Predictors for quality of life improvement in schizophrenia: a prospective study of patients in hospital-based rehabilitation programs

Enhancing quality of life (QoL) is a crucial goal in the rehabilitation of patients with schizophrenia (SCZ). Identifying factors associated with the outcomes of rehabilitation is of clinical importance. This study examined predictors of subjective QoL (SQoL) outcomes in SCZ patients undergoing a structured 24-week rehabilitation program. A total of 235 patients with SCZ completed the program. SQoL was assessed using the Schizophrenia Quality of Life Scale (SQLS), comprising three subdomains: psychosocial (PS), motivation/ energy (ME), and symptoms/side effects (SS). Clinical symptoms were evaluated using the Brief Psychiatric Rating Scale (BPRS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Scale (GAD-7). Cognitive impairment was assessed using the Ascertain Dementia 8 (AD8). Medication side effects were assessed using the Treatment Emergent Symptom Scale and Rating Scale for Extrapyramidal Side Effects. After 24 weeks, the response rate (≥ 20% reduction of SQLS total score post-training from baseline was 72.8% (171/235). Multiple regression analysis revealed that SQoL improvement was negatively associated with baseline scores of BPRS negative symptoms (P = 0.017) and PHQ-9 (P = 0.034), while positively associated with changes in BPRS negative symptoms (P = 0.031) and PHQ-9 (P = 0.034), and baseline PS subdomain (P = 0.021). The predictive model yielded an area under the curve of 0.798, which increased to 0.926 when changes in clinical symptoms were included. Structured rehabilitation training may significantly improve SQoL in patients with SCZ. Both baseline levels and changes in psychiatric symptoms, cognition, anxiety, and baseline PS subdomain levels significantly predict SQLS improvement, suggesting they could be targets for future comprehensive and individualized interventions. This protocol was registered on February 21, 2021, at chictr.org.cn (Identifier: ChiCTR2100043537).