Quality of life in Chinese patients with schizophrenia: A meta-analysis
Introduction
Schizophrenia is a severe psychiatric disorder characterized by positive and negative symptoms and cognitive deficits. Compared with healthy subjects, patients with schizophrenia are more likely to have physical comorbidities, impaired cognitive and occupational functioning, frequent hospitalizations, high treatment costs, and increased risk of suicide and mortality (Dickerson et al., 2017, Latham and Kirkpatrick, 2018, Sugawara et al., 2012, Teraishi et al., 2014, Xu et al., 2011), all of which are associated with high personal and family burden.
Quality of life (QOL) integrates a comprehensive range of aspects, such as individual values and life domains (Felce and Perry, 1995), and reflects an individual's perception of his/her position in life (WHO, 1995). QOL has been widely used as an outcome measure in clinical practice and research (Hofer et al., 2017). QOL between schizophrenia patients and healthy controls has been compared in Western countries (Afonso et al., 2014, Gomes et al., 2016, Hofer et al., 2017, Sum et al., 2015). However, it is evident that QOL is largely determined by economic and sociocultural factors, thus Western findings cannot be generalized to other parts of the world with different sociocultural and economic context (Xiang et al., 2010a). For example, only positive symptoms significantly influence the QOL of Chinese schizophrenia patients (Xiang et al., 2008), unlike most Western findings that only negative symptoms (Browne et al., 1996, Novick et al., 2015), or both negative and positive symptoms are significantly associated with QOL (Eack and Newhill, 2007, Norman et al., 2000).
In China the lifetime prevalence of schizophrenia was estimated at 5.4/1000 (Long et al., 2014), which is higher than the worldwide median figures reported from 46 countries (4.0/1000) (Saha et al., 2005). Several studies have compared QOL between Chinese schizophrenia patients and healthy subjects (Chen et al., 2012, Jiang, 2016, Liu et al., 2011), but the results have been inconsistent, particularly in terms of the effect size between the patients and controls and the factors that moderate QOL. Most studies have been reported in Chinese-language journals and are less accessible to the international readership.
No meta-analysis comparing QOL between schizophrenia patients and healthy controls in China had been published which gave the impetus to conduct a meta-analysis to compare overall and different QOL domains between Chinese schizophrenia patients and healthy controls and also explore factors that could moderate QOL.
Section snippets
Search strategy
This meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD 42017081037). Two reviewers (ZLN and ZQQ) searched articles independently in the following databases: PubMed, PsycINFO, EMBASE, Chinese National Knowledge Infrastructure (CNKI), SinoMed and WanFang from their commencement to September 6, 2017. Search terms
Characteristics of eligible studies
Of the 8,300 potentially eligible publications, 18 studies with 4,497 participants (2,425 patients and 2,072 healthy controls) met the inclusion criteria for the meta-analyses (Fig. 1). Huang et al. (2006) reported QOL data in Zhuang and Han ethnic Chinese samples separately, while (An and Li, 2004) examined community-dwelling patients and inpatients separately. Both these arms in each study were combined into one single group. Seventeen studies were rated as of high quality. Details of the
Discussion
This was the first meta-analysis that compared QOL between schizophrenia patients and healthy controls in China. The main finding was that patients had lower QOL than controls in overall QOL as well as the physical, psychological, social relationships and environmental QOL domains with medium to large effect sizes.
Patients’ lower QOL is likely to be related to clinical factors, such as more medical conditions, psychotic symptoms, cognitive dysfunction (Hintze and Borkowska, 2015), comorbid
Conflict of interest
We declare that the authors have no competing interests related to the topic of this meta-analysis.
Acknowledgment
The study was supported by the University of Macau (MYRG2015-00230-FHS; MYRG2016-00005-FHS). The University of Macau had no role in the study design, generating or interpreting the results and publication of the study.
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These authors contributed equally to the work.