University Paris Saclay - UVSQ, Health Sciences department, EA 4047 HANDIReSP, Laboratory for clinical and public health research on psychological, cognitive and motor disability, Versailles, France.
University Department of Adult Psychiatry and Addictology, Versailles Hospital, Le Chesnay, France.
Psychol Med. 2022 Jun;52(8):1501-1508. doi: 10.1017/S0033291720003311. Epub 2020 Sep 23.
The determinants of quality of life (QoL) in schizophrenia are largely debated, mainly due to methodological discrepancies and divergence about the concepts concerned. As most studies have investigated bi- or tri-variate models, a multivariate model accounting for simultaneous potential mediations is necessary to have a comprehensive view of the determinants of QOL. We sought to estimate the associations between cognitive reserve, cognition, functioning, insight, depression, schizophrenic symptoms, and QoL in schizophrenia and their potential mediation relationships.
We used structural equation modeling with mediation analyses to test a model based on existing literature in a sample of 776 patients with schizophrenia from the FondaMental Foundation FACE-SZ cohort.
Our model showed a good fit to the data. We found better functioning to be positively associated with a better QoL, whereas better cognition, better insight, higher levels of depression, and schizophrenic symptoms were associated with a lower QoL in our sample. Cognitive reserve is not directly linked to QoL, but indirectly in a negative manner via cognition. We confirm the negative relationship between cognition and subjective QoL which was previously evidenced by other studies; moreover, this relationship seems to be robust as it survived in our multivariate model. It was not explained by insight as some suggested, thus the mechanism at stake remains to be explained.
The pathways to subjective QoL in schizophrenia are complex and the determinants largely influence each other. Longitudinal studies are warranted to confirm these cross-sectional findings.
精神分裂症患者的生活质量（QoL）的决定因素存在很大争议，主要是由于方法学上的差异以及对相关概念的分歧。由于大多数研究都调查了双变量或三变量模型，因此需要一个多变量模型来同时考虑潜在的中介因素，以全面了解 QoL 的决定因素。我们旨在评估认知储备、认知、功能、洞察力、抑郁、精神分裂症症状与精神分裂症患者 QoL 之间的关联，并探讨其潜在的中介关系。
我们使用结构方程模型和中介分析来检验基于 FondaMental Foundation FACE-SZ 队列中 776 名精神分裂症患者现有文献的模型。
我们的模型与数据拟合良好。我们发现，更好的功能与更好的 QoL 呈正相关，而更好的认知、更好的洞察力、更高的抑郁水平和精神分裂症症状与我们样本中的较低 QoL 相关。认知储备与 QoL 没有直接联系，但通过认知以负向间接相关。我们确认了认知与主观 QoL 之间的负相关关系，这是先前其他研究已经证明的；此外，这种关系似乎很稳健，因为它在我们的多变量模型中仍然存在。它没有像一些人所建议的那样被洞察力所解释，因此，相关的机制仍有待解释。
精神分裂症患者主观 QoL 的途径很复杂，决定因素在很大程度上相互影响。需要进行纵向研究来证实这些横断面研究结果。
