Happiness in schizophrenia

Schizophrenia is among the most severe forms of mental illness, yet some people with the disease are as happy as those in good physical and mental health according to a study led by researchers at the University of California, San Diego School of Medicine.

The study is published online this week in the journal Schizophrenia Research.

“People tend to think that happiness in schizophrenia is an oxymoron,” said senior author Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences.

“Without discounting the suffering this disease inflicts on people, our study shows that happiness is an attainable goal for at least some schizophrenia patients,” said Jeste, who is also the Estelle and Edgar Levi Chair in Aging and director of the Sam and Rose Stein Institute for Research on Aging at UC San Diego. “This means we can help make these individuals' lives happier.”

In a survey of people with the disease, researchers found that 37 percent of patients reported being happy all or most of the time.

Of clinical significance in terms of helping people with mental illness, the patients' happiness was unrelated to the severity or duration of their illness, to cognitive or physical function or to socioeconomic factors such as age and education, which among healthy adults have been linked to a greater sense of well-being.

Instead, the study shows that happiness among those with chronic forms of schizophrenia is associated with positive psychological and social attributes such as resilience, optimism and lower perceived stress.

The researchers believe that these positive psychosocial attributes could be taught through behavioral modification and mindfulness training techniques.

The study is based on a survey of 72 English-speaking outpatients with schizophrenia in the San Diego area. At the time of the survey, all but nine of the patients were on at least one anti-psychotic medication and 59 percent were residents in assisted-living facilities.

The comparison group for the study included 64 healthy men and women who were part of an ongoing study on successful aging. These participants were not currently using alcohol or illicit substances and did not have diagnoses of dementia or other neurological problems. Participants ranged in age from 23 to 70 years old; the mean age for both groups was 50 years.

The survey probed respondents' happiness during the previous week, asking them to rate statements such as “I was happy” and “I enjoyed life” on a scale from “never or rarely” to “all or most of the time.”

Responses suggest that about 37 percent of schizophrenia patients were happy most or all of the time, compared with about 83 percent for those in the comparison group.

Approximately 15 percent of schizophrenia patients reported being never or rarely happy. By contrast, none of in the comparison group reported such a low level of happiness for the week prior.

People's self-reported happiness was then examined in relation to other factors, such as age, gender, education, living situation, medication status, anxiety levels and other mental health metrics, as well as physical health, cognitive function, and a list of “psychosocial factors” that included perceived stress, attitude toward aging, spirituality, optimism, resilience and personal mastery.

“People with schizophrenia are clearly less happy than those in the general population at large, but this is not surprising,” said lead author Barton W. Palmer, PhD, professor in the UC San Diego Department of Psychiatry. “What is impressive is that almost 40 percent of these patients are reporting happiness and that their happiness is associated with positive psychosocial attributes that can be potentially enhanced.”

Co-authors include A'verria S. Martin and Danielle K. Glorioso, UC San Diego; and Colin Depp, UC San Diego and Veterans Affairs San Diego Healthcare System.

The study was funded in part by the National Institute of Mental Health (grants 5R01MH094151 and 5T32MH019934) and Sam and Rose Stein Institute for Research on Aging at UC San Diego.