Quality of life in schizophrenia: a meta-analysis of comparative studies.
Abstract
Studies and findings regarding the impact of schizophrenia on quality of life (QOL) has been highly variable. This meta-analysis compared QOL between schizophrenia subjects and healthy controls with a focus on standardized measures. A systematic literature search was conducted through Pubmed, PsycINFO, EMBASE, Cochrane Library and Web of Science databases. Only studies using the World Health Organization Quality of Life (WHOQOL) or its brief version or the Short Form-36 Health Survey (SF-36) were included. Fifteen case-control studies with 2195 schizophrenia subjects and 1508 healthy controls were included in this meta-analysis. The WHOQOL/WHOQOL-BREF score was significantly lower in physical health (SMD = -1.80, 95% CI: -2.31 to -1.28, P < 0.001), psychological health (SMD = -1.28, 95% CI: -1.72 to -0.83, P < 0.001), social relationships (SMD = -1.60, 95% CI: -2.05 to -1.15, P < 0.001), and environment domains (SMD = -0.98, 95% CI: -1.38 to -0.59, P < 0.001) in schizophrenia subjects compared to controls. The SF-36 score was significantly lower in both physical (SMD = -1.09, 95% CI: -1.41 to -0.76, P < 0.001 and mental health domains (SMD = -2.08, 95% CI: -3.58 to -0.59, P = 0.006) in schizophrenia subjects than in controls. Subgroup and meta-regression analyses found that age, male gender, illness duration and income have significant moderating effects on QOL. The meta-analysis of studies with standardized measures confirmed that QOL in schizophrenia subjects is significantly lower than healthy controls. Effective interventions should be developed to improve QOL for this population.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Both severe positive symptoms and crisis-associated hospitalization are believed to contribute to secondary activation of negative symptoms and comorbid mood/anxiety disorders, resulting in increased chronification risk.
“Both are believed to contribute to the secondary activation of negative symptoms such as poor rapport (83) and comorbid disorders like mood and anxiety disorders (84) resulting in an increased chronification risk (85).”
From Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach (2023) · cites this paper as [85]
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823 · see citing works
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The PRISMA Group (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000097 · Cited by 64,042 · see citing works
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722 · see citing works
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859 · see citing works
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,577 · see citing works
Stroup, D. F. (2000) · JAMA · doi:10.1001/jama.283.15.2008 · Cited by 20,623 · see citing works
Wang, G., Ma, R., Qiao, G., Wada, K., Aizawa, Y., & Satoh, T. (2015) · Integrative Medicine International · doi:10.1159/000368408 · Cited by 18,759 · see citing works
Self-citation(2014) · Medical Entomology and Zoology · Cited by 17,633 · see citing works
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152 · see citing works
Duval, S., & Tweedie, R. (2000) · Biometrics · doi:10.1111/j.0006-341x.2000.00455.x · Cited by 14,099 · see citing works
Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment
THE WHOQOL GROUP (1998) · Psychological Medicine · doi:10.1017/s0033291798006667 · Cited by 7,933 · see citing works
(1995) · Social Science & Medicine · doi:10.1016/0277-9536(95)00112-k · Cited by 7,643 · see citing works
The MOS Short-form General Health Survey: Reliability and Validity in a Patient Population
Stewart, A. L., Hays, R. D., & Ware, J. E. (1988) · Medical Care · doi:10.1097/00005650-198807000-00007 · Cited by 3,339 · see citing works
A Systematic Review of the Prevalence of Schizophrenia
