Correlation of physician and patient rated quality of life during antipsychotic treatment in outpatients with schizophrenia

Perception of quality of life (QOL) may differ depending on the perspective. This 12-month, prospective, naturalistic study compared QOL ratings in outpatients on antipsychotic treatment for schizophrenia both from a “subjective” patient rated and an “objective” physician rated perspective. Included were 1462 patients. Two scales were used to assess patient and physician perspectives: the Subjective Well-being on Neuroleptics (SWN) scale and the Quality of Life Scale (QLS). Linear correlation was found between both ratings: 10 points on the SWN corresponded to 9.35 points on the QLS. Spearman's correlation coefficients increased over time up to r = 0.71 at Month 12. Patients were grouped into four cohorts depending on the degree of concordance between SWN and QLS ratings. Several factors affecting the concordance of both ratings were identified. Compared to the cohort with QLS = SWN, higher QOL ratings by the physician (QLS ≫ SWN) were more likely in females than in males (OR = 1.36; 95% CI 1.00 – 1.85) and in older than in younger patients (≤ 30 years vs. > 50 years: OR = 0.58, 95% CI 0.34 – 0.998), but less likely in patients with high baseline CGI-severity (CGI > 4; OR = 0.63; 95% CI 0.47 – 0.86) or treatment with oral typicals before baseline (OR = 0.53; 95% CI 0.31 – 0.91). Higher QOL ratings by the patient (SWN ≫ QLS) were less likely in patients with psychotherapy before baseline (OR = 0.54; 95% CI 0.36 – 0.81), medication intolerability before baseline (OR = 0.53; 95% CI 0.36 – 0.78) or patient request of treatment change at baseline (OR = 0.64; 95% CI 0.42 – 0.96). The combination of several factors predicted concordant ratings, including male sex, young age, high CGI at baseline, and psychotherapy prior to the study.