Small area variations in non-affective first-episode psychosis: the role of socioeconomic and environmental factors.

BACKGROUND: There is strong evidence supporting the association between environmental factors and increased risk of non-affective psychotic disorders. However, the use of sound statistical methods to account for spatial variations associated with environmental risk factors, such as urbanicity, migration, or deprivation, is scarce in the literature. METHODS: We studied the geographical distribution of non-affective first-episode psychosis (NA-FEP) in a northern region of Spain (Navarra) during a 54-month period considering area-level socioeconomic indicators as putative explanatory variables. We used several Bayesian hierarchical Poisson models to smooth the standardized incidence ratios (SIR). We included neighborhood-level variables in the spatial models as covariates. RESULTS: We identified 430 NA-FEP cases over a 54-month period for a population at risk of 365,213 inhabitants per year. NA-FEP incidence risks showed spatial patterning and a significant ecological association with the migrant population, unemployment, and consumption of anxiolytics and antidepressants. The high-risk areas corresponded mostly to peripheral urban regions; very few basic health sectors of rural areas emerged as high-risk areas in the spatial models with covariates. DISCUSSION: Increased rates of unemployment, the migrant population, and consumption of anxiolytics and antidepressants showed significant associations linked to the spatial-geographic incidence of NA-FEP. These results may allow targeting geographical areas to provide preventive interventions that potentially address modifiable environmental risk factors for NA-FEP. Further investigation is needed to understand the mechanisms underlying the associations between environmental risk factors and the incidence of NA-FEP.

The Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) questionnaire. A validation study with Spanish schizophrenia spectrum outpatients.

INTRODUCTION: The Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4) is a disease-specific subjective Quality of Life (QL) questionnaire for patients with schizophrenia. This study assesses the psychometric properties of the SQLS-R4 when applied to a sample of Spanish schizophrenia spectrum outpatients with stable disease. METHODS: The SQLS-R4 and EUROQOL-5D-5L were completed once by 168 schizophrenia and schizoaffective disorder patients. Of these, 61 also completed the WHOQOL-BREF and 50 completed the SQLS-R4 one week later. Psychometric evaluation of structure, reliability and validity was conducted. RESULTS: Multi-trait scaling confirmed the two multiitem scales. Internal consistency for the two scales (Cronbach’s coefficients>0.89) and the whole questionnaire (0.96) was adequate, as was test–retest reliability (intraclass correlation coefficients>0.79). Correlations with related areas of EUROQOL-5D-5L and WHOQOL-BREF (Spearman’s Rho>0.60) supported convergent validity. Divergent validity was confirmed through low correlations with less-related areas of these two questionnaires (Spearman’s Rho<0.30). Patients with higher levels of depression, more acute episodes and schizoaffective disorder had higher QL limitations. CONCLUSIONS: The SQLS-R4 is a reliable and valid instrument when applied to Spanish outpatients with stable disease. The results of our validation study concur with those of other psychometric studies performed in Europe and other cultural areas.

The association of clinical insight and depression with quality of life in schizophrenia.

This study assesses how insight influences depression and Quality of Life (QOL) in schizophrenia-spectrum outpatients and whether depression modifies the relationship between insight and QOL. 141 patients with schizophrenia or schizoaffective disorders with stable disease completed the EUROQOL-5D-5L and SQLS-R4, SAI-E and Calgary scales. Univariate and multivariate linear regression models were fitted to assess whether insight was related to QOL and/or depression. Higher levels of insight were (inversely) only related to EuroQOL-health but showed no relationship with depression. Depression showed an inversely strong relationship with EuroQOL-health. The relationship between clinical insight and QOL does not seem to be associated with depression.