Saha, S., Chant, D., Welham, J., & McGrath, J. (2005) · PLoS Medicine · doi:10.1371/journal.pmed.0020141 · Cited by 2,168 · see citing works
van Os, J., & Kapur, S. (2009) · The Lancet · doi:10.1016/s0140-6736(09)60995-8 · Cited by 1,971 · see citing works
A Heuristic Vulnerability/Stress Model of Schizophrenic Episodes
Nuechterlein, K. H., & Dawson, M. E. (1984) · Schizophrenia Bulletin · doi:10.1093/schbul/10.2.300 · Cited by 1,004 · see citing works
Marwaha, S., & Johnson, S. (2004) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-004-0762-4 · Cited by 927 · see citing works
Sex differences in schizophrenia
Abel, K. M., Drake, R., & Goldstein, J. M. (2010) · International Review of Psychiatry · doi:10.3109/09540261.2010.515205 · Cited by 762 · see citing works
Vancampfort, D., Correll, C. U., Galling, B., Probst, M., De Hert, M., Ward, P. B., Rosenbaum, S., Gaughran, F., Lally, J., & Stubbs, B. (2016) · World Psychiatry · doi:10.1002/wps.20309 · Cited by 659 · see citing works
Metabolic syndrome in people with schizophrenia: a review
DE HERT, M., SCHREURS, V., VANCAMPFORT, D., & VAN WINKEL, R. (2009) · World Psychiatry · doi:10.1002/j.2051-5545.2009.tb00199.x · Cited by 634 · see citing works
Schizophrenic syndromes, cognitive performance and neurological dysfunction
Liddle, P. F. (1987) · Psychological Medicine · doi:10.1017/s0033291700012976 · Cited by 552 · see citing works
Barriers to Employment for People With Schizophrenia
Rosenheck, R., Leslie, D., Keefe, R., McEvoy, J., Swartz, M., Perkins, D., Stroup, S., Hsiao, J. K., Lieberman, J., & CATIE Study Investigators Group (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.3.411 · Cited by 465 · see citing works
Stubbs, B., Firth, J., Berry, A., Schuch, F. B., Rosenbaum, S., Gaughran, F., Veronesse, N., Williams, J., Craig, T., Yung, A. R., et al. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.05.017 · Cited by 379 · see citing works
How sedentary are people with psychosis? A systematic review and meta-analysis
Stubbs, B., Williams, J., Gaughran, F., & Craig, T. (2016) · Schizophrenia Research · doi:10.1016/j.schres.2016.01.034 · Cited by 284 · see citing works
Gender and the Course of Schizophrenia: Differences in Treated Outcomes
Angermeyer, M. C., Kuhn, L., & Goldstein, J. M. (1990) · Schizophrenia Bulletin · doi:10.1093/schbul/16.2.293 · Cited by 281 · see citing works
Subjective and objective quality of life in schizophrenia
Narvaez, J. M., Twamley, E. W., McKibbin, C. L., Heaton, R. K., & Patterson, T. L. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2007.09.001 · Cited by 270 · see citing works
Staring, A., van der Gaag, M., van den Berge, M., Duivenvoorden, H., & Mulder, C. (2009) · Schizophrenia Research · doi:10.1016/j.schres.2009.06.015 · Cited by 242 · see citing works
Chen, Y. (2002) · Psychopathology · doi:10.1159/000065140 · Cited by 232 · see citing works
Sibitz, I., Amering, M., Unger, A., Seyringer, M.-E., Bachmann, A. F., Schrank, B., Benesch, T., Schulze, B., & Woppmann, A. (2010) · European Psychiatry · doi:10.1016/j.eurpsy.2010.08.010 · Cited by 214 · see citing works
Teasdale, S. B., Ward, P. B., Rosenbaum, S., Samaras, K., & Stubbs, B. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.115.177139 · Cited by 198 · see citing works
Measuring Quality of Life in Patients with Schizophrenia
Awad, A. G., & Voruganti, L. N. P. (2012) · PharmacoEconomics · doi:10.2165/11594470-000000000-00000 · Cited by 171 · see citing works
Subject and observer‐rated quality of life in schizophrenia
Fitzgerald, P. B., Williams, C. L., Corteling, N., Filia, S., Brewer, K., Adams, A., de Castella, A. R., Rolfe, T., Davey, P., & Kulkarni, J. (2001) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2001.00254.x · Cited by 157 · see citing works
Is quality of life associated with cognitive impairment in schizophrenia?
