MedWire News: Real-world residential outcomes are widely different among schizophrenia patients from different cultures, despite similar scores on performance-based measures of everyday living, international study findings indicate.
Although functional capacity measures are standardized tests that provide valid predictors of everyday activities such as financial management and medication management, other environmental and experiential factors may lead to discrepancies between an individual’s theoretical functional capacity and what they achieve in everyday life.
To investigate further, Philip Harvey, from Emory University School of Medicine in Atlanta, Georgia, USA, and colleagues administered the University of California, San Diego, Performance-Based Skills Assessment-Brief Version (UPSA-B), the Specific Level of Functioning Scale (SLFS), and a neuropsychological battery to 146 schizophrenia patients living in rural Sweden and 244 patients living in New York City.
In addition, the team gathered information from medical records and case managers on demographic characteristics, independent living, working, and patient experiences of a stable romantic relationship.
The US sample was more ethnically diverse than the Swedish population, as well as slightly older, slightly worse educated, and less likely to be female, the team reports in the American Journal of Psychiatry.
Scores on the USPA-B were virtually identical in the two samples, both in terms of raw scores, at 13.30 for Swedish patients and 13.84 for US patients, and when the scores were converted to the USPA-B’s 100-point scale, at 69.89 and 69.03, respectively.
In addition, impairments in physical functioning, acceptable behavior, and everyday activities were comparable in the two countries, although US patients were rated by their case managers as less impaired in basic activities of daily living, social activities, and work-related activities.
Neuropsychological performance was significantly poorer in US than in Swedish patients, at average composite scores of 32.23 versus 35.59, while Swedish patients had significantly more impairment on the SLFS than US patients, at 183.23 versus 196.63.
While there were no differences in social and vocational outcomes between Swedish and US patients, Swedish patients were significantly more likely to be living independently, at 80% versus 46%.
Correlations between composite scores on neuropsychological performance, total USPA-B scores, and total SLFS scores were very similar between the two country samples, the team notes.
They conclude: “Given that these data suggest negligible differences in the ability to perform everyday living skills in the assessment setting and marked differences in residential outcomes, it appears likely that residential outcomes, like employment outcomes, may be driven by factors other than ability.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
Free abstract
