Health-related quality of life of patients with schizophrenia at a comprehensive specialized hospital in Northern Ethiopia

Health-related quality of life of patients with schizophrenia at a comprehensive specialized hospital in Northern Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Health-related quality of life of patients with schizophrenia at a comprehensive specialized hospital in Northern Ethiopia Elias Fitsum Yigzaw, Alemseged Beyene Berha, Minyahil Alebachew This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8401395/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Schizophrenia is a severe psychiatric disorder significantly affecting individuals' health, functioning, and health-related quality of life (HRQoL). Here, we aimed to assess HRQoL, associated factors of HRQoL, and utilities among schizophrenia outpatients at Ayder Comprehensive Specialized Hospital, Ethiopia. Methods A hospital-based cross-sectional study was conducted from March 13th to June 11th, 2023, at Ayder Comprehensive Specialized Hospital, Ethiopia. Data were collected from 391 randomly sampled patients with patient interviews and chart reviews. The validated Amharic version Euro Quality of Life (EQ-5D-5L questionnaire was used to assess the HRQOL. Descriptive statistics were used to present patient characteristics. Kruskal-Wallis and Mann-Whitney U tests were performed to explore differences in the median scores of EQ-5D-5L utility and visual analog scale. Multivariable Tobit regression models were employed to identify factors associated with HRQoL. Utility scores were calculated using disutility weights of the Ethiopian general population. P-value < 0.05 was considered statistically significant. Results The mean age of the study participants was 33.97 ± 9.061 years. The mean (SD) PANSS scores of the study participants were: positive symptoms, 17.18 (3.986); negative symptoms, 15.82 (3.246); general psychopathology, 28.66 (7.071); and total score, 61.66 (12.509). The most frequently reported health problems were the anxiety/depression dimension (97.7%) and self-care (82.4%). The median [IQRs] EQ-5D-5L utility value and EQ-VAS score of the study participants were 0.859 [0.774–0.917] and 65 [55–70], respectively. Being not working, the presence of comorbid physical, being on antipsychotic polypharmacy, poor medication adherence, and experiencing a severe side effect were significantly negatively associated with the EQ-5D-5L utility score. Conversely, female sex was significantly positively associated with EQ-5D-5L utility score. Conclusion Overall, patients with schizophrenia reported a lower HRQoL compared to the general population. The anxiety/depression and self-care dimensions were identified to have a critical influence on reducing the HRQoL of adult schizophrenia patients in the context of Ethiopia. This study also provides estimates of EQ-5D utility scores that can be used in economic evaluations. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Biological sciences/Psychology Social science/Psychology EQ-5D-5L Utility HRQoL antipsychotic polypharmacy Ethiopia Figures Figure 1 Figure 2 Introduction Schizophrenia is a severe, chronic, and debilitating psychiatric disorder characterized by abnormal thinking, perceptual disturbances, and diminished or exaggerated emotional expression ( 1 ). This illness is characterized by an early onset, usually during adolescence, with diagnosis typically occurring between the ages of 15 and 25 ( 2 ). It affects general health, functioning, autonomy, subjective well-being, and life satisfaction for individuals experiencing the illness ( 1 , 3 ). Genetic and environmental factors are believed to be the greatest risk factors for schizophrenia, which is thought to be a multifactorial disorder, despite the exact cause not yet being known ( 2 ). Schizophrenia has a consistent incidence rate across diverse countries, cultural groups, and genders, with a lifetime prevalence estimated to be between 0.5% and 1% ( 4 ). According to the World Health Organization, approximately 24 million people worldwide suffer from schizophrenia, which is considered one of the top ten illnesses contributing to the global burden of disease ( 5 , 6 ). In Ethiopia, the lifetime prevalence of schizophrenia is reported to be about 0.47% ( 7 ), with schizophrenia being among the top ten most burdensome conditions ( 8 ). Individuals with schizophrenia can manifest three primary types of symptoms: psychotic, negative, and cognitive. Psychotic symptoms include hallucinations, delusions, disorganized speech, and unusual behavior. Negative symptoms comprise alogia, avolition, flat affect, anhedonia, and social isolation. Cognitive impairments involve executive function deficits, memory difficulties, and decreased mental processing speed ( 9 , 10 ). Schizophrenia can have a profound impact on daily life, often leading to social isolation, marginalization, and difficulties in various areas of functioning. People with this illness may struggle with poor living conditions, limited financial resources, inadequate education, and deficits in vocational and social skills, all of which contribute to poor quality of life ( 11 , 12 ). In psychiatry, quality of life has emerged as a widely accepted outcome indicator over the past few decades, as it effectively captures the therapeutic efficacy of psychosocial interventions and pharmacological treatments ( 12 , 13 ). Schizophrenia not only impairs psychosocial functioning, but it also significantly impacts the quality of life of patients through both positive and negative symptoms ( 14 ). Therefore, the treatment of schizophrenia should aim to enhance the HRQoL of patients, as this has been linked to higher levels of satisfaction with care and improved adherence to treatment ( 15 ). Schizophrenia patients have a lower HRQoL than the general population, which could be attributed to factors such as the chronic nature of the illness, limited effective treatments, poor treatment outcomes, lack of awareness, societal stigma, and side effects of medications ( 16 – 19 ). Therefore, the treatment approach for this disorder aims to go beyond merely alleviating symptoms, also focusing on enhancing the patient's overall HRQoL. However, clinicians often prioritize treating psychotic symptoms in patients with schizophrenia while overlooking the factors directly linked to patients' quality of life ( 13 ). Therefore, treatment regimens for schizophrenia involve antipsychotic medication, with a primary focus on reducing both positive and negative symptoms. However, improving patients' quality of life has also been acknowledged as a crucial therapeutic objective ( 20 ). Assessing the factors associated with the quality of life of people with schizophrenia is crucial to mitigate the impact of the disorder and optimize treatment outcomes, ultimately enhancing their overall well-being. Health-related disability and dysfunction should be evaluated through HRQoL measures, as they provide a comprehensive understanding of how health conditions impact a person's daily functioning and well-being. A key component in quantifying HRQoL is the health state utility value, a numerical representation reflecting an individual's quality of life by incorporating personal preferences and societal values. This utility value translates subjective health experiences into measurable data, allowing for a standardized assessment of health outcomes. Both HRQoL and health state utility values are crucial for evaluating the necessity and effectiveness of medical interventions from the patient's perspective, ensuring that treatments address the real-life impacts on quality of life. Moreover, health state utility values are widely recognized and favored in health technology assessments because they facilitate cost-effectiveness analyses and support decision-making processes in healthcare policy ( 21 , 22 ). HRQoL can be measured using either generic or disease-specific HRQoL scales. Both generic, like EQ-5D ( 23 ) and Short-Form 36-item Health Survey (SF-36) ( 24 ), and disease-specific HRQoL, like Schizophrenia Quality of Life Scale (SQLS) ( 25 ), can be used to assess quality of life in individuals with schizophrenia. Generic scales provide a broad evaluation applicable across various health conditions, allowing for comparative analysis among diverse populations. In contrast, disease-specific scales are designed to capture the unique symptoms, challenges, and functional impairments faced by individuals with particular health issues ( 26 ). The use of generic HRQoL scales in assessing schizophrenia has gained significant support. Regulatory bodies in the United States of America (USA), the United Kingdom (UK), and France endorse the integration of HRQoL measures for evaluating treatment effects in individuals with chronic health conditions ( 27 ). Since health-policy decisions encompass all health conditions, these agencies primarily rely on generic HRQoL measures, such as the EQ-5D. Consequently, generic HRQoL scales are increasingly utilized to assess the health-related quality of life of patients with schizophrenia. In Ethiopia, A few studies have explored patients' perspectives on the impact of schizophrenia and its treatments using the SF-36 and the World Health Organization Quality of Life (WHOQOL-BREF) instrument ( 28 – 30 ). However, there are no prior studies on the HRQoL of schizophrenia patients in Ethiopia using the EQ-5D-5L, and no research has been conducted specifically in the study area focused on this patient population. As a result, healthcare decision-makers in Ethiopia lack well-established utility values for schizophrenia based on various health states of the disease. Therefore, the current study aims to assess HRQoL and determine health state utility values and the factors influencing these values among schizophrenia patients in Ethiopia. The EQ-5D-5L is particularly advantageous as it generates utility values that can inform health policy and resource allocation decisions. This study also assesses the association of HRQoL with antipsychotic polypharmacy, psychiatric symptoms, antipsychotic side effect burden, and early onset of illness at Ayder Comprehensive Specialized Hospital (ACSH), psychiatry clinic, Northern Ethiopia. Materials and methods Study setting, design, and period A hospital-based cross-sectional study was conducted from March to July 2023 among patients attending an outpatient psychiatry clinic at ACSH in Mekelle, Ethiopia. The hospital is which is one of the largest public referral and teaching hospitals under Mekelle University (MU). The psychiatry unit of ACSH contains sixteen beds for inpatients and an outpatient department that provides services to more than 9000 patients with psychiatric disorders annually. Recruitment of participants All adult patients with schizophrenia who were in follow-up at the outpatient psychiatry clinic of ACSH were the source population, while all adult schizophrenia patients who were in follow-up and who visited the outpatient psychiatry unit at the time of the data collection were the study population. All adult patients (aged ≥ 18 years) with a diagnosis of schizophrenia who had been followed with a minimum of one or more previous visits and were on antipsychotics for at least three months before the initiation of the study were included. In contrast, patients who were acutely disturbed, unable to communicate, whose medication was collected by others on behalf of the patients, who were unwilling to participate in the study, who were unable to complete the interview, and whose medical charts had incomplete records were excluded from the study. The sample size necessary for this study was determined using a single-proportion sample size estimation formula ( 31 ). Due to the absence of studies done using EQ-5D-5L in schizophrenia patients and to obtain a maximum sample size, an estimated proportion of patients who had utility values above the average was considered to be 50%, was used to calculate the sample size. Hence, n = Sample size; Zα/2 = Confidence level at 95% = 1.96, P = proportion of patients with utility above the average is 50%, d = margin of error of 5% =0.05 The calculated sample size was 384, and considering 5% of the contingency value, the total calculated sample size was 404. A systematic random sampling method was used to recruit samples for the study. The sampling interval (k th ) was determined by dividing the total number of schizophrenic patients within the study period by the estimated sample size (k th = 866/404 ≈ 2). The first patient was selected randomly, and then every other patient was interviewed until the required sample was reached. In this study, 391 study participants were included in the final analysis after excluding patients with incomplete data and those unable to complete the interview. All methods were performed in accordance with the relevant guidelines and regulations. Ethical approval was obtained from the Ethical Review Board of the School of Pharmacy at Addis Ababa University (AAU) (Ref No: ERB/SOP/282/13/2021) and expedited approval from Mekelle University College of Health Science Institutional Review Board (Ref. NO MU-IRB-1871/2021). Before participating, individuals received an information sheet and an informed consent form for review and signature. To maintain confidentiality, interviews were conducted in a private room organized by the hospital staff. Study variables Health-related quality of life was the main outcome variable, while independent variables were Socio-demographic and behavioral factors (such as sex, age, marital status, educational status, residence, working status, and current substance use). Clinical factors (such as the onset of illness, duration of illness, duration of treatment, number of previous psychiatric hospitalizations, comorbid mental illness, comorbid physical illness, and severity of psychotic symptoms). Medication-related factors (such as anticholinergic drug use, adjuvant medication use, total daily antipsychotic dose, antipsychotic polypharmacy, and antipsychotic medication adherence). Data collection instruments In this study, the validated Amharic version of the 5-level EQ-5D (EQ-5D-5L) and the EuroQol-visual analog scale (EQVAS) were used to evaluate HRQoL and generate utility, as developed by the EuroQol Research Foundation ( 32 , 33 ). The EQ-5D-5L is a preference-based, multi-attribute utility evaluation instrument that is widely recommended for generating input data for economic evaluations and assessing patient health states for clinical and economic assessments ( 34 ). The EQ-5D-5L is the new version of the original EQ-5D-3L (three levels for each dimension), which essentially consists of two parts: the descriptive system and the EuroQoL Visual Analogue Scale (EQ-VAS). The descriptive system examines five dimensions of HRQoL: mobility (MO), self-care (SC), usual activities (UA), pain/discomfort (PD), and anxiety/depression (AD), with a 5-level response (from 1 = no problem to 5 = extreme problem). The responses to the five dimensions generated 3125 ( 55 ) combinations of HRQoL states, with ‘11111’ indicating ‘no problems at all’ and ‘55555’ indicating ‘extreme problems’ in all five dimensions. Each combination was then given a single score using a scoring algorithm based on public preference. The EQ-VAS scale, on which the overall state of health is marked by the patient in the form of a number (0 = worst imaginable state of health, 100 = best imaginable state of health). The utility value is between the worst and best, on 0 to 1, 0 is for death, and 1 is for perfect health ( 35 ). The Glasgow Antipsychotic Side-effect Scale (GASS) is an easy-to-use patient self-reported measurement scale consisting of twenty-two questions that cover a wide range of antipsychotic medication-related side effects ( 36 ). The GASS assesses side effects such as