Patterns, predictors and outcomes of trajectories for subjective quality of life in patients with early psychosis: 12-year follow-up of the randomized controlled trial on extended early intervention.

Evidence has underscored clinical significance of subjective quality of life (SQoL) as a key therapeutic goal for early psychosis. However, the patterns, predictors and outcomes of SQoL trajectories over long-term follow-up in early psychosis have not been explored. We conducted a 12-year follow-up of the randomized-controlled-trial on extended early intervention for first-episode psychosis with an aim to identify distinct trajectories of the SQoL, their baseline predictors and relationships with 12-year outcomes. Premorbid adjustment, illness characteristics, symptom severity, functioning, and treatment profiles were assessed. Latent growth mixture modeling was employed to derive SQoL trajectories based on 36-Item Short Form Health Survey (SF-36) mental-health component summary scores over 12-year follow-up. Participants who completed SF-36 at three or more time points, including baseline, and 1-, 2-, 3- and 12-year follow-up, were included in the analysis, resulting in 144 patients. Our results identified three distinct trajectories, including high-stable class (36.8 %, n = 53), moderate-improving class (40.3 %, n = 58) and low-stable class (22.9 %, n = 33). Patients in high-stable class had less severe depressive symptoms at baseline than those in moderate-improving class, and less severe positive, negative and depressive symptoms at baseline compared to patients in low-stable class. Additionally, patients with high-stable trajectory exhibited higher rate of personal recovery and lower depressive symptom severity at 12-year follow-up relative to patients with low-stable trajectory. In conclusion, approximately one-fourths of patients displayed consistently poor SQoL over 12 years. Depressive symptoms represent a major determinant of SQoL trajectories, indicating the need to optimize treatment for depression in early psychosis to enhance SQoL outcome.