A systematic literature review identifying associations between outcomes and quality of life (QoL) or healthcare resource utilization (HCRU) in schizophrenia

Figures & data

Table 1. Main outcomes.

Main outcomes
Clinical
Relapse/Remission/Response
Time from/to Relapse/Remission/Response
PANSS Positive and Negative Syndrome Scale^19
PNS-Q, The Positive and Negative Symptoms Questionnaire^20
CGI, Clinical Global Impression^21
CGI-S, Clinical Global Impression of Severity
CGI-I, Clinical Global Impression of Improvement
NSA-16, 4-item Negative Symptom Assessment^22
BCIS, the Beck cognitive insight scale^23
BDI, the Beck depression inventory^24
Side-effects
LUNSERS, The Liverpool University Neuroleptic Side Effect Rating Scale^25
UKU SERS Pat, The Self Rating Version of the UKU Side Effect Rating Scale^26
Functioning
GAF, Global Assessment of Functioning^27
The Social Functioning Scale^28
PSP, Personal and Social Performance Scale^29
WHODAS-II, The WHO Disability Assessment Schedule^30
WPAI, Work productivity and activity impairment^31
WoRQ, Readiness for Work Questionnaire^32
Treatment Compliance/Adherence/Satisfaction
CRCS, the Clinician Rating of Compliance Scale^33
MARS, the Medication Adherence Rating Scale^34
DAI-30, the Hogan Drug Attitude Inventory^35
MMAS, Morisky Medication Adherence Scale^36
MSQ, Medication Satisfaction Questionnaire^37
Societal/Family/Caregiver Burden
Employment
Incarceration
PFBS, The Perceived Family Burden Scale^38
S-CGQoL, The Schizophrenia Caregiver Quality-of-Life Questionnaire^39

Table 2. Quality-of-life outcomes.

QoL Outcomes
EQ-5D, EuroQol-5D^40
SWN, Subjective Well-Being under Neuroleptics Scale—long form or short form^41
QLS, Quality-of-Life Scale^42
S-QoL, Quality-of-Life Questionnaire in Schizophrenia^43
SQLS, Schizophrenia Quality-of-Life Scale^44
SQLS-4, Schizophrenia Quality-of-Life Scale-Revision 4^45
Q-LES-Q, Quality-of-Life Enjoyment and Satisfaction Questionnaire (& version 18)^46
SOL, The Schizophrenia Quality-of-Life Scale^2
SF-36, Short Form 36 Health Survey SFS^47

Table 3. Inclusion and exclusion criteria.

PICOS	Inclusion criteria	Exclusion criteria
Population	Patients with schizophrenia.	Patients with major psychiatric or central nervous system comorbidities
Intervention and comparators	No restrictions	None
Outcomes	Association between any HRQoL OR HCRU outcome AND at least one of the main outcomes. See Tables 1 and 2 for details	Articles not documenting any direct association between outcomes of interest
Study design	Randomized controlled trials and observational studies	Articles reporting on psychometric validation
Other restrictions	Published since 2007 English publications only	Systematic literature reviews (These were listed and references compared to those included). Abstract or Poster only. Editorial

Figure 1. PRISMA flow chart.

Table 4. Summary of associations, strength of associations, number of associations, and references.

