Does the Psychiatrist's Use of Subjective Well-Being Measurement in People with Schizophrenia Provide a Better Alignment with the Patient's Well-Being Perception than Clinical Judgement Alone?

Abstract

To examine the agreement between patient and psychiatrist ratings of subjective well-being in people with schizophrenia using three well-being measurements: Satisfaction with Life, Subjective Happiness, and Subjective Well-being under Neuroleptic Treatment (SWN), including the SWN-subscale, and to investigate whether the psychiatrist's judgement or the psychiatrist-rated SWN is better at defining patient well-being. Patients with schizophrenia (n = 150) completed the three well-being measurements, then met psychiatrists, and their well-being was judged as either 'poor' or 'adequate' via the usual clinical assessment before being assessed again by the psychiatrist using the same measurements. Intra-class correlation was used to analyze the absolute agreement between 'patient-rated' and 'psychiatrist-rated' scores. Agreements on 'adequate' well-being status between patient-rated SWN (≥ 80; gold standard), psychiatrist-rated SWN, and psychiatrist's judgement were calculated using Kappa coefficients. We also calculated the sensitivity and specificity of the psychiatrist's judgement and the psychiatrist-rated SWN to define adequate well-being. SWN showed the strongest absolute agreement between patient-psychiatrist ratings (ICC = 0.7, p = 0.005), with physical functioning yielding the highest and self-control the lowest coefficients. The psychiatrist-rated SWN showed a better Kappa coefficient (0.4, p < 0.001) than the psychiatrist's judgement. Clinical judgement showed a 67% sensitivity and a 64% specificity, whereas the psychiatrist-rated SWN (score 93, AUC 81.4%) showed a 74% sensitivity and a 74% specificity for well-being prediction. The use of SWN by psychiatrists yielded a better alignment of well-being than the psychiatrist's judgement alone. The SWN subscale could help fill the gap between clinician and patient views on well-being. Psychiatrists should upskill in assessing patient wellbeing for appropriate treatment provision.

Keywords: Antipsychotic agents; Judgement; Psychiatry; Schizophrenia; Self-assessment; Treatment outcome.