Impact of depressive symptoms on subjective well-being: the importance of patient-reported outcomes in schizophrenia

Jorge Mauriño¹, Julio Sanjúan², Josep Maria Haro³, Teresa Díez¹, Javier Ballesteros^4
1AstraZeneca Medical Department, Madrid, Spain; ²Department of Psychiatry, University of Valencia, CIBERSAM, Valencia, Spain; ³Parc Sanitari Sant Joan de Deu, CIBERSAM, Sant Boi de Llobregat, Spain; ⁴Department of Neuroscience-Psychiatry, University of the Basque Country, UPV/EHU, CIBERSAM, Leioa, Spain

Objective: The subjective experience of psychotic patients toward treatment is a key factor in medication adherence, quality of life, and clinical outcome. The aim of this study was to assess the subjective well-being in patients with schizophrenia and to examine its relationship with the presence and severity of depressive symptoms.
Methods: A multicenter, cross-sectional study was conducted with clinically stable outpatients diagnosed with schizophrenia. The Subjective Well-Being under Neuroleptic Scale – short version (SWN-K) and the Calgary Depression Scale for Schizophrenia (CDSS) were used to gather information on well-being and the presence and severity of depressive symptoms, respectively. Spearman’s rank correlation was used to assess the associations between the SWN-K total score, its five subscales, and the CDSS total score. Discriminative validity was evaluated against that criterion by analysing the area under the curve (AUC).
Results: Ninety-seven patients were included in the study. Mean age was 35 years (standard deviation = 10) and 72% were male. Both the total SWN-K scale and its five subscales correlated inversely and significantly with the CDSS total score (P < 0.0001). The highest correlation was observed for the total SWN-K (Spearman’s rank order correlation [rho] = –0.59), being the other correlations: mental functioning (–0.47), social integration (–0.46), emotional regulation (–0.51), physical functioning (–0.48), and self-control (–0.41). A total of 33 patients (34%) were classified as depressed. Total SWN-K showed the highest AUC when discriminating between depressive severity levels (0.84), followed by emotional regulation (0.80), social integration (0.78), physical functioning and self-control (0.77), and mental functioning (0.73). Total SWN-K and its five subscales showed a significant linear trend against CDSS severity levels (P < 0.001).
Conclusion: The presence of moderate to severe depressive symptoms was relatively high, and correlated inversely with patients’ subjective well-being. Routine assessment of patient-reported measures in patients with schizophrenia might reduce potential discrepancy between patient and physician assessment, increase therapeutic alliance, and improve outcome.

Keywords: schizophrenia, subjective well-being, patient-reported outcome, depressive symptoms