Disease duration-stratified associations of thyroid hormone levels with psychopathology in hospitalized patients with schizophrenia: A cross-sectional study

doi:10.5498/wjp.v15.i9.109858

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World Journal of Psychiatry

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World J Psychiatry. Sep 19, 2025; 15(9): 109858
Published online Sep 19, 2025. doi: 10.5498/wjp.v15.i9.109858

Table 1 General information of enrolled in patients with stable schizophrenia, n (%)

General information		Total participants (n = 237)
Age (years), median (IQR)		50 (40-56)
Male sex		138 (58.2)
BMI (kg/m²), median (IQR)		24.49 (21.88-27.53)
Marital status (married)		49 (20.7)
Education attainment	Illiterate	15 (6.3)
	High school and below	201 (84.8)
	University and above	21 (8.9)
Age at onset(years), median (IQR)		26 (20-35)
Disease duration (years), median (IQR)		30 (24-34)
Hospitalization duration (months), median (IQR)		26 (8-51.5)
Family psychiatric history (yes)		54 (22.8)
First episode (yes)		4 (1.7)
Substance use history (yes)	Smoking	97 (40.9)
Substance use history (yes)	Alcohol use	59 (24.9)
Antipsychotics type	Typical	4 (1.7)
	Atypical	216 (91.1)
	Combined	17 (7.2)
Chlorpromazine equivalent dose (mg/day), median (IQR)		325 (200-550)
Chronic diseases (≥ 1)		79 (33.3)
Vision impairment		32 (13.5)
Hearing impairment		16 (6.8)
Falls history (yes)		15 (6.3)
COVID-19 infection history (yes)		94 (39.7)
PHQ-9 (depression), median (IQR)		3 (1-5)
GAD-7 (anxiety), median (IQR)		1 (0-3)
MoCA-C (cognitive function), median (IQR)		18 (11.5-23)
PANSS profile-total score, median (IQR)		61 (51-72)
PANSS profile-positive symptoms, median (IQR)		13 (9-17)
PANSS profile-negative symptoms, median (IQR)		18 (14-23)
PANSS profile-general psychopathology, median (IQR)		29 (25-35)
TSH (μIU/mL), median (IQR)		2.36 (1.78-3.47)
FT3 (pmol/L), median (IQR)		4.89 (4.44-5.27)
FT4 (pmol/L), median (IQR)		15.73 (14.14-17.68)
T3 (ng/mL), median (IQR)		1.08 (0.97-1.22)
T4 (μg/dL), median (IQR)		7.8 (6.91-8.8)

BMI: Body mass index; COVID-19: Coronavirus disease 2019; IQR: Interquartile range; PHQ-9: Patient Health Questionnaire-9; GAD-7: Generalized Anxiety Disorder 7-item; MoCA-C: Montreal Cognitive Assessment-Chinese version; PANSS: Positive and Negative Syndrome Scale; TSH: Thyroid stimulating hormone; T3: Triiodothyronine; FT3: Free triiodothyronine; T4: Thyroxine; FT4: Free thyroxine.

Table 2 Correlations between thyroid hormone levels and age, disease duration, and antipsychotic dose in stable schizophrenia patients, stratified by disease duration

Variable	Total participants			0-10 years group			10.1-20 years group			> 20 years group
Variable	Age	Disease duration	Chlorpromazine equivalent dose	Age	Disease duration	Chlorpromazine equivalent dose	Age	Disease duration	Chlorpromazine equivalent dose	Age	Disease duration	Chlorpromazine equivalent dose
TSH	0.021	0.013	0.02	0.024	-0.21	0.058	0.033	0.103	-0.076	0.036	0.031	0.068
FT3	-0.174^b	0.001	-0.08	-0.263^a	-0.106	-0.013	-0.194	0.089	-0.022	-0.206^a	-0.012	-0.157
FT4	0.079	0.155^a	-0.130^a	-0.131	-0.06	-0.107	-0.059	0.024	-0.092	0.055	-0.058	-0.134
T3	0.021	0.118	-0.273^b	-0.055	0.061	-0.135	0.026	0.289^a	-0.230^a	-0.084	0.019	-0.365^b
T4	0.04	0.177^b	-0.192^b	-0.023	0.182	-0.166	-0.105	0.246^a	-0.074	-0.005	0.043	-0.246^a

^aP < 0.05.

