Beyond Assessment of Quality of Life in Schizophrenia: Cultural, Clinical, and Research Perspectives from India, a Case Study

  • Santosh K. ChaturvediEmail author
  • M. Krishna Prasad
  • Abhishek Pathak


Quality of life (QOL) in schizophrenia is increasingly being recognized as an important patient-related outcome measure both in routine clinical practice and in research from India. This chapter explores the role of cultural ethos on QOL in schizophrenia from an Indian perspective and examines the various factors influencing the QOL in schizophrenia. The chapter also discusses the challenges in the measurement of QOL in schizophrenia in the Indian cultural context and the role of stigma and drug-related side effects on QOL. The studies on QOL in schizophrenia from India are also critically evaluated in the chapter. There is a need to be sensitive to local traditional and sociocultural factors during routine clinical evaluation of QOL; psychometrically sound local measures that are culture-free and fair need to be developed, adapted, and used. The QOL of other stakeholders that includes caregivers and mental health professionals handling persons with schizophrenia should not be neglected. The central goal of mental health care for persons with schizophrenia needs to include improvement of QOL and not merely an improvement in symptoms.


Mental Health Care Negative Symptom Differential Item Functioning Indian Setting Positive Religious Coping 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Aleman A, Kahn RS, Selten JP. Sex differences in the risk of schizophrenia: evidence from meta-analysis. Arch Gen Psychiatry. 2003;60:565–71.CrossRefPubMedGoogle Scholar
  2. Allison DB, Mackem JA, McDonnel DD. The impact of weight gain on quality of life among persons with schizophrenia. Psychiatr Serv. 2003;54:565–7.CrossRefPubMedGoogle Scholar
  3. Anthony WA, Cohen MR, Farkas M, Gagne C. Psychiatric rehabilitation. 2nd ed. Boston: Boston University, Center for Psychiatric Rehabilitation; 2002.Google Scholar
  4. Awad AG, Voruganti LN. Measuring quality of life in patients with schizophrenia. An update. Pharmacoeconomics. 2012;30:183–95.CrossRefPubMedGoogle Scholar
  5. Awad AG, Hogan TP, Voruganti LN, et al. Patients’ subjective experiences on antipsychotic medications: implications for outcome and quality of life. Int Clin Psychopharmacol. 1995;10 Suppl 3:l23–32.Google Scholar
  6. Awad AG, Voruganti LNP, Heslegrave RJ. Measuring quality of life in patients with schizophrenia. Pharmacoeconomics. 1997;11(1):32–47.CrossRefPubMedGoogle Scholar
  7. Balhara YP, Verma R, Deshpande SN. A study of profile of disability certificate seeking patients with schizophrenia over a 5 year period. Indian J Psychol Med. 2013;35:127–34.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Bobes J, Garcia-Portilla MP, Bascaran MT, et al. Quality of life in schizophrenic patients. Dialogues Clin Neurosci. 2007;9(2):215–26.PubMedPubMedCentralGoogle Scholar
  9. Browne S, Clarke M, Gervin M, et al. Determinants of quality of life at first presentation with schizophrenia. Br J Psychiatry. 2000;I76:I7.V6.Google Scholar
  10. Bullinger M, Schmidt S, Naber D. Cross cultural quality of life research in mental health. In: Ritsner MS, Awad AG, editors. Quality of life impairment in schizophrenia, mood and anxiety disorders. 1st ed. Dordrecht: Springer; 2007. p. 67–98.CrossRefGoogle Scholar
