Schizophrenia Quality Of Life Scale Revision 4 Research Articles

Schizophrenia Quality of Life Scale and Schizophrenia Quality of Life Scale Revision 4: A Systematic Review of Measurement Properties.

Schizophrenia is a severe mental disorder that has a significant impact on quality of life (QOL). Measuring QOL can offer insights into treatment efficacy and areas of intervention, highlighting the importance of valid tools assessing QOL in people with schizophrenia. We employed the COSMIN systematic review guideline to assess the psychometric properties of the schizophrenia quality of life scale (SQLS) and its 4th revision, the schizophrenia quality of life scale revision 4 (SQLS-R4), as patient-reported outcome measures (PROMs). The search yielded 455 papers, 16 were included, 7 for the SQLS and 9 for the SQLS-R4. Both scales demonstrated good results in risk of bias assessment for internal consistency and convergent validity, the SQLS-R4 additionally for known-groups validity. For the SQLS, PROM development, structural validity, and reliability were suboptimal. The SQLS-R4 showed suboptimality regarding structural validity and reliability and inadequacy for cross-cultural validity and responsiveness. The updated criteria for good measurement properties indicated good convergent validity for the SQLS and good internal consistency, reliability, and convergent validity for the SQLS-R4. The SQLS showed suboptimal results for reliability and known-groups validity, while the SQLS-R4 demonstrated suboptimality in structural validity and known-groups validity. The SQLS had indeterminate structural validity and internal consistency; the SQLS-R4 showed indeterminate responsiveness, and insufficient cross-cultural validity. When using the updated GRADE approach of the COSMIN group, both scales received a very low grade. The SQLS and SQLS-R4 hold the potential for recommendation in rating QOL. Identified weaknesses necessitate further validations.

Compensatory Cognitive Training for Psychosocial Outcomes and Self-Stigma in Individuals With Schizophrenia: A Randomized Controlled Trial Study

Individuals with schizophrenia often experience poor psychosocial outcomes and self-stigma. This study aimed to investigate the effect of compensatory cognitive training (CCT) on self-esteem, self-efficacy, quality of life, and self-stigma in schizophrenia. Forty-six participants with schizophrenia were randomly assigned to intervention (CCT group, n = 24) or treatment as usual (TAU group, n = 22). The Rosenberg Self-Esteem Scale (RSES), the General Self-Efficacy Scale (GSES), the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4), and the Internalized Stigma of Mental Illness Scale (ISMIS) were administered at pretest (T0), posttest (T1), and 1-month follow-up (T2). A significant result was found at T2 in the SQLS-R4 score between CCT and TAU groups ( P = 0.001). A significant result was also noted at T2 in the ISMIS score ( P = 0.004). These findings show that CCT contributes to improvement in quality of life and self-stigma in individuals with schizophrenia. Accordingly, CCT may enhance the effectiveness of psychiatric rehabilitation programs. [ Psychiatr Ann . 2023;53(10):473–481.]

Evidence for the continuum-severity model of psychosis through scrutiny of the architecture of symptoms associated with schizophrenia

ABSTRACTThe psychosis continuum provides a framework to develop a compelling insight into the architecture of psychotic experiences in non-clinical samples. Using schizophrenia-specific measures within non-clinical samples offers further opportunity to investigate psychotic experiences and compare to those reported in clinical samples.A cross sectional survey method was used to collect data from a non-clinical sample (n = 510) using the Schizophrenia Quality of Life Scale-Revision 4 (SQLS-R4) and the Hospital Anxiety and Depression Scale (HADS).Conducting confirmatory factor analysis and bi-factor modelling found that a bi-factor model offered a better model fit to the data than the established two factor model. A general factor explained most item variance whilst seven domain specific factors explained a further small amount of item variance. Participants with higher anxiety reported comparatively poorer Quality of Life to those with lower anxiety. Comparison with data taken from a clinical sample found similarities in both the internal consistency and correlation coefficients between SQLS-R4 totals and sub-scales and HADS total scores and sub-scales.These results show the presence of a robust general psychosis Quality of Life factor within a non-clinical sample. The use of schizophrenia-specific measures and bi-factor modelling can provide suitable methods for investigating the nature of the psychosis continuum.