^bP < 0.001.

The P value obtained by comparing the three groups stratified by disease duration. TSH: Thyroid stimulating hormone; T3: Triiodothyronine; FT3: Free triiodothyronine; T4: Thyroxine; FT4: Free thyroxine.

Table 3 Correlational analysis of thyroid hormone levels and Positive and Negative Syndrome Scale profile scores in patients with stable schizophrenia

Variable	0-10 years group				10.1-20 years group				> 20 years group
Variable	Total score	Positive symptoms	Negative symptoms	General psychopathology	Total score	Positive symptoms	Negative symptoms	General psychopathology	Total score	Positive symptoms	Negative symptoms	General psychopathology
TSH	-0.027	-0.109	0.084	-0.057	-0.219	-0.185	-0.096	-0.310^b	-0.114	-0.014	-0.123	-0.13
FT3	-0.207	-0.041	-0.116	-0.385^b	0.07	-0.055	0.121	0.091	-0.001	0.081	-0.058	-0.065
FT4	-0.044	-0.003	-0.106	-0.089	-0.248^a	-0.213	-0.169	-0.165	0.001	0.02	-0.009	0.033
T3	-0.102	-0.145	0.091	-0.291^a	0.006	0.089	0.139	0.06	0.081	0.053	0.077	0.015
T4	-0.224	-0.158	-0.177	-0.298^a	-0.115	-0.195	0.11	-0.101	-0.014	-0.09	0.015	0.007

^aP < 0.05.

^bP < 0.001.

TSH: Thyroid stimulating hormone; T3: Triiodothyronine; FT3: Free triiodothyronine; T4: Thyroxine; FT4: Free thyroxine.

Table 4 Univariate analysis of general information and Positive and Negative Syndrome Scale profile scores in patients with stable schizophrenia

Variable	PANSS profile
	Standardized β (disease duration: 0-10 years, n = 58)				Standardized β (disease duration: 10.1-20 years, n = 74)				Standardized β (disease duration: > 20 years, n = 105)
	Total score	Positive symptoms	Negative symptoms	General psychopathology	Total score	Positive symptoms	Negative symptoms	General psychopathology	Total score	Positive symptoms	Negative symptoms	General psychopathology
Age	0.136	0.04	0.173	0.095	-0.125	-0.128	-0.033	-0.152	0.16	0.24^a	0.019	0.136
Sex	0.09	0.027	0.155	0.022	0.294^a	0.136	0.253^a	0.336^a	0.167	0.153	0.129	0.133
BMI (kg/m²)	0.03	-0.055	0.156	-0.037	-0.026	-0.038	-0.022	-0.024	-0.1	0.007	-0.037	-0.176
Marital status	-0.135	-0.099	-0.212	0.001	-0.036	0.051	-0.056	-0.113	0.059	0.011	0.111	0.006
Education attainment	-0.109	-0.145	-0.167	0.059	0.081	0.157	-0.025	0.055	-0.247^a	-0.127	-0.181	-0.263^a
Hospitalization duration	-0.126	-0.091	-0.058	-0.143	-0.027^a	-0.25^a	-0.166	-0.248^a	-0.253^a	-0.102	-0.218^a	-0.279^a
Family psychiatric history	0.071	0.004	0.088	-0.067	-0.183	-0.112	-0.133	-0.202	0.087	0.038	0.036	0.133
First episode	-0.033	0.205	-0.058	-0.053	0.038	-0.138	0.169	0.067	-0.117	-0.008	-0.154	-0.094
Smoking	0.043	0.161	-0.138	0.089	0.164	0.216	0.062	0.091	-0.331^b	-0.242^a	-0.276^a	-0.258^a
Alcohol use	0.003	0.111	-0.138	0.043	0.062	0.066	0.061	0.012	-0.139	-0.094	-0.133	-0.092
Age at onset	0.138	0.049	0.169	0.100	-0.116	-0.079	-0.064	-0.151	0.056	0.176	-0.102	0.075
Antipsychotics type	-0.4^b	-0.423^b	-0.097	-0.416^b	0.183	0.169	0.054	0.204	0.062	0.117	0.019	0.032
Chlorpromazine equivalent dose	-0.012	0.038	-0.071	0.009	0.264^a	0.397^b	-0.021	0.255^a	-0.139	0.063	-0.193	-0.150
Chronic diseases	0.143	0.04	0.157	0.128	0.06	-0.093	0.18	0.057	0.088	0.078	0.04	0.081
Vision impairment	-0.032	0.057	-0.047	-0.079	0.029	0.008	-0.041	0.092	0.029	0.053	-0.025	0.054
Hearing impairment	0.116	0.008	0.111	0.143	0.168	0.216	0.291^a	0.194	-0.025	-0.013	-0.062	0.022
Falls history	-0.035	-0.118	0.007	0.024	0.104	-0.079	0.13	0.199	0.116	0.148	0.064	0.085
COVID-19 infection history	-0.261^a	-0.305^a	-0.051	-0.258^a	0.125	-0.021	0.203	0.102	-0.008	-0.054	0.023	0.009
PHQ-9 (depression)	0.007	-0.002	-0.1	0.119	0.262^a	0.067	0.277^a	0.302^a	0.165	0.051	0.118	0.219^a
GAD-7 (anxiety)	-0.036	-0.051	-0.194	0.163	0.247^a	0.257^a	0.08	0.285^a	0.138	0.112	0.029	0.198^a
MoCA-C (cognitive function)	-0.112	0.015	-0.299^a	0.037	-0.434^b	-0.123	-0.515^b	-0.41^b	-0.494^b	-0.041	-0.589^b	-0.481^b