Alptekın, K., Akvardar, Y., Akdede, B. B., Dumlu, K., Işık, D., Pirinçci, F., Yahssin, S., & Kitiş, A. (2004) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2004.11.006 · Cited by 131 · see citing works
Age, Gender and Quality of Life
Mercier, C., Péladeau, N., & Tempier, R. (1998) · Community Mental Health Journal · doi:10.1023/a:1018790429573 · Cited by 125 · see citing works
Karow, A., Pajonk, F., Reimer, J., Hirdes, F., Osterwald, C., Naber, D., & Moritz, S. (2007) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-007-0768-5 · Cited by 105 · see citing works
Caron, J., Mercier, C., Díaz, P., & Martin, A. (2005) · Psychiatry Research · doi:10.1016/j.psychres.2005.07.002 · Cited by 96 · see citing works
McCabe, R., Röder‐Wanner, U., Hoffmann, K. G., & Priebe, S. (1999) · International Journal of Social Psychiatry · doi:10.1177/002076409904500406 · Cited by 90 · see citing works
Alexandratos, K., Barnett, F., & Thomas, Y. (2012) · British Journal of Occupational Therapy · doi:10.4276/030802212x13286281650956 · Cited by 89 · see citing works
Yen, C., Cheng, C., Huang, C., Yen, J., Ko, C., & Chen, C. (2008) · Bipolar Disorders · doi:10.1111/j.1399-5618.2007.00577.x · Cited by 87 · see citing works
Lysaker, P. H., Yanos, P. T., Outcalt, J., & Roe, D. (2010) · Clinical Schizophrenia & Related Psychoses · doi:10.3371/csrp.4.1.3 · Cited by 83 · see citing works
Physical and mental health-related quality of life among older people with schizophrenia
Folsom, D. P., Depp, C. A., Palmer, B. W., Mausbach, B. T., Golshan, S., Fellows, I. E., Cárdenas, V., Patterson, T. L., KRAEMER, H. C., & Jeste, D. V. (2009) · Schizophrenia Research · doi:10.1016/j.schres.2008.12.008 · Cited by 83 · see citing works
Quality of Life and New Antipsychotics in Schizophrenia Are Patients Better Off?
Awad, A. G., & Voruganti, L. N. P. (1999) · International Journal of Social Psychiatry · doi:10.1177/002076409904500405 · Cited by 77 · see citing works
Karagianis, J. L., Novick, D., Pečeňák, J., Haro, J. M., Dossenbach, M. R. K., Treuer, T., Montgomery, W. S., Walton, R., & Lowry, A. J. (2009) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2009.02191.x · Cited by 68 · see citing works
Sleep–wake patterns in schizophrenia patients compared to healthy controls
Afonso, P., Figueira, M. L., & Paiva, T. (2014) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2012.756987 · Cited by 65 · see citing works
Woon, P. S., Chia, M. Y., Chan, W. Y., & Sim, K. (2010) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2010.01.014 · Cited by 64 · see citing works
Franz, M., Meyer, T., Reber, T., & Gallhofer, B. (2000) · Quality of Life Research · doi:10.1023/a:1008938011554 · Cited by 58 · see citing works
The sensitivity of quality-of-life scale WHOQOL-100 to psychopathological measures in schizophrenia
Örsel, S., Akdemir, A., & Dağ, İ. (2003) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2003.09.006 · Cited by 58 · see citing works
Prospective memory deficits in patients with depression: A meta-analysis
Zhou, F.-C., Wang, Y.-Y., Zheng, W., Zhang, Q., Ungvari, G. S., Ng, C. H., Zhang, J., & Xiang, Y.-T. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.05.042 · Cited by 52 · see citing works
Self-citationRitsner, M. S., & Blumenkrantz, H. (2006) · Psychiatry Research · doi:10.1016/j.psychres.2006.01.002 · Cited by 51 · see citing works
Quality of life and mental health in Chinese culture
Xiang, Y., Chiu, H. F., & Ungvari, G. S. (2009) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e328333d60f · Cited by 43 · see citing works
Self-citationThe quality of life of the mentally ill living in residential facilities
Picardi, A., Rucci, P., de Girolamo, G., et al. (2006) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-006-0647-5 · Cited by 40 · see citing works
Xiang, Y., Wang, C., Wang, Y., Chiu, H. F. K., Zhao, J., Chen, Q., Chan, S. S. M., Lee, E. H. M., & Ungvari, G. S. (2010) · Quality of Life Research · doi:10.1007/s11136-010-9593-9 · Cited by 38 · see citing works
