Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.
Eur Arch Psychiatry Clin Neurosci. 2018 Feb;268(1):27-38. doi: 10.1007/s00406-017-0829-3. Epub 2017 Jul 29.
Impaired quality of life (QoL) is a common and clinically relevant feature of schizophrenia. In the present study, we attempted to formulate a model of QoL in the chronic stage of schizophrenia by including key variables-namely cognitive insight, self-stigma, insight into treatment, and medication compliance-that were proposed as its significant predictors in previous studies. We employed structural equation modeling (SEM) to simultaneously test the associations between these variables. A total of 170 community-dwelling patients with schizophrenia participated in this study. Cognitive insight, self-stigma, insight into treatment, medication compliance, and QoL were assessed through self-reporting. Symptoms were rated by interviewers. The influences of cognitive insight, stigma, insight into treatment, and medication compliance on QoL were supported using SEM. Our findings indicated that cognitive insight had a significant, positive, and direct effect on both self-stigma and insight into treatment; in contrast, it had a negative and direct effect on medication compliance. Notably, no evidence indicated a direct effect of cognitive insight on QoL. Thus, individuals with high cognitive insight reported low QoL because of stigma, low medication compliance, and their increased insight into treatment. In contrast, cognitive insight might indirectly ameliorate QoL mediated by the effect of insight into treatment on medication compliance. The findings provide additional support of the links between cognitive and clinical insight, self-stigma, medication compliance, and QoL in those with schizophrenia and suggest the need for screening and intervention services appropriate for this high-risk population.
生活质量受损（QoL）是精神分裂症的一个常见且具有临床意义的特征。在本研究中，我们试图通过纳入认知洞察力、自我污名、治疗洞察力和药物依从性等关键变量来构建精神分裂症慢性期的 QoL 模型，这些变量在前研究中被提出是其重要的预测因子。我们采用结构方程建模（SEM）来同时检验这些变量之间的关联。共有 170 名居住在社区的精神分裂症患者参与了这项研究。认知洞察力、自我污名、治疗洞察力、药物依从性和 QoL 通过自我报告进行评估。症状由访谈者进行评估。SEM 支持认知洞察力、污名、治疗洞察力和药物依从性对 QoL 的影响。我们的研究结果表明，认知洞察力对自我污名和治疗洞察力具有显著的积极直接影响，而对药物依从性具有显著的消极直接影响。值得注意的是，认知洞察力对 QoL 没有直接影响的证据。因此，认知洞察力高的个体报告 QoL 较低，这是由于污名、低药物依从性和对治疗的深入了解所致。相比之下，认知洞察力可能通过治疗洞察力对药物依从性的影响间接地改善 QoL。这些发现为认知和临床洞察力、自我污名、药物依从性和精神分裂症患者的 QoL 之间的联系提供了额外的支持，并表明需要为这一高风险人群提供适当的筛查和干预服务。
