Skip to main content Accessibility help

Patient-reported outcomes in schizophrenia

  • Rosemarie McCabe (a1), Marya Saidi (a1) and Stefan Priebe (a1)



Patient-reported outcomes are increasingly used to evaluate the care of people with schizophrenia


To review established and emerging patient-reported outcomes in schizophrenia research, assessment tools and key findings


A non-systematic review addressing relevant constructs, the associated scales and key empirical findings


Patient-reported outcomes in schizophrenia relate either to evaluation of illness and benef it from treatment or to resilience of the self. Of the former, needs for care, treatment satisfaction and the therapeutic relationship are most common. Less common are symptoms, insight, attitude towards medication, and clinical communication. Increasing expectations of treatment have led to new measures assessing resilience of the self, including empowerment, self-esteem, sense of coherence and recovery Scores of different patient-related outcomes overlap and are influenced by a general tendency, largely influenced by mood, for more or less positive appraisal


The conceptual and empirical basis for different patient-reported outcomes varies, with most data available for treatment satisfaction. More than one such outcome should be used only if there is a specific hypothesis. For new patient-reported outcomes, relative independence from existing constructs should be demonstrated


Corresponding author

Dr Rosemarie McCabe, Unit for Social and Community Psychiatry Newham Centre for Mental Health, Glen Road, London E13 8SP UK. Email:


