Abstract
Social functioning (SF) is the ultimate target aimed in treatment plans in schizophrenia, thus it is critical to know what are the factors that determine SF. Gender is a well-established variable influencing SF, yet it is not known how social variables and symptoms interact in schizophrenia patients. Furthermore, it remains unclear whether the interaction between social variables and symptoms is different in men compared to women. Our aim is to test whether social variables are better predictors of SF in community-dwelled individuals with schizophrenia, and whether men and women differ in how symptoms and social variables interact to impact SF. Community-dwelling individuals with schizophrenia (N = 231) were randomly selected from a register. Participants were assessed with symptom measures (PANSS), performance-based social scale (LSP), objective social and demographic variables. Stratification by gender and stepwise multivariate regression analyses by gender were used to find the best-fitting models that predict SF in both gender. Men had poorer SF than women in spite of showing similar symptom scores. On stepwise regression analyses, gender was the main variable explaining SF, with a significant contribution by disorganized and excitatory symptoms. Age of onset made a less marked, yet significant, contribution to explain SF. When the sample was stratified by gender, disorganized symptoms and ‘Income’ variable entered the model and accounted for a 30.8% of the SF variance in women. On the other hand, positive and disorganized symptoms entered the model and accounted for a 36.1% of the SF variance in men. Community-dwelling men and women with schizophrenia differ in the constellation of variables associated with SF. Symptom scores still account for most of the variance in SF in both genders.
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Mueser K, Tarrier N: The Handbook of Social Functioning in Schizophrenia. Boston, Allyn & Bacon, 1998
Priebe S: Social outcomes in schizophrenia. British Journal of Psychiatry 191(suppl.50):s15–s20, 2007
Cohen AS, Dinzeo TJ, Nienow TM, et al.: Diminished emotionality and social functioning in schizophrenia. Journal of Nervous and Mental Disease 193(12):796–802, 2005
Halford WK, Hayes RL: Social skills in schizophrenia: Assessing the relationship between social skills, psychopathology and community functioning. Social Psychiatry and Psychiatric Epidemiology 30(1):14–19, 1995
Reeder C, Newton E, Frangou S, et al.: Which executive skills should we target to affect social functioning and symptom change? A study of a cognitive remediation therapy program. Schizophrenia Bulletin 30(1):87–100, 2004
Vetter P, Koller O: Clinical and psychosocial variables in different diagnostic groups: Their interrelationships and value as predictors of course and outcome during a 14-year follow-up. Psychopathology 29(3):159–168, 1996
Bowie CR, Reichenberg A, Patterson TL, et al.: Determinants of real-world functional performance in schizophrenia subjects: Correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry 163(3):418–425, 2006
Haro JM, Novick D, Suarez D, et al.: Predictors of the course of illness in outpatients with schizophrenia: A prospective three year study. Progress in Neuro-Psychopharmacology and Biological Psychiatry 32(5):1287–1292, 2008
Wiersma D, Wanderling J, Dragomirecka E, et al.: Social disability in schizophrenia: Its development and prediction over 15 years in incidence cohorts in six European centres. Psychological Medicine 30(5):1155–1167, 2000
Angermeyer MC, Goldstein JM, Kuehn L: Gender differences in schizophrenia: Rehospitalization and community survival. Psychological Medicine 19(2):365–382, 1989
Usall J, Haro JM, Ochoa S, et al.: Influence of gender on social outcome in schizophrenia. Acta Psychiatrica Scandinavica 106(5):337–342, 2002
Watt DC, Katz K, Shepherd M: The natural history of schizophrenia: A 5-year prospective follow-up of a representative sample of schizophrenics by means of a standardized clinical and social assessment. Psychological Medicine 13(3):663–670, 1983
Strous RD, Maayan R, Lapidus R, et al.: Increased circulatory dehydroepiandrosterone and dehydroepiandrosteronesulphate in first-episode schizophrenia: Relationship to gender, aggression and symptomatology. Schizophrenia Research 71(2–3):427–434, 2004
Walder DJ, Seidman LJ, Makris N, et al.: Neuroanatomic substrates of sex differences in language dysfunction in schizophrenia: A pilot study. Schizophrenia Research 90:295–301, 2007
Scholten MR, Aleman A, Kahn RS: The processing of emotional prosody and semantics in schizophrenia: Relationship to gender and IQ. Psychological Medicine 38(6):887–898, 2008
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC, American Psychiatric Association, 1994
Rickham PP: Human Experimentation. Code of Ethics of the World Medical Association. Declaration of Helsinki. British Medical Journal 2(5402):177, 1964
Bulbena VA, Fernandez de Larrinoa PP, Dominguez Panchon AI: Spanish adaptation of the Life Skills Profile. Profile of activities of daily living. Structure and factorial composition. Actas Luso-Españolas de Neurologia, Psiquiatria y Ciencias Afines 20(2):51–60,1992
