Social Functioning Outcomes Research Articles

Social networks and functional status in patients with psychosis

To investigate whether large social networks are associated with better functional outcome in psychotic disorders. A prospective cohort study of epidemiologically representative patients with psychosis was analysed to examine the relationship between social networks and functional outcome. Standardized validated measures were used for diagnosis, social networks and outcome. There was strong evidence of cross-sectional associations between the size of the social network and the number of active interactions, and functional outcome. Structural equation modelling found weak evidence of an additional longitudinal association. There was consistent evidence of a positive correlation between the total size of patients' social networks and the number of active interactions, and functional outcome. The direction of causality cannot be determined by this analysis, although it is suggested that the effect of social networks on functioning is stronger than vice versa. Patients' functioning may improve with interventions that improve social networks.

Specialty mental health care improves patients' outcomes: findings from a nationwide program to monitor the quality of care for patients with substance use disorders.

To describe the implementation of a nationwide program to monitor the quality of treatment for substance use disorders in the Department of Veterans Affairs, and to examine how the provision of outpatient mental health care, and the duration and intensity of care, relate to patients' outcomes. Clinicians completed a baseline Addiction Severity Index (ASI) on more than 34,000 patients with substance use disorders; more than 21,000 (63%) were reassessed with the ASI an average of 12 months later. Nationwide health service utilization databases were used to obtain information about patients' diagnoses and their use of services during an index episode of care. On average, patients who received specialty outpatient mental health care experienced better risk-adjusted outcomes than did patients who did not receive such care. Patients who had longer index episodes of mental health care improved more than did those who had shorter episodes. There was some evidence that the duration of care contributed more to better outcomes among patients with only substance use disorders, whereas the intensity of care was more important for patients with both substance use and psychiatric disorders. The provision of specialty outpatient mental health care, and longer episodes of specialty care, were associated with better risk-adjusted substance use, symptom and social functioning outcomes for patients with substance use disorders. More emphasis should be placed on ensuring that these patients enter specialty care and on keeping them in treatment.

Age-of-Onset Classification of Conduct Disorder: Reliability and Validity in a Prospective Cohort Study

To test in a prospective clinical cohort study the reliability and validity of the age-of-onset subtyping of conduct disorder. Participants were adolescents referred to psychiatric clinics who met DSM-III-R criteria for conduct disorder by structured diagnostic interview. Age of onset was the reported age of the first conduct disorder symptom. The reliability of age-of-onset report was tested by assessing agreement within informant on interviews 2 to 4 weeks apart. Age-of-onset groups were compared within informant on rates of correlates and symptom and social functioning outcomes over a period of 3 years. The reliability of age-of-onset report was low (kappa of 0.1 and 0.4 by adolescent and parent informant, respectively). Although the early-onset group had elevated rates of attention-deficit/hyperactivity disorder, family disadvantage, and aggressive and nonaggressive antisocial behaviors at inclusion, growth curve analysis showed that age-of-onset subtyping had no predictive validity. The reliability of ascertainment of age of onset of antisocial behavior requires further study. While age-of-onset subtyping has heuristic value with respect to the study of the causal pathways to conduct disorder, it is premature to use this system in clinic settings.

A Comparative Evaluation of Substance Abuse Treatment IV. The Effect of Comorbid Psychiatric Diagnoses on Amount of Treatment, Continuing Care, and 1‐Year Outcomes

Recent surveys of the substance abuse patient population have shown a striking increase in the proportion of patients with a comorbid psychiatric disorder. In this study, patients with substance abuse and psychotic, anxiety/depressive, or personality disorders were compared with patients with only substance use disorders on treatment experiences and outcomes. Regardless of dual diagnosis status, patients generally improved on both substance use and social functioning outcomes after substance abuse treatment. At the 1-year follow-up, dually diagnosed patients, and patients with only substance use disorders, had comparable substance use outcomes. However, patients with major psychiatric disorders, specifically psychotic and anxiety/depressive disorders, fared worse on psychological symptoms and employment outcomes than did patients with personality disorders and only substance use disorders. Although there were some group differences on the amount of index treatment received and continuing care, the overall pattern of relationships between treatment variables and outcomes was comparable for the patient groups. In addition, there was no diagnostic group by treatment orientation matching effects, which indicated that the dual diagnosis patient groups improved as much in 12-Step as in cognitive-behavioral substance abuse programs.