	Costs	Resource utilization	QoL	Employment status
Clinical/symptoms
PANSS total score	+++ n = 2^67	– n = 1^67	– n = 2^53^,^68	– n = 1^61
		++ n = 2^59	++ n = 2^53^,^58
		+++ n = 1^59	+++ n = 2^68
PANSS-N	– n = 13^62^,^69	– n = 7^59^,^62	– n = 11^53^,^55^,^64^,^66^,^68^,^70	– n = 1^61
	+ n = 1^69	++ n = 3^62^,^71	+ n = 4^53^,^72	+ n = 1^61
	++ n = 6^62	+++ n = 1^65	++ n = 8^58^,^64^,^66^,^71–73	++ n = 1^50
			+++ n = 3^66^,^68
PANSS-P	– n = 7^69	– n = 1^59	– n = 12^53^,^55^,^64^,^66^,^68^,^70	– n = 1^61
	+ n = 1^69	++ n = 2^59^,^71	+ n = 5^53^,^64^,^72	++ n = 1^50
		+++ n = 3^65	++ n = 2^66^,^71
			+++ n = 2^68
PANSS-G		– n = 2^59	– n = 7^53^,^66^,^68^,^70
		++ n = 1^59	+ n = 1^53
			++ n = 7^53^,^58^,^66^,^73
			+++ n = 3^68
PANSS mixed			– n = 1^55
PANSS cognitive factor			– n = 1^72
			+ n = 2^72
			++ n = 2^72
PANSS anxiety/depression			– n = 2^72
			++ n = 2^72
PANSS Mood symptoms		+++ n = 1^65
PANSS disorganized			– n = 1^73
PANSS excited			+ n = 3^72
			– n = 1^73
Refractory status			++ n = 1^54
Relapse/outpatient	– n = 5^69	– n = 3^74	++ n = 3^51^,^75	– n = 1^57
	+ n = 1^60	+ n = 2^74		+ n = 1^60
	++ n = 13^69^,^74^,^75	++ n = 12^74^,^77
	+++ n = 3^60
Remission		++ n = 1^52	+++ n = 1^78
CGI			+++ n = 1^79
CGI-S			– n = 1^49
			+ n = 2^53^,^64
			++ n = 4^49^,^53^,^58
CGI-SCH negative			− n = 1^78
CGI-SCH cognitive			++ n = 1^78
CGI-SCH depressive			+++ n = 1^78
Functioning
GAF		– n = 4^53	– n = 1^70
		++ n = 2^53	+ n = 1^58
PSP total score		– n = 1^49	– n = 1^49
		+ n = 1^49	++ n = 2^49
			+++ n = 1^63
WoRQ			+++ n = 1^80
Adherence
MARS		+ n = 1^57	+ n = 1^62
Employment
Employment status	– n = 7^69	++ n = 1^77	– n = 2^55^,^58
	+ n = 1^69		+ n = 1^55
			++ n = 1^58

If p-value not available: ±0.70: +++; ±0.50: ++; ±0.30: +.

For cost results, the strength was reported as (++) if the difference was higher than 20% between the two groups.

+++: p < 0.0001; ++: p < 0.01; +: p < 0.05; –: p > 0.05.

Table 5. Summary of associations between clinical outcomes and HCRU/cost.

	Costs	Resource utilization	Study countries
Clinical
PANSS total score	+++ n = 2^67	– n = 1^67	^67: Germany
		++ n = 2^59	^59: US
		+++ n = 1^59
PANSS-N	– n = 13^62^,^69	– n = 7^59^,^62	^62: Spain; ^69: France, UK, & Germany; ^71: US; ^65: Germany, Greece, Italy, & Spain
	+ n = 1^69	++ n = 3^62^,^71	^59: US
	++ n = 6^62	+++ n = 1^65
PANSS-P	– n = 7^69	– n = 1^59	^69: France, UK, & Germany; ^71: US; ^65: Germany, Greece, Italy, & Spain
	+ n = 1^69	++ n = 2^59^,^71	^59: US
		+++ n = 3^65
PANSS-G		– n = 2^59	^59: US
		++ n = 1^59
PANSS Mood symptoms		+++ n = 1^65	^65: Germany, Greece, Italy, & Spain
Relapse/outpatient	– n = 5^69	– n = 3^74	^69: France, UK, & Germany; ^77: Japan; ^74: US; ^60: Germany, Italy, Spain, France, Denmark, Greece, Ireland, UK, Netherlands, Portugal
	+ n = 1^60	+ n = 2^74
	++ n = 13^60^,^69^,^74	++ n = 12^74^,^77
	+++ n = 3^60
Remission		++ n = 1^52	^52: Malaysia

If p-value not available: ±0.70: +++; ±0.50: ++; ±0.30: +.

For cost results, the strength was reported as (++) if the difference was higher than 20% between the two groups.

+++: p < 0.0001; ++: p < 0.01; +: p < 0.05; –: p > 0.05.

Table 6. Summary of associations between clinical outcomes and QoL.

