Exploring the relationship between baseline health-related quality of life (AQoL-4D utility values) and mortality during long-term follow-up for people living with a psychotic disorder

Amanda L Neil; Katherine J Chappell; Adriana G Nevarez-Flores; Anna Waterreus; Taryn L Ambrosi; Vera A Morgan

doi:10.1016/j.schres.2023.10.038

Exploring the relationship between baseline health-related quality of life (AQoL-4D utility values) and mortality during long-term follow-up for people living with a psychotic disorder

Schizophr Res. 2023 Dec:262:121-129. doi: 10.1016/j.schres.2023.10.038. Epub 2023 Nov 9.

Authors

Amanda L Neil¹, Katherine J Chappell², Adriana G Nevarez-Flores³, Anna Waterreus⁴, Taryn L Ambrosi⁴, Vera A Morgan⁵

Affiliations

¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; The ALIVE National Centre for Mental Health Research Translation, University of Tasmania, Hobart, Tasmania, Australia. Electronic address: amanda.neil@utas.edu.au.
² Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
³ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; The ALIVE National Centre for Mental Health Research Translation, University of Tasmania, Hobart, Tasmania, Australia.
⁴ Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.
⁵ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia; The ALIVE National Centre for Mental Health Research Translation, The University of Western Australia, Perth, Western Australia, Australia.

PMID: 37948885
DOI: 10.1016/j.schres.2023.10.038

Abstract

Holistic summary measures of health-related quality of life (HRQoL) could provide useful information for screening and/or monitoring high-risk individuals. This study explores the association of baseline HRQoL (AQoL-4D values) with death from natural and external causes (such as suicide, overdose, or accident) in a prevalent cohort over a mean follow-up of 6.9-years. Baseline data were obtained from the 2010 National Survey of High Impact Psychosis (SHIP) and its 2012 sister survey, the North-Metro Survey of High Impact Psychosis. Follow-up data were obtained from the National Deaths Index (to January 18, 2018). Associations between baseline HRQoL (and the 12 individual items of the AQoL-4D) and deaths by cause, stratified by sex were investigated using multivariable Cox Proportional Hazards models, with age used as the time scale. Overall, 7.6 % of the cohort (137 of 1805 people meeting ICD-10 criteria for a psychotic disorder and agreeing to linkage) died, 4.2 % from natural causes (primarily heart disease and cancer) and 3.4 % from external causes. There was an association between low HRQoL (AQoL-4D ≤ 0.20) and mortality due to natural causes, primarily driven by difficulties with mobility and vision in men, and difficulty with household tasks in women. No significant associations were obtained between AQoL-4D utilities and death from external causes. Sleep problems were associated with death from external causes for men only. As people with psychotic disorders experience multiple causes of death with complex associations which are difficult to quantify, monitoring for low HRQoL using the AQoL-4D could be a useful indicator of increased mortality risk in this population. TWITTER: Monitoring for low HRQoL (AQoL-4D ≤ 0.20) could be a useful indicator of increased mortality risk from natural causes in people living with psychotic disorders, with differing but specific items of relevance to men and women.

Keywords: Competing risks; Health status; Mortality; Predictors; Schizophrenia; Utility values.

MeSH terms

Female
Follow-Up Studies
Humans
Male
Psychotic Disorders* / epidemiology
Quality of Life*
Surveys and Questionnaires