sedation, cardiovascular side effects, extrapyramidal side effects, anticholinergic side effects, and weight gain. For the first 20 questions, the frequency of side effects was rated on a 4-point scale, ranging from "none" (0 points) to "every day" (3 points), and for the final 2 questions ( 21 – 22 ), no (0) and yes (3 points). The severity of the side effects experienced by the participants was categorized based on their total GASS score. A score of 0–12 indicated absent or mild side effects, a score of 13–26 indicated moderate side effects, and a score greater than 26 indicated severe side effects. This tool has been used in various studies conducted in Ethiopia to assess antipsychotic side effects ( 37 – 39 ). Adherence was assessed using the self-reported Morisky Green Levine (MGL) Adherence Scale ( 40 ), available online ( https://www.moriskyscale.com/mgl-morisky-green-levine-scale.html#/ ). This scale consists of four items, scored as "Yes" = 1 and "No" = 0, resulting in a total score ranging from 0 to 4. Scores were categorized as good adherence (MGL = 0) and poor adherence (MGL ≥ 1). The PANSS is a well-validated instrument that is widely used for assessing the severity of positive and negative symptoms in schizophrenia patients as well as global psychopathology in schizophrenia patients. It has 30 items (7 items for the positive scale, 7 for the negative scale, and 16 for the general psychopathology scale). Each item is scored from 1 to 7 depending on the severity level of psychopathology, with higher scores indicating greater symptom severity ( 41 ). The PANSS has been employed in research conducted in Ethiopia among patients with schizophrenia ( 42 – 44 ). Data collection procedure and quality assurance Face-to-face interviews were carried out to collect data on sociodemographic and clinical characteristics, the EQ-5D-5L and EQ-VAS, MGL, GASS, and PANSS. Clinical and medication-related characteristics were collected from the medical chart following patient interviews. The first author (EFY) verified the completeness, accuracy, and consistency of all collected data at the data collection site. A pre-test was conducted on 5% of the sample one week before the actual data collection, leading to necessary adjustments. Respondents from the pre-test were excluded from the data analysis. Data collectors received training and were closely supervised throughout the data collection process. Before analysis, data cleaning was done by observing the descriptive statistics output. Data Processing and Analysis Data were entered using Epi Info version 7.2.1 and analyzed with STATA version 14. Descriptive analysis was computed as frequency and percent for categorical variables, and mean and standard deviation (SD) for continuous variables. The utility score was calculated using Microsoft Excel 2016. Patient health profiles from EQ-5D-5L were converted into a single index (utility) based on the preference of the general population of Ethiopia, and coefficients that represented level-specific disutility values obtained from the general population were used for computing utility values ( 45 ). Four dummies were created for each dimension by considering level one as a reference to represent a decrease in utility in moving from one level to the next higher level (e.g., moving from AD1 to AD2 resulted in a utility decrement of 0.0258862) (Eq. 1). As EQ-5D-5L utility and EQ-VAS scores were non-normally distributed (Kolmogorov–Smirnov test and Shapiro-Wilk test, p < 0.05) and histogram inspection revealed skewed towards 1, we presented median (IQR) scores (Fig. 1 ). The Kruskal-Wallis and Mann-Whitney U tests were used to determine the significant differences in EQ-5D-5L utility value and EQ-VAS score across the sociodemographic, clinical characteristics, and medication-related variables between patient subgroups. Spearman-rank correlation coefficient was used to assess the correlation between the EQ-VAS score, EQ-5D-5L utility index, and PANSS scores. We then established a multivariate Tobit regression model on the EQ-5D-5L utility score to identify variables associated with study participants' HRQoL, including all of the independent variables that showed statistical significance (p < 0.05) in the Kruskal-Wallis and Mann-Whitney U tests ( 46 ). The ceiling effect is common in HRQoL studies, which is particularly evident with EQ-5D instruments, leading to some utility scores censored at a point. A general linear regression model is inappropriate for censored data. Therefore, for censored data, the Tobit regression model is advised ( 47 , 48 ). Statistical significance was set at a p-value less than 0.05 at a 95% CI. The results were presented with text, tables, graphs, and charts. Utility value = 1 - (MO2 ∗ 0.0337341 + MO3 ∗ 0.0644715 + MO4 ∗ 0.2276493 + MO5 ∗ 0.3598963) + (SC2 ∗ 0.0235125 + SC3 ∗ 0.0394815 + SC4 ∗ 0.1419238 + SC5 ∗ 0.2223553) + (UA2 ∗ 0.0323013 + UA3 ∗ 0.0482993 + UA4 ∗ 0.1573934 + UA5 ∗ 0.2721253) + (PD2 ∗ 0.0360808 + PD3 ∗ 0.0515949 + PD4 ∗ 0.2703189 + PD5 ∗ 0.4063984) + (AD2 ∗ 0.0258862 + AD3 ∗ 0.0848133 + AD4 ∗ 0.2987388 + AD5 ∗ 0.4577938) MO-mobility; SC-self-care; UA-usual activity; P/D-pain/discomfort; A/D-anxiety/depression Equation 1:The equation for computing the utility score. Results Sociodemographic and Behavioral Characteristics of the Study Participants. A total of 391 patients with schizophrenia participated in the study (response rate of 96.8%). Among these participants, over half (54.7%,214) were female, with a mean age of 33.97 years (± 9.06), ranging from 21 to 58 years. Nearly half (49.1%,192) had completed secondary education. A significant majority (86.2%, 337) resided in urban areas. Approximately two-thirds (64.7%, 253) of the participants were unmarried, and just over half (58.3%, 228) were not actively employed. Additionally, nearly a quarter (24.8%,97) reported being active substance users, engaging in behaviours such as alcohol consumption, cigarette smoking, or khat chewing (Table 1 ). Table 1 Sociodemographic and behavioral characteristics of the participants. Variables Categories Frequency Percentage (%) Sex Male 177 45.3 Female 214 54.7 Age(years) Mean ± SD 33.97 ± 9.061 ≤ 25 67 17.1 26–35 189 48.3 ≥ 36 135 34.5 Marital status Unmarried 228 58.3 Married 122 31.2 Divorced 29 7.4 Widowed 12 3.1 Educational status No formal education 27 6.9 Primary 72 18.4 Secondary 192 49.1 Higher education 100 25.6 Residence Urban 337 86.2 Rural 54 13.8 Working Status Working 138 35.3 Not working 253 64.7 Current substance use Yes 97 24.8 No 294 75.2 Clinical and Medication-Related Characteristics of the Study Participants Table 2 shows that nearly (41.7%, 163) of participants had an earlier age of onset of illness with a mean (± SD) of 29.1(± 8.89) years. Approximately three-fifths (59.1%, 231) had an illness duration of < 5 years, and more than two-thirds of the participants (267, 68.3%) had been receiving antipsychotic treatment for less than five years. The mean (± SD) psychiatry admission history of these patients was 1.14 (± 1.34), ranging from no admission to five times. More than half of the study participants (54.7%, 241) had at least one previous psychiatric hospital admission. About one-fifth of the study participants (17.6%, 69) and approximately one-seventh of the participants (14.3%, 56) had co-morbid mental and physical illnesses, respectively (Table 2 ). An assessment of patients' responses to the Morisky Green Levine scale revealed that (55%, 215) exhibited good adherence to antipsychotic medications, while (45%, 176) demonstrated poor adherence, with (25.8%, 101) on antipsychotic polypharmacy. Additionally, (18.2%, 71) and (17.4%, 68) of patients were using anticholinergic and other adjuvant medications, respectively. According to the GASS (46.3%,181), participants reported experiencing either absent or mild side effects, whereas (14.1%, 55) experienced severe side effects. Furthermore, the mean scores for the PANSS positive, negative, and general psychopathology subscales were 17.18 ± 3.986, 15.82 ± 3.246, and 28.66 ± 7.071, respectively, resulting in a PANSS total score of 61.66 ± 12.509 (Table 2 ). Distribution of the mean EQ-5D-5L utility scores of patients with schizophrenia Table 2 Clinical and medication-related characteristics of the participants. Variables Categories Frequency Percentage (%) Onset of illness(years) Mean ± SD 29.1 ± 8.89 < 25 163 41.7 ≥ 25 228 58.3 Duration of illness 10 years 42 10.7 Duration of treatment 10 years 14 3.6 Number of psychiatric hospitalizations No Admission 177 45.3 One Admission 74 18.9 ≥ Two Admission 140 35.8 Co-morbid Mental Illness Yes* 69 17.6 No 322 82.4 Co-morbid physical Illness Yes** 56 14.3 No 335 85.7 Anticholinergic drug use Yes 71 18.2 No 320 81.8 Adjuvant medication use Yes 68 17.4 No 323 81.8 Total Daily Dose in CPZeq dose (mg) Mean ± SD 360.73 ± 301.813 Subtherapeutic ( 1000 mg) 11 2.8 Medication adherence Good 215 55 Poor 176 45 Severity of side effects based on GASS Absent/mild side effects 181 46.3 Moderate side effects 155 39.6 Severe side effects 55 14.1 Antipsychotic polypharmacy Yes 101 25.8 No 290 74.2 PANSS Positive Score Mean and SD 17.18 ± 3.986 Negative Score Mean and SD 15.82 ± 3.246 General Psychopathology Score Mean and SD 28.66 ± 7.071 PANSS Total Score Mean and SD 61.66 ± 12.509 * Major depressive disorder, Sleep disorder, Anxiety disorder, Substance use disorder: ** Epilepsy, Diabetes mellitus, retroviral infection, and Hypertension: CPZeq: chlorpromazine equivalents Health-Related Quality of Life of the Study Participants Patients’ self-reported health status for the five dimensions of EQ-5D-5L is presented in Fig. 1 . Of the total participants, 73.1% and 63.9% reported “no problem” in the pain/discomfort and mobility dimension, respectively. In contrast, the most frequent health problems were reported for the “anxiety/depression dimension” (97.7%, all levels), followed by “self-care” (82.4%, all levels), and “usual activity” (81.1%, all levels) (Fig. 2 ). The study participants had an EQ-VAS score median (IQR) of 65 ( 55 – 70 ), and their median (IQR) EQ-5D-5L utility value was 0.859 (0.774–0.917). Conversely, the mean (SD) EQ-VAS score and EQ-5D-5L utility value were 64.6 ± 10.12 and 0.813 ± 0.137, respectively (Fig. 1 ). Percentage distribution of the five-dimensional EQ-5D-5 L questionnaire of patients with schizophrenia at ACSH, Mekelle, Ethiopia, 2023 The Mann‒Whitney U test and the Kruskal‒Wallis H test revealed significant differences in the median (IQR) EQ-5D-5L utility and EQ-VAS score across different variables: sex, marital status, working status, current substance use, duration of illness, duration of treatment, psychiatric hospitalization, comorbid physical illness, antipsychotic polypharmacy, total daily dose, anticholinergic drug use, medication adherence, and side effect burden, with a p-value of < 0.05 (Table 3 ). Table 3 Median (IQR) differences in the EQ-5D-5L utility and EQ-VAS scores with patient demographic, clinical, and medication characteristics (n = 391). Variables EQ-VAS score median (IQR) Mean rank P value EQ-5D-5L index score median (IQR) Mean rank P value Overall scores 65( 55 – 70 ) 0.859 (0.774–0.917) Sex Male 60( 55 – 70 ) 176.18 0.001 0.843(0.646–0.885) 175.03 0.001 Female 65( 60 – 75 ) 212.39 0.859(0.810–0.918) 213.31 Age(years) ≤ 25 70( 60 – 70 ) 218.74 0.169 0.882(0.831–0.938) 227.86 0.015 26–35 65( 55 – 70 ) 188.93 0.859(0.646–0.885) 181.89 ≥ 36 65( 55 – 70 ) 194.61 0.859(0.795–0.918) 199.94 Marital status Unmarried 65( 60 – 70 ) 204.42 0.011 0.859(0.795–0.917) 202.52 0.04 Married 65(58.75-70) 195.38 0.859(0.774–0.918) 196.85 Divorced 60( 50 – 65 ) 131.02 0.803(0.612–0.882) 138.53 Widowed 62.5(55-78.75) 199.42 0.863(0.798–0.916) 202.42 Educational status No formal education 65( 60 – 70 ) 185.57 0.585 0.833(0.790–0.918) 194.20 0.031 Primary 65(56.25-70) 209.26 0.822(0.801–0.939) 231.23 Secondary 65( 55 – 70 ) 190.14 0.859(0.698–0.980) 189.47 Higher education 65( 55 – 75 ) 200.5 0.847(0.779–0.890) 183.67 Residence Urban 65( 55 – 70 ) 198.79 0.217 0.859(0.776–0.917) 196.98 0.667 Rural 62.5( 55 – 70 ) 178.58 0.859(0.742–0.898) 189.86 Working Status Working 65( 60 – 75 ) 215.61 0.010 0.863(0.815–0.918) 217.44 0.006 Not working 65( 55 – 70 ) 185.31 0.858(0.669–0.908) 184.30 Table 3 Continued… Variables EQ-VAS score median (IQR) Mean rank P value EQ-5D-5L index score median (IQR) Mean rank P value Current substance use Yes 60( 55 – 65 ) 157.94 0.001 0.826(0.635–0.880) 158.56 0.001 No 65( 60 – 75 ) 208.56 0.859(0.801–0.918) 208.35 Onset of illness < 25 70( 55 – 70 ) 189.44 0.326 0.859(0.646–0.918) 194.14 0.783 ≥ 25 65( 60 – 70 ) 200.69 0.859(0.795–0.915) 197.33 Duration of illness 10 years 60( 55 – 70 ) 164.92 0.826(0.743–0.874) 159.73 Duration of treatment 10 years 62.5( 55 – 70 ) 182 0.826(0.617–0.918) 172.36 Number of psychiatry hospitalizations No Admission 70( 60 – 75 ) 226.98 0.001 0.882(0.826–0.918) 230.68 0.001 One Admission 65( 55 – 75 ) 202.64 0.859(0.797–0.915) 200.51 ≥ Two Admission 60( 55 – 65 ) 153.32 0.826(0.613–0.872) 149.77 Co-morbid Mental Illness Yes 60( 55 – 70 ) 152.51 0.001 0.831(0.635–0.883) 173.66 0.070 No 65( 60 – 70 ) 205.32 0.859(0.790–0.918) 200.79 Co-morbid physical Illness Yes 60( 50 – 65 ) 133.95 0.001 0.800(0.640–0.859) 139.02 0.001 No 65( 60 – 70 ) 206.37 0.859(0.795–0.918) 205.53 Table 3 : Continued … Variables EQ-VAS score median (IQR) Mean rank P value EQ-5D-5L index score median (IQR) Mean rank P value Antipsychotic polypharmacy Yes 60( 55 – 65 ) 141.71 0.001 0.810(0.610–0.859) 136.50 0.001 No 65( 60 – 75 ) 214.94 0.867(0.810–0.918) 216.72 Anticholinergic drug use Yes 60( 55 – 65 ) 145.42 0.001 0.810(0.596–0.859) 131.35 0.001 No 65( 60 – 70 ) 207.22 0.859(0.797–0.918) 210.35 Adjuvant medication use Yes 60( 60 – 70 ) 190.15 0.635 0.859(0.791–0.892) 195.99 0.999 No 65( 55 – 70 ) 197.23 0.859(0.774–0.918) 196 Total Daily Dose Subtherapeutic 70( 60 – 75 ) 223.97 0.001 0.872(0.823–0.918) 223.69 0.001 Optimum 60( 55 – 70 ) 174 0.831(0.612–0.882) 164.04 High 60( 55 – 65 ) 129.38 0.813(0.656–0.863) 147.71 Very High 65( 50 – 70 ) 163.77 0.599(0.513–0.885) 122.64 Drug adherence Good 70( 60 – 75 ) 226.47 0.001 0.882(0.843–0.918 229.54 0.001 Poor 60( 55 – 65 ) 158.78 0.811(0.613–0.882) 155.03 Side effect burden absent/mild 70( 60 – 75 ) 232.69 0.001 0.883(0.859–0.918) 239.78 0.001 Moderate 65( 55 – 70 ) 182.87 0.833(0.767–0.885) 178.63 Severe 55( 50 – 65 ) 112.25 0.635(0.583–0.833) 100.89 EQ-5D-5L: EuroQoL life questionnaires with five dimensions and five levels; EQ-VAS: EuroQoL visual analogue scale; IQR: Interquartile Range. There were significant, modest negative correlations between PANSS positive score with the EQ-5D-5L utility and the EQ-VAS scores, and significant weak negative correlations between negative and general psychopathology symptoms scores with EQ-5D-5L utility and EQ-VAS scores. The Spearman rank correlation coefficient between mean scores of PANSS positive, negative, and general psychopathology symptoms scores and the EQ-5D-5L utility score was − 0.329, -0.178, and − 0.214, respectively. The correlation between PANSS positive, negative, and general psychopathology symptoms scores and EQ-VAS scores was − 0.321, -0.149, and − 0.216, respectively (Table 4 ). Table 4 Spearman rank correlation coefficient between the PANSS score and HRQoL scale (EQ-5D-5L and EQ-VAS). PANSS SCORE EQ-5D-5L Utility P value EQ-VAS score P value Positive symptoms score -0.329 < 0.01 -0.321 < 0.01 Negative symptoms score -0.178 < 0.01 -0.149 < 0.003 General Psychopathology symptoms score -0.214 < 0.01 -0.216 < 0.01 EQ-5D-5L: EuroQoL life questionnaires, five dimensions with five levels; EQ-VAS: EuroQoL visual analog scale; HRQoL: health-related quality of life. 5.7. Factors Associated with Health-Related Quality of Life. A multivariate Tobit regression model was used to identify variables associated with the HRQoL, and it revealed that being not working (β = -0.033, 95% CI=-0.059, -0.070), presence of comorbid physical illness (β = -0.060, 95% CI = -0.097, -0.023), have antipsychotic polypharmacy (β = -0.040, 95% CI= -0.075, -0.006), poor medication adherence (β = -0.043, 95% CI= -0.072, -0.013), and experiencing a severe side effect (β = -0.081, 95% CI=-0.135, -0.028) were significantly negatively associated with the EQ-5D-5L utility score. Conversely, female sex (β = 0.0332, 95% CI = 0.007, 0.059) was significantly positively associated with the EQ-5D-5L utility score. Similarly, divorce (β = -4.035, 95% CI = -7.737, -0.334) and the presence of comorbid medical illness (β = -5.462, 95% CI = -8.263, -2.661) were negatively associated with the EQ-VAS score, whereas female sex (β = 3.323, 95% CI = 1.373, 5.273) was positively associated with the EQ-VAS score (Table 5 ). Table 5 Factors associated with HRQoL in patients with schizophrenia at the outpatient psychiatry clinic of ACSH, Mekelle, Ethiopia, March - June 2023 (n = 391). EQ-5D-5L utility score EQ-VAS score Variables β-Coefficient [95% CI] P-value β-Coefficient [95% CI] P-value Sex, female Ref (male) 0.0332(0.007;0.059) 0.012 3.323(1.373;5.273) 0.001 Marital status (Ref = single) Married - -0.388(-2.471;1.694) 0.714 Divorced - -4.035(-7.737; -0.334) 0.033 Widowed - 0.708(-4.637;6.055) 0.794 Working status, Ref (working) Not working -0.033(-0.059; -0.070) 0.013 Comorbid physical illness, Ref (No) Yes -0.060(-0.097; -0.023) 0.001 -5.462(-8.263; -2.661) 0.001 Antipsychotic polypharmacy, Ref (No) Yes -0.040(-0.075; -0.006) 0.021 Medication adherence, Ref (Good adherence) Poor adherence -0.043(-0.072; -0.013) 0.004 Side effect burden, Ref(absent/mild) Moderate -0.011(-0.042;0.019) 0.466 Severe -0.081(-0.135;-0.028) 0.003 EQ-5D-5L: EuroQoL life questionnaires five dimensions with five levels; EQ-VAS: EuroQoL visual analog scale; CI: Confidence Interval Discussion This study examined the HRQoL of outpatients with schizophrenia using the EQ-5D-5L. The median EQ-VAS score (65%) was lower than the general Ethiopian population (median of 90%) ( 45 ). This reduced quality of life aligns with evidence that schizophrenia patients typically have a lower HRQoL compared to the general population ( 49 – 52 ). Similar to previous studies, the current study revealed that patients with schizophrenia reported problems with all descriptive dimensions of the EQ-5D-5L ( 53 – 55 ). A significant proportion of outpatients in our study reported problems with anxiety/depression, self-care, and daily activities, which suggests their HRQoL is impacted not only by mental function, but also by daily functioning. To support social reintegration and daily functioning, a safe and secure living environment that addresses their physical, social, and mental needs is crucial. Clinicians and family members must understand their specific challenges and take targeted steps to address them. The study revealed that the mean EQ-5D-5L utility value for patients with schizophrenia was 0.813, which was lower than the mean for the general Ethiopian population (0.94) ( 45 ). This difference can be attributed to the multitude of challenges faced by individuals with schizophrenia. These include positive and negative symptoms, a chronic nature, and long-term treatment of the illness, as well as its debilitating medication side effects and social stigma, leading to marginalized living conditions, poor housing, low income, limited education, and inadequate vocational and social skills ( 11 , 56 ). Compared with previous studies, our mean EQ-5D-5L utility score (0.81) was lower than that reported in the Serbian study (0.86) ( 57 ), and approximately similar to that reported in two studies from Singapore (0.82 and 0.81) ( 58 , 59 ), and Taiwan (0.80) ( 60 ), but higher than reported in Europeans (0.57) ( 61 ), the UK (0.69) ( 50 ), and Japan (0.77) ( 51 ). These discrepancies may be attributed to differences in patient characteristics, sociocultural beliefs, medication availability, healthcare systems, and access, as well as the value set used, which could have contributed to these variations. Furthermore, our study identified factors associated with HRQoL. A statistically significant association was found between the EQ-5D-5L utility score and female sex, being not working, the presence of comorbid physical illness, antipsychotic polypharmacy, poor medication adherence, and experiencing severe side effects. The findings of the present study are consistent with those of other studies that revealed the female sex was associated with higher QOL when compared to males with schizophrenia ( 62 – 64 ). One possible explanation is that the early onset of psychosis in males, which is often associated with a more severe clinical presentation, can also have devastating consequences, including disadvantages in schooling, employment, friendships, and intimate relationships may contribute to poor HRQoL in males ( 65 , 66 ). The other possible reason could be that females tend to have higher estrogen levels, which have an antidopaminergic effect that may contribute to a milder course of illness ( 67 ). This could explain why females have a better HRQoL than males with schizophrenia, which is supported by a literature review suggesting that, compared to males, females with schizophrenia have a better response to medications, a more favorable prognosis of illness, and better social functioning ( 68 ). Another factor that was negatively associated with HRQOL in the current study was that participants who were not working had a lower HRQoL compared to those who were working. This finding was supported by studies done in China ( 64 ) and Jordan ( 63 ). The chronic nature of schizophrenia and its clinical symptoms, such as a lack of motivation and goal-oriented activity, often make it challenging for individuals to consistently perform job duties. This can lead to job loss and unemployment, which in turn can contribute to financial hardship, social isolation, decreased self-esteem, and a loss of daily structure. Our results suggest that having a job plays a key role in the daily life of the individual, which is supported by the previous literature, showing that occupation not only results in financial gain but also promotes individual integration in the community and supports the perception of self-worth and growth ( 69 ). The presence of co-morbid physical illness was also a factor that negatively affected HRQoL in our study. Our finding was consistent with studies done in Ethiopia ( 70 , 71 ), Nigeria ( 72 ), and A multi-centered study of eight countries ( 73 ). Chronic medical conditions can negatively impact HRQoL by causing physical impairments, such as pain, balance issues, and reduced strength, which limit physical function and activity, leading to overall HRQoL deterioration. ( 74 ). Our findings indicate that early detection and treatment of comorbid physical illnesses in individuals with schizophrenia are crucial for achieving better treatment outcomes and improving their overall quality of life. This study also revealed that non-adherence to antipsychotic medications is significantly and negatively associated with HRQoL, and this result is in line with the previous studies in Nigeria ( 75 ) and Ethiopia ( 70 , 71 ). Similarly, another study from Nigeria showed that good medication adherence is positively associated with good HRQoL ( 76 ). This could be because non-adherence to medication may contribute to poor symptom control, increased risk of relapse, and decreased functionality, ultimately leading to a further decline in mental health and health-related quality of life. These findings indicate that medication adherence plays a crucial role in the quality of life of individuals with schizophrenia and that improving medication adherence through counselling and follow-up is a promising approach to enhancing the quality of life of individuals with schizophrenia. In the present study, experiencing severe side effects, as reflected by higher GASS scores, was found to be a factor that is significantly and negatively associated with patients' HRQoL, and our finding is consistent with those of previous studies, including a multicenter study across seven countries ( 77 ) and Japan ( 51 ). The adverse effects of antipsychotics (including Extrapyramidal Symptoms (EPS), sexual dysfunction, sedation, and weight gain) have also been reported to be associated with lower EQ-5D scores and decreased utility scores ( 78 , 79 ). Our finding suggests that the burden of antipsychotic side effects can significantly impact patients' HRQoL. The negative impact of side effects on quality of life can be attributed to reduced functional capacity, emotional distress, decreased adherence, stigma, and social withdrawal. Therefore, effective side effect management is essential, and strategies such as regular monitoring and dose optimization are necessary to alleviate the burden of antipsychotic side effects and enhance HRQoL. Antipsychotic polypharmacy (APP), which is defined as the use of two or more antipsychotic medications, was also another factor that was significantly and negatively associated with HRQoL in the current study. This finding is consistent with studies done in Germany ( 80 ), Turkey ( 81 ), and Ethiopia ( 71 ). This might be due to the fact that APP, which is associated with greater illness severity, treatment resistance, higher overall doses, side effects, higher use of concurrent anticholinergic medications, drug interaction, non-adherence, and increasing cost of treatment ( 82 – 84 ), may contribute to a negative impact on the HRQoL for individuals with schizophrenia. In addition, attributed to the fact that the most common combination of APP in our participants was the combination of two first-generation antipsychotics (FGAs), which is known to increase the risk of EPS and other side effects ( 85 ). Furthermore, patients on APP exhibited higher symptom scores on measurement scales compared to those on APM, and a significant proportion (32.6%) of APP users experienced severe side effects, which may have contributed to the lower HRQoL observed in this group. Consequently, implementing targeted programs for optimal antipsychotic utilization and regular follow-up care may need to improve the HRQoL for individuals with schizophrenia receiving APP. Contrary to our findings, a study done in China reported that APP was associated with higher QOL ( 10 ). This discrepancy could be attributed to the difference in the HRQoL measurement tool used and the influence of social support from family members, which the author suggested as a possible explanation for the better mental health-related QOL in the APP group. Another possible explanation could be that the difference in HRQoL between the two groups could be difficult to detect in clinically stable outpatients. Our study has some limitations. First, since this is a cross-sectional study, it is not possible to demonstrate causal relationships between associated factors and HRQoL. Additionally, the generalizability of the results is limited, as patients were recruited from a single tertiary hospital. Moreover, the study did not assess important factors such as social support and stigma, which could significantly influence HRQoL in schizophrenia patients. Despite these limitations, this study was the first to establish the utility value and to assess the association between HRQoL and symptom severity, onset of illness, antipsychotic side effect burden, and antipsychotic polypharmacy in patients with schizophrenia in Ethiopia. Importantly, our study generated utility values based on a value set specific to the Ethiopian population ( 45 ), thereby minimizing potential bias since preference-based measures of HRQoL can vary across different populations. These findings are valuable for practitioners and policymakers in designing strategies to improve schizophrenia care, as the utility weights produced are essential for future economic evaluations. Consequently, the utility values derived from the EQ-5D-5L can be utilized for cost-utility analyses and to prioritize interventions, programs, and policies aimed at enhancing health outcomes for Ethiopian patients with schizophrenia. Furthermore, the study enrolled a large sample size, which increases the precision of the findings. Conclusions The study found that outpatients with schizophrenia had lower HRQoL compared to the non-schizophrenic general population in Ethiopia, as measured by the EQ-5D-5L utility and EQ-VAS scores. Most patients reported problems in the Anxiety/depression and self-care dimension of EQ-5D-5L. Being not working, the presence of comorbid medical illness, antipsychotic polypharmacy, poor medication adherence, and experiencing a severe side effect were significantly negatively associated with HRQoL. Conversely, the female sex was significantly positively associated with HRQoL. Hence, interventions to improve HRQoL should focus on enhancing medication adherence, monitoring and managing medication side effects, optimizing medication, managing comorbidities, and providing employment support. The health preference-based utility value generated in this study could be used to monitor clinical outcomes and conduct economic evaluations of different healthcare interventions in patients with schizophrenia. Abbreviations AAU Addis Ababa University APP Antipsychotic Polypharmacy CI Confidence Interval CPZeq Chlorpromazine Equivalents EQ 5D - 3L -EuroQoL 5-Dimensions 3-Levels EQ 5D - 5L -EuroQoL 5-Dimensions 5-Levels EQ VAS -EuroQoL Visual Analogue Scale EPS Extrapyramidal Symptoms FGA First-Generation Antipsychotics GASS Glasgow Antipsychotic Side-effect Scale HRQoL Health-Related Quality of Life IQR Interquartile Range MGL Morisky Green Levine Adherence Scale MO Mobility PD Pain/Discomfort SC Self-Care SF 36 -Short-Form 36-item Health Survey SQLS Schizophrenia Quality of Life Scale UA Usual Activities UK United Kingdom USA United States of America WHOQOL BREF -World Health Organization Quality of Life Brief AD Anxiety/Depression Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ethical Review Board of the School of Pharmacy at Addis Ababa University (AAU) (Ref No: ERB/SOP/282/13/2021) and expedited approval from Mekelle University College of Health Science Institutional Review Board (Ref. NO MU-IRB-1871/2021). Additionally, permission was secured from the study site department and the head of the psychiatry unit. Informed consent was obtained from all participants prior to their participation in the study, and they were informed of their right to decline participation or withdraw at any time. The study's purpose was explained before the interview, and participants' anonymity and confidentiality were ensured by removing personal identifiers and restricting access to the data. Consent for publication: Not applicable. Clinical trial number: Not applicable. Availability of data and materials All relevant data are within the manuscript. If additional information is needed, it is available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding : No funding. Author details 1 Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia 2 Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Authors' contributions EFY conceived and designed the study, developed the proposal, and actively participated in data collection. EFY, MA, and ABB contributed to the data analysis, interpretation, and drafting of the manuscript. All the authors reviewed and approved the final version of the manuscript. Acknowledgment The authors would like to acknowledge the study participants for their willingness to participate in this study and for giving their valuable time to respond to the questions. We are also thankful to the data collectors and supervisors, administrators, and staff of the hospital for their cooperation during the data collection process. 