Background: Most studies of outcome in schizophrenia have focused on incidence cohorts or samples identified through specialist mental health services; population-based samples provide a more complete picture of the effectiveness of community services.
Aims: To examine whether outcome predictors, derived from studies of selected patients with prolonged schizophrenia, would emerge in a largely community-dwelling population sample.
Methods: A follow-up sample of 114 adults with schizophrenia was identified via two censuses of key informants conducted for two prevalence surveys in North London, five years apart. Symptomatic, clinical and functional outcomes were assessed after five years. A composite score was derived for each individual. Multiple Linear Regression analyses were conducted in two phases to derive a best subset of predictors for global outcome.
Results: After five years, 33% were worse and 62% were better overall. The four best predictors (social isolation, living apart from relatives, longer illness and being an inpatient at first census) accounted for 32% of the variance in outcome of those with schizophrenia and related diagnoses.
Conclusions: Social relationships during the course of illness are an important predictor of overall outcome and relationships with friends and family each seem to make a positive contribution. Policy and service developments should focus on improving participation in community life for people with schizophrenia, particularly their social connectedness.
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References
1.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Washington, DC: American Psychiatric Association .
2.
Anderson, J. , Dayson, D. , Wills, W. , Gooch, C. , Margoulis, O. , O'Driscoll, C. & Leff, J. (1993) The TAPS Project. 13: clinical and social outcome of long-stay psychiatric patients after one year in the community . British Journal of Psychiatry, 162, 45—56 .
3.
Baldessarini, R.J. & Davis, J.M. (1980) What is the best maintenance dose of neuroleptics in schizophrenia ? Psychiatry Research, 3, 115—122 .
4.
Barnes, T.R.E. & Liddle, P.F. (1990) Evidence for the validity of negative symptoms . In Schizophrenia: Positive and Negative Symptoms and Syndromes (ed. N.C. Andreason). New York: Karger .
5.
Bates, P. (2002) Working for Inclusion: Making Social Inclusion a Reality for People with Severe Mental Health Problems. London: The Sainsbury Centre for Mental Health .
6.
Braun, P. , Kochansky, G. , Shapiro, R. , Green, S. , Gudeman, J.E. , Johson, S. & Shore, M.F. (1981) Overview: deinstitutionalization of psychiatric patients, a critical review of outcome studies . American Journal of Psychiatry,138, 736—749 .
7.
Breier, A. , Schreiber, J.L. , Dyer, J. & Pickar, D. (1991) National Institute of Mental Health longitudinal study of chronic schizophrenia: prognosis and predictors of outcome . Archives of General Psychiatry, 48, 239—246 .
8.
Carpenter, W.T. & Strauss, J.S. (1991) The prediction of outcome in schizophrenia IV: eleven-year follow-up of the Washington IPSS cohort . The Journal of Nervous and Mental Disease, 179, 517—525 .
9.
Davidson, L. , Haglund, K.E. , Stayner, D.A. , Rakfeldt, J. , Chinman, M.J. & Tebes, J.K. (2001) It was just realizing that life isn't one big horror: A qualitative study of supported socialization . Psychiatric Rehabilitation Journal, 24, 275—292 .
10.
Davidson, L. , Hoge, M.A. , Godleski, L. , Rakfeldt, J. & Griffith, E.E.H. (1996) Hospital or community living? Examining consumer perspectives on deinstitutionalization . Psychiatric Rehabilitation Journal, 19, 49—58 .
11.
Davidson, L. & Stayner, D. (1997) Loss, loneliness, and the desire for love: perspectives on the social lives of people with schizophrenia . Psychiatric Rehabilitation Journal, 20, 3—12 .
12.
Evert, H. , Harvey, C. , Trauer, T. & Herrman, H. (2003) The relationship between social networks and occupational and self-care functioning in people with psychosis . Social Psychiatry and Psychiatric Epidemiology, 38, 180—188 .
13.