Hide All

Declaration of Interest




Hide All
Andersen, R., Caputi, P. & Oades, L. (2006) Stages of recovery instrument: development of a measure of recovery from serious mental illness. Australian and New Zealand Journal of Psychiatry, 40, 972980.
Antonovsky, A. (1987) Unravelling the Mystery of Health: How People Manage Stress and Stay Well. Jossey-Bass.
Antonovsky, A. (1993) The structure and properties of the Sense of Coherence Scale. Social Science and Medicine, 36, 725733.
Ascher-Svanum, H. (1999) Development and validation of a measure of patients' knowledge about schizophrenia. Psychiatric Services, 50, 561563.
Attkisson, C. C. & Zwick, R. (1982) The client satisfaction questionnaire: Psychometric properties and correlations with service utilization and psychotherapy outcome. Evaluation and Program Planning, 5, 233237.
Awad, A. G. (1993) Subjective response to neuroleptics in schizophrenia. Schizophrenia Bulletin, 19, 609618.
Bale, R., Catty, J., Watt, H., et al (2006) Measures of the therapeutic relationship in severe psychotic illness: a comparison of two scales. International Journal of Social Psychiatry, 52, 256266.
Barrowclough, C., Tarrier, N., Humphreys, L., et al (2003) Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology. Journal of Abnormal Psychology, 112, 9299.
Bengtsson-Tops, A. & Hansson, L. (2001) Quantitative and qualitative aspects of the social network in schizophrenic patientslivingin the community. Relationship to sociodemographic characteristics and clinical factors and subjective quality of life. International Journal of Social Psychiatry, 47, 6777.
Birchwood, M., Smith, J., Drury, V., et al (1994) A self-report Insight Scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica, 89, 6267.
Brewin, C. R., Wing, J. K., Mange, S. P., et al (1987) Principles and practice in measuring needs in the long-term mentally ill: the MRC Needs for Care Assessment. Psychological Medicine, 17, 971981
Buhler, J., Oades, L. G., Leicester, S. J., et al (2001) Effect of executive functioning on perceived needs in chronic schizophrenia. International Journal of Psychiatry in Clinical Practice, 5, 119122.
Chue, P. (2006) The relationship between patient satisfaction and treatment outcomes in schizophrenia. Journal of Psychopharmacology, 20 (suppl. 6), 3856.
Corrigan, P. W., & Garman, A. N. (1997) Research on consumer empowerment: Methodological issues. Psychiatric Services, 48, 347352.
Corrigan, P. W., Giffort, D., Rashid, F., et al (1999) Recovery as a psychological construct. Community Mental Health Journal, 35, 231240.
David, A. S. (1990) Insight and psychosis. British Journal of Psychiatry, 156, 798808.
Day, J. C., Kinderman, P. & Bentall, R. (1998) A comparison of patients' and prescribers' beliefs about neuroleptic side-effects, prevalence, distress and causation. Acta Psychiatrica Scandinavica, 97, 9397.
Day, J. C., Bentall, R. P., Roberts, C., et al (2005) Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals. Archives of General Psychiatry, 62, 717724.
De Wilde, E. F. & Hendriks, V. M. (2005) The Client Satisfaction Questionnaire: psychometric properties in a Dutch addict population. European Addiction Research, 11, 157162.
Deluty, B. M., Deluty, R. H. & Carver, C. S. (1986) Concordance between clinicians' and patients' rating of anxiety and depression as mediated by private self-consciousness. Journal of Personal Assessment, 50, 93106.
Derogatis, L. R. (1983) SCL-90R Administration, Scoring and Procedures Manual. Clinical Psychometric Research.
Derogatis, L. R. (1992) The Brief Symptom Inventory (BSI): Administration, Scoring, and Procedures. Manual–II (2nd edn). Clinical Psychometric Research.
Dott, S. G., Weiden, P., Hopwood, P., et al (2001) An innovative approach to clinical communication in schizophrenia: the approaches to schizophrenia communication checklists. CNS Spectrums, 4, 333338.
Draine, J. & Solomon, P. (1996) Case manager alliance with clients in an older cohort. Community Mental Health Journal, 32, 125134.
Ellwood, P. M. (1988) Shattuck lecture – outcomes management. Atechnology of patientexperience. New England Journal of Medicine, 318, 15491556.
Fakhoury, W. K. H. & Priebe, S. (2002) Subjective quality of life: its association with other constructs. International Review of Psychiatry, 14, 219224.
Fakhoury, W. K. H., Kaiser, W., Röder-Wanner, U. U. et al (2002) Subjective evaluation: is there more than one criterion? Schizophrenia Bulletin, 28, 319327.
Fava, G. A., Kellner, R., Sansky, J., et al (1986) Rating depression in normals and depressives: observer versus self-ratings cales. Journal of Affective Disorders, 11, 2933.
