Association of depressive symptoms with worse functioning in schizophrenia: A study in older outpatients

Background: Subsyndromal depressive symptoms are highly prevalent and assoc iated with substantial impairments of daily function in the general populat ion. Depressive symptoms are common in schizophrenia. However, few studies have examined the relationship of functioning and well-being to the presenc e of depressive symptoms in schizophrenia. Method. 202 middle-aged or elderly outpatients with schizophrenia (DSM-IH-R or DSM-IV criteria) were categorized by severity of depressive symptoms on the Hamilton Rating Scale for Depression (HAM-D) using previously validate d cutoff points, i.e., HAM-D total score less than or equal to 6 (low), fro m 7 to 16 (medium), and greater than or equal to 17 (high). We also assesse d severity of positive and negative symptoms, movement disorders, neurocogn itive performance, daily functioning, and health-related quality of well-be ing with standardized measures. Results: A total of 11.4% of patients had HAM-D scores greater than or equa l to 17, and 56.4% had HAM-D scores from 7 to 16. Even after adjusting for severity of other psychopathology, patients with more severe depressive sym ptoms had significantly worse everyday functioning (p < .02), except for ph ysical functioning, and health-related quality of well-being (r = -.365, p < .001) than did those with lower HAM-D scores. These differences were unre lated to those in demographics, extrapyramidal symptoms, tardive dyskinesia , neurocognitive performance, or number of physical illnesses. Conclusion: The results suggest the importance of evaluating schizophrenia patients for the presence of depressive symptoms. Effectiveness of adjunct treatment of depressive symptoms with antidepressants and psychosocial mana gement in improving functioning of schizophrenia patients deserves further study.