Assessment of functioning and disability in patients with schizophrenia using the WHO Disability Assessment Schedule 2.0 in a large-scale database

Comparison of the 12-item and 36-item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 using longitudinal data from community mental health outreach service users

AIM

This study aimed to compare the 12-item and 36-item versions of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 using longitudinal data from community mental health outreach service users.

METHODS

Using data from Tokorozawa City mental health outreach service users in Japan, total and domain WHODAS-12 and WHODAS-36 scores were compared. First, we examined score-change differences by domain at the start of outreach services (T1) and 1 year later (T2) for each version. Next, we compared differences between the two versions using Pearson's correlation, Wilcoxon signed-rank test, and Bland-Altman analysis.

RESULTS

Among 20 participants, total scores and scores of some domains (i.e., cognition, getting along, life activities, and participation) were significantly lower at T2 than at T1 on both versions (p < 0.010). WHODAS-36 scores were significantly lower at T2 than at T1 for the self-care domain (p = 0.018). Except for self-care, strong correlations were found between scores from the two versions (p < 0.001). In the Wilcoxon signed-rank test and Bland-Altman analysis, we found significant differences between the scores of the two versions in the mobility, self-care, and participation domains. There were no significant differences in the distribution or systematic errors between the two versions in scores for the other domains or total score.

CONCLUSION

We found strong positive correlations between WHODAS-12 and WHODAS-36 total scores with no statistical differences between them. For some domains, differences in distribution and systematic errors were found.

Determinants of Disability Among Individuals Living with Schizophrenia Attending Psychiatric Follow-Up Clinic in Jimma, Southwest Ethiopia: An Institution-Based Case-Control Study

Background

Disability due to schizophrenia ends up with a higher degree of impairment in occupational, social and interpersonal functioning than other chronic illnesses. Despite severe and long-lasting schizophrenia associated disability, little has been explored so far to identify determinants of disability among individuals living with schizophrenia in Ethiopia.

Objective

To identify the determinants of disability among individuals living with schizophrenia attending the psychiatric follow-up clinic at Jimma Medical Center (JMC).

Methods

An institution-based unmatched case-control study was conducted among 98 Cases and 98 controls of individuals living with schizophrenia attending the JMC psychiatric clinic from September 1 to October 30, 2022. Consecutive sampling technique was used to recruit the required sample size of both groups. The cases group were participants who scored >12 total on the WHO Disability Assessment Scale version 2-0 (WHODAS 2-0) whereas the control group were those who scored 12 total on the WHODAS 2-0.

Results

Being jobless (AOR = 2.29; 95% CI: 1.10-4.77), longer than 5-year duration of illness without treatment (AOR = 3.13; 95% CI: 1.23-7.98), poor social support (AOR = 2.54; 95% CI: 1.04-6.22), negative symptoms (AOR = 2.45; 95% CI: 1.14-5.29), known family history of mental illness (AOR = 3.59; 95%: 1.67-7.73) and risky khat use (AOR = 4.37; 95% CI: 1.86-10.29) were found to be determinants of disability among schizophrenia patients.

Conclusion

Joblessness, longer than 5-year duration of illness without treatment, poor social support, negative symptoms, known family history of mental illness and risky khat use were found to be determinants of disability in schizophrenia patients. Interventions targeting reducing of disability and improving quality of life of schizophrenia patients should consider the aforementioned determinants.

Risk of unemployment and work disability among refugee and non-refugee migrants with incident psychotic disorders in Sweden and Denmark

BACKGROUND

Unemployment and work disability are common among individuals with non-affective psychotic disorders (NAPDs) but it is unknown whether rates differ among migrants and native-born individuals. The present study aimed to compare the risk of these outcomes during the first 5 years of illness in non-refugee migrants, refugees and native-born individuals with NAPDs in Sweden and Denmark-two countries with different immigration policies and models of early psychosis care.