Fischer, E. P., Shumway, M. & Owen, R. R. (2002) Priorities of consumers, providers, and family members in the treatment of schizophrenia. Psychiatric Services, 53, 724729.
Fleischhacker, W. W., Rabinowitz, J., Kemmler, G., et al (2005) Perceived functioning, well-being and psychiatric symptoms in patients with stable schizophrenia treated with long-acting risperidone for 1 year. British Journal of Psychiatry, 187, 131136.
Frank, A. F. & Gunderson, J. G. (1990) The role of the therapeutic alliance in the treatment of schizophrenia. Archives of General Psychiatry, 47, 228236.
Freudenreich, O., Cather, C., Evins, A. E., et al (2004) Attitudes of schizophrenia outpatients toward psychiatric medications: relationship to clinical variables and insight. Journal of Clinical Psychiatry, 65, 13721376.
Giffort, D., Schmook, A., Woody, C., et al (1995) Construction of a Scale to Measure Consumer Recovery. Illinois Office of Mental Health.
Gumley, A., Karatzias, A., Power, K., et al (2006) Earlyintervention for relapse in schizophrenia: impact of cognitive behavioural therapy on negative beliefs about psychosis and self-esteem. British Journal of Clinical Psychology, 45, 247260.
Hamann, J., Cohen, R., Leucht, S., et al (2005) Do patients with schizophrenia wish to be involved in decisions about their medical treatment? American Journal of Psychiatry, 162, 23822384.
Hamann, J., Langer, B., Winkler, V., et al (2006) Shared decision making for in-patients with schizophrenia. Acta Psychiatrica Scandinavica, 114, 265273.
Hansson, L., Vinding, H. R., Mackeprang, T., et al (2001) Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study. Acta Psychiatrica Scandinavica, 103, 4551.
Hansson, L., Bjorkman, T. & Priebe, S. (2007) Are important patient rated outcomesin community mental health care explained by only one factor? Acta Psychiatrica Scandinavica, in press.
Hassan, I., McCabe, R. & Priebe, S. (2007) Professional –patient communication in the treatment of mental illness: a review. Communication and Medicine, in press.
Henderson, C., Hales, H. & Ruggeri, M. (2003) Cross-cultural differences in the conceptualisation of patients' satisfaction with psychiatric services: content validity of the English version of the Verona Service Satisfaction Scale. Social Psychiatry and Psychiatric Epidemiology, 38, 142148.
Hogan, T. P., Awad, A. G. & Eastwood, R. (1983) A self-report scale predictive of drug compliance in schizophrenia: reliability and discriminative ability. Psychological Medicine, 13, 177183.
Horvath, A. O. & Greenberg, L. S. (1989) Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 64, 223233.
Johansson, H. & Eklund, M. (2003) Patients' opinion on what constitutes good psychiatric care. Scandinavian Journal of Caring Sciences, 17, 339346.
Karow, A., & Pajonk, FG. (2006) Insight and quality of life in schizophrenia: recent findings and treatment implications. Current Opinion in Psychiatry, 19 (6), 637641.
Klinkenberg, W. D., Cho, D. W. & Vieweg, B. (1998) Reliability and validity of the interview and self-report versions of the BASIS-32. Psychiatric Services, 49, 12291231.
Kovess-Masféty, V., Wiersma, D., Xavier, M., et al (2006) Needs for care among patients with schizophrenia in six European countries: a one-year follow-up study. Clinical Practice and Epidemiology in Mental Health, 222.
Laugharne, R. & Priebe, S. (2006) Trust, choice and mental health: A literature review. Social Psychiatry and Psychiatric Epidemiology, 41, 843852.
Markova, I. S. & Berrios, G. E. (1992) The assessment of insight in clinical psychiatry: a new scale. Acta Psychiatrica Scandinavica, 86, 159164.
Mlonzi, E. N. (1998) Antonovsky's Sense of Coherence Scale and 16PF second-order factors. Social Behavior and Personality, 26, 3950.
McCabe, R. & Priebe, S. (2003) Are therapeutic relationships in psychiatry explained by patients' symptoms? Factors influencing patient ratings. European Psychiatry, 18, 220225.
McCabe, R. & Priebe, S. (2004) The therapeutic relationship in the treatment of severe mental illness: a review of methods and findings. International Journal of Social Psychiatry, 50, 115128.
McGuire-Snieckus, R., McCabe, R., Catty, J., et al (2007) A new scale to assess the therapeutic relationship in community mental health care: STAR. Psychological Medicine, 37, 8595.
Nasrallah, H. A., Targum, S. D., Tandon, R., et al (2005) Defining and measuring clinical effectiveness in the treatment of schizophrenia. Psychiatric Services, 56, 273282.
Neale, M. S. & Rosenheck, R. A. (1995) Therapeutic alliance and outcome in aVA intensive case management program. Psychiatric Services, 46, 719721.
