Measuring community functioning in schizophrenia with the Social Behaviour Schedule

A systematic review of social functioning outcome measures in schizophrenia with a focus on suitability for intervention research

Social functioning is an important part of recovery and a key treatment target in clinical research in schizophrenia. Evaluating and comparing interventions is challenged by the choice of many measures which focus on different aspects of functioning, with little to guide selection. This results in difficulties comparing outcomes of treatment where studies have used different measures. To improve the measurement of social functioning in intervention research, we aimed to provide practical information on suitability of measures. We conducted a systematic review of measures developed or psychometrically evaluated since 2007, and assessed and discussed the structure, content, quality, and the use of the measures in intervention research. Thirty-two measures of social functioning and 22 validation papers were identified. Measures included structured questionnaires, semi-structured interviews, and assessment of performance on specific tasks. The content of measures was organised into eight categories, which are in order of frequency with which they were covered by measures: activities of daily living, productive activity, relationships, leisure activities, cognition, anti-social behaviour, psychosis symptoms and self-esteem and empowerment. In terms of quality, most measures were rated as moderate, with the Personal and Social Performance Scale gaining the highest rating. However, there was little data on responsiveness of measures, or how they compare to objective or 'real-world' indicators of functioning. The Social Functioning Scale and Personal and Social Performance Scale have been most frequently used in intervention studies to date. Future research should aim to provide further data on psychometric properties relevant to intervention research.

Quality of life and social functioning of former long-stay psychiatric patients transferred into the community: a 10 year follow up study

PURPOSE

Deinstitutionalisation in Ireland began following the impetus of the successful transfer of psychiatric patients into the community in other countries. This study sought to evaluate the quality of life (QoL) and social functioning (SF) of former long-stay institutionalised patients with severe and enduring mental illness who had been relocated into local community settings and followed up 10 years later.

METHOD

One month prior to hospital closure, 87 former long-stay psychiatric patients, the majority of whom had a diagnosis of schizophrenia, were assessed on a range of QoL and SF measures. Patients were followed-up 10 years later in the community, to evaluate baseline predictors of quality of life and social functioning.

RESULTS

Study completers (n = 35) improved significantly on a range of QoL and SF measures over the 10 year period. Specific improvements were noted in domestic skills (t = - 2.8, p < 0.0008), community skills (t = - 4.9, p < 0.001), as well as the activity and social relations measure (t = - 4.1, p < 0.001). Increased social function (t = - 6.3, p < 0.001) and improvement on the social behaviour scale (t = 7.6, p < 0.001) were noted at follow-up. Linear regression analysis found that less social behaviour problems at baseline predicted QoL 10 years later (t = - 2.6, p < 0.02).

CONCLUSION

This study demonstrated that transfer into the community from an institutional environment was associated with long-term improvements in quality of life and social functioning, even in those who spent many years in the institution. Those who demonstrated the greatest improvement in QoL had less social behavioural problems at baseline assessment, providing further evidence of the success of community living for former long-stay patients.

An exploratory study into therapeutic alliance, defeat, entrapment and suicidality on mental health wards

WHAT IS KNOWN ON THE SUBJECT?: The strength of a relationship between people with mental health difficulties and professionals has been linked to patients feeling suicidal. A relationship has been found between how defeated and trapped people with mental health difficulties feel and how suicidal they feel. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study explored the relationship between alliance, suicidality, defeat and entrapment in people admitted to mental health wards as previous research has focused on people in the community. Patient-rated defeat, entrapment and suicidality are related in this sample of people admitted to mental health wards. A relationship was found between how well nurses said they bonded with their named patient and how trapped the patients felt by their environment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should consider if patients are feeling defeated or trapped when helping people with mental health difficulties to feel less suicidal.