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Factors associated with health‐related quality of life in long‐stay inpatients with chronic schizophrenia. 2022;1(3):e42. Xiang Y-T, Hou Y-Z, Yan F, Dixon LB, Ungvari GS, Dickerson F, et al. Quality of life in community-dwelling patients with schizophrenia in China. 2012;200(7):584-7. de Willige Gv, Wiersma D, Nienhuis FJ, Jenner JAJQoLR. Changes in quality of life in chronic psychiatric patients: a comparison between EuroQol (EQ-5D) and WHOQoL. 2005;14:441-51. König H-H, Roick C, Angermeyer MCJEP. Validity of the EQ-5D in assessing and valuing health status in patients with schizophrenic, schizotypal or delusional disorders. 2007;22(3):177-87. NEN APÄ, KI M, ENDICOTT J, KATAJISTO J, LUUKKAALA T, KOIVUNEN M, et al. Assessing quality of life in patients with schizophrenia in an acute psychiatric setting: Reliability, validity and feasibility of the EQ-5D and the Q-LES-Q. 2011. Mannarini S, Taccini F, Sato I, Rossi AAJPR. Understanding stigma toward schizophrenia. 2022;318:114970. Petrović-Kitić A, Jankovic S. Quality of life in institutionalized patients with schizophrenia. 2018. Rekhi G, Saw YE, Lim K, Keefe RS, Lee JJBs. Impact of cognitive impairments on health-related quality of life in schizophrenia. 2023;13(2):215. Seow LSE, Lau JH, Abdin E, Verma SK, Tan KB, Subramaniam MJERoP, et al. Mapping the schizophrenia quality of life scale to EQ-5D, HUI3 and SF-6D utility scores in patients with schizophrenia. 2023;23(7):813-21. Chang L-R, Lin Y-H, Chang H-CW, Chen Y-Z, Huang W-L, Liu C-M, et al. Psychopathology, rehospitalization and quality of life among patients with schizophrenia under home care case management in Taiwan. 2013;112(4):208-15. Alonso J, Croudace T, Brown J, Gasquet I, Knapp MR, Suárez D, et al. Health‐related quality of life (HRQL) and continuous antipsychotic treatment: 3‐year results from the Schizophrenia Health Outcomes (SOHO) study. 2009;12(4):536-43. Cardoso CS, Caiaffa WT, Bandeira M, Siqueira AL, Abreu MNS, Fonseca JOPJCdSP. Factors associated with low quality of life in schizophrenia. 2005;21(5):1338-40. Hasan AA-HJPR. The correlation between the quality of life and clinical variables among outpatients with schizophrenia. 2019;271:39-45. Li Y, Hou C-L, Ma X-R, Zhong B-L, Zang Y, Jia F-J, et al. Quality of life in Chinese patients with schizophrenia treated in primary care. Psychiatry research. 2017;254:80-4. Selvendra A, Toh WL, Neill E, Tan EJ, Rossell SL, Morgan VA, et al. Age of onset by sex in schizophrenia: Proximal and distal characteristics. 2022;151:454-60. Clemmensen L, Vernal DL, Steinhausen H-CJBp. A systematic review of the long-term outcome of early onset schizophrenia. 2012;12:1-16. Seeman MVJAJoP. Psychopathology in women and men: focus on female hormones. 1997;154(12):1641-7. Ochoa S, Usall J, Cobo J, Labad X, Kulkarni J. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophrenia research and treatment. 2012;2012:916198. Kao Y-C, Liu Y-P, Chou M-K, Cheng T-HJCP. Subjective quality of life in patients with chronic schizophrenia: relationships between psychosocial and clinical characteristics. 2011;52(2):171-80. Desalegn D, Girma S, Abdeta TJH, Outcomes QoL. Quality of life and its association with current substance use, medication non-adherence and clinical factors of people with schizophrenia in Southwest Ethiopia: a hospital-based cross-sectional study. 2020;18:1-9. Tamene FB, Mihiretie EA, Dagnew FN, Gubae K, Tafesse FA, Wondm SAJFiPH. Health-related quality of life and associated factors among health care providers in the northwest of Ethiopia: a multicenter cross-sectional study, 2023. 2024;12:1357856. Adewuya A, Makanjuola RJAPS. Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlates. 2009;120(2):160-4. Domenech C, Pastore A, Altamura AC, Bernasconi C, Corral R, Elkis H, et al. Correlation of health-related quality of life in clinically stable outpatients with schizophrenia. 2019:3475-86. Sexton E, King-Kallimanis B, Layte R, Hickey AJA, health m. CASP-19 special section: how does chronic disease status affect CASP quality of life at older ages? Examining the WHO ICF disability domains as mediators of this relationship. 2015;19(7):622-33. Adelufosi AO, Adebowale TO, Abayomi O, Mosanya JTJGhp. Medication adherence and quality of life among Nigerian outpatients with schizophrenia. 2012;34(1):72-9. Lasebikan V, Owoaje EJCmhj. Quality of life in psychosis: prevalence and associated factors in a Nigerian clinical population. 2015;51:491-6. Tandon R, Lenderking WR, Weiss C, Shalhoub H, Barbosa CD, Chen J, et al. The impact on functioning of second-generation antipsychotic medication side effects for patients with schizophrenia: a worldwide, cross-sectional, web-based survey. 2020;19:1-11. Millier A, Amri I, Boyer L, Auquier P, Toumi MJJoME. Utility decrements associated with side effects in schizophrenia. 2014;17(12):853-61. Lenert LA, Sturley AP, Rapaport MH, Chavez S, Mohr PE, Rupnow MJSr. Public preferences for health states with schizophrenia and a mapping function to estimate utilities from positive and negative symptom scale scores. 2004;71(1):155-65. Kilian R, Angermeyer MCJQolr. The effects of antipsychotic treatment on quality of life of schizophrenic patients under naturalistic treatment conditions: an application of random effect regression models and propensity scores in an observational prospective trial. 2005;14:1275-89. Ceylan D, Yesilyurt S, AKDEDE B, Sayin Z, ALPTEKİN KJAPD-AJOP. The associatons of the antipsychotic polypharmacy in schizophrenia treatment with the symptoms, side effects and the quality of life. 2016;17(6). Baandrup L, Sørensen J, Lublin H, Nordentoft M, Glenthoj B. Association of antipsychotic polypharmacy with health service cost: a register-based cost analysis. The European Journal of Health Economics. 2012;13(3):355-63. Gallego JA, Bonetti J, Zhang J, Kane JM, Correll CU. Prevalence and correlates of antipsychotic polypharmacy: a systematic review and meta-regression of global and regional trends from the 1970s to 2009. Schizophrenia research. 2012;138(1):18-28. San Ang M, Rashid NAA, Lam M, Rapisarda A, Kraus M, Keefe RS, et al. The impact of medication anticholinergic burden on cognitive performance in people with schizophrenia. Journal of Clinical Psychopharmacology. 2017;37(6):651. Ayano GJR, Chemistry RJo. First generation antipsychotics: pharmacokinetics, pharmacodynamics, therapeutic effects and side effects: a review. 2016. Additional Declarations No competing interests reported. Supplementary Files S2.ethicalconsetanddatacollectiontool..docx S1.SPSSDATASET.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 10 Apr, 2026 Editor assigned by journal 07 Apr, 2026 Editor invited by journal 24 Dec, 2025 Submission checks completed at journal 23 Dec, 2025 First submitted to journal 23 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8401395","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":621386290,"identity":"e23ebb1b-cbab-4428-a9ac-570118a9766c","order_by":0,"name":"Elias Fitsum Yigzaw","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIie2PsWrDMBCGdWgIHYzXC3kJby108IN0SeisoZuH1KgY5KUPoEBIXiFdTEabA3cxZC5dCn4Bd4u3XtOSoSCn3QrRBzqk0/8hnRAez39kBFqAxsO+7BKuUuphRR4VCZVtvjvDCq+vjJR0YcTx6CSU8uG9317Fl/muJFjd34Q5K/ukcCrjDLJJ0OBs2dwKuiuelSXQ8Ni8OpWIAxMwOEXByqKoleaOBONWYoKs7w3GGLaCgmWt1qeUiG8xMAgW+ZVAz9XmlIIE5vpzFottVNm6VE+sVEOzhHnevvTblD82a7tunqrVjqq3feJWfkKHWv46z6R/CXs8Hs+Z8AEKf1zNN9XWGAAAAABJRU5ErkJggg==","orcid":"","institution":"Mekelle University","correspondingAuthor":true,"prefix":"","firstName":"Elias","middleName":"Fitsum","lastName":"Yigzaw","suffix":""},{"id":621386291,"identity":"1ef3e9d0-0050-4685-a207-f38d2bc004c6","order_by":1,"name":"Alemseged Beyene Berha","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Alemseged","middleName":"Beyene","lastName":"Berha","suffix":""},{"id":621386292,"identity":"f77a48bc-a929-43cb-81d9-0e222bf5336f","order_by":2,"name":"Minyahil Alebachew","email":"","orcid":"","institution":"Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Minyahil","middleName":"","lastName":"Alebachew","suffix":""}],"badges":[],"createdAt":"2025-12-19 06:38:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8401395/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8401395/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107303800,"identity":"5ffc6c9f-304c-4360-947e-a9a6128006a3","added_by":"auto","created_at":"2026-04-20 08:03:44","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25202,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of the mean EQ-5D-5L utility scores of patients with schizophrenia at the outpatient psychiatry clinic of ACSH, Mekelle, Ethiopia, March – June 2023 (n=391).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8401395/v1/bb6bf3b604a38c04d806b074.png"},{"id":107485973,"identity":"df450078-f7d6-4d90-af52-9c6290f426d3","added_by":"auto","created_at":"2026-04-22 02:37:04","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":155499,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePercentage distribution of self-reported health problems using the EQ-5D-5L descriptive dimensions of patients with schizophrenia (n=391).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8401395/v1/701715c6831caecc23df52ae.png"},{"id":107488350,"identity":"a9bae232-f7d2-4bf2-9eda-67a793ebb450","added_by":"auto","created_at":"2026-04-22 02:44:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1869379,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8401395/v1/ef25987a-4e92-477d-9fe1-de11ca586a02.pdf"},{"id":107484526,"identity":"e32e7b78-b87d-4858-acef-1af4a9dae8c4","added_by":"auto","created_at":"2026-04-22 02:32:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":54405,"visible":true,"origin":"","legend":"","description":"","filename":"S2.ethicalconsetanddatacollectiontool..docx","url":"https://assets-eu.researchsquare.com/files/rs-8401395/v1/2520ebce02f9358e5fb66983.docx"},{"id":107483862,"identity":"14c1ec64-724b-4c74-bece-05e04f0184b5","added_by":"auto","created_at":"2026-04-22 02:29:56","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":221724,"visible":true,"origin":"","legend":"","description":"","filename":"S1.SPSSDATASET.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8401395/v1/9a57c16cc9785eb27a4cf349.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health-related quality of life of patients with schizophrenia at a comprehensive specialized hospital in Northern Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSchizophrenia is a severe, chronic, and debilitating psychiatric disorder characterized by abnormal thinking, perceptual disturbances, and diminished or exaggerated emotional expression (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This illness is characterized by an early onset, usually during adolescence, with diagnosis typically occurring between the ages of 15 and 25 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It affects general health, functioning, autonomy, subjective well-being, and life satisfaction for individuals experiencing the illness (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Genetic and environmental factors are believed to be the greatest risk factors for schizophrenia, which is thought to be a multifactorial disorder, despite the exact cause not yet being known (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSchizophrenia has a consistent incidence rate across diverse countries, cultural groups, and genders, with a lifetime prevalence estimated to be between 0.5% and 1% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). According to the World Health Organization, approximately 24\u0026nbsp;million people worldwide suffer from schizophrenia, which is considered one of the top ten illnesses contributing to the global burden of disease (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In Ethiopia, the lifetime prevalence of schizophrenia is reported to be about 0.47% (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), with schizophrenia being among the top ten most burdensome conditions (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndividuals with schizophrenia can manifest three primary types of symptoms: psychotic, negative, and cognitive. Psychotic symptoms include hallucinations, delusions, disorganized speech, and unusual behavior. Negative symptoms comprise alogia, avolition, flat affect, anhedonia, and social isolation. Cognitive impairments involve executive function deficits, memory difficulties, and decreased mental processing speed (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSchizophrenia can have a profound impact on daily life, often leading to social isolation, marginalization, and difficulties in various areas of functioning. People with this illness may struggle with poor living conditions, limited financial resources, inadequate education, and deficits in vocational and social skills, all of which contribute to poor quality of life (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn psychiatry, quality of life has emerged as a widely accepted outcome indicator over the past few decades, as it effectively captures the therapeutic efficacy of psychosocial interventions and pharmacological treatments (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Schizophrenia not only impairs psychosocial functioning, but it also significantly impacts the quality of life of patients through both positive and negative symptoms (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Therefore, the treatment of schizophrenia should aim to enhance the HRQoL of patients, as this has been linked to higher levels of satisfaction with care and improved adherence to treatment (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSchizophrenia patients have a lower HRQoL than the general population, which could be attributed to factors such as the chronic nature of the illness, limited effective treatments, poor treatment outcomes, lack of awareness, societal stigma, and side effects of medications (\u003cspan additionalcitationids=\"CR17 CR18\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Therefore, the treatment approach for this disorder aims to go beyond merely alleviating symptoms, also focusing on enhancing the patient's overall HRQoL. However, clinicians often prioritize treating psychotic symptoms in patients with schizophrenia while overlooking the factors directly linked to patients' quality of life (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, treatment regimens for schizophrenia involve antipsychotic medication, with a primary focus on reducing both positive and negative symptoms. However, improving patients' quality of life has also been acknowledged as a crucial therapeutic objective (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Assessing the factors associated with the quality of life of people with schizophrenia is crucial to mitigate the impact of the disorder and optimize treatment outcomes, ultimately enhancing their overall well-being.