	SWN	EQ-5D	SF36	QLS	S-QOL	Study Countries
Clinical/symptoms
PANSS total score		++ n = 1^53	– n = 1^68	+++ n = 1^68		^68: Russia, US, & Croatia; ^58: Italy
		– n = 1^53	+++ n = 1^68	++ n = 1^58		^53: Taiwan
PANSS-N	– n = 1^64	– n = 2^53^,^70	– n = 1^68	– n = 1^55	– n = 6^66	^68: Russia, US, & Croatia; ^70: France, Germany, UK; ^58: Italy
	+ n = 1^72	+ n = 2^53	+++ n = 1^68	++ n = 3^72	++ n = 1^66	^71: US; ^72: 10 European countries (not named); ^64: Germany; ^55: Brazil; ^66: France
	++ n = 2^64^,^72			+ n = 1^72	+++ n = 1^66
				++ n = 3^58^,^71^,^73
				+++ n = 1^68
PANSS-P	– n = 1^64	– n = 2^53^,^70	– n = 1^68	– n = 1^55	– n = 7^66-	^68: Russia, US, & Croatia; ^71: US
	+ n = 2^64^,^72	+ n = 1^53	+++ n = 1^68	+ n = 2^72	++ n = 1^66	^72: 10 European countries (not named); ^64: Germany; ^55: Brazil
				++ n = 1^71		^53: Taiwan; ^66: France
				+++ n = 1^68
PANSS-G		– n = 2^53^,^70	– n = 1^68	++ n = 2^58^,^73	– n = 4^66	^68: Russia, US, & Croatia; ^5: France, Germany, UK; ^58: Italy
		+ n = 1^53	+++ n = 1^68	+++ n = 1^68	++ n = 4^66	^73: US; ^53: Taiwan; ^66: France
		++ n = 1^53
PANSS mixed				– n = 1^55		^55: Brazil
PANSS cognitive factor	– n = 1^72			+ n = 1^72		^72: 10 European countries (not named)
	++ n = 2^72			++ n = 3^72
PANSS anxiety/depression	– n = 1^72			– n = 1^72		^72: 10 European countries (not named)
				++ n = 1^72
PANSS disorganized				– n = 1^73		^73: US
PANSS excited				– n = 1^73		^73: US; ^72: 10 European countries (not named)
				+ n = 3^72
Refractory status				++ n = 1^54		^54: Brazil
Relapse/outpatient	++ n = 1^51		++ n = 2^75			^51: 11 centers in Europe (not named); ^75: France, Germany, UK
Remission		+++ n = 1^78				^78: Germany, Italy, Spain, France, Denmark, Greece, Ireland, UK, Netherlands, Portugal
CGI		+++ n = 1^79				^79: Denmark, Italy, Portugal, Spain, Ireland, UK
CGI-S	+ n = 1^64	+ n = 1^53		– n = 1^49		^58: Italy; ^49: Italy; ^64: Germany
		++ n = 1^53		++ n = 3^49^,^58		^53: Taiwan
CGI-SCH negative		– n = 1^78				^78: Germany, Italy, Spain, France, Denmark, Greece, Ireland, UK, Netherlands, Portugal
CGI-SCH cognitive		++ n = 1^78				^78: Germany, Italy, Spain, France, Denmark, Greece, Ireland, UK, Netherlands, Portugal
CGI-SCH depressive		+++ n = 1^78				^78: Germany, Italy, Spain, France, Denmark, Greece, Ireland, UK, Netherlands, Portugal

If p-value not available: ±0.70: +++; ±0.50: ++; ±0.30: +.

For cost results, the strength was reported as (++) if the difference was higher than 20% between the two groups.

+++: p < 0.0001; ++: p < 0.01; +: p < 0.05; –: p > 0.05.

Table 7. Summary of associations between clinical endpoints and employment status.

	Employment status	Study countries
Clinical
PANSS total score	– n = 1^61	^61: Malaysia
PANSS-N	– n = 1^61	^61: Malaysia
	+ n = 1^61	^50: Bangladesh
	++ n = 1^50
PANSS-P	– n = 1^61	^61: Malaysia
	++ n = 1^50	^50: Bangladesh
Relapse/outpatient	– n = 1^57	^57: Malaysia
	+ n = 1^60	^60: Germany, Italy, Spain, France, Denmark, Greece, Ireland, UK, NL, Portugal

If p-value not available: ±0.70: +++; ±0.50: ++; ±0.30: +.

For cost results, the strength was reported as (++) if the difference was higher than 20% between the two groups.

+++: p < 0.0001; ++: p < 0.01; +: p < 0.05; –: p > 0.05.

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