Quality of Life Research

, Volume 21, Issue 5, pp 837–847

Ten-year quality of life outcomes among patients with schizophrenia and schizoaffective disorders: I. Predictive value of disorder-related factors

  • Michael S. Ritsner
  • Alexander Lisker
  • Marina Arbitman



To provide data on long-term health-related quality of life (HRQL) outcomes among patients with schizophrenia (SZ) and schizoaffective (SA) disorders and determine the predictive value of disorder-related factors.


A total of 108 patients with SZ/SA were assessed during stabilization phase and over 10 years with the Quality of Life Enjoyment and Life Satisfaction Questionnaire (Q-LES-Q), Clinical Global Impression Scale, Positive and Negative Syndromes Scale (PANSS), Distress Scale for Adverse Symptoms (DSAS), Talbieh Brief Distress Inventory (TBDI), Brief Symptom Inventory-Somatization Scale (BSI-S), and Global Assessment of Functioning Scale (GAF). Variability and relationships between Q-LES-Q and disorder-related dimensions over time were analyzed.


There were no differences in Q-LES-Q dimensions between patients with SZ and SA disorders. Poor outcomes were found among 76% of the patients with SZ/SA disorders who remained dissatisfied (64%) or worsened (12%) with their HRQL over time. However, 24% of patients reported improved quality of life (16%), or remained satisfied (8%). Changes in TBDI, DSAS, BSI-S, PANSS, and GAF measures accounted for 20–50% of the total variance in satisfaction changes in Q-LES-Q domains across time.


Long-term quality of life outcomes are characterized by four different types that fit changes over time in emotional distress, side effects, somatization, symptom dimensions, and general functioning scores. Revealed predictors are factors that can be ameliorated and thereby enhance satisfaction with quality of life over time.