METHODS

Using national registers, we identified all individuals aged 18-35 years in Sweden and Denmark who received an incident NAPD diagnosis between 2006 and 2013 (N = 6750 and 8320, respectively). Cohorts were followed for 5 years to determine the days of unemployment and sickness absence (analyzed using zero-inflated negative binomial models) and the time to receipt of disability pension (analyzed using complementary log-log models).

RESULTS

Relative to their native-born peers, refugees and non-refugee migrants in Sweden and non-refugee migrants in Denmark were significantly less likely to have zero unemployment days (OR range: 0.54-0.72) and all migrant groups experienced more unemployment days (IRR range: 1.26-1.37). Results were largely unchanged after adjustment for sociodemographic and clinical factors. In the adjusted model, both Swedish migrant groups and refugees in Denmark were more likely to experience zero sickness absence days than native-born individuals (OR range: 1.48-1.56). Only refugees in Denmark were at greater risk of disability pension.

CONCLUSIONS

Non-refugee migrants and refugees with NAPDs in both Sweden and Denmark are particularly vulnerable to experiencing unemployment. Targeted interventions may help to reduce these disparities and promote long-term work ability among migrant groups.

The relationship between self-esteem and mental disability in patients with schizophrenia: the mediating role of resilience and the moderating role of gender

This study aims to verify the mediating role of resilience between self-esteem and mental disability and to analyze the moderating role of gender in the relationship between resilience and mental disability in patients with schizophrenia. Patients with schizophrenia have been selected from Harbin Psychiatric (Baiyupao) Hospital and Daqing Third Hospital in Heilongjiang Province from January to December 2021. The study recruited a total of 220 patients with schizophrenia, including 120 males and 100 females to measure their self-esteem, resilience and mental disability. The results were as follows: Self-esteem and resilience are important protective factors that have a buffering effect on mental disability. The mediating effect of resilience on self-esteem and mental disability is stronger in males than in females. The results provide new ideas for delaying mental disability and for formulating intervention programs and applying them to clinical practice. The study indicates that psychiatric medical staff should not only treat the patients with schizophrenia psychotic symptoms but also improve their self-esteem and resilience through effective intervention to reduce the occurrence of mental disability.

Longitudinal clinical and functional outcome in distinct cognitive subgroups of first-episode psychosis: a cluster analysis

BACKGROUND

Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes.

METHODS

204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up.

RESULTS

Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present.

CONCLUSIONS

Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.

A Scoping and Systematic Review of Employment Processes and Outcomes for Young Adults Experiencing Psychosis

Young adults who experience psychosis want to work but are less likely to be employed than their peers. Sixty two studies relating to young adults with psychosis and employment were reviewed following a systematic search of five databases: CINAHL, PsycINFO, MEDLINE, SCOPUS and EMBASE. Publication date ranged from 1973 to 2019 with > 70% between 2010 and 2019. Intervention was considered in 29 papers; critical appraisal revealed 90% of these had moderate to good methodological quality with only three RCTs. Of 11 intervention types "Early Intervention" and "Individual Placement and Support" were most common; both demonstrating positive impact on obtaining employment. The review identified minimal participant perspectives and great variability in: terminology used; the reporting of participant attributes; intervention characteristics and ways employment outcomes were measured. Employment processes identified were preparing for, seeking, obtaining, keeping and re-obtaining employment, with current research efforts focused on obtaining work. More focus is required on keeping and re-obtaining employment.

Mobility, educational, and social performance of children with learning problems in Taiwan: A 3-year follow-up study

AIM

This study evaluated the performance of children with learning problems in Taiwan by using the Taiwan Data Bank of Persons with Disability.

METHOD

We included 3854 children (2343 males, 1511 females; mean [SD] age 9y 11mo [2y 4mo]) with specific learning disorder (SLD), attention-deficit/hyperactivity disorder (ADHD), autism, epilepsy, or intellectual disabilities for analysis. We used the Functioning Scale of the Disability Evaluation System-Child version to investigate performance at follow-up for at least 3 years.