Rosen A, Hadzi-Pavlovic D, Parker G: The life skills profile: A measure assessing function and disability in schizophrenia. Schizophrenia Bulletin 15(2):325–337, 1989
Kay SR, Fiszbein A, Vital-Herne M, et al.: The positive and negative syndrome scale—Spanish adaptation. Journal of Nervous and Mental Disease 178(8):510–517, 1990
Peralta M, V, Cuesta Zorita MJ: Validation of positive and negative symptom scale (PANSS) in a sample of Spanish schizophrenic patients. Actas Luso-Españolas de Neurologia, Psiquiatria y Ciencias Afines 22(4):171–177, 1994
Kay SR, Sevy S: Piramidical model of schizophrenia. Schizophrenia Bulletin 16:537–544, 1990
Shirakawa I, Mari JJ, Chaves AC, et al.: Family expectation, social adjustment and gender differences in a sample of schizophrenic patients. Revista de Saude Publica 30(3):205–212, 1996
Angermeyer MC, Kuhn L: Gender differences in age at onset of schizophrenia. An overview. European Archives of Psychiatry and Neurological Sciences 237(6):351–364, 1988
Faraone SV, Chen WJ, Goldstein JM, et al.: Gender differences in age at onset of schizophrenia. British Journal of Psychiatry 164(5):625–629, 1994
Häfner H, Riecher-Rossler A, An der Heiden W, et al.: Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia. Psychological Medicine 23(4):925–940, 1993
An der Heiden W, Häfner H. The epidemiology of onset and course of schizophrenia. European Archives of Psychiatry and Clinical Neuroscience 250(6):292–303, 2000
Amminger GP, Resch F, Mutschlechner R, et al.: Premorbid adjustment and remission of positive symptoms in first-episode psychosis. European Child and Adolescent Psychiatry 6(4):212–218, 1997
Pezzimenti M, Haro JM, Ochoa S, et al.: Assessment of service use patterns in out-patients with schizophrenia: A Spanish study. Acta Psychiatrica Scandinavica 114(Suppl. 432):12–18, 2006
Morgan VA, Castle DJ, Jablensky AV: Do women express and experience psychosis differently from men? Epidemiological evidence from the Australian National Study of Low Prevalence (Psychotic) Disorders. Australian and New Zealand Journal of Psychiatry 42:74–82, 2008
Greenwood KE, Landau S, Wykes T: Negative symptoms and specific cognitive impairments as combined targets for improved functional outcome within cognitive remediation therapy. Schizophrenia Bulletin 31(4):910–921, 2005
Rocca P, Bellino S, Calvarese P, et al.: Depressive and negative symptoms in schizophrenia: Different effects on clinical features. Comprehensive Psychiatry 46(4):304–310, 2005
Aki H, Tomotake M, Kaneda Y, et al.: Subjective and objective quality of life, levels of life skills, and their clinical determinants in outpatients with schizophrenia. Psychiatry Research 158:19–25, 2008
Salokangas RK, Honkonen T, Stengård E, et al.: Symptom dimensions and their association with outcome and treatment setting in longterm schizophrenia. Results of the DSP project. Nordic Journal of Psychiatry 56(5):319–327, 2002
Ochoa S, Haro JM, Usall J, et al.: Needs and its relation to symptom dimensions in a sample of outpatients with schizophrenia. Schizophrenia Research 75(1):129–134, 2005
Ochoa S, Vilaplana M, Haro JM, et al.: Do needs, symptoms or disability of outpatients with schizophrenia influence family burden? Social Psychiatry and Psychiatric Epidemiology 43(8):612–618, 2008
Burns T, Patrick D: Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatrica Scandinavica 116(6):403–418, 2007
Muller MJ, Regenbogen B, Sachse J, et al.: Gender aspects in the clinical treatment of schizophrenic inpatients with amisulpride: A therapeutic drug monitoring study. Pharmacopsychiatry 39(2):41–46, 2006
Leifker FR, Patterson TL, Heaton RK, et al.: Validating measures of real-world outcome: The results of the VALERO Expert Survey and RAND Panel. Schizophrenia Bulletin, 2009. Ahead of print. doi:10.1093/schbul/sbp044.
Bowie CR, Depp C, McGrath JA, et al.: Prediction of real-world functional disability in chronic mental disorders: A comparison of schizophrenia and bipolar disorder. The American Journal of Psychiatry, 2010. Ahead of print. doi:10.1176/appi.ajp.2010.09101406.
Acknowledgments
We are thankfully indebted to patients and families who participated in the study as well as mental health staff who assisted us in this study. This project has received the financial help of the Spanish Fondo de Investigaciones Sanitarias (FIS 97/1275) and the Spanish Health Services Research Network RIRAG (G03/061) (Red de Investigacion de Resultados Aplicados a la Gestion en Discapacidad y Salud Mental). This project is supported by CIBER Salud Mental (Instituto de Salud Carlos III).
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None of the authors have any conflict of interest regarding the present research.
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Vila-Rodriguez, F., Ochoa, S., Autonell, J. et al. Complex Interaction Between Symptoms, Social Factors, and Gender in Social Functioning in a Community-Dwelling Sample of Schizophrenia. Psychiatr Q 82, 261–274 (2011). https://doi.org/10.1007/s11126-011-9168-0
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DOI: https://doi.org/10.1007/s11126-011-9168-0