Self-citationQuality of Life in Community-Dwelling Patients With Schizophrenia in China
Xiang, Y., Hou, Y., Yan, F., Dixon, L. B., Ungvari, G. S., Dickerson, F., Li, W.-Y., Li, W.-X., Zhu, Y.-L., Chan, S. S. M., et al. (2012) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e31825bfc71 · Cited by 31 · see citing works
Self-citationXiang, Y., Wang, Y., Wang, C., Chiu, H. F. K., Chen, Q., Chan, S. S. M., Lai, K. Y. C., Lee, E. H. M., & Ungvari, G. S. (2011) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2011.04.001 · Cited by 30 · see citing works
Self-citationEffect of thought disorders on quality of life in patients with schizophrenia
Ulaş, H., Akdede, B. B., Ozbay, D., & Alptekın, K. (2007) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2007.08.033 · Cited by 30 · see citing works
Xiang, Y., Weng, Y., Leung, C. M., Tang, W. K., Chan, S. S. M., Wang, C., Han, B., & Ungvari, G. S. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048670903489858 · Cited by 20 · see citing works
Self-citationSum, M. Y., Ho, N. F., & Sim, K. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.08.030 · Cited by 16 · see citing works
Impact of panic attacks on quality of life among patients with schizophrenia
Ulaş, H., Polat, S., Akdede, B. B., & Alptekın, K. (2010) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2010.07.014 · Cited by 14 · see citing works
Quality of life in outpatients with schizophrenia
Dickerson, F., Boronow, J. J., Ringel, N., & Parente, F. J. (1997) · Schizophrenia Research · doi:10.1016/s0920-9964(97)82030-0 · Cited by 9 · see citing works
Quality of Life Assessment in Turkish Patients with Schizophrenia and Their Relatives
Alptekın, K., Akdede, B. B., Akvardar, Y., çelikgün, S., Dilşen, N. S., Durak, G., Türk, A., & Fıdaner, H. (2004) · Psychological Reports · doi:10.2466/pr0.95.1.197-206 · Cited by 9 · see citing works
Taylor, K., & Granquist, M. D. (2019) · Cited by 3 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Gussmann, E., Lucae, S., Falkai, P., Padberg, F., Egli, S., & Kopf-Beck, J. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1160075 · Cited by 2 · see citing works
“Both are believed to contribute to the secondary activation of negative symptoms such as poor rapport (83) and comorbid disorders like mood and anxiety disorders (84) resulting in an increased chronification risk (85).”
Background
- Authors
- Dong, M., Lu, L., Zhang, L., Zhang, Y.-S., Ng, C. H., Ungvari, G. S., Li, G., Meng, X., Wang, G., & Xiang, Y.-T.
- Affiliations
- University of Macau (MO)
- Capital Medical University (CN)
- Hebei Mental Health Center (CN)
- The University of Melbourne (AU)
- The University of Western Australia (AU)
- Douglas Mental Health University Institute (CA)
- Corresponding author
- Wang, Gang
- Xiang, Yu-Tao
- ORCID
- Venue
- Psychiatric Quarterly
- Published
- 2019-05-22
- Volume
- 90
- Issue
- 3
- Pages
- 519-532
- ISSN
- 0033-2720 (ISSN-L)
- 1573-6709
- OpenAlex
- W2945623015
- Cited by
- 142
- References
- 62
- Citations by year
- 2026: 24 · 2025: 26 · 2024: 32 · 2023: 22 · 2022: 22 · 2021: 7 · 2020: 7 · 2019: 2
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychiatric Quarterly (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- University of Macau (MYRG2015-00230-FHS; MYRG2016-00005-FHS)
- National Key Research & Development Program of China (2016YFC1307200)
- Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (ZYLX201607)
- Beijing Municipal Administration of Hospitals’ Ascent Plan (DFL20151801)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- schizophrenia, quality of life, WHOQOL, SF-36, physical health, mental health, interpersonal relationships, environmental domain, disease duration, income, gender differences
- MeSH terms
- Adult, Female, Humans, Male, Quality of Life, Schizophrenic Psychology, Case-Control Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