Subjective quality of life Severe mental illness Long-term follow-up 


  1. 1.
    Lehman, A. F. (1996). Measures of quality of life among persons with severe and persistent mental disorders. Social Psychiatry and Psychiatric Epidemiology, 31, 78–88.PubMedCrossRefGoogle Scholar
  2. 2.
    Priebe, S. I., Roeder-Wanner, U. U., & Kaiser, W. (2000). Quality of life in first-admitted schizophrenia patients: A follow-up study. Psychological Medicine, 30, 225–230.PubMedCrossRefGoogle Scholar
  3. 3.
    Ritsner, M., Modai, I., Endicott, J., Rivkin, O., Nechamkin, Y., Barak, P., et al. (2000). Differences in quality of life domains and psychopathologic and psychosocial factors in psychiatric patients. Journal of Clinical Psychiatry, 61, 880–889.PubMedCrossRefGoogle Scholar
  4. 4.
    Ritsner, M.S., & Gibel, A. (2007). Quality of life impairment syndrome in schizophrenia. In: M. S. Ritsner, A. G. Awad (Eds.), (173–226) Netherlands: Springer.Google Scholar
  5. 5.
    Dickerson, F. B., Ringel, N. B., & Parente, F. (1998). Subjective quality of life in out-patients with schizophrenia: Clinical and utilization correlates. Acta Psychiatrica Scandinavica, 98, 124–127.PubMedCrossRefGoogle Scholar
  6. 6.
    Packer, S., Husted, J., Cohen, S., & Tomlinson, G. (1998). Psychopathology and quality of life in schizophrenia. Journal of Psychiatry & Neuroscience, 22, 231–234.Google Scholar
  7. 7.
    Fitzgerald, P. B., Williams, C. L., & Corteling, N. (2001). Subject and observer-rated quality of life in schizophrenia. Acta Psychiatrica Scandinavica, 103, 387–392.PubMedCrossRefGoogle Scholar
  8. 8.
    Bechdolf, A., Klosterkotter, J., Hambrecht, M., Knost, B., Kuntermann, C., Schiller, S., et al. (2003). Determinants of subjective quality of life in post acute patients with schizophrenia. European Archives of Psychiatry and Clinical Neuroscience, 253, 228–235.PubMedCrossRefGoogle Scholar
  9. 9.
    Voruganti, L. N., Heslegrave, R. J., & Awad, A. G. (1997). Quality of life measurement during antipsychotic drug therapy of schizophrenia. Journal of Psychiatry & Neuroscience, 22, 267–274.Google Scholar
  10. 10.
    Young, A. S., Sullivan, G., & Burnam, M. A. (1998). Measuring the quality of outpatient treatment for schizophrenia. Archives of General Psychiatry, 28, 1221–1230.Google Scholar
  11. 11.
    Ritsner, M., Ponizovsky, A., Endicott, J., Nechamkin, Y., Rauchverger, B., Silver, H., et al. (2002). Relatively small impact adverse events of antipsychotics on life satisfaction of schizophrenia patients: A naturalistic study. European Neuropsychopharmacology, 12, 31–38.PubMedCrossRefGoogle Scholar
  12. 12.
    Lasalvia, A., Ruggeri, M., & Santolini, N. (2002). Subjective quality of life: Its relationship with clinician-rated and patient-rated psychopathology. The South-Verona outcome project 6. Psychotherapy and Psychosomatics, 71, 275–284.PubMedCrossRefGoogle Scholar
  13. 13.
    Ritsner, M., & Kurs, R. (2002). Impact of antipsychotic agents and their side effects on the quality of life in schizophrenia. Expert Review in Pharmacoeconomics Outcomes Research, 2, 89–98.Google Scholar
  14. 14.
    Ritsner, M., & Kurs, R. (2003). Quality of life outcomes in mental illness: Schizophrenia, mood and anxiety disorders. Expert Review in Pharmacoeconomics Outcomes Research, 3, 189–199.CrossRefGoogle Scholar
  15. 15.
    Awad, A. G., & Voruganti, L. N. (2004). Impact of atypical antipsychotics on quality of life in patients with schizophrenia. CNS Drugs, 18, 877–893.PubMedCrossRefGoogle Scholar
  16. 16.
    Lambert, M., & Naber, D. (2004). Current issues in schizophrenia: Overview of patient acceptability, functioning capacity and quality of life. CNS Drugs 18(Suppl 2), 5–17.Google Scholar
  17. 17.
    Ritsner, M., Gibel, A., & Ratner, Y. (2006). Determinants of changes in perceived quality of life in the course of schizophrenia. Quality of Life Research, 15, 515–526.PubMedCrossRefGoogle Scholar
  18. 18.
    Bengtsson-Tops, A., & Hansson, L. (2001). Quantitative and qualitative aspects of the social network in schizophrenic patients living in the community. Relationship to sociodemographic characteristics and clinical factors and subjective quality of life. International Journal of Social Psychiatry, 47, 67–77.PubMedCrossRefGoogle Scholar
