Many young people experiencing first episode psychosis report good quality of life

Many young people experiencing first episode psychosis report good quality of life

21 December 2021

Almost a third of young people experiencing first episode psychosis (FEP) report having good quality of life, Orygen research has found.

The study, which drew on the experiences of 145 young people with FEP, suggests that addressing depression, social inclusion and social/occupational functioning could help to improve quality of life among other young people experiencing FEP.

Orygen’s head of health services and outcomes research, Professor Sue Cotton, who led the study, said the research was the first to identify and validate quality of life ‘cluster groups’ for young people experiencing FEP.

“People with FEP tend to report lower quality of life than those without psychosis, but this new research has identified a group of people – 30 per cent of people with FEP – who report having good quality of life,” Professor Cotton said.

The paper, published in Quality of Life Research, assessed the quality of life of young people with FEP using the World Health Organization Quality of Life - Bref (WHO-QoL-BREF) scale, which assesses four domains: physical health, psychological, social relationships and environment.

Three distinct quality of life groups were identified, based on responses to the WHO-QoL-Bref self-report scale: one group had good quality of life across all four domains (30 per cent of respondents); one group had poor quality of life, particularly in the psychological and social relationships domains (28 per cent); and an intermediate group had comparatively low psychological quality of life (42 per cent).

Professor Cotton said the researchers were surprised to find that people with good quality of life were just as satisfied as the general population in terms of social relationships and environmental quality of life, but they reported significantly higher psychological quality of life than the general population.

“This finding is surprising and contradictory to previous reports of lower quality of life in untreated or stable FEP or schizophrenia compared to the general population,” Professor Cotton said.

“This could be because participants were a bit younger than in other studies, or because their condition was stable and they were enrolled in a clinical trial of vocational recovery – perhaps the prospect of returning to education or employment boosted them.”

Importantly, the analysis found that depression was predictive of which group people fell within.

“Depression was the strongest predictor of poor quality of life. This is an important finding, given that depressive symptoms are commonly overlooked in individuals with psychosis, particularly those with first episode schizophrenia,” Professor Cotton said.

“There is often more focus on treating the positive psychotic symptoms (such as hallucinations) and negative psychotic symptoms (such as inability to feel pleasure in activities usually found enjoyable and social withdrawal).

“Although there is overlap between depression and negative symptoms, depressive symptoms seem to be an important driver of quality of life. More research is needed into treatments of depression in psychosis and whether they can also help improve quality of life of young people.”

Social inclusion and social/occupational functioning were also predictive, with young people with good quality of life more likely to have higher social/occupational functioning and social inclusion.

Interestingly, those with poor verbal fluency (a measure of executive functioning and ability to access words from memory), tended to have higher quality of life.

“One possible explanation is that people whose cognitive abilities are hampered may have less insight into their illness and are less aware about the impact that psychosis is having on their lives,” Professor Cotton said.

It’s hoped that future research will look at specific therapeutic interventions that could improve quality of life by focussing on these predictive factors: depression, social inclusion and social/occupational functioning.

This study was undertaken by an honours student, Zishan (Rebecca) Liao. Her research was supervised by Professor Cotton, Associate Professor Kelly Allott and Dr Jacqueline Anderson.

The study was supported by Australian Rotary Health, the Australian Research Council and the National Health and Medical Research Council of Australia.