OBJECTIVES: The aim of this study was to assess the impact of positive and negative symptoms and cognitive impairment (CI) on health-related quality of life (HRQOL), productivity loss and health care resource utilization (HCRU) in European patients with schizophrenia. METHODS: An analysis of patient and physician-reported data from the cross-sectional Adelphi Schizophrenia Disease-Specific-Programme was conducted. Subjects 18 years or older with ≥4 physician visits in the past year were selected (n=2411). Patient-reported HRQOL was assessed by the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), EQ-5D and EQ-5D Visual Analogue Scale (VAS) and work productivity via the Work Productivity Activity and Impairment (WPAI). HCRU included number of outpatient, emergency and inpatient visits and length of hospital stay (LOS). Analyses of outcomes and utilization by level and severity of physician-rated positive, negative and cognitive symptoms employed multivariate methods (linear, logistic, negative binomial, tobit and ordered probit regressions) with a backward selection process. Age, gender, ethnicity, home circumstances, employment, number of comorbidities, anxiety, depression, non-drug therapy, substance abuse, obesity and medication compliance served as covariates.  RESULTS:  Most patients were older, male, Caucasian, lived alone or with family and were unemployed. Positive symptoms (delusions, disordered thoughts) and negative symptoms (blunted affect, social withdrawal) were reported in 40-50% of the patients. Average severity scores for positive and negative symptoms were >40 (max. 100, higher scores are more severe). A total of 84% of patients suffered “mild” to “continuous or severe CI”. Multivariate analysis showed that the presence and severity of negative symptoms decreased Q-LES-Q-SF and EQ-5D VAS scores. CI severity significantly predicted HRQOL measures, productivity loss in terms of decreased ability to do regular activities, outpatient, inpatient visits, LOS and non-drug therapy. CONCLUSIONS: CI was uniquely associated with patient functioning and HCRU.  Pharmacological and non-pharmacological interventions targeted toward CIs may result in better functioning and lower HCRU.