Elsevier

Schizophrenia Research

Volume 131, Issues 1–3, September 2011, Pages 250-255
Schizophrenia Research

Assessing everyday functioning in schizophrenia: Not all informants seem equally informative,☆☆

https://doi.org/10.1016/j.schres.2011.05.003Get rights and content

Abstract

Self reports of everyday functioning on the part of people with schizophrenia have been found to be poorly correlated with the reports of other informants and with their own performance of tests of cognition and functional abilities. However, it is not clear which informants are best for providing accurate reports of everyday functioning. This study examined the convergence between self-reports on the part of people with schizophrenia (n = 193), whose real-world functioning was rated by a friend or relative (n = 154), or a high contact clinician (n = 39) across 6 functional status rating scales. In addition, correlations between these reports and patient's performance on neuropsychological tests and a performance-based measure of functional capacity were also calculated. For convergence between raters, friend or relative informants and patient reports were significantly correlated for 4/6 rating scales. For the smaller sample of clinician informants, the correlations were significant on 2/6 scales. In the analyses of convergence between patient performance scores and functioning ratings, only 1/12 correlations between patient report and performance were significant, while friend or relative reports also were only correlated with performance on one rating scale. In contrast, clinician reports of functioning were correlated with patients' functional capacity performance on 4/6 rating scales and with neuropsychological test performance on 2/6. High contact clinicians appear to generate ratings of everyday functioning that are more closely linked to patients' ability scores than friend or relative informants. Later analyses will determine if there are differences between friend or relative informants.

Section snippets

Subjects

The study participants were patients with schizophrenia who were receiving treatment at one of three different outpatient service delivery systems, two in Atlanta and one in San Diego. In addition, informants were interviewed for each of the patients, with these informants either being a high-contact clinician (case manager, psychiatrist, therapist or residential facility manager) or a friend or relative. All of research participants (including informants) provided signed, informed consent, and

Results

Table 1 presents the demographic and clinical characteristics of the patient samples as a function of the type of informant. As we examined the convergence in reports between patients and informants as a function of the different informant types, we were interested in whether these samples of patients who had different informants were different from each other. Patients who were rated by clinicians were more likely to be Caucasian, were younger, and had more years of education (all p  0.03).

Discussion

Our study revealed that across six different functional status rating scales, patients generated self-reports that were modestly correlated with informant reports, including both clinicians and friend/relatives serving as informants. The severity levels of each measure were only slightly different for the two measures that differed significantly (SBS and QLS), with patients under-reporting impairment when compared to both types of informants. Overall, clinician reports were more consistently

Role of funding source

This research was funded by the National Institute of Mental Health, who provided no input into the analyses and presentation of these data.

Contributors

Drs. Harvey, Heaton, and Patterson designed the overall study and obtained funding. Dr. Sabbag conceptualized and conducted the current analyses and wrote the first draft of the paper. Dr. Harvey provided scientific oversight throughout the project and edited the manuscript. Drs Heaton, Patterson, and Twamley and Ms Vella provided detailed comments to the paper across three drafts of the manuscript.

Conflict of interest

Dr. Harvey has received consulting fees for Abbott Labs, BMS, Cypress Bioscience,, En Vivo, Genentech, Merck and Company, Shire Pharma, Sunovion Pharma, and Takeda Pharma during the past year. He has received research funding from Astra-Zeneca. None of the other authors have any commercial interests to report.

Acknowledgments

All individuals who contributed to this paper are listed as authors. No professional medical writer was involved in any portion of the preparation of the manuscripts. Data were collected by paid research assistants who did not contribute to the scientific work in this paper.

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    This research was supported by Grants MH078775 to Dr. Harvey and MH078737 to Dr. Patterson from the National Institute of Mental Health.

    ☆☆

    Dr. Harvey has received consulting fees from Abbott Labs, Bristol Myers Squibb, Cypress Bioscience, En Vivo, Genentech, Merck and Company, Shire Pharma, Sunovion Pharma, and Takeda Pharma, during the past year. None of the other authors have any commercial interests to report. This study was funded by the NIMH and is unrelated to Dr. Harvey's Consulting work.

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