Life engagement as a new outcome measure for people with schizophrenia

Life engagement represents a holistic construct that encompasses different outcomes, including life satisfaction, well-being and participation in valued and meaningful activities. Recent research emphasizes the importance of life engagement in improving well-being and quality of life of individuals with schizophrenia. Life engagement can be considered as a salient patient-reported outcome, that takes into account the patients view, with their own experiences. Life engagement should be included as a new outcome measure in schizophrenia patients, in particular in those studies that evaluate the benefits and risks of pharmacological, psychological, and psychosocial treatment, in order to achieve recovery in this population. 

Article

Schizophrenia is a severe and chronic mental disorder that affects millions of people worldwide, characterized by delusions, hallucinations, negative symptoms and cognitive impairments, that leads to significant challenges to patients’ functioning and overall quality of life. In this context, social isolation and lack of engagement in daily life activities are significant problems that can exacerbate symptoms and hinder recovery ^1,2.

It is now increasingly recognized the importance, in evaluating the outcome and effectiveness of treatments in severe mental disorders, of patient-reported outcomes (PROs), a category of specific performance indicators, that takes into account the patients view, with their own experiences. This kind of approach, complementing the information deriving from traditional clinician reported outcomes (CROs), encourages the development of more patient-centered interventions, and this represents one of the reasons why PROs are even increasingly relevant in clinical trials ³.

In this framework, recent research points up the importance of life engagement – actively participating in meaningful activities of daily living – in improving the well-being of individuals with schizophrenia. This concept incorporates aspects of emotional, physical, social and cognitive functioning and well-being and includes a range of activities, such as maintaining social relationships, engaging in recreational, occupational and educational activities, and participating in community initiatives. For people with schizophrenia, maintaining a high level of life engagement can help in improving quality of life and in achieving recovery ⁴. Therefore, life engagement represents a holistic construct that encompasses different outcomes, including life satisfaction, well-being and participation in valued and meaningful activities ⁵. This construct includes positive health features linked to cognitive functioning, as well as vitality, motivation, and the capacity to feel pleasure, and tools have been developed to assess and measure it ⁶.

A recent study regarding life engagement in a large sample of schizophrenia patients, demonstrated how psychotic and depressive symptoms severity, neurocognitive and social cognitive functioning, premorbid IQ, functional capacity, and psychosocial functioning resulted as correlates of patient life engagement ⁷. In particular, higher symptoms severity and a larger impairment in functional capacity, in interpersonal relationships, in social abilities, and in employment outcomes emerged as individual predictors of a worse patient life engagement ⁷.

Research has shown that targeting and improving life engagement can have several benefits for people with schizophrenia, including the following: i) symptoms reduction, especially of psychotic, cognitive, and depressive symptoms; and ii) psychosocial functioning improvement, increasing social connection and interactions in the perspective that participating in social activities can reduce isolation and improve social skills, also helping in building an essential support network ³.

To promote life engagement in people with schizophrenia, targeted strategies are needed, including the following: ii) psychosocial interventions, such as cognitive behavioral therapy for psychosis, social skills training, and cognitive remediation; ii) supported education and vocational interventions, with the aim not only to promote access to education and work opportunities, but also to improve self-esteem and a sense of personal accomplishment; iii) antipsychotic treatment with optimal balance of efficacy and tolerability and maintained over time in order to prevent psychotic relapses or clinical deterioration; iv) community support, such as support groups, social clubs, and volunteer programs, with the purpose to create inclusive and supportive communities in which people with schizophrenia can actively participate ^1-3.

Recently, it has been demonstrated how the integration of digital technologies in mental health care could enhance life engagement among individuals with schizophrenia. In particular, digital interventions, including smartphone applications and wearable devices, have been utilized to promote self-management and prevent relapse. These tools, offering real-time monitoring and personalized feedback, seem to be useful in helping patients to manage their symptoms more effectively and to stay engaged in their treatment plans ⁸.

So, patient life engagement appears to be an useful PRO that needs further investigations, not only in clinical trials, but also in epidemiological research in clinical populations. Future research should further demonstrate the effectiveness of different pharmacological treatments and psychosocial interventions on patients’ life engagement, also conceptualizing and validating new tools for assessing this domain in clinical practice. Moreover, future research should include life engagement as a key outcome measure in schizophrenia patients, in particular in those studies that evaluate the benefits and risks of pharmacological, psychological, and psychosocial treatments ⁷.

Life engagement is a crucial element in improving the quality of life of people with schizophrenia, and reaching clinical and personal recovery. Investing in strategies that promote active and meaningful participation in daily life activities not only reduces symptoms, but also promotes greater social integration and overall mental health improvement.

It is essential that mental health professionals, families, and the community work together to create a supportive environment that facilitates life engagement in people living with schizophrenia.

Conflict of interest statement

The authors declare no conflict of interest.

Funding

This research received no specific grant from any funding agency, commercial, or not-for-profit sectors.

Authors’ contributions

A.V.: conceptualization; A.V., S.B.: writing—original draft preparation; A.V., S.B.: writing—review and editing; A.V.: supervision.