Adolescent Outcomes of Social Functioning in Chinese Children

A sample of Chinese children in Shanghai, People’s Republic of China, initially aged 8 and 10 years, participated in this four-year longitudinal project. Information on social functioning including sociability-leadership, aggression-disruption, and shyness-sensitivity was collected from peer assessments in the original study. Data on indexes of social and school adjustment, including peer acceptance, teachers’ perceptions of school-related competence, leadership, academic achievement, adjustment problems, and self-perceptions of competence, were collected from multiple sources in the follow-up study. Consistent with Western literature, sociability-leadership positively predicted indexes of social and school adjustment. Aggression was positively associated with adolescent maladjustment for boys and adjustment for girls. Finally, inconsistent with the Western literature, shyness-sensitivity in childhood was positively predictive of indexes of adolescent adjustment such as teacher-assessed competence, leadership, and academic achievement.

Insight and illness in chronic schizophrenia

The role of insight in relation to the diagnosis and treatment of psychotic disorders has received renewed attention in psychiatric and psychological literature. Degree of insight has been found to generally associate with social and occupational functioning, prognosis, and treatment outcome. However, the relationship between insight and symptoms of illness is not known due to previous studies that yielded conflicting results. This study tested the association between general insight and symptomatology in a sample of 66 patients with chronic schizophrenia. Degree of insight was significantly related to positive symptomatology; however, it was not related to demographics, negative symptoms, general psychopathology, or global functioning. These results are supported by several other investigations in this area.

The Nature of Social Competence: A Theoretical Review

AbstractConsistent with much of the research literature, social competence is defined as effectiveness in social interaction. Effectiveness is broadly considered, and includes both self and other perspectives. Social competence is viewed as an organizing construct, with transactional, context‐dependent, and goal‐specific characteristics. Four general approaches to the operational definition of social competence are identified: social skills, sociometric status, relationships, and functional outcomes. A Prism Model of social competence is presented, based on theoretical, index and skills levels of analyses. The implications of the Prism Model for developmental, gender, cultural, assessment and intervention issues are also discussed.

The relationship between social support systems and functional outcomes in acutely ill stroke patients in a rehabilitation hospital: Dorothy Hadley, R.N., MS, Ph.D. (Manor Care Sandia, Albuquerque, NM)

The relationship between social support systems and functional outcomes in acutely ill stroke patients in a rehabilitation hospital: Dorothy Hadley, R.N., MS, Ph.D. (Manor Care Sandia, Albuquerque, NM)

Inclusion: Considerations from social validity and Functional Outcome Analysis

Inclusion and particularly “full inclusion” has become a hotly debated topic. While proponents of inclusion believe that social, behavioral, academic, and developmental benefits occur for children with disabilities as well as for other, nondisabled, children in the classroom, research into inclusion provides equivocal results. This paper (a) describes inclusion, highlighting the inconsistencies in definitions and research; (b) discusses the importance of social validity in making inclusion decisions; and (c) presents an approach to inclusion using Functional Outcome Analysis (Noell & Gresham, 1993). While inclusion may be philosophically desirable, the research does not support its application as an all-inclusive approach. Inclusion decisions must be made on a case-by-case basis after a functional analysis of the student's behavior has been conducted.

Studies of the course and outcome of schizophrenia in later life

Infurmation about the course and outcome ofschizophrenia among patients age 55 and older will become increasingly important in the coming years, as the proportion of elderly persons in the general population grows. Over the next 30 years, the number of aging persons with schizophrenia is expected to double. They will have spent considerably less time in mental institutions than people with schizophrenia in earlier generations and consequently will need to negotiate health and social service systems that may be ill prepared to dealwith them. Besides providing data for service planning, research on schizophrenia in later life, by which time the disorder generally has developed a highly complex form, provides many keys to understanding the illness. This column discusses issues in research on outcomes of schizophrenia in later life and reviews findings on psychopathology, social functioning, and treatment outcome among older persons with schizophrenia.

The course and outcome of depression in different cultures: 10-year follow-up of the WHO Collaborative Study on the Assessment of Depressive Disorders

The World Health Organization's study on depressive disorders in different cultures began in 1972. Cohorts of depressed patients were identified in Basle, Montreal, Nagasaki, Teheran and Tokyo. The patients were assessed using standardized measures of social and clinical functioning. Ten-year follow-up data on clinical course, service contact, suicidal acts and social function outcomes were available for 439 (79%) patients. Over one-third (36%) were re-admitted at least once in the follow-up period, half of whom (18%) had very poor clinical outcome. Twenty-four per cent suffered severe social impairment for over half the follow-up period, and over one-fifth (21%) showed no full remissions. The best clinical course (one or two reasonably short episodes of depression with complete remission between episodes) was experienced twice as frequently in patients with a diagnosis of endogenous (65%) as in those diagnosed as suffering from psychogenic depression (29%). Among all patients, a fifth (22%) had at least one episode lasting for more than 1 year, and 10% had an episode lasting over 2 years during follow-up. Death by suicide occurred in 11% of patients, with a further 14% making unsuccessful suicide attempts.

