Health-related quality of life in severe psychotic disorders during integrated care: 5-year course, prediction and treatment implications (ACCESS II)

Anja Christine Rohenkohl, Anne Daubmann, Jürgen Gallinat, Anne Karow, Vivien Kraft, Friederike Rühl, Daniel Schöttle, Martin Lambert, Romy Schröter, Anja Christine Rohenkohl, Anne Daubmann, Jürgen Gallinat, Anne Karow, Vivien Kraft, Friederike Rühl, Daniel Schöttle, Martin Lambert, Romy Schröter

Abstract

Purpose: Studies on outcomes mapping Quality of Life (QoL) as patient-reported outcome over a longer period in severe psychotic disorders are scarce. However, such data would be particularly important for structuring, implementing and operating effective and efficient care models and for promoting satisfaction with care, service engagement and adherence.

Methods: The ACCESS II study is a prospective long-term study of an integrated care model for people with severe psychotic disorders. The model includes Therapeutic Assertive Community Treatment within a cross-sectoral and interdisciplinary network. This publication analyses the course of QoL assessed with the Q-LES-Q-18 using a mixed model for repeated measures.

Results: Mapping the course of QoL in N = 329 participants, there is a significant increase in the first 6 weeks of treatment (early course). Comparison to a published norm show significant lower QoL for severe psychotic disorders. The variable having a traumatic event before the age of 18 was significantly negatively associated with QoL. A decrease in the severity of depressive as well as in positive symptomatology in the first six weeks after admission was associated with increase of QoL.

Conclusion: Results indicate that the overall symptom burden at time of inclusion is not decisive for the perceived QoL in the long-term course while the reduction in the severity of depressive and positive symptoms is important. This means focusing even more on the treatment of depressive symptoms and include traumatherapeutic aspects in the long-term treatment of severe psychotic disorders if needed.

Trail registration: ClinicalTrials.gov (identifier: NCT01888627).

Keywords: Assertive community treatment; Integrated care; Patient-reported outcome; Psychosis; Quality of life; Severe mental illness.

Conflict of interest statement

Anja Christine Rohenkohl: has received speakers fee from Pfizer Pharma GmbH. Anne Daubmann: Nothing to declare. Jürgen Gallinat: Speaker fees from Lundbeck GmbH, Otsuka Pharma GmbH, Janssen Cilag GmbH, Boeringer Ingel-heim. Anne Karow: Consultant or speaker fees from AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH. Vivien Kraft: Nothing to declare. Friederike Rühl: Nothing to declare. Daniel Schöttle: Consultant and/or advisor fees from Astra Zeneca, Otsuka Pharma GmbH, Lundbeck GmbH and Janssen Cilag GmbH. Martin Lambert: Consultant or speaker fees AstraZeneca, Bristol-Myers Squibb, Lilly Deutschland GmbH, Janssen Cilag GmbH, Lundbeck GmbH, Otsuka Pharma GmbH, Roche Deutschland Holding GmbH, Sanovi Aventis, Trommsdorff GmbH & Co. KG. Romy Schröter: Nothing to declare. The authors have no relevant financial or non-financial interests to disclose related to this manuscript.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Five-year course in QoL. *Mean values of each scale were transformed to a range of values from 0–100; T1 = Baseline, T2 = 6 weeks after admission, T3 = 3 months after admission, T4 = 6 months after admission, and thereafter every 6 months

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