Phelan, M., Slade, M., Thornicroft, G., et al (1995) The Camberwell Assessment of Need (CAN): the validity and reliability of an instrument to assess the needs of people with severe mental illness. British Journal of Psychiatry, 167, 589595.
Priebe, S. & Gruyters, T. (1993) The role of helping alliance in psychiatric community care – A prospective study. Journal of Nervous and Mental Disease, 181, 552557.
Priebe, S. & Gruyters, T. (1995) Patients'assessment of treatment predicting outcome. Schizophrenia Bulletin, 21, 8794.
Priebe, S., Gruyters, T., Heinze, M., et al (1995) Subjective criteria for evaluation of psychiatric care: methods for assessment in research and routine care. Psychiatrische Praxis, 22, 140144.
Priebe, S., Kaiser, W., Huxley, P. J., et al (1998) Do Different subjective evaluation criteria reflect distinct constructs? Journal of Nervous and Mental Disease, 186, 385392.
Priebe, S., McCabe, R., Bullenkamp, J., et al (2007) Structured patient–clinician communication and one-year outcome in community mental health care. A cluster randomised controlled trial. British Journal of Psychiatry, in press.
Roberts, G. & Wolfson, P. (2004) The rediscovery of recovery: open to all. Advances in Psychiatric Treatment, 10, 3749.
Rogers, E. S., Chamberlin, J., Ellison, M. L., et al (1997) A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services, 48, 10421047.
Rosenberg, M. (1965) Society and the Adolescent Self-image. Princeton University Press.
Rosenheck, R., Stroup, S., Keefe, R. S. E., et al (2005) Measuring outcome priorities and preferences in people with schizophrenia. British Journal of Psychiatry, 187, 529536.
Ruggeri, M. & Dall'Agnola, R. (1993) The development and use of the Verona Expectations for Care Scale (VECS) and the Verona Service Satisfaction Scale (VSSS) for measuring expectations and satisfaction with community-based psychiatric services in patients, relatives and professionals. Psychological Medicine, 23, 511523.
Slade, M., Phelan, M. & Thornicroft, G. (1998) A comparison of needs assessed by staff and by an epidemiologically representative sample of patients with psychosis. Psychological Medicine, 28, 543550.
Slade, M., Thornicroft, G., Loftus, L., et al (1999) CAN: Camberwell Assessment of Need. A Comprehensive Needs Assessment Tool for People with Severe Mental Illness. Gaskell.
Slade, M., Leese, M., Gillard, M., et al (2006) Premorbid IQ and response to routine outcome assessment. Psychological Medicine, 36, 11831191.
Smith, G. R., Fischer, E. P., Nordquist, C. R., et al (1997) Implementing outcomes management systems in mental health settings. Psychiatric Services, 48, 364368.
Smith, B., Fowler, D. G., Freeman, D., et al (2006) Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophrenia Research, 86, 181188.
Sörgaard, K. W., Heikkilä, J., Hansson, L., et al (2002) Self-esteem in persons with schizophrenia. A Nordic multicentre study. Journal of Mental Health, 11, 405415.
Stark, F. M., Lewandowski, G. & Buchkremer, G. (1992) Therapist-patient relationships as a predictor of the course of schizophrenia illness. European Psychiatry, 7, 161169.
Tattan, T. & Tarrier, N. (2000) The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes. Psychological Medicine, 30, 195204.
U. S. Food and Drug Administration (2006) Guidance for industry. Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims. FDA.
van Os, J. (2004) Does the urban environment cause psychosis? British Journal of Psychiatry, 184, 287288.
van Os, J., Bak, M., Hanssen, M., et al (2002) Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology, 156, 319327.
van Os, J., Altamura, A. C., Bobes, J., et al (2004) Evaluation of the Two-Way Communication Checklist as a clinical intervention. Results of a multinational, randomised controlled trial. British Journal of Psychiatry, 184, 7983.
Weiden, P. J. & Miller, A. L. (2001) Which side effects really matter? Screening for common and distressing side effects of antipsychotic medications. Journal of Psychiatric Practice, 7, 4147.
Wowra, S. A. & McCarter, R. (1999) Validation of the Empowerment Scale with an outpatient mental health population. Psychiatric Services, 50, 959961.
Young, S. & Bullock, W. (2003) illness Management and Recovery and the Role of the Mental Health Recovery Measure (MHRM) in Outcomes Research. Ohio Department of Mental Health, Ohio Coordinating Center for Excellence for Illness and Recovery.
Young, S. L. & Ensing, D. S. (1999) Exploring recovery from the perspective of people with psychiatric disabilities. Psychiatric Rehabilitation Journal, 22, 219231.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Patient-reported outcomes in schizophrenia

  • Rosemarie McCabe (a1), Marya Saidi (a1) and Stefan Priebe (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *