urizar et al., 2016; Picco et al., 2016). Examining the relationships of QOL with socio-demographic and clinical characteristics could help design more effective clinical interventions. Some studies have shown that the QOL among schizophrenia patients was associated with the use of antipsychotic medications, depressive symptoms, extrapyramidal side effects (EPS), insomnia, and suicidality (Foldemo and Bogren, 2002, Hobbs et al., 2002, Bechdolf et al., 2003a, Xiang et al., 2009b).

Most studies on QOL in schizophrenia were conducted in Western countries. There is compelling evidence that QOL is significantly influenced by socio-cultural factors (Pinikahana et al., 2002, Xiang et al., 2010a). Therefore, findings reported in Western countries may not be generalized to patients living under different socio-cultural circumstances. Findings of studies examining the correlates of QOL of Chinese patients with schizophrenia (Chan et al., 2003, Law et al., 2005, Xiang et al., 2008b, Xiang et al., 2008c, Xiang et al., 2009a) are not completely consistent with those reported from the Western world. For example, positive symptoms are negatively associated with overall and physical QOL domains in Chinese patients with schizophrenia (Xiang et al., 2010a), which contrasts with the notion in the West that QOL is not associated with positive symptoms, but more associated with negative symptoms (Corrigan and Buican, 1995, Browne et al., 1996).

Schizophrenia is severe psychiatric disorder that is associated with immeasurable suffering of patients and their families and causes a massive economic burden (Kaplan and Sadock, 2003). In China there are 1.4 billion people and the estimated prevalence of schizophrenia is 0.49% (Xiang et al., 2008a). Therefore, there are approximately 6.9 million patients with schizophrenia nationwide. However, the number of psychiatrists (approximately 20,000) is inadequate to meet this demand (Ng et al., 2009) and the majority of the workforce is concentrated in the urban psychiatric hospitals (Xiang et al., 2012b). China is a developing country which has no well-established community or catchment mental health services that are found in developed countries. (Cook et al., 2012, Wright et al., 2016, Osborn and Stein, 2017). The primary care doctors usually receive regular training in psychiatric hospitals, and provide maintenance treatment for clinically stable patients with schizophrenia in the community.

The objective of this study was to investigate the QOL in Chinese community-dwelling patients with schizophrenia managed in primary care and explore the sociodemographic and clinical characteristics associated with patient QOL.