Russo P, Smith MW; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 14.
Outcomes Research and Econometrics, The MEDSTAT Group, Inc., 4301 Connecticut Avenue NW, Suite 330, Washington, DC 20008; Tel: (202) 719-7826; Fax: (202) 719-7801; E-mail: pat.russo@medstat.com
RESEARCH OBJECTIVE: To examine the relationship between self-reported and clinically assessed quality of life (QoL) among participants in the U.S. Schizophrenia Care and Assessment Program (SCAP) and to determine the role of participants' clinical symptoms on objective and subjective quality-of-life ratings. STUDY DESIGN: Data reflect measures obtained at the 12-month assessment period (n= 908). Clinical instruments used were the Quality of Life Scale (QLS), the Montgomery-Asberg Depression Rating Scale (MADRS), the Positive and Negative Symptoms Scale (PANSS) and Abnormal Involuntary Movement Scale (AIMS). Self-report data were obtained from the Life Satisfaction (LifeSat) scale and the Depression scale, component scales of the SCAP Health Questionnaire. Cross-sectional regression analyses were conducted and demographic factors were included as controls. POPULATION STUDIED: Persons enrolled in the SCAP study. PRINCIPAL FINDINGS: Correlation between the subjective and objective scale totals and component items were significant in most instances with magnitudes ranging from 0.2 to 0.6. Clinical rating of QLS was significantly and inversely impacted by PANSS (p<0.001) and MADRS (p<0.001). Unlike QLS, self-reported LifeSat was impacted by MADRS (p<0.001) and not by symptoms (PANSS). The magnitude of effect of MADRS was 38% greater on LifeSat than on QLS. Two QLS sub-scales (common objects and activities (COA) and interpersonal relations (IPR)) exhibited a significant relationship with LifeSat (p<0.01 and p<0.001, respectively). In the presence of MADRS, however, significance of clinical symptoms and QLS subscales diminished and R-squared increased. Clinically assessed depression exhibited a significant relationship (0.38; p<0.001) to self-reported depression. CONCLUSIONS: These findings demonstrate several important points: 1) participant self-reports and clinical assessments exhibit significant interrelation for both QoL and depression; 2) clinical symptoms and side effects are not important drivers of self-reported QoL; 3) level of depression is an important factor in patients' own sense of life satisfaction; and 4) depression scores exhibit a mediating effect between psychiatric symptom presentation and valuation of quality of life. The observed relationship between clinically assessed and self-reported QoL scales found in this study contrasts with earlier findings (Fitzgerald et al., 2001) and may be a function of the increased sample size available here. The observed interrelation suggests that among these patients, self-reported information about life satisfaction could supplement the development of treatment-planning regimens. Results indicate that patients' assessment of quality of life depends more on level of depression than primary disease symptomology. The observed mediating effect of depression might explain this result as it suggests that there may be an indirect effect of symptoms on QoL. As well, these patients may have achieved a degree of acceptance of or resignation to their psychiatric symptoms. The mediating role of depression may also suggest that comparison of MADRS scores could accurately predict differences in life satisfaction both across individuals and within individuals across time. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The relationship of self-report to clinical assessment is of particular interest for persons with schizophrenia given the current climate of participatory treatment planning and outcome milestone achievement. Further, elucidating the drivers of quality of life can inform both practitioners and policymakers. PRIMARY FUNDING SOURCE: Eli Lilly and Company
Publication Types:
Keywords:
- Autobiography
- Cross-Sectional Studies
- Depression
- Depressive Disorder
- Humans
- Life
- Personal Satisfaction
- Physical Examination
- Psychiatric Status Rating Scales
- Quality of Life
- Questionnaires
- Schizophrenia
- United States
- methods
- psychology
- hsrmtgs
Other ID:
UI: 102273612
From Meeting Abstracts