Social Functioning Outcomes Research Articles

(209) Impact of Co-Morbid Depression on Self-Reported Pain and Physical and Emotional Functioning in Low Back Pain Patients

The demand to document meaningful outcomes is pressuring pain clinics to develop methods to systematically assess the patient's physical, emotional, and social functioning and to include such factors as monitored patient outcomes. To further understand the factors that affect these outcomes, data from 4,113 consecutive pain clinic patients were examined. At a clinic visit, these individuals were administered the SF-36 and a clinical questionnaire. Diagnoses were made by a single pain medicine physician. All patient data were entered into the data registry of the AAPM Uniform Outcomes Measures project and were searched to identify those with low back pain (LBP). LBP patients were further classified according to the presence or absence of a depression diagnosis. The impact of co-morbid depression for patient functioning, as indicated by initial and subsequent SF-36 scores was evaluated. 1,628 individuals had at least one LBP diagnosis. This sample was predominantly female (58%) and middle-aged (mean 55 [SD 15.5]). The most common LBP diagnoses were: radiculopathy (62.2%), disc herniation (17.7%) and spinal stenosis (5.3%) but the sample included the full range of problems causing LBP. 32% of the sample received a diagnosis of depression. While scores for the total LBP group on all eight SF-36 domains were significantly lower (P < .0001) than those of a comparison non-pain patient group, the additional impact of co-morbid depression was striking. Comparison of SF-36 scores indicated LBP patients with a diagnosis of co-morbid depression were 1.7 to 3.2 times more likely than comparable non-depressed LBP patients to be in the worst quartiles of physical and emotional functioning. Moreover, the effects of depression persisted over time. This study demonstrates the feasibility of assessing physical, emotional, and social functioning outcomes in the pain clinic setting. It also provides important evidence supporting the need for the routine evaluation and management of co-morbid depression.

Effects of early lead exposure on neuroanatomical and social functional outcomes in young adults

Effects of early lead exposure on neuroanatomical and social functional outcomes in young adults

Comparative benefits and harms of competing medications for adults with attention-deficit hyperactivity disorder: a systematic review and indirect comparison meta-analysis

Recommended medication prescribing hierarchies for adult attention-deficit hyperactivity disorder (ADHD) vary between different guideline committees. Few trials directly compare competing ADHD medications in adults and provide little insight for clinicians making treatment choices. The objective of this study was to assess comparative benefits and harms of competing medications for adult ADHD using indirect comparison meta-analysis. Eligible studies were English-language publications of randomized controlled trials comparing ADHD drugs to placebo. Data sources were electronic bibliographic databases, Drugs@FDA, manufacturer data, and reference lists. Two reviewers independently abstracted data on design, internal validity, population, and results. Benefits and harms were compared between drug types using indirect comparison meta-regression (ratio of relative risks). Twenty-two placebo-controlled trials were included (n = 2,203). Relative benefit of clinical response for shorter-acting stimulants, primarily immediate release methylphenidate, was 3.26 times greater than for patients taking longer-acting stimulants (95% CI 2.03, 5.22) and 2.24 times greater than for patients taking longer-acting forms of bupropion (95% CI 1.23, 4.08). Immediate release methylphenidate is also the only drug shown to reduce ADHD symptoms in adults with substance abuse disorders. Neither non-stimulants nor longer-acting stimulants reduced adverse effects compared to shorter-acting stimulants. Key gaps in evidence were academic, occupational, social functioning, cardiovascular toxicity, and longer-term outcomes, influences of ADHD subtype and/or comorbidities, and misuse/diversion of the drugs. Current best evidence supports using immediate release methylphenidate as first-line treatment for most adults with ADHD.

Correlates of Adverse Childhood Events Among Adults With Schizophrenia Spectrum Disorders

Multiple studies have found that childhood adversity is related to a range of poor mental health, substance abuse, poor physical health, and poor social functioning outcomes in the general population of adults. However, despite the high rates of childhood adversity in schizophrenia, the clinical correlates of these events have not been systematically evaluated. This study evaluated the relationship between adverse experiences in childhood and functional, clinical, and health outcomes among adults with schizophrenia. The authors surveyed 569 adults with schizophrenia regarding adverse childhood events (including physical abuse, sexual abuse, parental mental illnesses, loss of a parent, parental separation or divorce, witnessing domestic violence, and foster or kinship care). The relationships between cumulative exposure to these events and psychiatric, physical, and functional outcomes were evaluated. Increased exposure to adverse childhood events was strongly related to psychiatric problems (suicidal thinking, hospitalizations, distress, and posttraumatic stress disorder), substance abuse, physical health problems (HIV infection), medical service utilization (physician visits), and poor social functioning (homelessness or criminal justice involvement). The findings extend the results of research in the general population by suggesting that childhood adversity contributes to worse mental health, substance abuse, worse physical health, and poor functional outcomes in schizophrenia.

