Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel.
Eur Psychiatry. 2018 Sep;53:100-106. doi: 10.1016/j.eurpsy.2018.06.004. Epub 2018 Jun 27.
Age of onset is considered central to understanding the course of schizophrenia, yet little is known regarding its association with quality of life in general, and specifically among males and females.
To examine the association between the age of schizophrenia onset and quality of life, in general, and among males and females, using data from a national sample and competing statistical models.
Participants with a diagnosis of schizophrenia (N = 1624) completed the Manchester Short Assessment of Quality of Life (MSA-QoL) and were rated on a parallel measure by their professional caregivers (N = 578). Multiple regression analysis models were computed for self-appraised quality of life, and mixed models with random intercepts were used for caregivers. Six competing models were tested for parsimony for each rating source. Three models without adjustment and three models adjusted for confounding variables. Sensitivity analyses were conducted for males and females separately.
Age of onset was statistically significantly (P < .05) negatively associated with self-appraised and caregiver-appraised quality of life on aggregate and among females. Among males, a significant (P < .01) quadratic effect of onset age on self-appraised quality of life demonstrated a negative association up to onset age of 36.67 years, after which the association was positive.
An earlier age of onset is associated with a better quality of life in schizophrenia which is tentatively explained by social decline. Specific trends in psychiatric symptom severity may account for this association among females while social advantages may account for the particular results found among males.
发病年龄被认为是理解精神分裂症病程的核心，但对于其与总体生活质量的关系，尤其是在男性和女性中的关系，我们知之甚少。
使用全国性样本和竞争统计模型，检验精神分裂症发病年龄与总体生活质量以及男性和女性生活质量之间的关联。
1624 名被诊断为精神分裂症的参与者完成了曼彻斯特简短生活质量评估（MSA-QoL），并由其专业护理人员（N=578）在平行测量中对其进行评分。对于自我评估的生活质量，计算了多个回归分析模型，对于护理人员，则使用了具有随机截距的混合模型。为每个评分来源测试了六个竞争模型的简约性。三种无调整模型和三种调整混杂变量的模型。分别对男性和女性进行敏感性分析。
总体而言，发病年龄与自我评估和护理人员评估的生活质量呈统计学显著负相关（P<0.05），且在女性中也呈显著负相关。在男性中，发病年龄对自我评估生活质量的二次效应显著（P<0.01），表明在发病年龄达到 36.67 岁之前，发病年龄与生活质量呈负相关，之后呈正相关。
在精神分裂症中，发病年龄越早，生活质量越好，这可以暂时用社会衰退来解释。女性中这种关联可能与精神症状严重程度的特定趋势有关，而男性中特定的结果可能与社会优势有关。