^aP < 0.05.

^bP < 0.01.

BMI: Body mass index; COVID-19: Coronavirus disease 2019; PHQ-9: Patient Health Questionnaire-9; GAD-7: Generalized Anxiety Disorder 7-item; MoCA-C: Montreal Cognitive Assessment-Chinese version.

Table 5 Correlations between thyroid hormone levels and Positive and Negative Syndrome Scale profile scores in patients with stable schizophrenia

Variable		Total score		General psychopathology
Variable		β (95%CI)	P value	β (95%CI)	P value
Disease duration: 0-10 years	T3	-	-	-5.457 (-13.899 to 2.985)	0.2
	T4	-	-	-0.848 (-1.564 to -0.133)	0.021
	FT3	-	-	-2.483 (-4.693 to -0.273)	0.028
Disease duration: 10.1-20 years	FT4	-0.981 (-2.139 to 0.177)	0.095	-	-
Disease duration: 10.1-20 years	TSH	-	-	-1.429 (-2.348 to -0.509)	0.003

Linear regression models assessing the association between thyroid hormone level and Positive and Negative Syndrome Scale profile scores. General psychopathology: For the subgroup with disease duration 0-10 years: When triiodothyronine or thyroxine were primary exposures, adjusted for antipsychotic type and coronavirus disease 2019 history; when free triiodothyronine was the primary exposure, adjusted for antipsychotic type, coronavirus disease 2019 history, and age. For the subgroup with disease duration 10.1-20 years: When thyroid stimulating hormone was the primary exposure, adjusted for sex, hospitalization duration, chlorpromazine equivalent dose, Patient Health Questionnaire-9 scores, Generalized Anxiety Disorder 7-item scores, and Montreal Cognitive Assessment-Chinese version scores. CI: Confidence interval; TSH: Thyroid stimulating hormone; T3: Triiodothyronine; FT3: Free triiodothyronine; T4: Thyroxine; FT4: Free thyroxine.

Citation: Lei XP, Liao DX, Wu GY, Shuai D, Zhang HL, Wang BY, Wang YL. Disease duration-stratified associations of thyroid hormone levels with psychopathology in hospitalized patients with schizophrenia: A cross-sectional study. World J Psychiatry 2025; 15(9): 109858
URL: https://www.wjgnet.com/2220-3206/full/v15/i9/109858.htm
DOI: https://dx.doi.org/10.5498/wjp.v15.i9.109858