  19. 19.
    Barry, M. M., & Crosby, C. (1996). Quality of life as an evaluative measure in assessing the impact of community care on people with long-term psychiatric disorders. British Journal of Psychiatry, 168, 210–216.PubMedCrossRefGoogle Scholar
  20. 20.
    Bow-Thomas, C. C., Velligan, D. I., Miller, A. L., & Olsen, J. (1999). Predicting quality of life from symptomatology in schizophrenia at exacerbation and stabilization. Psychiatry Research, 86, 131–142.PubMedCrossRefGoogle Scholar
  21. 21.
    Browne, S. (1999). Rehabilitation programmes and quality of life in severe mental illness. International Journal of Social Psychiatry, 45(4), 302–309.PubMedCrossRefGoogle Scholar
  22. 22.
    Lenz, G., & Demal, U. (2000). Quality of life in depression and anxiety disorders: An exploratory follow-up study after intensive inpatient cognitive behaviour therapy. Psychopathology, 33(6), 297–302.PubMedCrossRefGoogle Scholar
  23. 23.
    Holloway, F., & Carson, J. (1999). Subjective quality of life, psychopathology, satisfaction with care and insight: An exploratory study. International Journal of Social Psychiatry, 45, 259–267.PubMedCrossRefGoogle Scholar
  24. 24.
    Jarema, M., & Konieczynska, Z. (2001). Quality of life in schizophrenia: Impact of psychopathology, patients’ gender and antipsychotic treatment. International Journal of Psychiatry in Clinical Practice, 5(1), 19–26.Google Scholar
  25. 25.
    Tempier, R., Mercier, C., Leouffre, P., & Caron, J. (1997). Quality of life and social integration of severely mentally ill patients: A longitudinal study. Journal of Psychiatry & Neuroscience, 22, 249–255.Google Scholar
  26. 26.
    Salokangas, R. K., Honkonen, T., Stengård, E., & Koivisto, A. M. (2006). Subjective life satisfaction and living situations of persons in Finland with long-term schizophrenia. Psychiatric Services, 57(3), 373–381.PubMedCrossRefGoogle Scholar
  27. 27.
    Skantze, K. (1998). Subjective quality of life and standard of living: A 10-year follow-up of out-patients with schizophrenia. Acta Psychiatrica Scandinavica, 98(5), 390–399.PubMedCrossRefGoogle Scholar
  28. 28.
    Lehman, A. F. (1988). A quality of life interview for the chronically mental ill. Evaluation and Program Planning, 11, 51–62.CrossRefGoogle Scholar
  29. 29.
    Sullivan, G., Wells, K. B., & Leake, B. (1991). Quality of life of seriously mentally ill persons in Mississippi. Hospital & Community Psychiatry, 42, 752–755.Google Scholar
  30. 30.
    Malla, A., & Payne, J. (2005). First-episode psychosis: Psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin, 31, 650–671.PubMedCrossRefGoogle Scholar
  31. 31.
    Ritsner, M.S. (2007). The Distress/Protection Vulnerability Model of the quality of life impairment syndrome: Current evidence and new directions for research. In: M. S. Ritsner, A. G. Awad (Eds.), Quality of Life Impairment in Schizophrenia, Mood and Anxiety Disorders (pp. 3–19). Netherlands: Springer.Google Scholar
  32. 32.
    Awad, G. (1992). Quality of life of schizophrenic patients on medication and implications for new drug trials. Hospital & Community Psychiatry, 43, 262–266.Google Scholar
  33. 33.
    Skantze, K., & Malm, U. (1994). A new approach to facilitation of working alliances based on patients’ quality of life goals. Nordic Journal of Psychiatry, 1, 37–55.CrossRefGoogle Scholar
  34. 34.
    Zissi, A., Barry, M. M., & Cochrane, R. (1998). A mediational model of quality of life for individuals with severe mental health problems. Psychological Medicine, 28, 1221–1230.PubMedCrossRefGoogle Scholar
  35. 35.
    Ritsner, M., Kurs, R., Gibel, A., Hirschmann, S., Shinkarenko, E., & Ratner, Y. (2003). Predictors of quality of life in major psychoses: A naturalistic follow-up study. Journal of Clinical Psychiatry, 64, 308–315.PubMedCrossRefGoogle Scholar
  36. 36.
    Ritsner, M., & Kurs, R. (2006). Quality-of-life impairment in severe mental illness: Focus on schizoaffective disorders. In William. H. Murray (Ed.), Schizoaffective disorder: New research (pp. 69–107). New York: NOVA Publishers.Google Scholar
  37. 37.
    American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC: American Psychiatric Association.Google Scholar
  38. 38.