\u003c/p\u003e \u003cp\u003eHealth-related disability and dysfunction should be evaluated through HRQoL measures, as they provide a comprehensive understanding of how health conditions impact a person's daily functioning and well-being. A key component in quantifying HRQoL is the health state utility value, a numerical representation reflecting an individual's quality of life by incorporating personal preferences and societal values. This utility value translates subjective health experiences into measurable data, allowing for a standardized assessment of health outcomes. Both HRQoL and health state utility values are crucial for evaluating the necessity and effectiveness of medical interventions from the patient's perspective, ensuring that treatments address the real-life impacts on quality of life. Moreover, health state utility values are widely recognized and favored in health technology assessments because they facilitate cost-effectiveness analyses and support decision-making processes in healthcare policy (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHRQoL can be measured using either generic or disease-specific HRQoL scales. Both generic, like EQ-5D (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) and Short-Form 36-item Health Survey (SF-36) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), and disease-specific HRQoL, like Schizophrenia Quality of Life Scale (SQLS) (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), can be used to assess quality of life in individuals with schizophrenia. Generic scales provide a broad evaluation applicable across various health conditions, allowing for comparative analysis among diverse populations. In contrast, disease-specific scales are designed to capture the unique symptoms, challenges, and functional impairments faced by individuals with particular health issues (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). The use of generic HRQoL scales in assessing schizophrenia has gained significant support. Regulatory bodies in the United States of America (USA), the United Kingdom (UK), and France endorse the integration of HRQoL measures for evaluating treatment effects in individuals with chronic health conditions (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Since health-policy decisions encompass all health conditions, these agencies primarily rely on generic HRQoL measures, such as the EQ-5D. Consequently, generic HRQoL scales are increasingly utilized to assess the health-related quality of life of patients with schizophrenia.\u003c/p\u003e \u003cp\u003eIn Ethiopia, A few studies have explored patients' perspectives on the impact of schizophrenia and its treatments using the SF-36 and the World Health Organization Quality of Life (WHOQOL-BREF) instrument (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). However, there are no prior studies on the HRQoL of schizophrenia patients in Ethiopia using the EQ-5D-5L, and no research has been conducted specifically in the study area focused on this patient population. As a result, healthcare decision-makers in Ethiopia lack well-established utility values for schizophrenia based on various health states of the disease. Therefore, the current study aims to assess HRQoL and determine health state utility values and the factors influencing these values among schizophrenia patients in Ethiopia. The EQ-5D-5L is particularly advantageous as it generates utility values that can inform health policy and resource allocation decisions. This study also assesses the association of HRQoL with antipsychotic polypharmacy, psychiatric symptoms, antipsychotic side effect burden, and early onset of illness at Ayder Comprehensive Specialized Hospital (ACSH), psychiatry clinic, Northern Ethiopia.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy setting, design, and period\u003c/h2\u003e\n \u003cp\u003eA hospital-based cross-sectional study was conducted from March to July 2023 among patients attending an outpatient psychiatry clinic at ACSH in Mekelle, Ethiopia. The hospital is which is one of the largest public referral and teaching hospitals under Mekelle University (MU). The psychiatry unit of ACSH contains sixteen beds for inpatients and an outpatient department that provides services to more than 9000 patients with psychiatric disorders annually.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eRecruitment of participants\u003c/h3\u003e\n\u003cp\u003eAll adult patients with schizophrenia who were in follow-up at the outpatient psychiatry clinic of ACSH were the source population, while all adult schizophrenia patients who were in follow-up and who visited the outpatient psychiatry unit at the time of the data collection were the study population. All adult patients (aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years) with a diagnosis of schizophrenia who had been followed with a minimum of one or more previous visits and were on antipsychotics for at least three months before the initiation of the study were included. In contrast, patients who were acutely disturbed, unable to communicate, whose medication was collected by others on behalf of the patients, who were unwilling to participate in the study, who were unable to complete the interview, and whose medical charts had incomplete records were excluded from the study.\u003c/p\u003e\n\u003cp\u003eThe sample size necessary for this study was determined using a single-proportion sample size estimation formula (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Due to the absence of studies done using EQ-5D-5L in schizophrenia patients and to obtain a maximum sample size, an estimated proportion of patients who had utility values above the average was considered to be 50%, was used to calculate the sample size.\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003eHence, n\u0026thinsp;=\u0026thinsp;Sample size; Z\u0026alpha;/2\u0026thinsp;=\u0026thinsp;Confidence level at 95% = 1.96, P\u0026thinsp;=\u0026thinsp;proportion of patients with utility above the average is 50%, d\u0026thinsp;=\u0026thinsp;margin of error of 5% =0.05\u003c/p\u003e\n\u003cp\u003eThe calculated sample size was 384, and considering 5% of the contingency value, the total calculated sample size was 404. A systematic random sampling method was used to recruit samples for the study. The sampling interval (k\u003csup\u003eth\u003c/sup\u003e) was determined by dividing the total number of schizophrenic patients within the study period by the estimated sample size (k\u003csup\u003eth\u003c/sup\u003e = 866/404\u0026thinsp;\u0026asymp;\u0026thinsp;2). The first patient was selected randomly, and then every other patient was interviewed until the required sample was reached. In this study, 391 study participants were included in the final analysis after excluding patients with incomplete data and those unable to complete the interview. All methods were performed in accordance with the relevant guidelines and regulations. Ethical approval was obtained from the Ethical Review Board of the School of Pharmacy at Addis Ababa University (AAU) (Ref No: ERB/SOP/282/13/2021) and expedited approval from Mekelle University College of Health Science Institutional Review Board (Ref. NO MU-IRB-1871/2021). Before participating, individuals received an information sheet and an informed consent form for review and signature. To maintain confidentiality, interviews were conducted in a private room organized by the hospital staff.\u003c/p\u003e\n\u003ch3\u003eStudy variables\u003c/h3\u003e\n\u003cp\u003eHealth-related quality of life was the main outcome variable, while independent variables were Socio-demographic and behavioral factors (such as sex, age, marital status, educational status, residence, working status, and current substance use). Clinical factors (such as the onset of illness, duration of illness, duration of treatment, number of previous psychiatric hospitalizations, comorbid mental illness, comorbid physical illness, and severity of psychotic symptoms). Medication-related factors (such as anticholinergic drug use, adjuvant medication use, total daily antipsychotic dose, antipsychotic polypharmacy, and antipsychotic medication adherence).\u003c/p\u003e\n\u003ch3\u003eData collection instruments\u003c/h3\u003e\n\u003cp\u003eIn this study, the validated Amharic version of the 5-level EQ-5D (EQ-5D-5L) and the EuroQol-visual analog scale (EQVAS) were used to evaluate HRQoL and generate utility, as developed by the EuroQol Research Foundation (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The EQ-5D-5L is a preference-based, multi-attribute utility evaluation instrument that is widely recommended for generating input data for economic evaluations and assessing patient health states for clinical and economic assessments (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). The EQ-5D-5L is the new version of the original EQ-5D-3L (three levels for each dimension), which essentially consists of two parts: the descriptive system and the EuroQoL Visual Analogue Scale (EQ-VAS). The descriptive system examines five dimensions of HRQoL: mobility (MO), self-care (SC), usual activities (UA), pain/discomfort (PD), and anxiety/depression (AD), with a 5-level response (from 1\u0026thinsp;=\u0026thinsp;no problem to 5\u0026thinsp;=\u0026thinsp;extreme problem). The responses to the five dimensions generated 3125 (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e) combinations of HRQoL states, with \u0026lsquo;11111\u0026rsquo; indicating \u0026lsquo;no problems at all\u0026rsquo; and \u0026lsquo;55555\u0026rsquo; indicating \u0026lsquo;extreme problems\u0026rsquo; in all five dimensions. Each combination was then given a single score using a scoring algorithm based on public preference. The EQ-VAS scale, on which the overall state of health is marked by the patient in the form of a number (0\u0026thinsp;=\u0026thinsp;worst imaginable state of health, 100\u0026thinsp;=\u0026thinsp;best imaginable state of health). The utility value is between the worst and best, on 0 to 1, 0 is for death, and 1 is for perfect health (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe Glasgow Antipsychotic Side-effect Scale (GASS) is an easy-to-use patient self-reported measurement scale consisting of twenty-two questions that cover a wide range of antipsychotic medication-related side effects (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). The GASS assesses side effects such as sedation, cardiovascular side effects, extrapyramidal side effects, anticholinergic side effects, and weight gain. For the first 20 questions, the frequency of side effects was rated on a 4-point scale, ranging from \u0026quot;none\u0026quot; (0 points) to \u0026quot;every day\u0026quot; (3 points), and for the final 2 questions (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), no (0) and yes (3 points). The severity of the side effects experienced by the participants was categorized based on their total GASS score. A score of 0\u0026ndash;12 indicated absent or mild side effects, a score of 13\u0026ndash;26 indicated moderate side effects, and a score greater than 26 indicated severe side effects. This tool has been used in various studies conducted in Ethiopia to assess antipsychotic side effects (\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). Adherence was assessed using the self-reported Morisky Green Levine (MGL) Adherence Scale (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), available online (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.moriskyscale.com/mgl-morisky-green-levine-scale.html#/\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e).\u003c/span\u003e This scale consists of four items, scored as \u0026quot;Yes\u0026quot; = 1 and \u0026quot;No\u0026quot; = 0, resulting in a total score ranging from 0 to 4. Scores were categorized as good adherence (MGL\u0026thinsp;=\u0026thinsp;0) and poor adherence (MGL\u0026thinsp;\u0026ge;\u0026thinsp;1). The PANSS is a well-validated instrument that is widely used for assessing the severity of positive and negative symptoms in schizophrenia patients as well as global psychopathology in schizophrenia patients. It has 30 items (7 items for the positive scale, 7 for the negative scale, and 16 for the general psychopathology scale). Each item is scored from 1 to 7 depending on the severity level of psychopathology, with higher scores indicating greater symptom severity (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The PANSS has been employed in research conducted in Ethiopia among patients with schizophrenia (\u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eData collection procedure and quality assurance\u003c/h3\u003e\n\u003cp\u003eFace-to-face interviews were carried out to collect data on sociodemographic and clinical characteristics, the EQ-5D-5L and EQ-VAS, MGL, GASS, and PANSS. Clinical and medication-related characteristics were collected from the medical chart following patient interviews. The first author (EFY) verified the completeness, accuracy, and consistency of all collected data at the data collection site. A pre-test was conducted on 5% of the sample one week before the actual data collection, leading to necessary adjustments. Respondents from the pre-test were excluded from the data analysis. Data collectors received training and were closely supervised throughout the data collection process. Before analysis, data cleaning was done by observing the descriptive statistics output.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eData Processing and Analysis\u003c/h2\u003e\n \u003cp\u003eData were entered using Epi Info version 7.2.1 and analyzed with STATA version 14. Descriptive analysis was computed as frequency and percent for categorical variables, and mean and standard deviation (SD) for continuous variables. The utility score was calculated using Microsoft Excel 2016. Patient health profiles from EQ-5D-5L were converted into a single index (utility) based on the preference of the general population of Ethiopia, and coefficients that represented level-specific disutility values obtained from the general population were used for computing utility values (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Four dummies were created for each dimension by considering level one as a reference to represent a decrease in utility in moving from one level to the next higher level (e.g., moving from AD1 to AD2 resulted in a utility decrement of 0.0258862) (Eq.\u0026nbsp;1). As EQ-5D-5L utility and EQ-VAS scores were non-normally distributed (Kolmogorov\u0026ndash;Smirnov test and Shapiro-Wilk test, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and histogram inspection revealed skewed towards 1, we presented median (IQR) scores (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The Kruskal-Wallis and Mann-Whitney U tests were used to determine the significant differences in EQ-5D-5L utility value and EQ-VAS score across the sociodemographic, clinical characteristics, and medication-related variables between patient subgroups. Spearman-rank correlation coefficient was used to assess the correlation between the EQ-VAS score, EQ-5D-5L utility index, and PANSS scores. We then established a multivariate Tobit regression model on the EQ-5D-5L utility score to identify variables associated with study participants\u0026apos; HRQoL, including all of the independent variables that showed statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the Kruskal-Wallis and Mann-Whitney U tests (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). The ceiling effect is common in HRQoL studies, which is particularly evident with EQ-5D instruments, leading to some utility scores censored at a point. A general linear regression model is inappropriate for censored data. Therefore, for censored data, the Tobit regression model is advised (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Statistical significance was set at a p-value less than 0.05 at a 95% CI. The results were presented with text, tables, graphs, and charts.\u003c/p\u003e\n \u003cp\u003eUtility value\u0026thinsp;=\u0026thinsp;1 - (MO2 \u0026lowast; 0.0337341\u0026thinsp;+\u0026thinsp;MO3 \u0026lowast; 0.0644715\u0026thinsp;+\u0026thinsp;MO4 \u0026lowast; 0.2276493\u0026thinsp;+\u0026thinsp;MO5 \u0026lowast; 0.3598963) +\u003c/p\u003e\n \u003cp\u003e(SC2 \u0026lowast; 0.0235125\u0026thinsp;+\u0026thinsp;SC3 \u0026lowast; 0.0394815\u0026thinsp;+\u0026thinsp;SC4 \u0026lowast; 0.1419238\u0026thinsp;+\u0026thinsp;SC5 \u0026lowast; 0.2223553) +\u003c/p\u003e\n \u003cp\u003e(UA2 \u0026lowast; 0.0323013\u0026thinsp;+\u0026thinsp;UA3 \u0026lowast; 0.0482993\u0026thinsp;+\u0026thinsp;UA4 \u0026lowast; 0.1573934\u0026thinsp;+\u0026thinsp;UA5 \u0026lowast; 0.2721253) +\u003c/p\u003e\n \u003cp\u003e(PD2 \u0026lowast; 0.0360808\u0026thinsp;+\u0026thinsp;PD3 \u0026lowast; 0.0515949\u0026thinsp;+\u0026thinsp;PD4 \u0026lowast; 0.2703189\u0026thinsp;+\u0026thinsp;PD5 \u0026lowast; 0.4063984) +\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e(AD2 \u0026lowast; 0.0258862\u0026thinsp;+\u0026thinsp;AD3 \u0026lowast; 0.0848133\u0026thinsp;+\u0026thinsp;AD4 \u0026lowast; 0.2987388\u0026thinsp;+\u0026thinsp;AD5 \u0026lowast; 0.4577938)\u003c/h3\u003e\n\u003cp\u003eMO-mobility; SC-self-care; UA-usual activity; P/D-pain/discomfort; A/D-anxiety/depression\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEquation 1:The equation for computing the utility score.