Abstract
Aim: To assess associations between relapses and psychosocial outcomes in adult patients with schizophrenia treated in United States (US) healthcare settings.Methods: Data were derived from a point-in-time survey of psychiatrists and their patients with schizophrenia conducted across the US, France, Spain, China, and Japan between July and October 2019. For the purposes of this analysis, only data from US practitioners and patients were included. Disease-specific programmes (DSPs) are large surveys with a validated methodology conducted in clinical practise; they describe current disease management, disease burden, and associated treatment effects (clinical and physician-perceived). Participating psychiatrists completed patient record forms for their next 10 consecutive adult consulting patients with schizophrenia, with the same patients invited to voluntarily complete a patient self-completion (PSC) questionnaire. Surveys contained questions on the patients' disease background, treatment history, prior hospitalisation due to schizophrenia relapse and a series of psychosocial outcomes. Associations between relapses in the last 12 months and psychosocial outcomes were examined using multiple regression.Results: A total of 124 psychiatrists provided data on 1,204 patients. Of these, 469 patients (mean age, 39.6 years; 56.5% male) had known hospitalisation history for the last 12 months and completed a PSC; 116 (24.7%) patients had ≥1 relapse. Compared to patients without relapses, patients who relapsed were more likely to be homeless, unemployed, previously incarcerated, and currently have difficulties living independently (all p < 0.05). Patients who experience a relapse also had greater working impairment and poorer quality of life compared with those who did not relapse. In general, psychosocial outcomes became poorer with an increasing number of relapses.Conclusions: In this population of patients with schizophrenia from the US, relapse was significantly associated with poor psychosocial outcomes, with a greater number of relapses predicting worse outcomes. Early intervention to reduce the risk of relapse may improve psychosocial outcomes in patients with schizophrenia.
Highlights
Schizophrenia is a chronic and severe mental disorder characterised by abnormal behaviour, distortions of thinking and perception, and impaired daily functioning
The likelihood of experiencing these emotions increased with number of relapses, the ORs were significant for each relapse category only for feeling scared. In this population of patients with schizophrenia from the United States (US), we found that schizophrenia relapse was associated with poor psychosocial outcomes and reduced quality of life (QoL), with these outcomes being worse in patients who experienced a greater number of relapses in the last 12 months
One report that reviewed 27 studies of suicide risk in schizophrenia revealed that demoralisation was prevalent in patients with schizophrenia and that depression and suicide were moderated by hopelessness [34]
Summary
Schizophrenia is a chronic and severe mental disorder characterised by abnormal behaviour, distortions of thinking and perception, and impaired daily functioning. In the US, the annual costs attributable to schizophrenia are $155.7 billion, including $9.3 billion in direct medical costs and $117 billion in indirect costs [3]. Most patients develop schizophrenia between the ages of 18 and 35 years [6]. Psychiatric comorbidities, including panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, depression, and substance abuse, are common in patients with schizophrenia [7]. This patient population is at increased risk of other physical conditions such as cardiovascular and metabolic diseases [8]
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