Self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia.

BackgroundWe investigated self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia in order to shed light on the clinical correlates of subjective cognitive deficits in schizophrenia.MethodsSeventy outpatients with schizophrenia were evaluated. Patients’ self-perceived cognitive deficits, internalized stigma, and subjective quality of life were assessed using the Scale to Investigate Cognition in Schizophrenia (SSTICS), the Internalized Stigma of Mental Illness Scale (ISMI), and the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4), respectively. Correlation and regression analyses controlling for the severity of symptoms of schizophrenia were performed, and a mediation analysis was conducted to examine the hypothesis that internalized stigma mediates the relationship between self-perceived cognitive deficits and subjective quality of life.ResultsPearson’s partial correlation analysis showed significant correlations among the SSTICS, ISMI, and SQLS-R4 scores (P<0.01). Multiple regression analysis showed that the SSTICS and ISMI scores significantly predicted the SQLS-R4 score (P<0.01). Mediation analysis revealed that the strength of the association between the SSTICS and SQLS-R4 scores decreased from β=0.74 (P<0.01) to β=0.56 (P<0.01), when the ISMI score was statistically controlled. The Sobel test revealed that this difference was significant (P<0.01), indicating that internalized stigma partially mediated the relationship between self-perceived cognitive deficits and quality of life.ConclusionThe present study indicates that self-perceived cognitive deficits are significantly associated with internalized stigma and quality of life. Furthermore, internalized stigma was identified as a partial mediator of the relationship between self-perceived cognitive deficits and quality of life. These findings suggest that clinicians should be aware that patients with schizophrenia experience significantly greater self-stigma when they suffer subjective cognitive deficits, and that this may further compromise their quality of life.

Relationship between cognitive insight and subjective quality of life in outpatients with schizophrenia.

BackgroundThe concept of cognitive insight refers to the cognitive processes involved in patients’ re-evaluation of their anomalous experiences and of their misinterpretations. The purpose of the present study was to examine the relationship between cognitive insight and subjective quality of life in patients with schizophrenia to further shed light on the nature of cognitive insight and its functional correlates in schizophrenia.MethodsSeventy-one stable outpatients with schizophrenia were evaluated for cognitive insight and subjective quality of life using the Beck Cognitive Insight Scale (BCIS) and the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4). The symptoms of schizophrenia were also assessed. Pearson’s correlation analysis and partial correlation analysis that controlled for the severity of symptoms were performed to adjust for the possible effects of symptoms.ResultsThe self-reflectiveness subscale score of the BCIS had significant positive correlations with the SQLS-R4 psychosocial domain and total SQLS-R4 scores, indicating that the higher the level of cognitive insight, the lower the subjective quality of life. In partial correlation analysis controlling for symptoms, the BCIS self-reflectiveness subscale score still had a significant correlation with the SQLS-R4 psychosocial domain score. The correlation coefficient between the BCIS self-reflectiveness and total SQLS-R4 scores was reduced to a nonsignificant statistical tendency.ConclusionThe results of our study suggest that cognitive insight, particularly the level of self-reflectiveness, is negatively associated with the level of subjective quality of life in outpatients with schizophrenia and that this relationship is not wholly due to the confounding effect of symptoms. Future studies are necessary to explore possible mediating and moderating factors and to evaluate the effects of therapeutic interventions on the relationship.

