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Does Self-Efficacy Predict Functioning in Older Adults with Schizophrenia? A Cross-Sectional and Longitudinal Mediation Analysis

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Abstract

Background

Self-efficacy (belief in one’s ability to complete activities or manage symptoms) is often poor in people with schizophrenia. Low self-efficacy is associated with negative symptoms and neurocognition which, together, may worsen psychosocial functioning. This study explores causal patterns between these variables by assessing their temporal associations and their combined role in predicting functioning using cross-sectional and longitudinal data.

Methods

This study is a secondary analysis of data from 103 older adults with schizophrenia-spectrum disorders engaged in a randomized controlled trial (Helping Older People Experience Success or Treatment As Usual). Cross-sectional and longitudinal measures included neurocognition, positive and negative symptoms, self-efficacy, and three measures of functioning (Independent Living Skills Survey [ILSS], The Multnomah Community Ability Scale (MCAS), University of California, San Diego Performance-Based Skills Assessment [UPSA]).

Results

Self-efficacy was associated with self-reported functional skills (ILSS) only. The impact of self-efficacy on functioning was partially mediated by negative symptoms. This mediation was also present when predicting functioning at one year, unaffected when depression and positive symptoms were controlled.

Conclusions

This study suggests direct and indirect effects of self-efficacy, via negative symptoms, on functioning in older adults with schizophrenia. Self-efficacy and negative symptoms should be intervention targets to improve functional difficulties in older adults with schizophrenia.

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Authors and Affiliations

  1. Center for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac St., 6th Floor, Boston, MA, 02114, USA

    Abigail C. Wright & Corinne Cather

  2. Harvard Medical School, Boston, MA, USA

    Abigail C. Wright & Corinne Cather

  3. Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA

    Julia Browne

  4. Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Sarah I. Pratt

  5. Department of Medicine, Mongon Institute, Massachusetts General Hospital, Boston, MA, USA

    Stephen J. Bartels

  6. Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA

    Kim T. Mueser

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  1. Abigail C. Wright
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  2. Julia Browne
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  4. Sarah I. Pratt
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Correspondence to Abigail C. Wright.

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Conflict of Interest

Dr. Browne is funded by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship in Geriatrics. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the United States Government or Department of Veterans Affairs.

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All participant provided written consent to take part in the main intervention trial.

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Wright, A.C., Browne, J., Cather, C. et al. Does Self-Efficacy Predict Functioning in Older Adults with Schizophrenia? A Cross-Sectional and Longitudinal Mediation Analysis. Cogn Ther Res 45, 136–148 (2021). https://doi.org/10.1007/s10608-020-10171-8

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