RESULTS

These participants demonstrated improvement across all the domains of the International Classification of Functioning, Health, and Disability including for mobility, learning, social participation, and daily living. The children with SLD (p=0.3) and epilepsy (p=0.442) did not demonstrate significant improvement in learning, whereas those with ADHD (p<0.001), autism (p<0.001), and intellectual disabilities (p<0.001) did. The children with epilepsy displayed the most impairment and least improvement.

INTERPRETATION

This cross-diagnostic study of learning problems indicated the children with autism or ADHD received more structural education. However, education strategies for those with SLD or epilepsy required improvement. Finally, SLD is possibly underdiagnosed in children, and children with epilepsy are affected in multiple aspects.

WHAT THIS PAPER ADDS

Specific learning disorder (SLD), ADHD, autism, epilepsy, and intellectual disability can cause learning problems in children. Children with ADHD and autism showed more improvement in academic performance. SLD has been neglected and underdiagnosed, resulting in poor improvement. Children with epilepsy have multiple impairments and exhibited minimal improvement.

Imputation of missing values within WHODAS 2.0 data collected from low back pain patients using the response function approach

PURPOSE

To investigate the impact of missing data and imputation with the response function (RF) approach on bias and precision of disability estimates as well as reliability of scale of WHO Disability Assessment Schedule 2.0.

MATERIAL AND METHODS

Data were collected by face-to-face interviews and self-report surveys from 284 respondents with low back pain. Hypothetical datasets were created by using person and item parameters of real data. A simulation study was devised to assess the ability parameters and reliability measures on incomplete and imputed datasets. Rasch model was used to evaluate latent trait levels. Imputation was carried out using the response function method.

RESULTS

Almost the same level of bias and MSE was reached. While the missing rate increases, the Person separation index slightly reduced, still exceeded 0.94 and Cronbach alpha values have similar mean values of 0.99 with larger variations. After deletion of four items of "work or school activities" in domain 5, reliability measures reduced the lowest.

CONCLUSION

Construct validity is preserved. Problems regarding the compliance of the items with the target group still persist. When researchers encounter missingness in data collected with WHODAS 2.0, the response function can be usefully implemented to impute missing values to improve the reliability of disability level estimates.Implications for rehabilitationThe Turkish version of the 36-item WHODAS is reliable and valid for assessing health and disability status in patients with low back pain.A critical issue is a systematic nonresponse was highly observed in items related to "work/school life activities" which are allowed to be skipped and excluded from the scoring according to WHODAS 2.0 training manual.Imputation of missing values within four items of "work or school activities" in domain 5 using the response function approach showed satisfactory reliability for the estimation of disability in adults with low back pain.This study showed missing data imputations with response function can be implemented by a statistician as contribute to a missing data management process better tailored to clinicians' interpretations.

WHODAS 2.0: Associations of functional disability with sex, age, and length of care in outpatients with schizophrenia-spectrum disorders

Schizophrenia is a disabling mental disorder that is associated with impairments in both social and occupational functioning. Few studies, however, have explored functional domains of disability and its associations with age, sex, and length of care. As part of a hospital quality improvement initiative, data were collected on outpatients' age, sex, length of care, and levels of disability (using the WHODAS 2.0; N=180; M=45.72; 68% male). Mean disability summary and domain scores were compared with population norms from international samples and two published studies in schizophrenia. A series of three-way ANOVAs and post-hoc tests evaluated differences in levels of disability based on age, sex, and length of care categories. Sample mean summary scores were comparable to published studies in schizophrenia (M=24.81; SD=17.37; 85^th percentile). Statistically significant main effects of sex and age on summary and domain-specific scores were found, whereas length of care was not significant. A statistically significant three-way interaction of sex x length of care x age was found for summary and mobility scores. Findings provide support for the reliability and validity of the WHODAS 2.0 in outpatients with schizophrenia. Although causal inferences cannot be made, findings show that age and sex are important factors to consider in addressing disability.

Occupational Dysfunction as a Mediator between Recovery Process and Difficulties in Daily Life in Severe and Persistent Mental Illness: A Bayesian Structural Equation Modeling Approach

Background. This study is aimed at verifying a hypothetical model of the structural relationship between the recovery process and difficulties in daily life mediated by occupational dysfunction in severe and persistent mental illness (SPMI). Methods. Community-dwelling participants with SPMI were enrolled in this multicenter cross-sectional study. The Recovery Assessment Scale (RAS), the World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0), and the Classification and Assessment of Occupational Dysfunction (CAOD) were used for assessment. Confirmatory factor analysis, multiple regression analysis, and Bayesian structural equation modelling (BSEM) were determined to analyze the hypothesized model. If the mediation model was significant, the path coefficient from difficulty in daily life to recovery and the multiplication of the path coefficients mediated by occupational dysfunction were considered as each the direct effect and the indirect effect. The goodness of fit in the model was determined by the posterior predictive $P$ value (PPP). Each path coefficient was validated with median and 95% confidence interval (CI). Results. The participants comprised 98 individuals with SPMI. The factor structures of RAS, WHODAS 2.0, and CAOD were confirmed by confirmatory factor analysis to be similar to those of their original studies. Multiple regression analysis showed that the independent variables of RAS were WHODAS 2.0 and CAOD, and that of CAOD was WHODAS 2.0. The goodness of fit of the model in the BSEM was satisfactory with a $\text{PPP}=0.27$ . The standardized path coefficients were, respectively, significant at -0.372 from “difficulty in daily life” to “recovery” as the direct effect and at -0.322 (95% CI: -0.477, -0.171) mediated by “occupational dysfunction” as the indirect effect. Conclusions. An approach for reducing not only difficulty in daily life but also occupational dysfunction may be an additional strategy of person-centered, recovery-oriented practice in SPMI.

Functional status and return to work in people with major depression: a 3-year national follow-up study

PURPOSE

Major depressive disorder (MDD) affects a person's function of daily activities, including work participation. Such functional impairments often persist even when other symptoms of MDD are remitted. Increasing evidence highlights the health-promoting effects of returning to work (RTW) in various diseases. However, limited data are available regarding the impact of return to work on functional recovery in MDD. We explored the association between RTW and functional improvements in people with MDD using a large nationally representative database and a 3-year follow-up.

METHODS

Data of people with an MDD diagnosis were selected from the Taiwan Data Bank of Persons with disability for the period between July 11, 2012, and October 31, 2018. We included 4038 adults aged 18-64 years. The World Health Organization Disability Assessment Schedule 2.0 was used for functional assessment. The association between RTW and functional improvements was investigated using a multivariable regression analysis adjusted for confounding variables.

RESULTS

Women aged ≥ 45 years with a lower education level were vulnerable to prolonged unemployment. RTW was significantly associated with better functional improvements in cognition, mobility, self-care, getting along, life activity, and participation than unemployment.

CONCLUSIONS

RTW was positively associated with functional improvements in patients with MDD. A referral system targeting re-employment may be suggested during MDD treatment, especially for individuals at risk of prolonged unemployment.

Factor Structure of an ICF-Based Measure of Activity and Participations for Adults in Taiwan's Disability Eligibility Determination System

To assess activity and participation for adults in Taiwan's Disability Eligibility Determination System (DEDS), we developed a measure, the Functioning Disability Evaluation Scale—Adult version (FUNDES-Adult), based on the 36-item interviewer-administered version of the WHO Disability Assessment Schedule 2.0. The purpose of this study was to examine the factor structures of performance and capability dimensions of the FUNDES-Adult. This study followed a methodology research design to investigate the construct validity of the two dimensions of the FUNDES-Adult. Two samples were randomly stratified from the databank of adults with disabilities to examine structural validity by the exploratory factor analysis (EFA) (n = 8,730, mean age of 52.9 ± 16.81) and the confirmatory factor analysis (CFA) (n = 500, mean age of 54.3 ± 16.81). The results demonstrated that the EFA yielded 5-factor structures for both performance dimension (73.5% variance explained) and capability dimension (75.9% variance explained). The CFA indicated that the second-order factor structures of both dimensions were more parsimonious with adequate fit indices (GFI, NFI, CFI, and TLI ≥ 0.95, RMSEA < 0.09). The results of this study provide evidence that the FUNDES-Adult has acceptable structural validity for use in Taiwan's DEDS. Utility of the FUNDES-Adult in rehabilitation, employment, welfare, and long-term care services needs further study.

Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study

BACKGROUND

Recovery has become a priority in schizophrenia spectrum disorders (SSDs). This study aimed to investigate predictors of objective-general functioning and disability-and subjective-quality of life (QoL)-measures of functional outcomes in SSD.

METHODS

Sample: n = 77 SSD outpatients (age 18-64, IQ > 70) participating in a randomised controlled trial. Baseline data were used to build three multivariable linear regression models on: (i) general functioning-General Assessment of Functioning (GAF); (ii) disability-the World Health Organization Disability Assessment Schedule (WHODAS-2.0); and (iii) QoL-Satisfaction Life Domains Scale (SLDS).

RESULTS

Young age and being employed (R2 change = 0.211; p = 0.001), late adolescence premorbid adjustment (R2 change = 0.049; p = 0.0050), negative symptoms and disorganization (R2 change = 0.087; p = 0.025) and Theory of Mind (R2 change = 0.066, p = 0.053) predicted general functioning. Previous suicidal behaviour (R2 change = 0.068; p = 0.023) and negative and depressive symptoms (R2 change = 0.167; p = 0.001) were linked with disability. Previous suicidal behaviour (R2 change = 0.070, p = 0.026), depressive symptoms (R2 change = 0.157; p < 0.001) and illness recognition (R2 change = 0.046, p = 0.044) predicted QoL.

CONCLUSIONS

Negative, disorganization and depressive symptoms, older age, unemployment, poor premorbid adjustment, previous suicide attempts and illness awareness appear to underlie a poor global functional outcome in SSD. Achieving recovery in SSD appears to require both symptomatic remission (e.g., through antipsychotics) and measures to improve mastery and relieve low mood.

Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan: A 4-year follow-up study

BACKGROUND

Stroke is a leading cause of long-term disability and is considered a major global health burden.

OBJECTIVES

We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan.

METHODS

We used the "Taiwan Data Bank of Persons with Disability" (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults>18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects.

RESULTS

A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P<0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P<0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains.

CONCLUSION

Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up.

The magnitude of disability in patients with schizophrenia in North West Ethiopia: A multicenter hospital-based cross-sectional study

Objective

To assess the magnitude of disability and its associated factors among patients with schizophrenia in North West Ethiopia in selected hospitals, 2019.

Design

Multicenter hospital-based cross-sectional study.

Setting

Gondar, Felege Hiwot, and Debre Tabor hospitals.

Participants

We recruit 420 participants for interviews using a systematic random sampling technique.

Measurement

We collect the data by face-to-face interview. Disability was measured using the World Health Organization Disability Assessment Scale 2.0. Coded variables were entered into Epi data V.4.4.2 and exported to SPSS V.24 for analysis. Bivariate and multivariate logistic regressions with OR and 95% CI were employed.

Result

A total of 423 participants were interviewed, with a response rate of 99.3%. The magnitude of disability in this study was 41.7 % (95 %CI: 36.9, 46.4). Current use of alcohol (AOR = 2.47,n95CI; 1.36,4.48), being jobless (AOR = 3.27, 95CI; 1.80, 5.93), had negative symptoms (AOR = 13.05,95CI, 7.58,22.45), had 5 and more years of illness (AOR = 2.75,95CI; 1.29,5.86), and had 5 and more years of untreated psychosis (AOR = 3.78,95CI, 1.85,7.75) were predictors of disability.