ABSTRACT

Introduction Suicidality is prevalent worldwide, particularly in people who access mental health services. The quality of therapeutic alliance between people with mental health difficulties and staff has been associated with suicidality but only in community settings. Defeat and entrapment are correlated with suicidality and may mediate any relationship between alliance and suicidality. Therefore, this exploratory study explored these relationships in people admitted to mental health wards. Aim To explore defeat, entrapment, suicidality and alliance between nurses and people admitted to mental health wards. Method Fifty inpatient nurse-patient dyads completed questionnaires regarding demographics, defeat, entrapment, suicidality and alliance with their named nurse. Nurses completed questionnaires on demographics, alliance with their patient and the patients' suicidality. Results Defeat, entrapment and suicidality were correlated. A correlation between nurse-rated bond and external entrapment was found, but no other correlations between alliance, defeat, entrapment and suicidality were statistically significant. Discussion and clinical implications Ward-based nurses should consider the relationship between defeat, entrapment and suicidality when developing interventions to improve suicidality. Although there was no evidence of a relationship between total alliance and suicidality, developing closer bonds with patients may reduce patients' feelings of being trapped by their environment.

Predictors in use of mental health resources: The role of behaviour problems in patients with severe mental illness

BACKGROUND

In recent years, more variables are being included in the use of mental health resource prediction models. Some studies have shown that how well the patient can function is important for this prediction. However, the relevance of a variable as important as behaviour problems has scarcely been explored.

AIM

This study attempted to evaluate the effect of behaviour problems in patients with severe mental illness on the use of mental health resources.

METHOD

A total of 185 patients at a Community Mental Health Unit were evaluated using the Behaviour Problem Inventory. Later, a bivariate logistic regression was done to identify what behaviour problems could be specific predictors of use of mental health resources.

RESULTS

The results showed that the general index of behaviour problems predicts both use of hospitalization resources and outpatient attention. Underactivity/social withdrawal is the best predictor of all the different areas.

CONCLUSION

These results confirm the role of behaviour problems as predictors of the use of mental health resources in individuals with a severe mental illness.

A question of time: A study of time use in people with schizophrenia

BACKGROUND

Loss of functioning is a core feature associated with the diagnosis of schizophrenia. Several measures are used to asses this domain including activity measures assessing time use which has been demonstrated to be a valuable indicator of recovery. However there is limited information on the magnitude and the domains where time use may differ between people with schizophrenia and the general population.

METHOD

One hundred and seventy people with a diagnosis of schizophrenia and 1124 people from the general population were assessed and compared on the Time Use Survey. This estimates the time spent in everyday activities in ten domains. The influence of symptom severity and clinical variables on time-use was examined in people with schizophrenia.

RESULTS

People with schizophrenia spent less time in functional but also in social and leisure activities and more time resting and "doing nothing" compared to the general population. When compared with unemployed individuals and people with a physical disability, people with schizophrenia spent comparable time in functional activities but significantly less in leisure, socialising activities and travelling. Negative symptom severity was associated with time spent in passive activities and negatively influenced time in social and leisure activities.

CONCLUSIONS

Alongside significant effects on functional economic activities schizophrenia has also a profound impact on activities that make life enjoyable. Mapping time use will be a useful additional tool to assess progress towards recovery.

Mental simulation and experience as determinants of performance expectancies in people with schizophrenia spectrum disorder

People with schizophrenia demonstrate both impairment in mental time travel and reduced expectancies of performance on future tasks. We aimed to reconcile these findings within the Kahneman and Tversky (1982) simulation heuristic framework by testing a key prediction that impaired future simulation would be associated with reduced performance expectancies in people with schizophrenia spectrum disorder (SZSPEC). A total of 54 individuals (30 people with SZSPEC and 24 healthy controls) generated mental simulations of everyday scenarios; after each response they rated performance expectations, distress and the similarity of the scenario to experience. Independent raters coded the coherence of responses. We found that people with SZSPEC had, compared to healthy controls, lower performance expectations and greater anticipated distress when imaging everyday scenarios. Lower performance expectancies were associated with lower experience of similar scenarios, greater negative symptoms and social withdrawal in the SZSPEC group. The current study confirmed previous findings of both impaired mental simulation and abnormal performance expectations in people with SZSPEC, together with the association of the latter with negative symptoms. Experience with social or occupational activities plays a more important role in determining performance expectancies in people with SS than the ability to mentally simulate scenarios.