What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: First-episode drug-naïve schizophrenia (n=255). Intervention: Elevated HDL-c levels. Primary outcome: Severe anxiety symptoms (HAMA score ≥ 29) (OR 4.70, 95% CI 1.53-14.4, p=0.007).

July 30, 2025Open Access

The prevalence and clinical correlates of severe anxiety symptoms in first-episode drug-naïve schizophrenia: a Chinese population study

PXPing XuXuzhou Medical College SWShanshan WuNingbo University JZJie ZhaoHandan College

Key Result

In patients with first-episode drug-naïve schizophrenia, severe anxiety symptoms were present in 51.8% of cases and independently associated with higher HDL-c levels (OR 4.70) and elevated HAMD-24 scores.

Study Design

Type

Cross-Sectional (n=255)

Multicenter

Structured PICO

Population

255 Chinese patients with first-episode drug-naive (FEDN) schizophrenia, aged 18-59 years, Han Chinese ethnicity, with duration of symptoms not exceeding 60 months. Mean age 29.6 years, 47.8% male.

Outcome

Prevalence of severe anxiety symptoms (defined by a 14-item Hamilton Anxiety Rating Scale [HAMA-14] score ≥ 29) and its clinical correlatespatient reported

Severe anxiety symptoms are highly prevalent in first-episode drug-naïve schizophrenia and are independently associated with higher depressive symptoms and elevated HDL-c levels.

Main Result

Effect estimate: OR 4.70 (95% CI 1.53-14.4)

p-value: p=0.007

Limitations

Cross-sectional design limits establishing causal relationships between anxiety symptoms and associated factors.
Failed to incorporate several important factors, including physical activity patterns, alcohol consumption, detailed smoking history, and psychiatric family history.
Used a stringent HAMA threshold of ≥ 29 to define severe anxiety, which may underestimate associations.
Lacked assessments of inflammatory and neuroendocrine biomarkers.
Limited discriminative ability of HDL-c (AUC = 0.592).
Single-center investigation may not fully represent the broader population of FEDN schizophrenia patients.

Abstract

OBJECTIVE: Although anxiety symptoms frequently co-occur with schizophrenia and may substantially influence disease progression and treatment outcomes, systematic investigations of this comorbidity remain limited. This study aimed to investigate the prevalence and clinical correlations of severe anxiety symptoms among Chinese patients with first-episode drug-naive (FEDN) schizophrenia. METHODS: This cross-sectional study enrolled 255 FEDN schizophrenia patients. Comprehensive clinical and demographic data were collected from all participants. Psychiatric symptoms were assessed using PANSS, while anxiety and depression symptoms were evaluated using the 14-item Hamilton Anxiety Rating Scale (HAMA-14) and the 24-item Hamilton Depression Rating Scale (HAMD-24), respectively. Participants were stratified into two groups based on the presence or absence of severe anxiety symptoms, defined by a HAMA score ≥ 29. Multivariate logistic regression analysis was employed to identify potential correlates associated with severe anxiety symptoms in FEDN schizophrenia patients. RESULTS: The prevalence of severe anxiety symptoms among patients with FEDN schizophrenia was 51.8% (132/255). Multivariable logistic regression analysis revealed that both elevated HAMD-24 scores (OR = 1.17, 95% CI: 1.11-1.22, p < 0.001) and higher high-density lipoprotein cholesterol (HDL-c) levels (OR = 4.70, 95% CI: 1.53-14.4, p = 0.007) were independently associated with increased risk of severe anxiety symptoms. The area under the curve (AUC) analysis revealed distinct predictive capabilities: HAMD-24 demonstrated strong standalone predictive ability (AUC = 0.868), while HDL-c showed limited discriminative capacity (AUC = 0.592) despite statistical significance in multivariable regression. CONCLUSION: This study highlights the substantial prevalence of severe anxiety symptoms among patients with FEDN schizophrenia. Our multivariable analysis identified HAMD-24 scores and HDL-c levels as significant factors associated with severe anxiety symptoms in this population. These findings enhance our understanding of anxiety mechanisms in FEDN schizophrenia, potentially informing future treatment strategies.

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