Investigating the predictors of happiness, life satisfaction and success in schizophrenia

Highlights

• Patients with schizophrenia were not significantly less happy than healthy controls.

• Self-reported life satisfaction and success (LSS) was reduced in schizophrenia.

• Motivation deficits and depression predict lower levels of happiness and LSS.

• No robust link between functional impairments and lower happiness or LSS.

Abstract

Background

Previous studies have suggested that, despite marked functional impairments, remitted first episode patients with schizophrenia report levels of well-being that are comparable to healthy controls. The aim of the current study was to specifically evaluate self-reported happiness, life satisfaction and success in individuals with schizophrenia beyond their first-episode of psychosis, and to investigate the impact of symptoms and functioning on these subjective experiences.

Methods

Fifty-one schizophrenia patients and 56 matched healthy controls participated in the study. Factor scores were computed to compare happiness and life satisfaction and success (LSS) between groups. Hierarchical multiple regression analyses were conducted to investigate the predictive value of symptoms and functional impairments on patients' subjective reports of happiness and LSS.

Results

Schizophrenia participants endorsed lower levels of LSS compared to healthy controls, with no significant group differences in self-reported happiness. For patients with schizophrenia, motivation deficits and depressive symptoms predicted reductions in both happiness and LSS.

Conclusions

Patients with schizophrenia do not report significant reductions in their subjective experience of happiness, but do endorse lower levels of life satisfaction and success. Further, the absence of a robust link between poor functioning and lower happiness or LSS serves to reaffirm the notion that functional status does not dictate whether an individual with schizophrenia experiences a sense of happiness, satisfaction or success in life.

Introduction

According to the second World Happiness Report, mental illness is the single most important cause of unhappiness, hindering one's ability to flourish and lead a fulfilling life in accordance with the values at the core of the human condition [1]. This report, however, focused primarily on depressive and anxiety disorders, and did not evaluate the influence of schizophrenia, one of the most debilitating mental illnesses in the world. Characterized by persistent psychopathological symptoms and linked to enduring functional disability, it would be expected that individuals with schizophrenia are at least similarly unhappy and unsatisfied with their lives overall – especially compared to healthy individuals.

Recent findings, however, have begun to challenge these assumptions. For instance, remitted first-episode schizophrenia patients have reported levels of happiness, life satisfaction and sense of success that were comparable to healthy controls despite marked functional impairments [2], [3], although not consistently [4]. In these younger early episode samples, lower levels of happiness and life satisfaction have been associated with more severe negative and depressive symptoms, as well as worse functional outcomes [2], [4]. Studies of individuals with chronic schizophrenia have similarly revealed equivalent self-reported life satisfaction [5], [6], despite experiencing lower psychological well-being, although with some findings of a reduction in happiness [7]. Further, a recent study conducted by Edmonds et al [8] found that in a sample of older individuals with chronic schizophrenia, over one-third of the patients reported levels of positive psychological factors such as happiness, optimism, resilience, and perceived stress that were on par with healthy controls. In populations with longer durations of illness, symptom severity has also been associated with life satisfaction [5], but not with happiness [7].

Although happiness and life satisfaction are often equated with quality of life (QoL), it is important to note that these constructs are inherently distinct and represent separate components of well-being. Specifically, QoL is a broad construct that refers to the objective indicators and predefined determinants of overall well-being, whereas happiness and life satisfaction are subjective and internally defined experiences [2], [9]. That being said, happiness is associated with numerous objective societal values including physical and mental health, as well as occupational and interpersonal success [10], [11], [12], [13], [14], [15]. Indeed, that happiness, health, and functioning are so deeply intertwined has led many to infer that good health and high levels of functioning are prerequisites for happiness. However, the above findings raise the intriguing and somewhat counterintuitive notion that many patients with schizophrenia maintain the capacity for happiness and continue to report satisfaction with life despite chronic symptoms and functional impairments. Taken together, this apparent disconnect raises the question of whether functioning is relevant or even related to happiness and life satisfaction for individuals with schizophrenia, particularly for those with longer durations of illness where this has not been explored extensively. Thus, the aim of the current study was to specifically evaluate and compare self-reported levels of happiness, life satisfaction, and success in individuals with schizophrenia beyond their first-episode of psychosis to healthy individuals. Additionally, we sought to investigate the impact of objective illness-related symptoms and disturbances on subjective reports of happiness and life satisfaction for individuals with schizophrenia. We hypothesized that individuals with schizophrenia and healthy controls would report comparable levels of happiness, life satisfaction and success, and that these subjective experiences would not be related to functional impairments for schizophrenia patients.