Background The ultimate goal of successful schizophrenia treatment is not just to alleviate psychotic symptoms, but also to reduce distress and achieve subjective well-being (SWB). We aimed to identify the determinants of SWB and their interrelationships in schizophrenia. Methods Data were obtained from 637 patients with schizophrenia enrolled in multicenter, open-label, non-comparative clinical trials. The SWB under the Neuroleptic Treatment Scale (SWN) was utilized; a cut-off score of 80 indicated a high level of SWB at baseline and 6 months. Various machine learning (ML) algorithms were employed to identify the determinants of SWB. Furthermore, network analysis and structural equation modeling (SEM) were conducted to explore detailed relationship patterns. Results The random forest (RF) model had the highest area under the curve (AUC) of 0.794 at baseline. Obsessive-compulsive symptoms (OCS) had the most significant impact on high levels of SWB, followed by somatization, cognitive deficits, and depression. The network analysis demonstrated robust connections among the SWB, OCS, and somatization. SEM analysis revealed that OCS exerted the strongest direct effect on SWB, and also an indirect effect via the mediation of depression. Furthermore, the contribution of OCS at baseline to SWB was maintained 6 months later. Conclusions OCS, somatization, cognition, and depression, rather than psychotic symptoms, exerted significant impacts on SWB in schizophrenia. Notably, OCS exhibited the most significant contribution not only to the current state of well-being but also to follow-up SWB, implying that OCS was predictive of SWB. The findings demonstrated that OCS management is critical for the treatment of schizophrenia.

中文翻译：

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模拟精神分裂症主观幸福感的决定因素


背景 成功治疗精神分裂症的最终目标不仅是缓解精神病症状，还要减少痛苦并实现主观幸福感（SWB）。我们的目的是确定精神分裂症中主观幸福感的决定因素及其相互关系。方法 数据来自参加多中心、开放标签、非比较性临床试验的 637 名精神分裂症患者。使用抗精神病药治疗量表（SWN）下的SWB； 80 分的截止分数表明基线和 6 个月时的 SWB 水平较高。采用各种机器学习 (ML) 算法来识别 SWB 的决定因素。此外，还进行了网络分析和结构方程建模（SEM）来探索详细的关系模式。结果随机森林 (RF) 模型的基线曲线下面积 (AUC) 最高，为 0.794。强迫症状（OCS）对高水平主观幸福感的影响最为显着，其次是躯体化、认知缺陷和抑郁。网络分析证明了 SWB、OCS 和躯体化之间的牢固联系。 SEM分析显示OCS对SWB的直接影响最强，并且还通过抑郁的中介产生间接影响。此外，OCS 基线对 SWB 的贡献在 6 个月后保持不变。结论 OCS、躯体化、认知和抑郁，而不是精神病症状，对精神分裂症的 SWB 产生显着影响。值得注意的是，OCS 不仅对当前的福祉状态而且对后续的 SWB 都表现出最显着的贡献，这意味着 OCS 可以预测 SWB。研究结果表明，OCS 管理对于精神分裂症的治疗至关重要。