Subjective quality of life in psychiatric patients: Diagnosis and illness-specific profiles

Objective: In accordance with the definition of health by the World Health Organization, outcome measures beyond mere syndromic recovery, such as quality of life ratings, would aid psychiatric practice and research. This is the first study of psychiatric diagnosis and illness stage specific profiles of subjective quality of life (SQOL) impairment. Method: Patients (n = 150) hospitalized at the Prague Psychiatric Center rated their SQOL using the Schwartz Outcome Scale at admission and discharge. Severity of illness and clinical improvement were measured by the Clinical Global Impression Scale. Results: The highest and lowest SQOL at admission were reported by patients with psychosis and mood disorders respectively (F = 7.3, df = 2,147, P < 0.001). SQOL improved significantly during hospitalization in all diagnostic categories (F = 90.0, df = 1, 147, P < 0.001), with the smallest and largest improvement in patients with psychosis and mood disorders, respectively (F = 5.6, df = 2,147, P = 0.005). There was a trend for differences in ratings of clinical improvement by patients, compared with psychiatrists, across diagnostic categories (F = 2.9, df = 2,147, P = 0.06), with significant differences only in patients with anxiety disorders. These patients also reported the lowest SQOL at discharge (F = 3.0, df = 2,147, P = 0.05). Global improvement correlated with improvement in SQOL only in patients with mood disorders (r = -0.4, P = 0.005). Conclusions: Main psychiatric diagnostic categories differ in SQOL and in association between SQOL and treatment. These differences may reflect illness-specific mechanisms, such as depressive symptoms in mood disorders, low insight in psychotic patients, aggravation of anxiety before discharge in patients with anxiety disorders, and may aid in planning of specific treatment interventions.