  11. Burns T, Patrick D. Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatr Scand. 2007;116:403–18.CrossRefPubMedGoogle Scholar
  12. Campion J, Bhugra D. Experiences of religious healing in psychiatric patients in south India. Soc Psychiatry Psychiatr Epidemiol. 1997;32(4):215–21.CrossRefPubMedGoogle Scholar
  13. Carpiniello B, Pinna F, Tusconi M, Zaccheddu E, Fatteri F. Gender differences in remission and recovery of schizophrenic and schizoaffective patients: preliminary results of prospective cohort study. Schizophr Res Treatment. 2012;2012:576369.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Chandra PS. Measurement in quality of life. In: Chaturvedi SK, Chandra PS, editors. Quality of life in health & disease. Bangalore: Malalur printers; 2000. p. 27–36.Google Scholar
  15. Chandrasena R. Schneider’s first-rank symptoms: an international and interethnic comparative study. Acta Psychiatr Scand. 1987;76:574–8.CrossRefPubMedGoogle Scholar
  16. Chandrashekar H, Prashanth NR, Kasthuri P, Madhusudhan S. Psychiatric rehabilitation. Indian J Psychiatry. 2010;52:S278–80.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Channabasavanna SM. Rehabilitation in psychiatry. Indian J Psychiatry. 1987;29:1.PubMedPubMedCentralGoogle Scholar
  18. Chaturvedi SK. Negative symptoms in schizophrenia: cross-cultural differences. Indian J Psychiatry. 1986;2:59–65.Google Scholar
  19. Chaturvedi SK. What’s important for QOL to Indians in relation to cancer. Soc Sci Med. 1991;33:92–4.CrossRefGoogle Scholar
  20. Chaturvedi SK. Duration of untreated psychosis in LAMI countries. Br J Psychiatry. 2009;194:188.CrossRefPubMedGoogle Scholar
  21. Chaturvedi SK, Murali T, Gopinath PS. Quality of life of chronic schizophrenics-II. In: Kalyansundaram S, Varghese M, editors. Innovations in psychiatric rehabilitation. Bangalore: The Richmond fellowship society (India); 1995. p. 233–6.Google Scholar
  22. Chaturvedi SK, Savithasri EV, Rajashekhar K. Quality of life general concepts and research in India. In: Chaturvedi SK, Chandra PS, editors. Quality of life in health & disease. Bangalore: Malalur printers; 2000. p. 1–11.Google Scholar
  23. Chugh PK, Rehan HS, Unni KE, Sah RK. Predictive value of symptoms for quality of life in first-episode schizophrenia. Nord J Psychiatry. 2013;67(3):153–8.CrossRefPubMedGoogle Scholar
  24. Clark PA, Drain M, Malone MP. Addressing patients’ emotional and spiritual needs. Jt Comm J Qual Saf. 2003;29:659–70.PubMedGoogle Scholar
  25. Craig TJ, Siegel K, Hopper S, et al. Outcome in schizophrenia and related disorders compared between developing and developed countries. A recursive partitioning re-analysis of the DOSMeD data. Br J Psychiatry. 1997;170:229–33.CrossRefPubMedGoogle Scholar
  26. Dan A, Kumar S, Avasthi A, Grover S. A comparative study on quality of life of patients of schizophrenia with and without depression. Psychiatry Res. 2011;189(2):185–9.CrossRefPubMedGoogle Scholar
  27. Drake RJ, Haley CJ, Akhtar S. Causes and consequences of duration of untreated psychosis in schizophrenia. Br J Psychiatry. 2000;177:511–5.CrossRefPubMedGoogle Scholar
  28. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacol Bull. 1993;29:321–6.PubMedGoogle Scholar
  29. Ganguli HC. Epidemiological finding on prevalence of mental disorders in India. Indian J Psychiatry. 2000;42:14–20.PubMedPubMedCentralGoogle Scholar