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eSociodemographic and Behavioral Characteristics of the Study Participants.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA total of 391 patients with schizophrenia participated in the study (response rate of 96.8%). Among these participants, over half (54.7%,214) were female, with a mean age of 33.97 years (\u0026plusmn;\u0026thinsp;9.06), ranging from 21 to 58 years. Nearly half (49.1%,192) had completed secondary education. A significant majority (86.2%, 337) resided in urban areas. Approximately two-thirds (64.7%, 253) of the participants were unmarried, and just over half (58.3%, 228) were not actively employed. Additionally, nearly a quarter (24.8%,97) reported being active substance users, engaging in behaviours such as alcohol consumption, cigarette smoking, or khat chewing (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and behavioral characteristics of the participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.97\u0026thinsp;\u0026plusmn;\u0026thinsp;9.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent substance use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eClinical and Medication-Related Characteristics of the Study Participants\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that nearly (41.7%, 163) of participants had an earlier age of onset of illness with a mean (\u0026plusmn;\u0026thinsp;SD) of 29.1(\u0026plusmn;\u0026thinsp;8.89) years. Approximately three-fifths (59.1%, 231) had an illness duration of \u0026lt;\u0026thinsp;5 years, and more than two-thirds of the participants (267, 68.3%) had been receiving antipsychotic treatment for less than five years. The mean (\u0026plusmn;\u0026thinsp;SD) psychiatry admission history of these patients was 1.14 (\u0026plusmn;\u0026thinsp;1.34), ranging from no admission to five times. More than half of the study participants (54.7%, 241) had at least one previous psychiatric hospital admission. About one-fifth of the study participants (17.6%, 69) and approximately one-seventh of the participants (14.3%, 56) had co-morbid mental and physical illnesses, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAn assessment of patients' responses to the Morisky Green Levine scale revealed that (55%, 215) exhibited good adherence to antipsychotic medications, while (45%, 176) demonstrated poor adherence, with (25.8%, 101) on antipsychotic polypharmacy. Additionally, (18.2%, 71) and (17.4%, 68) of patients were using anticholinergic and other adjuvant medications, respectively. According to the GASS (46.3%,181), participants reported experiencing either absent or mild side effects, whereas (14.1%, 55) experienced severe side effects. Furthermore, the mean scores for the PANSS positive, negative, and general psychopathology subscales were 17.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.986, 15.82\u0026thinsp;\u0026plusmn;\u0026thinsp;3.246, and 28.66\u0026thinsp;\u0026plusmn;\u0026thinsp;7.071, respectively, resulting in a PANSS total score of 61.66\u0026thinsp;\u0026plusmn;\u0026thinsp;12.509 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDistribution of the mean EQ-5D-5L utility scores of patients with schizophrenia\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and medication-related characteristics of the participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOnset of illness(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of psychiatric hospitalizations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne Admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge; Two Admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCo-morbid Mental Illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCo-morbid physical Illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnticholinergic drug use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdjuvant medication use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Daily Dose in CPZeq dose (mg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e360.73\u0026thinsp;\u0026plusmn;\u0026thinsp;301.813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubtherapeutic (\u0026lt;\u0026thinsp;300 mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOptimum (300\u0026ndash;600 mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh (600\u0026ndash;1000 mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery High (\u0026gt;\u0026thinsp;1000 mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication adherence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSeverity of side effects\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003ebased on GASS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent/mild side effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate side effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere side effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntipsychotic polypharmacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePANSS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean and SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean and SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.82\u0026thinsp;\u0026plusmn;\u0026thinsp;3.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003cp\u003ePsychopathology Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean and SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.66\u0026thinsp;\u0026plusmn;\u0026thinsp;7.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS Total Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean and SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.66\u0026thinsp;\u0026plusmn;\u0026thinsp;12.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003e* Major depressive disorder, Sleep disorder, Anxiety disorder, Substance use disorder: ** Epilepsy, Diabetes mellitus, retroviral infection, and Hypertension: CPZeq: chlorpromazine equivalents\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eHealth-Related Quality of Life of the Study Participants\u003c/h2\u003e \u003cp\u003ePatients\u0026rsquo; self-reported health status for the five dimensions of EQ-5D-5L is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Of the total participants, 73.1% and 63.9% reported \u0026ldquo;no problem\u0026rdquo; in the pain/discomfort and mobility dimension, respectively. In contrast, the most frequent health problems were reported for the \u0026ldquo;anxiety/depression dimension\u0026rdquo; (97.7%, all levels), followed by \u0026ldquo;self-care\u0026rdquo; (82.4%, all levels), and \u0026ldquo;usual activity\u0026rdquo; (81.1%, all levels) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The study participants had an EQ-VAS score median (IQR) of 65 (\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e), and their median (IQR) EQ-5D-5L utility value was 0.859 (0.774\u0026ndash;0.917). Conversely, the mean (SD) EQ-VAS score and EQ-5D-5L utility value were 64.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.12 and 0.813\u0026thinsp;\u0026plusmn;\u0026thinsp;0.137, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003ePercentage distribution of the five-dimensional EQ-5D-5 L questionnaire of patients with schizophrenia at ACSH, Mekelle, Ethiopia, 2023\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe Mann‒Whitney U test and the Kruskal‒Wallis H test revealed significant differences in the median (IQR) EQ-5D-5L utility and EQ-VAS score across different variables: sex, marital status, working status, current substance use, duration of illness, duration of treatment, psychiatric hospitalization, comorbid physical illness, antipsychotic polypharmacy, total daily dose, anticholinergic drug use, medication adherence, and side effect burden, with a p-value of \u0026lt;\u0026thinsp;0.05 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMedian (IQR) differences in the EQ-5D-5L utility and EQ-VAS scores with patient demographic, clinical, and medication characteristics (n\u0026thinsp;=\u0026thinsp;391).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQ-VAS score median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEQ-5D-5L index score median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOverall scores\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859 (0.774\u0026ndash;0.917)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e176.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.843(0.646\u0026ndash;0.885)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e175.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.810\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e213.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.882(0.831\u0026ndash;0.938)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e227.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e188.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.646\u0026ndash;0.885)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e181.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e194.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.795\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e199.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.795\u0026ndash;0.917)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e202.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(58.75-70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e195.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.774\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e196.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.803(0.612\u0026ndash;0.882)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e138.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.5(55-78.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e199.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.863(0.798\u0026ndash;0.916)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e202.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.833(0.790\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e194.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.031\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(56.25-70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e209.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.822(0.801\u0026ndash;0.939)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e231.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e190.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.698\u0026ndash;0.980)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e189.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e200.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.847(0.779\u0026ndash;0.890)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e183.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.776\u0026ndash;0.917)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e196.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.5(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.742\u0026ndash;0.898)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e189.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e215.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.863(0.815\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e217.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.858(0.669\u0026ndash;0.908)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e184.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eContinued\u0026hellip;\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQ-VAS score median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEQ-5D-5L index score median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent substance use\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.826(0.635\u0026ndash;0.880)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e158.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e208.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.801\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e208.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOnset of illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.646\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e194.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.783\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.795\u0026ndash;0.915)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e197.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.882(0.831\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e226.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.810(0.629\u0026ndash;0.867)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e148.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.826(0.743\u0026ndash;0.874)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e159.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.867(0.802\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e215.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.819(0.634\u0026ndash;0.867)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e151.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.5(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.826(0.617\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e172.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of psychiatry hospitalizations\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e226.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.882(0.826\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e230.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne Admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.797\u0026ndash;0.915)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e200.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge; Two Admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.826(0.613\u0026ndash;0.872)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e149.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCo-morbid Mental Illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e152.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.831(0.635\u0026ndash;0.883)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e173.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e205.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.790\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e200.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCo-morbid physical Illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.800(0.640\u0026ndash;0.859)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e139.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e206.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.795\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e205.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e: \u003cb\u003eContinued\u003c/b\u003e\u003cb\u003e\u0026hellip;\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQ-VAS score median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEQ-5D-5L index score median (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMean rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntipsychotic polypharmacy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.810(0.610\u0026ndash;0.859)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e136.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.867(0.810\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e216.