Health-related quality of life and psychiatric comorbidity in first episode psychosis Kang Sim a,b,c, * , Rathi Mahendran c , Siow Ann Chong a a Department of Early Psychosis Intervention, Woodbridge Hospital/Institute of Mental Health, Singapore 539747, Republic of Singapore b Schizophrenia and Bipolar Disorders Program (AB347), McLean Hospital/Harvard Medical School, Belmont, MA 02478, USA c Department of Adult Psychiatry, Woodbridge Hospital/ Institute of Mental Health, Singapore, Republic of Singapore Abstract Background: Quality of life (QOL) has been increasingly recognized as an important outcome measure in the care of patients with severe mental illnesses. This study seeks to evaluate the health-related QOL in patients with first episode psychosis and comparing those with psychiatric comorbidity to those without in an Early Psychosis Intervention Program. Methods: Overall, 131 patients with first episode psychosis were evaluated on their principal Axis I diagnosis and any other comorbid diagnosis, severity of psychopathology, insight, social/occupational functioning, and QOL, respectively. Results: Patients with psychiatric comorbidity scored lower on Positive and Negative Symptom Scale positive symptom subscale (z = 2.84, P b .01), had a greater awareness of their mental illness (z = 3.44, P b .001) and its social consequences (z = 3.24, P b 0.001), but lower ratings on the overall QOL (z = 3.06, P b 0.01) as well as in the individual domains (physical, psychological health, social relationships, environment, all P b .05) compared with patients without any psychiatric comorbidity. On multivariate analysis, being single and the presence of psychiatric comorbidity were associated with a poorer QOL in the various subdomains. Conclusions: The association of psychiatric comorbidity with poorer QOL warrants attention. The differences in the clinical correlates may provide potential targets for early identification and highlight needs that are significant to these patients with first episode psychosis and psychiatric comorbidity. D 2005 Elsevier Inc. All rights reserved. 1. Introduction The notion of health-related quality of life (QOL) first appeared in clinical medicine and human sciences in the 1940s [1]. Over the last 2 decades, QOL has been increasingly recognized as an important outcome measure of mental healthcare apart from other outcome measures such as the resolution of symptoms or reduction of rates of hospitalization in the management of individuals with severe mental illnesses [2,3]. However, QOL is a complex construct with no uniformly accepted definition [4]. The World Health Organization defined QOL as ban individual’s perception of their position in life in the context of culture and value systems in which they live and in relation to their goals, expectations, standards and concernsQ [5]. This definition emphasizes the importance of appreciating the subjective sense of wellness of the individual in relation to life circumstances including the health status [6] and reinforces the concept that the ultimate goal of medical treatment is to improve the overall well-being of the individual patient. With regard to methods of rating, previous studies had found that the measures of QOL by trained raters (objective) and self-ratings (subjective) done on instruments provided to patients with psychosis were not necessarily well correlated [7,8]. Contrary to expectations, patients with psychotic disorders such as schizophrenia do not necessarily report a poor level of life satisfaction than their objective living circumstances would suggest [9-12]. Thus, incorporating the subjective ratings of the QOL would allow a more compre- hensive evaluation of the individual’s well-being with regard to role functioning, personal adjustment, and community integration [13]. It has been argued that in patients with psychotic disorders, clinical factors such as the severity of psychopathology [14] and lack of insight [7] may potentially 0010-440X/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.comppsych.2004.11.001 * Corresponding author. Schizophrenia and Bipolar Disorders Program (AB347), McLean Hospital/Harvard Medical School, Belmont, MA 02478, USA. Tel.: +65 617 8552961; fax: +65 617 8552895. E-mail addresses: ksim@mclean.harvard.edu, kang _ sim@imh.com.sg (K. Sim). Comprehensive Psychiatry 46 (2005) 278 – 283 www.elsevier.com/locate/comppsych