The functional significance of social cognition in schizophrenia: a review.

Deficits in a wide array of functional outcome areas (eg, social functioning, social skills, independent living skills, etc) are marked in schizophrenia. Consequently, much recent research has attempted to identify factors that may contribute to functional outcome; social cognition is one such domain. The purpose of this article is to review research examining the relationship between social cognition and functional outcome. Comprehensive searches of PsycINFO and MEDLINE/PUBMED were conducted to identify relevant published manuscripts to include in the current review. It is concluded that the relationship between social cognition and functional outcome depends on the specific domains of each construct examined; however, it can generally be concluded that there are clear and consistent relationships between aspects of functional outcome and social cognition. These findings are discussed in light of treatment implications for schizophrenia.

Outcome assessment of the VADO approach in psychiatric rehabilitation: a partially randomised multicentric trial

BackgroundRecent studies on representative samples of psychiatric services have shown that low proportions of cases received effective rehabilitation interventions. The following are likely to be the most important causes: the scarcity of mental health workers trained in social and work skills strategies and the absence of a structured framework to formulate rehabilitation practices.The aim of this study was to assess if a specific structured planning and evaluation manual, called VADO (Valutazione delle Abilità e Definizione degli Obiettivi – in english: Skills Assessment and Definition of Goals), is more effective than routine interventions in reducing disability in patients with schizophrenia.MethodEach of 10 mental health services were invited to recruit 10 patients with a schizophrenic disorder. Altogether 98 patients were recruited. Of these, 62 patients were randomly allocated to the intervention/experimental or a control group. The remaining group of 36 patients was not randomised and it was considered as a parallel effectiveness study. Assessment measures at the beginning of the study and at the one-year follow-up included the FPS scale of social functioning and the BPRS 4.0. Between group (VADO vs. Routine) and time effects were examined with ANOVA, Chi-square or Fisher exact. Clinical "improvement" was defined as an increase of at least ten points on the FPS or a decrease of at least 20% on BPRS scores.Results31 of the 62 randomized patients received the experimental interventions, while 31 followed the routine ones. At follow-up, the experimental group showed statistically and clinically greater improvements in psychopathology and social functioning.Better outcomes of both social functioning and symptom severity were observed in non randomised patients (parallel effectiveness study).ConclusionThe results suggest that setting personalised and measurable objectives, as recommended by the manual, can improve the outcome of rehabilitation of severe mental disorders. Better outcomes in the parallel effectiveness study could be attributed to the greater confidence and enthusiasm of staff in centres where the VADO approach originated.

Emotion Knowledge Skills in Low‐income Elementary School Children: Associations with Social Status and Peer Experiences

AbstractThis short‐term longitudinal study examined relations between emotion knowledge and social functioning in a sample of low‐income kindergarten and 1st graders. Individual differences in spontaneous emotion naming and emotion recognition skills were used to predict children's social functioning at school, including peer‐nominated sociometric status, and child self‐reports of negative experiences with peers in school (peer victimization and rejection). Children who had greater emotional vocabulary and recognized emotions more accurately had better outcomes in all areas, and many of the associations between fall emotion knowledge skills and spring social functioning outcomes held after covarying grade and children's previous status with regard to these outcomes. Results are discussed with regard to implications for prevention and intervention programs (e.g., the PATHS curriculum) that focus on teaching emotion knowledge skills in order to foster high‐risk children's social competence.