    Ritsner, M., Ben-Avi, I., Ponizovsky, A., Timinsky, I., Bistrov, E., & Modai, I. (2003). Quality of life and coping with schizophrenia symptoms. Quality of Life Research, 12, 1–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Ritsner, M. (2003). Predicting changes in domain-specific quality of life of schizophrenia patients. Journal of Nervous and Mental Disease, 191, 287–294.PubMedCrossRefGoogle Scholar
  40. 40.
    Endicott, J., Nee, J., Harrison, W., & Blumenthal, R. (1993). Quality of life enjoyment and satisfaction questionnaire: A new measure. Psychopharmacology Bulletin, 29, 321–326.PubMedGoogle Scholar
  41. 41.
    Guy, W. (1976). ECDU assessment manual for psychopharmacology. Rockville, MD: US Department of Health and Human Services.Google Scholar
  42. 42.
    Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.PubMedGoogle Scholar
  43. 43.
    Ritsner, M., Modai, I., Rivkin, O., Bystrov, E., Nehamkin, Y., & Ponizovsky, A. (1999). Distress scale for adverse symptoms: A new instrument for measuring the relationship between adverse drug symptoms and associated distress. 12th ECNP Congress, London—United Kingdom, September 21–25, 1999. European Neuropsychopharmacology 9(Suppl. 5), S258.Google Scholar
  44. 44.
    Ritsner, M., Rabinowitz, J., & Slyuzberg, M. (1995). The Talbieh brief distress inventory: A brief instrument to measure psychological distress among immigrants. Comprehensive Psychiatry, 36, 448–453.PubMedCrossRefGoogle Scholar
  45. 45.
    Ritsner, M., Modai, I., & Ponizovsky, A. (2002). Assessing psychological distress in psychiatric patients: Validation of the Talbieh brief distress inventory. Comprehensive Psychiatry, 43, 229–234.PubMedCrossRefGoogle Scholar
  46. 46.
    Derogatis, L. R., & Spencer, P. M. (1982). The brief symptom inventory (BSI): Administration, scoring and procedures manual. School of Medicine: Johns Hopkins University.Google Scholar
  47. 47.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.Google Scholar
  48. 48.
    Hintze, J. L. (1998). NCSS 6.0. Statistical System for Windows. User’s Guide. Kaysville Utah: Number Cruncher Statistical Systems.Google Scholar
  49. 49.
    Skantze, K., Malm, U., Dencker, S. J., May, P. R., & Corrigan, P. (1992). Comparison of quality of life with standard of living in schizophrenic outpatients. British Journal of Psychiatry, 161, 797–801.PubMedCrossRefGoogle Scholar
  50. 50.
    Lambert, M., Schimmelmann, B. G., Schacht, A., Karow, A., Wagner, T., Wehmeier, P. M., et al. (2009). Long-term patterns of subjective wellbeing in schizophrenia: Cluster, predictors of cluster affiliation, and their relation to recovery criteria in 2,842 patients followed over 3 years. Schizophrenia Research, 107(2–3), 165–172.PubMedCrossRefGoogle Scholar
  51. 51.
    Warner, R. (2009). Recovery from schizophrenia and the recovery model. Current Opinion in Psychiatry, 22(4), 374–380.PubMedCrossRefGoogle Scholar
  52. 52.
    Srivastava, A. K., Stitt, L., Thakar, M., Shah, N., & Chinnasam, G. (2009). The abilities of improved schizophrenia patients to work and live independently in the community: A 10-year long-term outcome study from Mumbai, India. Annals of General Psychiatry, 8, 24.PubMedCrossRefGoogle Scholar
  53. 53.
    Awad, A. G., Voruganti, L. N., & Heslegrave, R. J. (1997). A conceptual model of quality of life in schizophrenia: Description and preliminary clinical validation. Quality of Life Research, 6, 21–26.PubMedCrossRefGoogle Scholar
  54. 54.
    Franz, M., Meyer, T., Reber, T., & Gallhofer, B. (2000). The importance of social comparisons for high levels of subjective quality of life in chronic schizophrenic patients. Quality of Life Research, 9(5), 481–489.PubMedCrossRefGoogle Scholar
  55. 55.
    Heinrichs, D. W., Hanlon, T. E., & Carpenter, W. T., Jr. (1984). The quality of life scale: An instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10, 388–398.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Michael S. Ritsner
    • 1
    • 2
  • Alexander Lisker
    • 2
  • Marina Arbitman
    • 2
  1. 1.Department of Psychiatry, Rappaport Faculty of MedicineTechnion—Israel Institute of TechnologyHaifaIsrael
  2. 2.Acute DepartmentSha’ar Menashe Mental Health CenterHaderaIsrael

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