Quality of life in patients with schizophrenia: A systematic review and meta-analysis of case-control studies

Background Although numerous studies have examined the impact of schizophrenia on quality of life (QoL), the results have been mixed. This meta-analysis compared QoL across various domains between schizophrenia patients and healthy controls and identified the moderators of group differences. Methods A meta-analysis of case-control studies was conducted following PRISMA guidelines. Major international databases (PubMed, Web of Science, EMBASE and PsycINFO) and Chinese databases (CNKI and Wanfang) were searched from their inception to December 2024. Studies comparing QoL between patients with schizophrenia and healthy controls using standardized validated instruments (e.g., WHOQOL, SF-36) were included. Standardized mean differences (SMDs) were calculated using a random-effects model. Subgroup and meta-regression analyses were performed to explore the moderators of group differences. Results Thirty-six studies (5664 patients; 5042 controls) met the inclusion criteria, revealing significant QoL impairment in patients across all domains. Deficits were most pronounced in the physical domain (WHOQOL: SMD = −1.52; SF-36: SMD = −1.16; GQOLI: SMD = −2.38) and social domain (WHOQOL: SMD = −1.33; SF-36: SMD = −1.24; GQOLI: SMD = −2.56), with notable impairment also in psychological (WHOQOL: SMD = −1.11) and environmental (WHOQOL: SMD = −0.87) domains. Meta-regression demonstrated that more severe negative symptoms score (β = −0.051, p  = 0.043) and greater general psychopathology (β = −0.038, p  = 0.049) were significantly associated with poorer environmental QoL. Conclusion This meta-analysis demonstrated that patients with schizophrenia have significant QoL impairment across multiple domains, particularly in the physical and social functioning domains. These findings highlight the need to address clinical moderators to develop patient-centered interventions.