  30. Garg R, Chavan BS, Arun P. Quality of life after electroconvulsive therapy in persons with treatment resistant schizophrenia. Indian J Med Res. 2011;133:641–4.PubMedPubMedCentralGoogle Scholar
  31. George MR, Chaturvedi SK, Murali T, Gopinath PS, Rao S. Cognitive deficits in relation to quality of life in chronic schizophrenics. NIMHANS J. 1996;14:1–5.Google Scholar
  32. Gopinath PS, Chaturvedi SK. Distressing behaviour of schizophrenics at home. Acta Psychiatr Scand. 1992;86:185–8.CrossRefPubMedGoogle Scholar
  33. Grover S, Davuluri T, Chakrabarti S. Religion, spirituality, and schizophrenia: a review. Indian J Psychol Med. 2014;36(2):119–24. doi: 10.4103/0253-7176.130962.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Grover S, Avasthi A, Shah S, et al. Indian psychiatric society multicentric study on assessment of health-care needs of patients with severe mental illnesses. Indian J Psychiatry. 2015;57:43–50.CrossRefPubMedPubMedCentralGoogle Scholar
  35. Gupta S, Kulhara P, Verma SK. Quality of life in schizophrenia and dysthymia. Acta Psychiatr Scand. 1998;97:290–6.CrossRefPubMedGoogle Scholar
  36. Hansson L, Middelboe T, Merinder L, et al. Predictors of subjective quality of life in schizophrenic patients living in the community. A Nordic multicentre study. Int J Soc Psychiatry. 1999;45:247–58.CrossRefPubMedGoogle Scholar
  37. Harrison G, Hopper K, Craig T. Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry. 2001;178:506–17.CrossRefPubMedGoogle Scholar
  38. Heinrichs DW, Hanlon TE, Carpenter WT Jr. The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull. 1984;10(3):388–98.Google Scholar
  39. Hofer A, Kemmler G, Eder U, et al. Attitudes toward antipsychotics among outpatient clinic attendees with schizophrenia. J Clin Psychiatry. 2002;63:49–53.CrossRefPubMedGoogle Scholar
  40. Huguelet P, Binyet-Vogel S, Gonzalez C, Favre S, McQuillan A. Follow-up study of 67 first episode schizophrenic patients and their involvement in religious activities. Eur Psychiatry. 1997;12(6):279–83.CrossRefPubMedGoogle Scholar
  41. ICMR. Collaborative study on severe mental morbidity report. New Delhi: Indian Council of Medical Research and Department of Science and Technology; 1987.Google Scholar
  42. Isaac M, Kapur RL, Chandrasekhar CR. Management of schizophrenia patients in the community. An experimental report. Indian J Psychol Med. 1981;4:23–7.Google Scholar
  43. Kashyap K, Thunga R, Rao AK, Balamurali NP. Trends of utilization of government disability benefits among chronic mentally ill. Indian J Psychiatry. 2012;54:54–8.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Kate N, Grover S, Kulhara P, Nehra R. Relationship of quality of life with coping and burden in primary caregivers of patients with schizophrenia. Int J Soc Psychiatry. 2014;60(2):107–16.CrossRefPubMedGoogle Scholar
  45. Kaushik P, Bhatia MS. Burden and quality of life in spouses of patients with schizophrenia and bipolar disorder. Delhi Psychiatry J. 2013;16(1):83–9.Google Scholar
  46. Kay SR, Flszbein A, Opfer LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261–76.CrossRefPubMedGoogle Scholar
  47. Khandelwal SK, Jhingan HP, Ramesh S, Gupta RK, Srivastava VK. India mental health country profile. Int Rev Psychiatry. 2004;16(1–2):126–41.CrossRefPubMedGoogle Scholar