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnticholinergic drug use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.810(0.596\u0026ndash;0.859)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e131.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e207.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.797\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e210.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdjuvant medication use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e190.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.791\u0026ndash;0.892)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e195.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e197.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.859(0.774\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Daily Dose\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubtherapeutic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.872(0.823\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e223.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOptimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.831(0.612\u0026ndash;0.882)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e164.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.813(0.656\u0026ndash;0.863)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e147.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.599(0.513\u0026ndash;0.885)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e122.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug adherence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e226.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.882(0.843\u0026ndash;0.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e229.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.811(0.613\u0026ndash;0.882)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e155.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSide effect burden\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eabsent/mild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70(\u003cspan additionalcitationids=\"CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73 CR74\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e232.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.883(0.859\u0026ndash;0.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e239.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65(\u003cspan additionalcitationids=\"CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68 CR69\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e182.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.833(0.767\u0026ndash;0.885)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e178.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55(\u003cspan additionalcitationids=\"CR51 CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64\" citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.635(0.583\u0026ndash;0.833)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eEQ-5D-5L: EuroQoL life questionnaires with five dimensions and five levels; EQ-VAS: EuroQoL visual analogue scale; IQR: Interquartile Range.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThere were significant, modest negative correlations between PANSS positive score with the EQ-5D-5L utility and the EQ-VAS scores, and significant weak negative correlations between negative and general psychopathology symptoms scores with EQ-5D-5L utility and EQ-VAS scores. The Spearman rank correlation coefficient between mean scores of PANSS positive, negative, and general psychopathology symptoms scores and the EQ-5D-5L utility score was \u0026minus;\u0026thinsp;0.329, -0.178, and \u0026minus;\u0026thinsp;0.214, respectively. The correlation between PANSS positive, negative, and general psychopathology symptoms scores and EQ-VAS scores was \u0026minus;\u0026thinsp;0.321, -0.149, and \u0026minus;\u0026thinsp;0.216, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman rank correlation coefficient between the PANSS score and HRQoL scale (EQ-5D-5L and EQ-VAS).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePANSS SCORE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQ-5D-5L Utility\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEQ-VAS score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive symptoms score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative symptoms score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral Psychopathology symptoms score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eEQ-5D-5L: EuroQoL life questionnaires, five dimensions with five levels; EQ-VAS: EuroQoL visual analog scale; HRQoL: health-related quality of life.\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e5.7. Factors Associated with Health-Related Quality of Life.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA multivariate Tobit regression model was used to identify variables associated with the HRQoL, and it revealed that being not working (β = -0.033, 95% CI=-0.059, -0.070), presence of comorbid physical illness (β = -0.060, 95% CI = -0.097, -0.023), have antipsychotic polypharmacy (β = -0.040, 95% CI= -0.075, -0.006), poor medication adherence (β = -0.043, 95% CI= -0.072, -0.013), and experiencing a severe side effect (β = -0.081, 95% CI=-0.135, -0.028) were significantly negatively associated with the EQ-5D-5L utility score. Conversely, female sex (β\u0026thinsp;=\u0026thinsp;0.0332, 95% CI\u0026thinsp;=\u0026thinsp;0.007, 0.059) was significantly positively associated with the EQ-5D-5L utility score. Similarly, divorce (β = -4.035, 95% CI = -7.737, -0.334) and the presence of comorbid medical illness (β = -5.462, 95% CI = -8.263, -2.661) were negatively associated with the EQ-VAS score, whereas female sex (β\u0026thinsp;=\u0026thinsp;3.323, 95% CI\u0026thinsp;=\u0026thinsp;1.373, 5.273) was positively associated with the EQ-VAS score (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with HRQoL in patients with schizophrenia at the outpatient psychiatry clinic of ACSH, Mekelle, Ethiopia, March - June 2023 (n\u0026thinsp;=\u0026thinsp;391).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQ-5D-5L utility score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEQ-VAS score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ-Coefficient [95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ-Coefficient [95% CI]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, female Ref (male)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.0332(0.007;0.059)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.323(1.373;5.273)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status \u003cb\u003e(Ref\u0026thinsp;=\u0026thinsp;single)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.388(-2.471;1.694)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-4.035(-7.737; -0.334)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.708(-4.637;6.055)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWorking status, Ref (working)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.033(-0.059; -0.070)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComorbid physical illness, Ref (No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.060(-0.097; -0.023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.462(-8.263; -2.661)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntipsychotic polypharmacy, Ref (No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.040(-0.075; -0.006)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedication adherence, Ref (Good adherence)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor adherence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.043(-0.072; -0.013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSide effect burden, Ref(absent/mild)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.011(-0.042;0.019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.081(-0.135;-0.028)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eEQ-5D-5L: EuroQoL life questionnaires five dimensions with five levels; EQ-VAS: EuroQoL visual analog scale; CI: Confidence Interval\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined the HRQoL of outpatients with schizophrenia using the EQ-5D-5L. The median EQ-VAS score (65%) was lower than the general Ethiopian population (median of 90%) (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). This reduced quality of life aligns with evidence that schizophrenia patients typically have a lower HRQoL compared to the general population (\u003cspan additionalcitationids=\"CR50 CR51\" citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). Similar to previous studies, the current study revealed that patients with schizophrenia reported problems with all descriptive dimensions of the EQ-5D-5L (\u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). A significant proportion of outpatients in our study reported problems with anxiety/depression, self-care, and daily activities, which suggests their HRQoL is impacted not only by mental function, but also by daily functioning. To support social reintegration and daily functioning, a safe and secure living environment that addresses their physical, social, and mental needs is crucial. Clinicians and family members must understand their specific challenges and take targeted steps to address them.\u003c/p\u003e \u003cp\u003eThe study revealed that the mean EQ-5D-5L utility value for patients with schizophrenia was 0.813, which was lower than the mean for the general Ethiopian population (0.94) (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). This difference can be attributed to the multitude of challenges faced by individuals with schizophrenia. These include positive and negative symptoms, a chronic nature, and long-term treatment of the illness, as well as its debilitating medication side effects and social stigma, leading to marginalized living conditions, poor housing, low income, limited education, and inadequate vocational and social skills (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCompared with previous studies, our mean EQ-5D-5L utility score (0.81) was lower than that reported in the Serbian study (0.86) (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), and approximately similar to that reported in two studies from Singapore (0.82 and 0.81) (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e), and Taiwan (0.80) (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e), but higher than reported in Europeans (0.57) (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e), the UK (0.69) (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e), and Japan (0.77) (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). These discrepancies may be attributed to differences in patient characteristics, sociocultural beliefs, medication availability, healthcare systems, and access, as well as the value set used, which could have contributed to these variations.\u003c/p\u003e \u003cp\u003eFurthermore, our study identified factors associated with HRQoL. A statistically significant association was found between the EQ-5D-5L utility score and female sex, being not working, the presence of comorbid physical illness, antipsychotic polypharmacy, poor medication adherence, and experiencing severe side effects.\u003c/p\u003e \u003cp\u003eThe findings of the present study are consistent with those of other studies that revealed the female sex was associated with higher QOL when compared to males with schizophrenia (\u003cspan additionalcitationids=\"CR63\" citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). One possible explanation is that the early onset of psychosis in males, which is often associated with a more severe clinical presentation, can also have devastating consequences, including disadvantages in schooling, employment, friendships, and intimate relationships may contribute to poor HRQoL in males (\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e). The other possible reason could be that females tend to have higher estrogen levels, which have an antidopaminergic effect that may contribute to a milder course of illness (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). This could explain why females have a better HRQoL than males with schizophrenia, which is supported by a literature review suggesting that, compared to males, females with schizophrenia have a better response to medications, a more favorable prognosis of illness, and better social functioning (\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother factor that was negatively associated with HRQOL in the current study was that participants who were not working had a lower HRQoL compared to those who were working. This finding was supported by studies done in China (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e) and Jordan (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). The chronic nature of schizophrenia and its clinical symptoms, such as a lack of motivation and goal-oriented activity, often make it challenging for individuals to consistently perform job duties. This can lead to job loss and unemployment, which in turn can contribute to financial hardship, social isolation, decreased self-esteem, and a loss of daily structure. Our results suggest that having a job plays a key role in the daily life of the individual, which is supported by the previous literature, showing that occupation not only results in financial gain but also promotes individual integration in the community and supports the perception of self-worth and growth (\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe presence of co-morbid physical illness was also a factor that negatively affected HRQoL in our study. Our finding was consistent with studies done in Ethiopia (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e), Nigeria (\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e), and A multi-centered study of eight countries (\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e). Chronic medical conditions can negatively impact HRQoL by causing physical impairments, such as pain, balance issues, and reduced strength, which limit physical function and activity, leading to overall HRQoL deterioration. (\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e). Our findings indicate that early detection and treatment of comorbid physical illnesses in individuals with schizophrenia are crucial for achieving better treatment outcomes and improving their overall quality of life.\u003c/p\u003e \u003cp\u003eThis study also revealed that non-adherence to antipsychotic medications is significantly and negatively associated with HRQoL, and this result is in line with the previous studies in Nigeria (\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e) and Ethiopia (\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). Similarly, another study from Nigeria showed that good medication adherence is positively associated with good HRQoL (\u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e). This could be because non-adherence to medication may contribute to poor symptom control, increased risk of relapse, and decreased functionality, ultimately leading to a further decline in mental health and health-related quality of life. These findings indicate that medication adherence plays a crucial role in the quality of life of individuals with schizophrenia and that improving medication adherence through counselling and follow-up is a promising approach to enhancing the quality of life of individuals with schizophrenia.