Psychiatric Rehabilitation Journal, Vol 49(3), Sep 2026, 247-252; doi:10.1037/prj0000690
Objective: Throughout the course of schizophrenia spectrum disorders, individuals experience significant fluctuations in a variety of clinical and functional dimensions, often negatively impacting their quality of life (QoL). To better understand clinical correlates of QoL change and investigate treatment targets for future intervention development, this study sought to longitudinally examine the impact of symptom severity on QoL. Method: Individuals with schizophrenia spectrum disorders (N = 102) participated in an 18-month randomized trial of cognitive enhancement therapy. Measures of symptom severity and QoL were administered prior to treatment, and at 9- and 18-month timepoints. Symptom composite scores were generated and fitted using mixed-effects regression models to investigate the impact of changes in severity on QoL longitudinally. Results: Unconditional growth models detected improvements in total and psychological QoL over time across treatment groups. Incorporation of covariates detected an interaction between social relationships, QoL change, and age at entry (18–49 range), indicating smaller QoL improvement over time for older individuals. Increased affective symptomatology was predictive of diminished total, physical, psychological, and social relationships QoL, while increased positive symptomatology was predictive of diminished social relationships and environmental QoL. Conclusions and Implications for Practice: Affective symptomatology has been shown as a critical component of lasting QoL improvement. Implementing interventions that target affective symptoms in schizophrenia could prove effective in mitigating poor QoL, particularly in the early course of illness. Associations between positive symptomatology and environmental and social domains indicate that community-based services which integrate resource coordination and social support could prove efficacious in QoL improvement. (PsycInfo Database Record (c) 2026 APA, all rights reserved)