  48. Kujur NS, Kumar R, Verma AN. Differences in levels of disability and quality of life between genders in schizophrenia remission. Ind Psychiatry J. 2010;19:50–4.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Kulhara P. Course and outcome of schizophrenia: some transcultural observations with particular reference to developing countries. Eur Arch Psychiatry Clin Neurosci. 1994;244:227–35.CrossRefPubMedGoogle Scholar
  50. Kulhara P, Chakrabarti S. Culture and schizophrenia and other psychotic disorders. Psychiatr Clin North Am. 2001;24:449–64.CrossRefPubMedGoogle Scholar
  51. Kulhara P, Avasthi A, Sharma A. Magico-religious beliefs in schizophrenia: a study from north India. Psychopathology. 2000;33(2):62–8.CrossRefPubMedGoogle Scholar
  52. Kumar P, Nehra DK, Verma AN. Subjective well-being and coping among people with schizophrenia and epilepsy. Dysphrenia. 2013;4(1):25–30.Google Scholar
  53. Leff J, Sartorius N, Jablensky A, Korten A, Ernberg G. The international pilot study of schizophrenia: five-year follow-up findings. Psychol Med. 1992;22(1):131–45.CrossRefPubMedGoogle Scholar
  54. Lehman AF. A Quality of Life Interview for the chronically mentally ill (QOLI). Eval Prog Planning. 1988;11:51–62.Google Scholar
  55. Lobana A, Mattoo SK, Basu D, Gupta N. Quality of life in schizophrenia in India: comparison of three approaches. Acta Psychiatr Scand. 2001;104:51–5.CrossRefPubMedGoogle Scholar
  56. Lobana A, Mattoo SK, Basu D, Gupta N. Convergent validity of Quality of Life Interview (Qoli) in an Indian setting: preliminary findings. Indian J Psychiatry. 2002;44(2):118–24.PubMedPubMedCentralGoogle Scholar
  57. Loganathan S, Murthy SR. Experiences of stigma and discrimination endured by people suffering from schizophrenia. Indian J Psychiatry. 2008;50(1):39–46.CrossRefPubMedPubMedCentralGoogle Scholar
  58. Loganathan S, Murthy RS. Living with schizophrenia in India: gender perspectives. Transcult Psychiatry. 2011;48(5):569–84.CrossRefPubMedPubMedCentralGoogle Scholar
  59. Mohr S, Perroud N, Gillieron C, Brandt PY, Rieben I, Borras L, Huguelet P. Spirituality and religiousness as predictive factors of outcome in schizophrenia and schizo-affective disorders. Psychiatry Res. 2011;186(2–3):177–82.CrossRefPubMedGoogle Scholar
  60. Murali T, Chaturvedi SK, Gopinath PS. Quality of life of chronic schizophrenics-I. In: Kalyansundaram S, Varghese M, editors. Innovations in psychiatric rehabilitation. Bangalore: The Richmond fellowship society (India); 1995.Google Scholar
  61. Nagaswami V, Valecha V, Thara R, Rajkumar S, Menon SM. Rehabilitation needs of schizophrenic patients. Indian J Psychiatry. 1985;27:213–20.PubMedPubMedCentralGoogle Scholar
  62. Nanko S, Moridaria J. Reproductive rates in schizophrenic outpatients. Acta Psychiatr Scand. 1993;87:400–4.CrossRefPubMedGoogle Scholar
  63. Narasipuram S, Kasimahanti S. Quality of life and perception of burden among caregivers of persons with mental illness. AP J Psychol Med. 2012;13(2):99–103.Google Scholar
  64. Nolan JA, McEvoy JP, Koenig HG, Hooten EG, Whetten K, Pieper CF. Religious coping and quality of life among individuals living with schizophrenia. Psychiatr Serv. 2012;63(10):1051–4.CrossRefPubMedPubMedCentralGoogle Scholar
  65. Padmavathi R, Rajkumar S, Srinivasan TN. Schizophrenic patients who were never treated a study in an Indian urban community. Psychol Med. 1998;28:1113–7.CrossRefPubMedGoogle Scholar
  66. Panigrahi S, Acharya RK, Patel MK, Chandrani KV. Quality of life in caregivers of patients with schizophrenia and its correlation with severity of illness. Int J Eng Science. 2014;3(6):55–60.Google Scholar
