title: Improved quality of life over one year is associated with improved adherence in patients with schizophrenia.
abstract: OBJECTIVE
  Quality of life (QoL) is increasingly considered an important outcome in health research. We wished to explore the determinants of change in QoL in patients with schizophrenia over the course of a one-year RCT.
  
  
  METHODS
  Predictors of change in observer-rated QoL (Quality of Life Scale: QLS) were assessed in 363 patients with schizophrenia during the CUtLASS clinical trial.
  
  
  RESULTS
  Change in QLS score over the course of a year correlated with change in psychotic and depressive symptoms and treatment adherence. Linear regression showed that improvement in QoL was predicted by reduction in negative and depressive symptoms and improvement in adherence rating. These three change scores together explained 38% of the variance in QLS change. Exploration of the direction of any possible causal effect, using TETRAD, indicated that improved adherence leads to improved QoL, and that change in depression also leads to QoL change. The relationship between QoL and negative symptoms suggests that greater social activity (reflected as better QoL scores) improves negative symptoms. Such a direct relationship between treatment adherence and QoL has not been reported before.
  
  
  CONCLUSIONS
  Improving adherence to medication would appear to be a key approach to improving measured quality of life in people with schizophrenia.
authors.affiliation: Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom. Electronic address: karen.hayhurst@manchester.ac.uk.
authors.forename: K P
authors.initials: KP
authors.lastname: Hayhurst
authors.affiliation: Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom.
authors.forename: R J
authors.initials: RJ
authors.lastname: Drake
authors.affiliation: Mental Health Unit, Laureate House, Manchester Mental Health & Social Care Trust, Wythenshawe Hospital, Southmoor Road, Manchester, United Kingdom.
authors.forename: J A
authors.initials: JA
authors.lastname: Massie
authors.affiliation: Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Centre for Mental Health, Imperial College London, Charing Cross Campus, London, United Kingdom.
authors.forename: T R E
authors.initials: TR
authors.lastname: Barnes
authors.affiliation: Department of Psychiatry & CPFT, University of Cambridge, Cambridge, United Kingdom.
authors.forename: P B
authors.initials: PB
authors.lastname: Jones
authors.affiliation: Institute of Brain, Behaviour and Mental Health, The University of Manchester, Manchester, M13 9PL, United Kingdom.
authors.forename: S W
authors.initials: SW
authors.lastname: Lewis
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000188:drug therapy / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents
keywords: Adherence; Depression; Quality of life; Schizophrenia; Symptoms