A Comparison of the Cost-Effectiveness of Hospital-Based Home Care With That of a Conventional Outpatient Follow-up for Patients With Mental Illness

The purpose of this study was to compare the outcomes of a hospital-based home-care model with those of a conventional outpatient follow-up for mentally ill patients in Taiwan by means of cost-effectiveness analysis. The study design was a two group posthoc design. We interviewed 40 mentally ill patients who were followed up in the psychiatric outpatient department. Another 40 mentally ill patients who participated in a hospital based home care program were also interviewed. The outcome measures we used for interviews were disease maintenance behavior, psychotic symptoms, social function, service satisfaction, and cost. The cost for each patient was the sum of costs for all direct mental health services. The cost-effectiveness ratio showed that the costs of the hospital-based home care model (4.3) were lower than those of conventional outpatient follow-up (13.5) and that over a one-year period, the hospital-based home care model was associated with improvements in mental conditions, social functional outcomes, and service satisfaction. The improved outcomes and the lower costs in the hospital-based home care program support the view that it is the most cost-effective of the two. Policy makers may consider this analysis as they allocate resources and develop policy for the care of mentally ill patients.

Altruism Relates to Health in an Ethnically Diverse Sample of Older Adults

The existing literature indicates links between aspects of social network functioning and health outcomes. It is generally believed that networks that are larger or provide greater instrumental and emotional support contribute to improved health and, perhaps, greater longevity. Recently, it has been suggested that giving as well as receiving social support may be of benefit. On the basis of evolutionary theories of emotion and altruism, the current study sought to test this thesis in a large, ethnically diverse sample of community-dwelling older adults. As expected, levels of social support given were associated with lower morbidity, whereas levels of receiving were not. It is important that these relations held even when (a) socioeconomic status, education, marital status, age, gender, ethnicity, and (b) absolute network size and activity limitation were controlled for. Results are discussed in terms of their implications for theory regarding the relations among social exchanges, giving, and later life adaptation among older adults.

A Matched Lesion Analysis of Childhood Versus Adult-Onset Brain Injury Due to Unilateral Stroke

The literature on neuroplasticity lacks a direct comparison of chronic neuropsychological and social outcomes following brain damage acquired in childhood versus adulthood, when lesions are matched across adults and children for size and location. We paired adults and children with similar unilateral stroke lesions and then compared chronic neuropsychological and social outcomes. Quantitative comparisons were conducted, as well as qualitative analyses of each subject pair, focusing on specific domains of cognitive impairment and changes in social functioning. We found that learning and memory impairments were most common in both children and adults. Left hemisphere-lesioned children were normal on speech/language ratings, whereas their adult counterparts were borderline impaired. Impairments in social functioning were highly associated with hemispheric side of damage in adults, but not in children: Specifically, adults with right hemisphere lesions developed social defects much more frequently than adults with left hemisphere lesions, whereas this asymmetry was not evident in the children. Most importantly, though, was the overarching finding of a high degree of similarity between chronic neuropsychological and social function outcomes in adults and children with similarly located brain lesions due to unilateral stroke. On balance, the findings suggest that lesion location and size are prepotent factors determining neuropsychological and social recovery from stroke.

Electrophysiological indices associated with social functioning outcome in schizophrenia: a 5-year follow-up study

We previously demonstrated that event-related potentials (ERPs), such as N1/N2b amplitudes in an auditory selective attention task, were significantly associated with communication skills of schizophrenia. The present study investigated the relationship between N1/N2b amplitudes and the quality of life (QOL) 5 years after ERP measurement. QOL of 15 patients with schizophrenia was assessed using the quality of life scale (QLS). Correlational analyses revealed a significant relationship between N2b, but not N1, amplitude and specific domains of QOL. N2b amplitude, an electrophysiological index of orienting response, may be associated with longitudinal social functioning outcome in schizophrenia.

Schizophrenia and employment - a review.

Little is known about the extent to which work contributes to the recovery of people with schizophrenia. There is increasing interest in the subject because of new service models and the economic cost of unemployment in people with severe mental illness. A literature search was carried out with the aim of investigating: a). employment rates in schizophrenia and first-episode psychosis and the extent to which they have changed over time; b). the barriers to work; c). the factors associated with being employed among people with schizophrenia; and d). whether employment influences other outcomes in schizophrenia. There are wide variations in reported employment rates in schizophrenia. Most recent European studies report rates between 10 % and 20%, while the rate in the US is less clear. There is a higher level of employment among first-episode patients. The employment rate in schizophrenia appears to have declined over the last 50 years in the UK. Barriers to getting employment include stigma,discrimination, fear of loss of benefits and a lack of appropriate professional help. The most consistent predictor of employment is previous work history. Working is correlated with positive outcomes in social functioning, symptom levels, quality of life and self esteem, but a clear causal relationship has not been established. Very low employment rates are not intrinsic to schizophrenia, but appear to reflect an interplay between the social and economic pressures that patients face, the labour market and psychological and social barriers to working.

