title: A structural equation modelling approach to explore the determinants of quality of life in schizophrenia.
abstract: OBJECTIVE
  This study aimed to analyse the relationships among psychotic symptoms, depression, neurocognition and functioning as determinants of quality of life (QoL) in patients with schizophrenia.
  
  
  METHODS
  In this cross-sectional study, we evaluated QoL with the Schizophrenia Quality of Life 18-item scale (S-QoL 18), neurocognition with multiple tests exploring memory, attention and executive functions, the severity of psychotic symptoms with the Positive and Negative Syndrome Scale (PANSS), depression with the Calgary Depression Scale for Schizophrenia (CDSS) and functioning using the Functional Remission Of General Schizophrenia (FROGS) scale. We used Structural Equation Modelling (SEM) to describe the relationships among the severity of psychotic symptoms, depression, neurocognition, functioning and QoL.
  
  
  RESULTS
  Two hundred and seventy-one outpatients with schizophrenia participated in our study. SEM showed good fit with χ(2)/df=1.97, root mean square error of approximation=0.06, comparative fit index=0.93 and standardized root mean square residuals=0.05. This model revealed that depression was the most important feature associated with QoL, mainly for the self-esteem, autonomy and resilience dimensions (direct path coefficient=-0.46). The direct path between functioning and QoL was also significant (path coefficient=0.26). The severity of psychotic symptoms and neurocognitive impairment were weakly and indirectly associated with QoL via functioning (path coefficients=-0.18 and 0.04, respectively).
  
  
  CONCLUSIONS
  This study contributes to a better understanding of the determinants of QoL in schizophrenia. Our findings should be considered in developing effective strategies for improving QoL among this population.
authors.affiliation: Aix-Marseille Univ, EA 3279, Public Health, Chronic Diseases and Quality of Life Research Unit, 13005 Marseille, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Alessandrini
authors.affiliation: Aix-Marseille Univ, EA 3279, Public Health, Chronic Diseases and Quality of Life Research Unit, 13005 Marseille, France; Department of Psychiatry, La Conception University Hospital, 13009 Marseille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Lançon
authors.affiliation: Fondation FondaMental, Créteil, France; Pôle de Psychiatrie et d'addictologie des Hôpitaux Universitaires H Mondor, INSERM U955, Eq 15 Psychiatrie Génétique et psychopathologie, DHU Pe-PSY, Université Paris Est-Créteil, Créteil, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Fond
authors.affiliation: Aix-Marseille Univ, EA 3279, Public Health, Chronic Diseases and Quality of Life Research Unit, 13005 Marseille, France; Department of Psychiatry, La Conception University Hospital, 13009 Marseille, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Faget-Agius
authors.affiliation: Aix-Marseille Univ, EA 3279, Public Health, Chronic Diseases and Quality of Life Research Unit, 13005 Marseille, France; Department of Psychiatry, La Conception University Hospital, 13009 Marseille, France.
authors.forename: Raphaelle
authors.initials: R
authors.lastname: Richieri
authors.affiliation: Aix-Marseille Univ, EA 3279, Public Health, Chronic Diseases and Quality of Life Research Unit, 13005 Marseille, France; Department of Psychiatry, La Conception University Hospital, 13009 Marseille, France.
authors.forename: Melanie
authors.initials: M
authors.lastname: Faugere
authors.affiliation: Department of Psychiatry, La Conception University Hospital, 13009 Marseille, France.
authors.forename: Emeline
authors.initials: E
authors.lastname: Metairie
authors.affiliation: Aix-Marseille Univ, EA 3279, Public Health, Chronic Diseases and Quality of Life Research Unit, 13005 Marseille, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Boucekine
authors.affiliation: Fondation FondaMental, Créteil, France; Univ Clermont 1, UFR Medecine, EA7280, Clermont-Ferrand F-63001, France; CHU Clermont-Ferrand, Psychiatry B, Clermont-Ferrand F-63003, France.
authors.forename: Pierre-Michel
authors.initials: PM
authors.lastname: Llorca
authors.affiliation: Aix-Marseille Univ, EA 3279, Public Health, Chronic Diseases and Quality of Life Research Unit, 13005 Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Auquier
authors.affiliation: Aix-Marseille Univ, EA 3279, Public Health, Chronic Diseases and Quality of Life Research Unit, 13005 Marseille, France. Electronic address: laurent.boyer@ap-hm.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Boyer
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D008962:Models, Theoretical; D019964:Mood Disorders / Q000175:diagnosis / Q000209:etiology; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology*; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D013223:Statistics as Topic; D055815:Young Adult
keywords: Depression; Functioning; Neurocognition; Psychotic symptoms; Quality of life; Schizophrenia; Structural equation modelling