Abstract
A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-reporting their real-life functioning. In a large (n = 618) cohort of stable, community-dwelling schizophrenia patients we sought to: (1) examine the concordance of patients’ reports of their real-life functioning with the reports of their key caregiver; (2) identify which patient characteristics are associated to the differences between patients and informants. Patient-caregiver concordance of the ratings in three Specific Level of Functioning Scale (SLOF) domains (interpersonal relationships, everyday life skills, work skills) was evaluated with matched-pair t tests, the Lin’s concordance correlation, Somers’ D, and Bland–Altman plots with limits of agreement (LOA). Predictors of the patient-caregiver differences in SLOF ratings were assessed with a linear regression with multivariable fractional polynomials. Patients’ self-evaluation of functioning was higher than caregivers’ in all the evaluated domains of the SLOF and 17.6% of the patients exceeded the LOA, thus providing a self-evaluation discordant from their key caregivers. The strongest predictors of patient-caregiver discrepancies were caregivers’ ratings in each SLOF domain. In clinically stable outpatients with a moderate degree of functional impairment, self-evaluation with the SLOF scale can become a useful, informative and reliable clinical tool to design a tailored rehabilitation program.
Highlights
Patients with schizophrenia show notable impairments in everyday functioning, including deficits in social, vocational, and residential domains, even during periods of remission from active psychosis[1]
From the regression analyses performed using multiple imputation and multivariable fractional polynomials (MFPs, Table 4 and Fig. 2), we found that caregiver scores in each of the three domains of the SLOF analyzed were the strongest predictors of patient-caregiver discrepancies with negative coefficients
This study aimed at two main goals: (a) to assess the concordance between real-world functioning self-reported by people with schizophrenia and reports generated by informants; (b) to evaluate predictors of the agreement between these two evaluations
Summary
Patients with schizophrenia show notable impairments in everyday functioning, including deficits in social, vocational, and residential domains, even during periods of remission from active psychosis[1]. Many different instruments are available for the assessment of real-life functioning, including rating scales that employ informant and self-reports[2], direct observations by trained clinicians[3], and performance-based measures[4]. Studies have indicated that informant reports regarding the specific behaviors reflective of community functioning may be the most reliable assessment of functioning[5]. Many people with schizophrenia do not have informants readily available to report on their functioning[6] or they may have limited contact with them[7]. In outpatient samples, there are many behaviors to which the clinician has no access and the use of self-reports may be important to get a clearer picture of the subjective level of functioning of patients. 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[8]
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