Psychometric validations and comparisons of schizophrenia-specific health-related quality of life measures

To compare schizophrenia-specific quality of life measures, this study examined an 18-item Chinese version of 41-item Quality of Life Questionnaire in Schizophrenia (S-QoL; S-QoL-18-C) using 41 patients. The S-QoL-18-C was validated and compared with Schizophrenia Quality of Life Scale-Revision 4 (SQLS-R4). Index scores of S-QoL-18-C showed nearly identical psychometrics to S-QoL-C and S-QoL-18. No significant ceiling/floor effects were found, except with psychological and selfesteem subscales. Internal consistency was acceptable for whole scale and all subscales, except family relationships and sentimental life. Test–retest reliability was moderate to high (ICC=0.58–87). Score distributions and reliability of S-QoL-18-C were slightly lower than those of S-QoL-C. Convergent validity was supported by satisfactory correlations between subscales/index scores of S-QoL-18-C and similar scales (r=∣−0.35∣to 0.80) and between corresponding subscales in S-QoL-18-C and S-QoL-C (r=0.85–0.97). S-QoL-18-C and SQLS-R4 demonstrated discriminant validity by differentiating among 30 patients with symptom remission, 30 patients without symptom remission, and 30 healthy individuals. Two patient groups were classified by criteria proposed by Remission in Schizophrenia Working Group. Three groups were controlled for five factors. Furthermore SQLS-R4, but not S-QoL-18-C, differentiated between patient groups with different hospitalization frequencies. Overall, S-QoL-18-C and SQLS-R4 show different advantages psychometrically.

Functional recovery results from the risperidone long-acting injectable versus quetiapine relapse prevention trial (ConstaTRE).

ConstaTRE is an open-label, randomised, controlled, relapse prevention trial in patients with stable schizophrenia or schizoaffective disorder switched to risperidone long-acting injectable (RLAI) or oral quetiapine, and was designed to test the hypothesis that injectable antipsychotic treatment with risperidone would be more effective than oral therapy with quetiapine. Here we report the functional recovery results from the ConstaTRE trial. Clinically stable adults previously treated with oral risperidone, olanzapine, or oral first-generation antipsychotics were randomised to RLAI or quetiapine for 24 months. Functional recovery was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS) and two quality-of-life (QoL) measures [Medical Outcomes Survey Short Form-12 (SF-12) and Schizophrenia Quality-of-Life Scale Revision 4 (SQLS-R4)]. A total of 666 patients were randomised and treated with RLAI (n = 329) or quetiapine (n = 337). Relapse occurred in 16.5% RLAI and 31.3% quetiapine patients. Significant improvements in SOFAS, SF-12, and SQLS-R4 scores were observed from baseline to month 24 with both RLAI and quetiapine. At months 6, and 12, and endpoint, improvement in SOFAS score was significantly greater for RLAI than quetiapine (p < 0.05). Among patients with stable schizophrenia or schizoaffective disorder, the likelihood of functional recovery appears to be higher in those switching to RLAI than to quetiapine, although improvements in functional status and QoL were observed with both treatments.

Validation of the Schizophrenia Quality of Life Scale Revision 4 among Chronic Schizophrenia Patients in Malaysia

ObjectivesTo explore the validity and reliability of a disease-specific health-related quality-of-life questionnaire—the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4)—in patients with schizophrenia in Malaysia. MethodsA total of 222 outpatients with schizophrenia receiving treatment at the Universiti Kebangsaan Malaysia Medical Centre completed the SQLS-R4 in either the Malay or the English language. A generic self-report health-related quality-of-life measure—the EuroQoL group EuroQol five-dimensional questionnaire—and a measure of symptom severity—the Clinical Global Impression-Schizophrenia scale—were also administered to assess validity. ResultsGood internal consistency reliability was found for both the psychosocial and vitality domains (Cronbach's α = 0.95 and 0.85, respectively). Most items were also significantly correlated with their own scale score (rs ranging from 0.29 to 0.74). There was a moderate correlation between the SQLS-R4 “vitality” domain and the EuroQol five-dimensional questionnaire “usual activities” domain (rs = 0.44) and a large correlation between the SQLS-R4 “psychosocial” domain and the EuroQol five-dimensional questionnaire “anxiety/depression” domain (rs = 0.44–0.57). Most of the symptom dimensions of the Clinical Global Impression-Schizophrenia scale were also moderately correlated with the SQLS-R4 subscale scores. ConclusionsThe SQLS-R4 is a valid and reliable health-related quality-of-life instrument for use in minimally ill patients with schizophrenia in Malaysia, but some of the items may be redundant and irrelevant. Validation of SQLS-R4 in different types of patients and various levels of illness severity is required to further verify its application.