\u003c/p\u003e \u003cp\u003eIn the present study, experiencing severe side effects, as reflected by higher GASS scores, was found to be a factor that is significantly and negatively associated with patients' HRQoL, and our finding is consistent with those of previous studies, including a multicenter study across seven countries (\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e) and Japan (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). The adverse effects of antipsychotics (including Extrapyramidal Symptoms (EPS), sexual dysfunction, sedation, and weight gain) have also been reported to be associated with lower EQ-5D scores and decreased utility scores (\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e). Our finding suggests that the burden of antipsychotic side effects can significantly impact patients' HRQoL. The negative impact of side effects on quality of life can be attributed to reduced functional capacity, emotional distress, decreased adherence, stigma, and social withdrawal. Therefore, effective side effect management is essential, and strategies such as regular monitoring and dose optimization are necessary to alleviate the burden of antipsychotic side effects and enhance HRQoL.\u003c/p\u003e \u003cp\u003eAntipsychotic polypharmacy (APP), which is defined as the use of two or more antipsychotic medications, was also another factor that was significantly and negatively associated with HRQoL in the current study. This finding is consistent with studies done in Germany (\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e), Turkey (\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e), and Ethiopia (\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e). This might be due to the fact that APP, which is associated with greater illness severity, treatment resistance, higher overall doses, side effects, higher use of concurrent anticholinergic medications, drug interaction, non-adherence, and increasing cost of treatment (\u003cspan additionalcitationids=\"CR83\" citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e), may contribute to a negative impact on the HRQoL for individuals with schizophrenia. In addition, attributed to the fact that the most common combination of APP in our participants was the combination of two first-generation antipsychotics (FGAs), which is known to increase the risk of EPS and other side effects (\u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e). Furthermore, patients on APP exhibited higher symptom scores on measurement scales compared to those on APM, and a significant proportion (32.6%) of APP users experienced severe side effects, which may have contributed to the lower HRQoL observed in this group. Consequently, implementing targeted programs for optimal antipsychotic utilization and regular follow-up care may need to improve the HRQoL for individuals with schizophrenia receiving APP.\u003c/p\u003e \u003cp\u003eContrary to our findings, a study done in China reported that APP was associated with higher QOL (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This discrepancy could be attributed to the difference in the HRQoL measurement tool used and the influence of social support from family members, which the author suggested as a possible explanation for the better mental health-related QOL in the APP group. Another possible explanation could be that the difference in HRQoL between the two groups could be difficult to detect in clinically stable outpatients.\u003c/p\u003e \u003cp\u003eOur study has some limitations. First, since this is a cross-sectional study, it is not possible to demonstrate causal relationships between associated factors and HRQoL. Additionally, the generalizability of the results is limited, as patients were recruited from a single tertiary hospital. Moreover, the study did not assess important factors such as social support and stigma, which could significantly influence HRQoL in schizophrenia patients. Despite these limitations, this study was the first to establish the utility value and to assess the association between HRQoL and symptom severity, onset of illness, antipsychotic side effect burden, and antipsychotic polypharmacy in patients with schizophrenia in Ethiopia. Importantly, our study generated utility values based on a value set specific to the Ethiopian population (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), thereby minimizing potential bias since preference-based measures of HRQoL can vary across different populations. These findings are valuable for practitioners and policymakers in designing strategies to improve schizophrenia care, as the utility weights produced are essential for future economic evaluations. Consequently, the utility values derived from the EQ-5D-5L can be utilized for cost-utility analyses and to prioritize interventions, programs, and policies aimed at enhancing health outcomes for Ethiopian patients with schizophrenia. Furthermore, the study enrolled a large sample size, which increases the precision of the findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe study found that outpatients with schizophrenia had lower HRQoL compared to the non-schizophrenic general population in Ethiopia, as measured by the EQ-5D-5L utility and EQ-VAS scores. Most patients reported problems in the Anxiety/depression and self-care dimension of EQ-5D-5L. Being not working, the presence of comorbid medical illness, antipsychotic polypharmacy, poor medication adherence, and experiencing a severe side effect were significantly negatively associated with HRQoL. Conversely, the female sex was significantly positively associated with HRQoL. Hence, interventions to improve HRQoL should focus on enhancing medication adherence, monitoring and managing medication side effects, optimizing medication, managing comorbidities, and providing employment support. The health preference-based utility value generated in this study could be used to monitor clinical outcomes and conduct economic evaluations of different healthcare interventions in patients with schizophrenia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAAU\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAddis Ababa University\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAPP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntipsychotic Polypharmacy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCPZeq\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChlorpromazine Equivalents\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEQ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003e5D\u003c/b\u003e-\u003cb\u003e3L\u003c/b\u003e-EuroQoL 5-Dimensions 3-Levels\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEQ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003e5D\u003c/b\u003e-\u003cb\u003e5L\u003c/b\u003e-EuroQoL 5-Dimensions 5-Levels\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEQ\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003eVAS\u003c/b\u003e-EuroQoL Visual Analogue Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEPS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExtrapyramidal Symptoms\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eFGA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFirst-Generation Antipsychotics\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGASS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlasgow Antipsychotic Side-effect Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHRQoL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth-Related Quality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIQR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile Range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMGL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMorisky Green Levine Adherence Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMO\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMobility\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePain/Discomfort\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSelf-Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSF\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003e36\u003c/b\u003e-Short-Form 36-item Health Survey\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSQLS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSchizophrenia Quality of Life Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUsual Activities\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUK\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUSA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited States of America\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eWHOQOL\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e \u003cb\u003eBREF\u003c/b\u003e-World Health Organization Quality of Life Brief\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnxiety/Depression\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethical Review Board of the School of Pharmacy at Addis Ababa University (AAU) (Ref No: ERB/SOP/282/13/2021) and expedited approval from Mekelle University College of Health Science Institutional Review Board (Ref. NO MU-IRB-1871/2021). Additionally, permission was secured from the study site department and the head of the psychiatry unit. Informed consent was obtained from all participants prior to their participation in the study, and they were informed of their right to decline participation or withdraw at any time. \u0026nbsp;The study\u0026apos;s purpose was explained before the interview, and participants\u0026apos; anonymity and confidentiality were ensured by removing personal identifiers and restricting access to the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data are within the manuscript. If additional information is needed, it is available from the corresponding author upon reasonable request.\u003cdel cite=\"mailto:Editor%202\" datetime=\"2025-09-23T11:53\"\u003e\u0026nbsp;\u003c/del\u003e\u003cdel cite=\"mailto:Editor%202\" datetime=\"2025-09-23T11:53\"\u003e\u0026nbsp;\u003c/del\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEFY conceived and designed the study, developed the proposal, and actively participated in data collection. EFY, MA, and ABB contributed to the data analysis, interpretation, and drafting of the manuscript. All the authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the study participants for their willingness to participate in this study and for giving their valuable time to respond to the questions. We are also thankful to the data collectors and supervisors, administrators, and staff of the hospital for their cooperation during the data collection process. Finally, we are grateful to thank the School of Pharmacy, College of Health Sciences, Addis Ababa University, for supporting the study. Additionally, we wish to express our heartfelt gratitude to Abraham G. Welie for his unwavering support throughout this research work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePicchioni MM, Murray RM. Schizophrenia. Bmj. 2007;335(7610):91-5.\u003c/li\u003e\n \u003cli\u003eWalker E, Kestler L, Bollini A, Hochman KM. Schizophrenia: etiology and course. Annu Rev Psychol. 2004;55(1):401-30.\u003c/li\u003e\n \u003cli\u003eWang W-L, Zhou Y-Q, Chai N-N, Li G-H. Sleep disturbance and quality of life in clinically stable inpatients with schizophrenia in rural China. Quality of Life Research. 2020;29:2759-68.\u003c/li\u003e\n \u003cli\u003eSolmi M, Seitidis G, Mavridis D, Correll CU, Dragioti E, Guimond S, et al. Incidence, prevalence, and global burden of schizophrenia-data, with critical appraisal, from the Global Burden of Disease (GBD) 2019. 2023:1-9.\u003c/li\u003e\n \u003cli\u003eKessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. 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Schizophrenia research. 2012;138(1):18-28.\u003c/li\u003e\n \u003cli\u003eSan Ang M, Rashid NAA, Lam M, Rapisarda A, Kraus M, Keefe RS, et al. The impact of medication anticholinergic burden on cognitive performance in people with schizophrenia. Journal of Clinical Psychopharmacology. 2017;37(6):651.\u003c/li\u003e\n \u003cli\u003eAyano GJR, Chemistry RJo. First generation antipsychotics: pharmacokinetics, pharmacodynamics, therapeutic effects and side effects: a review. 2016.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"EQ-5D-5L, Utility, HRQoL, antipsychotic polypharmacy, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-8401395/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8401395/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSchizophrenia is a severe psychiatric disorder significantly affecting individuals' health, functioning, and health-related quality of life (HRQoL). Here, we aimed to assess HRQoL, associated factors of HRQoL, and utilities among schizophrenia outpatients at Ayder Comprehensive Specialized Hospital, Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA hospital-based cross-sectional study was conducted from March 13th to June 11th, 2023, at Ayder Comprehensive Specialized Hospital, Ethiopia. Data were collected from 391 randomly sampled patients with patient interviews and chart reviews. The validated Amharic version Euro Quality of Life (EQ-5D-5L questionnaire was used to assess the HRQOL. Descriptive statistics were used to present patient characteristics. Kruskal-Wallis and Mann-Whitney U tests were performed to explore differences in the median scores of EQ-5D-5L utility and visual analog scale. Multivariable Tobit regression models were employed to identify factors associated with HRQoL. Utility scores were calculated using disutility weights of the Ethiopian general population. P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age of the study participants was 33.97\u0026thinsp;\u0026plusmn;\u0026thinsp;9.061 years. The mean (SD) PANSS scores of the study participants were: positive symptoms, 17.18 (3.986); negative symptoms, 15.82 (3.246); general psychopathology, 28.66 (7.071); and total score, 61.66 (12.509). The most frequently reported health problems were the anxiety/depression dimension (97.7%) and self-care (82.4%). The median [IQRs] EQ-5D-5L utility value and EQ-VAS score of the study participants were 0.859 [0.774\u0026ndash;0.917] and 65 [55\u0026ndash;70], respectively. Being not working, the presence of comorbid physical, being on antipsychotic polypharmacy, poor medication adherence, and experiencing a severe side effect were significantly negatively associated with the EQ-5D-5L utility score. Conversely, female sex was significantly positively associated with EQ-5D-5L utility score.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOverall, patients with schizophrenia reported a lower HRQoL compared to the general population. The anxiety/depression and self-care dimensions were identified to have a critical influence on reducing the HRQoL of adult schizophrenia patients in the context of Ethiopia. This study also provides estimates of EQ-5D utility scores that can be used in economic evaluations.\u003c/p\u003e","manuscriptTitle":"Health-related quality of life of patients with schizophrenia at a comprehensive specialized hospital in Northern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-20 08:03:40","doi":"10.21203/rs.3.rs-8401395/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-10T08:10:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-07T14:40:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-24T19:59:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-23T06:39:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-12-23T06:25:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"838a92dc-670f-4087-ba12-e269e20c07bb","owner":[],"postedDate":"April 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":66130379,"name":"Health sciences/Diseases"},{"id":66130380,"name":"Health sciences/Health care"},{"id":66130381,"name":"Health sciences/Medical research"},{"id":66130382,"name":"Biological sciences/Psychology"},{"id":66130383,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-04-20T08:03:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-20 08:03:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8401395","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8401395","identity":"rs-8401395","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}