Conclusion and recommendation

The magnitude of disability in this study was 41.7 %. Avoidance of alcohol usage, early initiation of treatment, creating job opportunities, and giving special emphasis to patients having negative symptoms is recommended.

Using WHODAS 2.0 to Assess Functional Impairment in People with Depression: Should Employment Receive More Attention?

Background: Major depressive disorder (MDD) is a highly prevalent mental disorder which causes public health burden and personal disabilities. In people with mental illness, unemployment is an index character of functional impairment. Methods: Using the Taiwan Databank of Persons with Disability (TDPD), we collected the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) scores for people with MDD-associated disability. We recorded and analyzed the scores of participants during a 3-year period to determine the impact of employment on the trajectory of functional change. Logistic regression was performed to analyze the association between employment and changes in WHODAS 2.0 scores. Results: In people with MDD-associated disability, unemployed individuals present a worse function initially compared to employed individuals. After a 3-year period, the employed group showed a significant functional improvement in the domains of cognition, mobility, and participation. In logistic regression, the odds of having functional improvement were twice as high for those who were employed compared with those who were not. Conclusions: Higher odds of having functional improvement were noted in participants who stay in employment. Programs and strategies to help people with MDD-associated disability resume work warrant more clinical attention and supportive policies from the government.

How does neighbourhood socio-economic status affect the interrelationships between functioning dimensions in first episode of psychosis? A network analysis approach

The links between psychosis and socio-economic disadvantage have been widely studied. No previous study has analysed the interrelationships and mutual influences between functioning dimensions in first episode of psychosis (FEP) according to their neighbourhood household income, using a multidimensional and transdiagnostic perspective. 170 patients and 129 controls, participants in an observational study (AGES-CM), comprised the study sample. The WHO Disability Assessment Schedule (WHODAS 2.0) was used to assess functioning, whereas participants' postcodes were used to obtain the average household income for each neighbourhood, collected by the Spanish National Statistics Institute (INE). Network analyses were conducted with the aim of defining the interrelationships between the different dimensions of functioning according to the neighbourhood household income. Our results show that lower neighbourhood socioeconomic level is associated with lower functioning in patients with FEP. Moreover, our findings suggest that "household responsibilities" plays a central role in the disability of patients who live in low-income neighbourhoods, whereas "dealing with strangers" is the most important node in the network of patients who live in high-income neighbourhoods. These results could help to personalize treatments, by allowing the identification of potential functioning areas to be prioritized in the treatment of FEP according to the patient's neighbourhood characteristics.

The Relationship of Urbanization and Performance of Activity and Participation Functioning among Adults with Developmental Disabilities in Taiwan

Developmental disability is likely to be lifelong in nature and to result in substantial activity and societal participation limitations. The performance of individuals is related to the environment, supports, and urbanization of living cities. Most of the surveys for people with disabilities have not discussed the relationship between the cognitive impairment properties and performance of participation and activities functioning, and most cognitive impairments are regarded as having similar performance. The location of residence in childhood is mainly influenced by parents and main caregivers, but the factors related to the preferences of adults with cognitive impairment in the location of residence are more complicated. Objective(s): The aim was to explore and compare the relationships of the urbanization degree of their living cities and the functioning performance of daily living in various domains among adults with intellectual disability (ID), autism, and concomitant communicative impairment (CCI). Method: The cross-sectional study was applied, and the data was collected face-to-face by professionals in all authorized hospitals in Taiwan. The participants were 5374 adults with ID (n = 4455), autism (n = 670), CCI (n = 110) and combination disabilities (n = 139) which were according to the International Statistical Classification of Diseases 9th Revision (ICD-9) from a total of 167,069 adults with disabilities from the Disability Eligibility System (DES) in Taiwan between July 2012 and October 2013. The authors used the World Health Organization Disability Assessment Schedule 2.0–36 item version of WHO (WHODAS 2.0-36 items) to measure performance and capability of daily living. Results and Conclusions: There were significant differences in age, gender, disabled severity, and the urbanization between all subgroups (p < 0.05). After adjusting the age of all participators, the degree of urbanization just significantly affected the functioning score distribution in domain 1: cognition for an adult with ID, autism, and CCI; in domain 2, mobility for an adult with CCI and combination disability; in domain 3, self-care; domain 4, independent domains for ID (p < 0.05). There were no significant differences between urbanization degree and functioning scores in all domains for adults with autism. All in all, only in groups with combination disability did we find that the worse the degree of impairment was, the lower the degree of urbanization of their place of residence was, and there was no such phenomenon in adults with autism and ID in our study.

