Measurement of social disability in a schizophrenic patient group

Summary

This paper presents findings of the German participants in the WHO multicenter study on “The Assessment of Disability Associated with Schizophrenic Disorders.” Using the PSE, the Disability Assessment Schedule (DAS) and additional WHO instruments, a prospective cohort of 70 schizophrenic patients with recent onset was assessed at half-yearly intervals. The paper describes the changes in severity and patterns of disability during the course of illness until the 2-year follow-up. First, an empirically developed score was used to measure changes in disability over the follow-up period. According to the mean score, the degree of disability for the sample as a whole remained unchanged. However, when the patients were grouped into a good outcome group, an intermediate and a poor outcome group, significant changes could be detected: the number of patients in each of the two extreme groups increased, whereas the number of those with intermediate scores decreased. In order to examine the course of disability, different course types (patterns) were defined, based on à priori considerations, which could be replicated by cluster analysis. In a second step, the profile of disability was analyzed on the basis of the ratings of specific social roles (single items). This analysis was carried out separately for patients in acute psychotic episodes and in the intervals between these. The group profiles at each of the four follow-up assessments are similar to one another. Patients not in an acute episode at the time of assessment were most disabled in their heterosexual role, social activities, and in their work performance. The relationships between course of disability and different characteristics are discussed: sociodemographic variables appeared to be predictive, whereas variables concerning mental status at the time of onset were not.