Comparison of characteristics between geriatric and younger subjects with schizophrenia in community

Relatively little is known about the different characteristics of non-institutionalized geriatric and younger subjects with schizophrenia. This study compared demographic and clinical characteristics of all the geriatric, middle-age and young subjects with schizophrenia living in a Chinese rural community. Geriatric (age ⩾65 years) ( N=51), middle-age (age 41–64 years) ( N=263) and young subjects with schizophrenia (age 15–40 years) ( N=196) in a rural community were assessed with the Present State Examination and Social Disability Screening Schedule. Age at first onset was significantly older in geriatric male and female groups. While there were no significant differences of negative symptoms among the three groups, the rates of lifetime nuclear syndrome were significantly lower in geriatric subjects compared to the other two groups. Geriatric subjects were less likely to have been hospitalized (9.8%) than middle-age (19.0%) and younger subjects (24.8%). Although the duration of illness was significantly longer in geriatric subjects than in the other two groups, the clinical outcome was significantly better in the geriatric group and social functioning scores were similar among the three groups. Geriatric subjects were more likely to be female, with longer duration of illness, fewer “core” symptoms, relatively stable social functioning and clinical outcome. The pathogenesis and psychopathology of geriatric subjects may be different compared to younger subjects with schizophrenia.

Kick’n’On: Helping young males kick back into life

Young men with psychotic disorders have persistently poorer outcomes in social functioning when interventions aimed at arresting social isolation are not implemented. Recent literature has indicated that it is important to develop rehabilitation programmes that are based on areas of needs that are identified by the participants. To assist in the design of a group programme, a qualitative (focus group) investigation of the perceptions of young males concerning male roles and identity in today’s society was conducted. The participants were six young males with psychotic disorders who had been referred to an Australian regional rehabilitation service to address poor social functioning and social isolation. Three main themes emerged from the focus groups. These were role models, concept of what is a man, and societal expectations. The findings were used to develop a group programme called Kick’n’On.

Karenni refugees living in Thai–Burmese border camps: traumatic experiences, mental health outcomes, and social functioning

In June 2001, we assessed mental health problems among Karenni refugees residing in camps in Mae Hong Son, Thailand, to determine the prevalence of mental illness, identify risk factors, and develop a culturally appropriate intervention program. A systematic random sample was used with stratification for the three camps; 495 people aged 15 years or older from 317 households participated. We constructed a questionnaire that included demographic characteristics, culture-specific symptoms of mental illness, the Hopkins Symptoms Checklist-25, the Harvard Trauma Questionnaire, and selected questions from the SF-36 Health Survey. Mental health outcome scores indicated elevated levels of depression and anxiety symptoms; post-traumatic stress disorder (PTSD) scores were comparable to scores in other communities affected by war and persecution. Psychosocial risk factors for poorer mental health and social functioning outcomes were insufficient food, higher number of trauma events, previous mental illness, and landmine injuries. Modifications in refugee policy may improve social functioning, and innovative mental health and psychosocial programs need to be implemented, monitored, and evaluated for efficacy.

Favorable Cardiovascular Risk Profile in Middle Age and Health-Related Quality of Life in Older Age

Life expectancy is greater for people with favorable midlife cardiovascular risk profiles (ie, low risk). However, some speculate that increased longevity may lead to large numbers of ill, disabled, older persons with lower quality of life. Few data exist on this important issue. This study evaluates the relationship of midlife low-risk status to quality of life and illness in older age. Cohort of middle-aged adults from the Chicago Heart Association Detection Project in Industry (2692 women and 3650 men; baseline ages, 36-64 years [average age, 73.2 years in 1996]) without baseline (1967-1973) major electrocardiographic abnormalities or history of diabetes or myocardial infarction. Quality of life (12-item Health Status Questionnaire [HSQ-12] on physical, mental, and social well-being) and self-reported diseases were assessed after 26 years of follow-up. Baseline risk strata included low risk (favorable blood pressure and serum cholesterol levels, no smoking, and no minor electrocardiographic abnormalities); 0 risk factors (ie, no high risk factors but >or=1 risk factors not at favorable levels); or any 1, any 2, or 3 or more of the following 4 risk factors: high blood pressure, high serum cholesterol level, smoking, and minor electrocardiographic abnormalities. The HSQ-12 scores and disease outcomes for low risk were compared with other strata. Adjusted scores for physical, mental, social functioning, and disease-free outcomes were highest for low-risk individuals and decreased significantly with number of risk factors (eg, 58% of low-risk women had excellent/very good health compared with 28% of women with >or=3 risk factors). Favorable cardiovascular risk profile in middle age is associated with better quality of life and lower risk of diseases in older age. Moreover, the fewer the risk factors, the higher the quality of life.