Using World Health Organization Disability Assessment Schedule 2.0 in people with schizophrenia: a 4-year follow-up

Little is known about the changes of people with schizophrenia disability in Taiwan who receive routine treatments under the current mental healthcare system. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to assess and track changes in the degree of disability in people with schizophrenia before and after 4 years of follow-up. Data on 4497 people with schizophrenia were acquired from the Taiwan Data Bank of Persons with Disability. The WHODAS 2.0 was used for disability assessment, and the chi-square test, logistic regression and generalised estimating equations were adopted for statistical analysis. People with schizophrenia exhibited improvement in cognition, mobility and participation among the six domains as well as in the overall score. The degree of disability in all domains remained mild to moderate among people aged 18-64 years; the degree of disability in cognition declined from moderate to severe among patients aged ≥65 years. The degree of disability in all domains remained mild to moderate among people with mild to moderate impairment; among those with severe impairment, the degree of disability in the domains of cognition and life activities declined from moderate to severe and the degree of disability in the domain of mobility declined from mild to moderate. Community-dwelling patients exhibited less degree of disability in all domains than their institutionalised peers. Early detection and treatment and an emphasis on communication and social problem-solving skills in rehabilitation programmes are recommended for people with schizophrenia.

Onset of schizophrenia diagnoses in a large clinical cohort

We aimed to describe the diagnostic patterns preceding and following the onset of schizophrenia diagnoses in outpatient clinics. A large clinical sample of 26,163 patients with a diagnosis of schizophrenia in at least one outpatient visit was investigated. We applied a Continuous Time Hidden Markov Model to describe the probability of transition from other diagnoses to schizophrenia considering time proximity. Although the most frequent diagnoses before schizophrenia were anxiety and mood disorders, direct transitions to schizophrenia usually came from psychotic-spectrum disorders. The initial diagnosis of schizophrenia was not likely to change for two of every three patients if it was confirmed some months after its onset. When not confirmed, the most frequent alternative diagnoses were personality, affective or non-schizophrenia psychotic disorders. Misdiagnosis or comorbidity with affective, anxiety and personality disorders are frequent before and after the diagnosis of schizophrenia. Our findings give partial support to a dimensional view of schizophrenia and emphasize the need for longitudinal assessment.

Does CBT for Psychosis Have an Impact on Delusions by Improving Reasoning Biases and Negative Self-Schemas?

Abstract. Cognitive-behavioral therapy for psychosis (CBTp) builds on theoretical models that postulate reasoning biases and negative self-schemas to be involved in the formation and maintenance of delusions. However, it is unclear whether CBTp induces change in delusions by improving these proposed causal mechanisms. This study reports on a mediation analysis of a CBTp effectiveness trial in which delusions were a secondary outcome. Patients with psychosis were randomized to individualized CBTp (n = 36) or a waiting list condition (WL; n = 34). Reasoning biases (jumping to conclusions, theory of mind, attribution biases) and self-schemas (implicit and explicit self-esteem; self-schemas related to different domains) were assessed pre- and post-therapy/WL. The results reveal an intervention effect on two of four measures of delusions and on implicit self-esteem. Nevertheless, the intervention effect on delusions was not mediated by implicit self-esteem. Changes in explicit self-schemas and reasoning biases did also not mediate the intervention effects on delusions. More focused interventions may be required to produce change in reasoning and self-schemas that have the potential to carry over to delusions.