The Effect Of Somatic Comorbidity On Quality Of Life In Schizophrenics: The Mediating Role Of Depression And Anxiety

Objective:Schizophrenia is a serious mental disease with prolonged course.Chronic schizophrenia patients have a high rate of somatic comorbidity and a large number,which seriously affects the quality of life of patients.Anxiety and depression also affect the quality of life of patients,but whether they play a mediating role in the impact of somatic comorbidity on the quality of life of patients has not been studied yet.Therefore,this study provides theoretical basis for improving the quality of life of schizophrenics from the perspective of comorbidity diagnosis and treatment by exploring the intermediary role of depression and anxiety between somatic comorbidity and quality of life of schizophrenics.Methods : In this study,schizophrenia patients from multiple psychiatric specialized hospitals of Liaoning Province were selected by cluster sampling from October 2019 to September 2021 for cross-sectional survey,and the general demographic information,somatic disease information,medication information,quality of life,psychotic symptoms,depression and anxiety symptoms were investigated by face-to-face interview.The quality of life,depression,and anxiety of patients with schizophrenia were assessed using the Schizophrenia Quality of Life Scale(SQLS),Hamilton Depression Rating scale-17(HAMD-17),and Hamilton Anxiety Rating Scale(HAMA),whereas the somatic comorbidity of patients was assessed using the simple disease count and the age adjusted Charlson comorbidity index(ACCI).Epidata 3.1 and SPSS26.0 software were used for entry verification as well as statistical analysis,and the main statistical methods were descriptive analysis,t-test,ANOVA,rank sum test,Spearman rank correlation analysis as well as mediation effect analysis.The intermediary effect is analyzed using the PROCESS macro program plug-in of SPSS software.Results:1.Sample distribution: 937 schizophrenic patients were included in this study.The average age of the patients was 47.49 ± 11.24 years,including 580 males(61.9%).The average duration of the patients was 19.00 ± 10.56 years,and the average score of PANSS was 48.86 ± 14.51.2.The results of the current study showed that the average score of the patients’ total quality of life was 64.44 ± 33.39;The comorbidity rate of patients with physical diseases is 76.4%.According to the simple disease count,each person has about 2.90 ± 1.79 kinds of physical diseases,with an average score of 1.78 ±1.41.Among all physical diseases,the prevalence rate ranks the top three: hyperlipidemia(48.8%),hypertension(29.2%)and obesity(26.3%);The prevalence of depression and anxiety in patients was 23.3% and 27.2%,respectively.The median score of depression and anxiety was 4,and the distance between the four scores was 5 and 6,respectively.3.The results of univariate analysis showed that the quality of life,somatic comorbidity,depression and anxiety of patients were affected by many factors,among which marriage,education level and interpersonal relationship were the common influencing factors(P<0.05).The correlation analysis showed that the simple disease count was positively correlated with the total score of quality of life,psychosocial dimension,symptom side effect dimension,as well as depression and anxiety(P<0.05);ACCI was positively correlated with the dimension of symptoms and side effects of quality of life(P<0.01);The total scores of depression,anxiety,quality of life and its all dimensions were positively correlated(P<0.05).Multivariate analysis showed that simple disease count and ACCI were independent risk factors for the quality of life of schizophrenics.4.The results of mediating effects showed that when the simple disease count and ACCI were independent variables,depression and anxiety had chain mediating effects between somatic comorbidity and quality of life in schizophrenic patients,with the overall mediating effects accounting for 39.33% and 48.08%,respectively.Conclusions: 1.Schizophrenic patients have a high comorbidity rate,a large number and a high degree of somatic diseases,while patients with severe depression and anxiety have fewer but higher prevalence.The comorbidity of schizophrenics needs to be paid attention to by the public health field and clinicians.2.depression and anxiety have a chain mediating effect between somatic comorbidities and quality of life of schizophrenics,and somatic comorbidities can affect the quality of life of patients through multiple ways.Clinical workers can alleviate the impact of somatic comorbidity on the quality of life of patients by improving their depression and anxiety symptoms.