Cognition in Schizophrenia: Impairments, Importance, and Treatment Strategies

Cognition in Schizophrenia: Impairments, Importance, and Treatment Strategies

A Meta-Analytic Review of the Common-Sense Model of Illness Representations

A meta-analysis of empirical studies ( N = 45) adopting Leventhal, Meyer and Nerenz's (1980) Common Sense Model (CSM) of illness representations is presented. The average corrected intercorrelation matrix for the sample of studies showed that the CSM illness cognition dimensions of consequences, control/cure, identity and timeline followed a logical pattern supporting their construct and discriminant validity across illness types. A content analysis classified coping strategies into seven distinctive categories and health outcomes into six categories. Examining the average corrected correlation coefficients across the studies revealed that perceptions of a strong illness identity were significantly and positively related to the use of coping strategies of avoidance and emotion expression. In addition, perceived controllability of the illness was significantly associated with cognitive reappraisal, expressing emotions and problem-focused coping strategies. Perceptions of the illness as highly symptomatic, having a chronic timeline and serious consequences was significantly correlated with avoidance and expressing emotions coping strategies. Further, perceptions that the illness was curable/controllable was significantly and positively related to the adaptive outcomes of psychological well-being, social functioning and vitality and negatively related to psychological distress and disease state. Conversely, illness consequences, timeline and identity exhibited significant, negative relationships with psychological well being, role and social functioning and vitality. The analyses provide evidence for theoretically predictable relations between illness cognitions, coping and outcomes across studies.

Learning (potential) and social functioning in schizophrenia

Cognitive dysfunction in schizophrenia has well-known functional consequences. The ability to learn (learning potential) may be an important mediator. This study examines the relationship between learning and functional status in schizophrenia patients before and after participation in a rehabilitation program. We reasoned that learning is a broad construct, encompassing controlled, effortful as well as automatic (learning by doing) mechanisms, called explicit and implicit learning, respectively. Both types of learning ability are important in daily life. The study included 44 medicated schizophrenia patients and 79 healthy controls. We included measures of implicit and explicit learning as well as measures of the cognitive domains for which significant relationships with functional outcome have been established: immediate and secondary verbal memory, card sorting and vigilance. Learning potential and the patient's ‘learner status’ were also assessed. The results show that learning, as assessed by measures of explicit and implicit learning and learning potential, was not associated with social functioning or rehabilitation outcome. The highest correlations between cognitive functioning and social functioning were found for more or less ‘static’ performance measures when they were assessed for a second time with or without instructions on how to do the test. Optimized cognitive performance (i.e. performance after instruction or training) seems to be a better predictor of complex domains of functioning than naive or everyday performance.

Outpatient mental health care, self-help groups, and patients' one-year treatment outcomes.

To examine the association between the duration and amount of outpatient mental health care, participation in self-help groups, and patients' casemix-adjusted one-year outcomes. A total of 2,376 patients with substance use disorders, 35% of whom also had psychiatric disorders, were assessed at entry to treatment and at a one-year follow-up. Information about the duration and amount of outpatient mental health care was obtained from a centralized health services utilization database. Patients who obtained regular outpatient mental health care over a longer interval and patients who attended more self-help group meetings had better one-year substance use and social functioning outcomes than did patients who were less involved in formal and informal care. The amount of outpatient mental health care did not independently predict one-year outcomes. The duration of outpatient mental health care and the level of self-help involvement are independently associated with less substance use and more positive social functioning. The provision of low intensity treatment for a longer time interval may be a cost-effective way to enhance substance abuse and psychiatric patients' long-term outcomes.