Gender, premorbid social functioning, and long-term outcome in DSM-III schizophrenia

The present study examined the relationships among premorbid social functioning, gender, and long-term outcome in a group of 82 subjects (41 men and 41 women) who were retrospectively rediagnosed to meet the criteria for DSM-III schizophrenia. The Premorbid Adjustment Scale was used to assess premorbid social functioning along a developmental continuum. The Community Adjustment Scale provided outcome data related to the subjects' degree of productivity, ability to maintain close relationships, and presence/absence of symptomatology an average of 32 years after initial admission. The results indicated that females tended to exhibit better premorbid functioning than males. Although the outcome data did not reveal a statistically significant relationship between gender and long-term functioning, the results were in the predicted direction, with females again demonstrating more favorable outcome than males. Despite the absence of a statistically significant gender effect, a relationship did appear to exist between premorbid functioning and very long-term outcome, with premorbid asocial functioning predicting poor outcome.

Mental Status Changes in Children Receiving Glucocorticoids

Glucocorticoid preparations are used commonly in the treatment of many diseases in children and adolescents. Although their physiologic side of effects have been described well, the psychiatric side effects of these medications have received little attention. Limited data suggest that disturbances of affect and behavior may occur in 25-50% of children receiving glucocorticoid. These steroid-induced mental changes may be underrecognized in children, and yet these changes can have considerable impact on social and psychological functioning and treatment outcome. An enhanced awareness and reporting of this phenomenon by clinicians, parents, and teachers would likely lead to better compliance with treatment, improved outcomes, and greater understanding of emotional concomitants of illness.

Gender, Premorbid Social Functioning, and Long-term Outcome in DSM-III Schizophrenia

The present study examined the relationships among premorbid social functioning, gender, and long-term outcome in a group of 82 subjects (41 men and 41 women) who were retrospectively rediagnosed to meet the criteria for DSM-III schizophrenia. The Premorbid Adjustment Scale was used to assess premorbid social functioning along a developmental continuum. The Community Adjustment Scale provided outcome data related to the subjects' degree of productivity, ability to maintain close relationships, and presence/absence of symptomatology an average of 32 years after initial admission. The results indicated that females tended to exhibit better premorbid functioning than males. Although the outcome data did not reveal a statistically significant relationship between gender and long-term functioning, the results were in the predicted direction, with females again demonstrating more favorable outcome than males. Despite the absence of a statistically significant gender effect, a relationship did appear to exist between premorbid functioning and very long-term outcome, with premorbid asocial functioning predicting poor outcome.

Electrodermal nonresponding, premorbid adjustment, and symptomatology as predictors of long-term social functioning in schizophrenics.

The hypothesis that electrodermal nonresponsiveness to orienting stimuli delineates a core group of "Kraepelinian" type schizophrenics was tested by following up social functioning outcome over a 2-year period in 37 schizophrenics. Good social functioning outcome required both some self-supporting ability in the job market and a minimal social life. The prior assessments included monitoring of electrodermal responses to a series of moderately intense tones, ratings of reported and observed symptoms during an interview, and ratings of premorbid adjustment on the basis of an interview with a close relative. Electrodermal nonresponding, poor premorbid adjustment, and negative symptomatology predicted poor social functioning during the second follow-up year, but the relationship to nonresponding pertained exclusively to a group of 15 first-episode patients. Discriminant analysis showed that electrodermal nonresponding and symptoms were the only independent predictors of outcome.

The triage experiment in coordinated care for the elderly.

Triage is a model project designed to overcome the organizational and financial barriers inhibiting the provision of appropriate care to the elderly. Teams made up of a nurse clinician and a social worker performed assessment, service coordination, and monitoring functions. Services arranged by the teams were financed through a series of waivers on the use of the Medicare Trust Fund. Three hundred and seven Triage clients were followed and compared to a group of 195 elderly in a two year quasi-experimental study of functioning status outcomes, use of services, and health care costs. Triage clients had slightly better mental functioning outcomes than comparison clients; results of physical and social functioning outcomes were inconclusive. Both service utilization and costs were somewhat higher for Triage clients; the proportional difference in utilization was greater than the proportional difference in costs.