  67. Patra S, Mishra A. Association of psychopathology with quality of life in acute phase of schizophrenia; an experience from east India. Ind Psychiatry J. 2012;21(2):104–8.CrossRefPubMedPubMedCentralGoogle Scholar
  68. Radhakrishnan R, Menon J, Kanigere M, Ashok M, Shobha V, Galgali RB. Domains and determinants of quality of life in schizophrenia and systemic lupus erythematosus. Indian J Psychol Med. 2012;34:49–55.CrossRefPubMedPubMedCentralGoogle Scholar
  69. Rai A, Khess CR, Bhattacharjee D, et al. Self-concept, stigma and quality of life in chronic schizophrenia and chronic skin disorders: a comparative study. Delhi Psychiatry J. 2014;17(1):65–73.Google Scholar
  70. Reddy MV, Chandrashekar CR. Prevalence of mental and behavioral disorders in India: a meta-analysis. Indian J Psychiatry. 1998;40:149–57.PubMedPubMedCentralGoogle Scholar
  71. Ritsner M, Kurs R, Gibel A, et al. Predictors of quality of life in major psychoses: a naturalistic follow-up study. J Clin Psychiatry. 2003;64:308–15.CrossRefPubMedGoogle Scholar
  72. Sainfort F, Becker M, Diamond R. Judgments of quality of life of individuals with severe mental disorders: patient self-report versus provider perspectives. Am J Psychiatry. 1996;153:497–502.CrossRefPubMedGoogle Scholar
  73. Saravanan B, Jacob KS, Deepak MG, Prince M, David AS, Bhugra D. Perceptions about psychosis and psychiatric services: a qualitative study from Vellore, India. Soc Psychiatry Psychiatr Epidemiol. 2008;43(3):231–8.CrossRefPubMedGoogle Scholar
  74. Sartorius N, Jablensky A, Ernberg G, et al. Course of schizophrenia in different cultures: some results of a WHO international 5 year follow up study. In: Hafner H, Gattaz WF, Janzarik W, editors. Search for the cause of schizophrenia. Berlin: Springer; 1987. p. 107–13.CrossRefGoogle Scholar
  75. Saxena S, Chandiramani A, Bhargava R. WHOQOL-Hindi: a questionnaire for assessing quality of life in health care settings in India. Natl Med J India. 1998;11:160–6.PubMedGoogle Scholar
  76. Saxena S, Quinn K, Sharan P, Naresh B, Yuantao H, Power M. Cross-linguistic equivalence of WHOQOL-100: a study from north India. Qual Life Res. 2005;14(3):891–7.CrossRefPubMedGoogle Scholar
  77. Sell H, Nagpal R. Assessment of subjective well being. New Delhi: World Health Organisation; 1992.Google Scholar
  78. Shah R, Kulhara P, Grover S, Kumar S, Malhotra R, Tyagi S. Contribution of spirituality to quality of life in patients with residual schizophrenia. Psychiatry Res. 2011;190(2–3):200–5.CrossRefPubMedGoogle Scholar
  79. Shrivastava A, Johnston M, Terpstra K, et al. Atypical antipsychotics usage in long-term follow-up of first episode schizophrenia. Indian J Psychiatry. 2012;54:248–52.CrossRefPubMedPubMedCentralGoogle Scholar
  80. Skantze K, Malm U, Dencker SJ, et al. Comparison of quality of life with standard of living in schizophrenia out-patients. Br J Psychiatry. 1992;161:797–801.CrossRefPubMedGoogle Scholar
  81. Solanki RK, Singh P, Midha A, Chugh K. Schizophrenia: impact on quality of life. Indian J Psychiatry. 2008;50:181–6.CrossRefPubMedPubMedCentralGoogle Scholar
  82. Solanki RK, Singh P, Midha A, Chugh K, Swami MK. Disability and quality of life in schizophrenia and obsessive compulsive disorder: a cross sectional comparative study. East Asian Arch Psychiatry. 2010;20:7–13.PubMedGoogle Scholar
