A pilot validation study of a new measure of activity in psychosis

Abstract

Background

Wing and Brown [Wing JK and Brown GW (1970) Institutionalism and schizophrenia: a comparative study of three mental health hospitals 1960–1968. Cambridge University Press, London] demonstrated a clear relationship between activity and clinical improvement, using time budget methodology with people with psychosis. However, existing time budget measures are demanding to complete, and simpler, check-box measures of activity rely on subjective frequency judgements and do not include the full range of activities in which an individual might be involved. We report on a pilot validation of a simplified time budget measure of activity levels for routine use as a measure of change with people with psychosis.

Methods

Forty-two participants living in the local community with a schizophrenia spectrum diagnosis were grouped according to length of illness and, within the longer duration group, into high/low activity. All completed the time budget. On a second occasion, 15 participants also completed the subscales of the Social Functioning Scale (SFS) (Br J Psychiatry 157:853–859, 1990) to assess construct validity, and 15 completed the time budget to assess test–retest reliability.

Results

The time budget discriminated between duration and activity level groups and showed good inter-rater reliability and test–retest reliability. On the SFS, correlations with subscales measuring withdrawal, activities of daily living and employment were found.

Conclusions

Results indicate that our measure is tapping the activity component of social functioning. A larger scale validation study and investigation of sensitivity to change is underway.

Appendix

Time budget full scoring criteria and measure

• 0 Nothing—lying thinking, sleeping, sitting etc.

• 1 Predominantly passive activity. Watching TV, listening to radio, eating a meal prepared by someone else. Includes brief chatting with people who are already there (e.g. staff, group home or hostel), unless there is evidence that person actively sought out and engaged in company and conversation (see 2). Taking care of basic hygiene

• 2 An independent activity requiring some planning and motivation, but relatively simple or brief, e.g. a walk to the local shops to get cigarettes, tidying room, washing-up, preparing a simple meal for oneself. Attending a group in a hostel. Accompanied group outing from a hostel. Social contact that does not require much planning, e.g. seeking out and talking to friend in a hostel; being visited, without any specific activity or preparation. Talking to people sitting with during lunch (if not in hostel or group home). Reading (e.g. browsing through the paper or a magazine, flicking through a book or a brief period of involved reading). A phone call to someone

• 3 Several 2-rated activities completely filling a time period, sounding ‘busy’ (e.g. got breakfast, washed up, got newspapers from shop, looked at papers, made coffee, got cigarettes from shop, tidied up, listened to music and chatted with friend in hostel, went out for milk for staff) or a more complex and demanding but unvaried or shorter activity. Examples: visiting somebody when this requires a journey but a limited range of activities—e.g. ‘went to Mum's on bus’, e.g. ‘played computer bridge all morning’. Attending a day centre or rehabilitation centre. A trip out which takes time but may not be very demanding—e.g. ‘went to church’ for whole time period, e.g.‘went to pub with friend’, e.g. preparing a complicated meal for self. Reading if lengthy and obviously goal directed (e.g. read a novel, or read something for course of study)

• 4 Time period filled with a variety of demanding independent activities requiring significant motivation and planning and with some variation in tasks, e.g. work, a course of study, a trip out requiring organisation—meeting people, transport, varied activities, e.g. ‘met friend went round shopping centre shopping together, went for lunch together’; e.g. ‘took tube into central London, went to museum, tea at café, walked around park’; e.g. ‘met friends, went to pub, went on to club, talking and dancing’