Factor analysis of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) Chinese version and related factors

Objectives. To validate the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) Chinese version with factor analysis. We also investigated factors influencing quality of life results. Method. One hundred patients with schizophrenia participated in this study. Experienced psychiatrists evaluated each patient's current psychological condition to assure intact judgment. Participants then filled out the quality of life questionnaire, SQLS-R4. We used principal component analysis to analyze SQLS-R4 with oblique rotation. We also collected demographic data, another subjective and objective quality of life questionnaire, and information about the functional status of the participants at the same time. Multiple linear regression was used to analyze collected factors which may influence the quality of life of schizophrenic patients. Results. We extracted seven factors that explained a 68.1% variance in the patients' quality of life. The factors were relationships with others, loneliness, exhaustion, depressed thinking, somatic concerns, vitality, and worry. Conclusion. We found that the SQLS-R4 factor analysis provided insights into the structure of the quality of life of patients with schizophrenia. We also found that subjective social participation, subjective health, and depression were quality-of-life-related factors. Whether other factors influence the quality of life in patients with schizophrenia requires further investigation.

Factor analysis of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) Chinese version and related factors

Factor analysis of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) Chinese version and related factors

Validation of the Chinese version of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) in Taiwanese patients with schizophrenia

We tested the reliability, sensitivity, and validity of a Chinese translation of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4). One hundred Taiwanese individuals with schizophrenia were recruited. The internal consistency reliability was satisfactory for both the psychosocial and vitality domains (Cronbach's alpha = 0.92, 0.84). The test-retest reliability was also high (psychosocial: ICC = 0.84, vitality: ICC = 0.84) for those individuals whose psychological conditions remained stable between the two-week interval. However, the responsiveness coefficient for those with considerable changes in psychological conditions ranged from very small to moderate, suggesting either low responsiveness for the vitality domain or a complex relationship between the change of psychological conditions and quality of life, and the need to estimate responsiveness more conclusively in a future intervention study. The convergent validity was supported by moderate-to-large correlations between domains measuring related constructs of the SQLS-R4 and SF-36 (r = -0.65 to -0.67). Overall, the results of this study provide preliminary evidence for the reliability and validity of the SQLS-R4 used in Taiwanese individuals with schizophrenia. This study provides a common ground for international researchers to understand quality of life in Taiwanese patients with schizophrenia.

Factor structure of the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4)

The Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) appears to offer excellent potential as an easily administered and patient acceptable assessment and monitoring measure of quality of life (QoL). However, a principle psychometric criterion crucial to the use and validity of the instrument concerns the underlying factor structure. The SQLS-R4 comprises two sub-scales, these being cognition and vitality QoL and psychosocial feelings QoL. However, the factor structure of the SQLS-R4 has yet to be established in a patient group in the UK. Confirmatory factor analysis was conducted on the SQLS-R4 to determine its psychometric properties in 100 patients with a primary ICD-10 diagnosis of schizophrenia. Internal reliability of the SQLS-R4 cognition and vitality QoL and psychosocial feelings QoL sub-scales was found to be excellent. Consistent with the original validation of the SQLS-R4, two correlated factors comprising cognition and vitality QoL and psychosocial feelings QoL were observed to offer the best fit to the data. In conclusion, the SQLS-R4 would appear to be suitable for use in patients with a primary diagnosis of schizophrenia in the UK. Potential clinical uses and the direction of future research with the SQLS-R4 are indicated.