  83. Srinivasan TN, Thara R. How do men with schizophrenia fare at work? A follow up study from India. Schizophr Res. 1997;25:149–54.CrossRefPubMedGoogle Scholar
  84. Talwar P, Matheiken ST. Caregivers in schizophrenia: a cross cultural perspective. Indian J Psychol Med. 2010;32(1):29–33.CrossRefPubMedPubMedCentralGoogle Scholar
  85. Thara R, et al. Twenty-year course of schizophrenia: the Madras Longitudinal Study. Can J Psychiatry. 2004;49(8):564–9.Google Scholar
  86. Thara R, Eaton WW. Outcome of schizophrenia: the Madras longitudinal study. Aust N Z J Psychiatry. 1996;30:516–22.CrossRefPubMedGoogle Scholar
  87. Thara R, Kamath S, Kumar S. Women with schizophrenia and broken marriages – doubly disadvantaged? I. Patient perspective. Int J Soc Psychiatry. 2003;49:225–32.CrossRefPubMedGoogle Scholar
  88. The EuroQol Group. EuroQol – a new facility for the measurement of health related quality of life. Health Policy. 1990;16:199–208.CrossRefGoogle Scholar
  89. The WHOQOL Group. Development of the WHOQOL: rationale and current status. Int J Ment Health. 1994;23:24–8.CrossRefGoogle Scholar
  90. The WHOQOL Group. The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;10:1403–9.Google Scholar
  91. Tseng WS. Culture, behavior and pathology. In: Tseng WS, editor. Clinician’s guide to cultural psychiatry. 1st ed. California: Academic; 2003a. p. 1–53.CrossRefGoogle Scholar
  92. Tseng WS. Ethnicity, culture and drug therapy. In: Tseng WS, editor. Clinician’s guide to cultural psychiatry. 1st ed. California: Academic; 2003b. p. 343–52.CrossRefGoogle Scholar
  93. Vasudevan S. Quality of life in health and disease: a spiritual perspective. In: Chaturvedi SK, Chandra PS, editors. Quality of life in health & disease. Bangalore: Malalur printers; 2000. p. 12–7.Google Scholar
  94. Verghese A, John JK, Rajkumar S, et al. Factors associated with the course and outcome of schizophrenia in India. Results of a two-year multicentre follow-up study. Br J Psychiatry. 1989;154:499–503.CrossRefPubMedGoogle Scholar
  95. Verma SK, Dubey BL, Gupta D. PGI general well being scale: some correlates. Indian J Clin Psychol. 1983;10:299–304.Google Scholar
  96. Vishwanath B, Chaturvedi SK. Cultural aspects of major mental disorders: a critical review from an Indian perspective. Indian J Psychol Med. 2012;34(4):306–12.CrossRefGoogle Scholar
  97. WHOQOL SRPB Group. A cross-cultural study of spirituality, religion, and personal beliefs as components of quality of life. Soc Sci Med. 2006;62:1486–97.Google Scholar
  98. Wig NN. Keynote address. In: Kulhara P, Avasthi A, Verma S, editors. Schizophrenia-Indian scene. Mumbai: Searle (India); 1997.Google Scholar
  99. Wilkinson G, Hesdon B, Wild D, et al. Self-report quality of life measure for people with schizophrenia: the SQLS. Br J Psychiatry. 2000;177:42–6.CrossRefPubMedGoogle Scholar
  100. World Health Organization. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment, field trial version. Geneva: World Health Organization; 1996.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Santosh K. Chaturvedi
    • 1
    • 2
    Email author
  • M. Krishna Prasad
    • 2
  • Abhishek Pathak
    • 2
  1. 1.Department of Mental Health EducationNational Institute of Mental Health & Neuro SciencesBangaloreIndia
  2. 2.Department of PsychiatryNational Institute of Mental Health & Neuro SciencesBangaloreIndia

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