Fossey, E.M. & Harvey, C.A. (2001) A conceptual review of functioning: implications for the development of consumer outcome measures . Australian and New Zealand Journal of Psychiatry, 35, 91—98 .
14.
Foster, K. , Meltzer, H. , Gill, B. & Hinds, K. (1996) OPCS surveys of psychiatric morbidity in Great Britain. Report 8: adults with a psychotic disorder living in the community . London: HMSO .
15.
Harding, C.M. , Zubin, J. & Strauss, J.S. (1987) Chronicity in schizophrenia: fact, partial fact, or artifact?Hospital and Community Psychiatry, 38, 477—486 .
16.
Harrison, G. , Croudace, T. , Mason, P. , Glazebrook, C. & Medley, I. (1996) Predicting the long-term outcome of schizophrenia . Psychological Medicine, 26, 697—705 .
17.
Harrison, G. , Hopper, K. , Craig, T. , Laska, E. , Siegel, C. , Wanderling, J. , Dube, K.C. , Ganev, K. , Giel, R. , An Der Heiden, W. , Holmberg, S.K. , Janca, A. , Lee, P.W.H. , Leon, A. , Malhotra, S. , Marsella, A.J. , Nakane, Y. , Sartorius, N. , Shen, Y. , Skoda, C. , Thara, R. , Tsirkin, S.J. , Varma, V.K. , Walsh, D. & Wiersma, D. (2001) Recovery from psychotic illness: a 15- and 25-year international follow-up study . British Journal of Psychiatry , 178, 506—517 .
18.
Harrison, G. & Mason, P. (1993) Schizophrenia — falling incidence and better outcome ? British Journal of Psychiatry, 163, 535—541 .
19.
Harvey, C. , Fossey, E. , Jackson, H. & Shimitras, L. (2006) Time use of people with schizophrenia living in North London: predictors of participation in occupations and their implications for improving social inclusion . Journal of Mental Health, 15, 43—55 .
20.
Harvey, C. , Pantelis, C. , Taylor, J. , McCabe, P.J. , Lefevre, K. , Campbell, P.G. & Hirsch, S.R. (1996a) The Camden Schizophrenia Surveys. II: High prevalence of schizophrenia in an inner London borough and its relationship to socio-demographic factors . British Journal of Psychiatry, 168, 418—426 .
21.
Harvey, C.A. , Curson, D.A. , Pantelis, C. , Taylor, J. & Barnes, T.R.E. (1996b) Four behavioural syndromes of schizophrenia . British Journal of Psychiatry, 168, 562—570 .
22.
Harvey, C.A. (1996) The Camden Schizophrenia Surveys. I: the psychiatric, behavioural and social characteristics of the severely mentally ill in an inner London health district . British Journal of Psychiatry , 168, 410—417 .
23.
Hegarty, J.D. , Baldessarini, R.J. , Tohen, M. , Waternaux, C. & Oepen, G. (1994) One hundred years of schizophrenia: a meta-analysis of the outcome literature . American Journal of Psychiatry , 151, 1409—1416 .
24.
Herrman, H. & Harvey, C. (2005) Community care for people with psychosis: outcomes and needs for care . International Review of Psychiatry, 17, 89—95 .
25.
Ho, B.C. , Nopoulos, P. , Flaum, M. , Arndt, S. & Andreasen, N.C. (1998) Two-year outcome in firstepisode schizophrenia: predictive value of symptoms for quality of life . American Journal of Psychiatry, 155, 1196—1201 .
26.
Jablensky, A. (2000) Course and outcome of schizophrenia and their prediction . In New Oxford Textbook of Psychiatry (eds M.G. Gelder,J. Lopez-Ibor Jr & N.C. Andreasen ). Oxford: Oxford University Press .
27.
Jablensky, A. , McGrath, J. , Herrman, H. , Castle, D. , Gureje, O. , Evans, M. , Carr, V. , Morgan, V. , Korten, A. & Harvey, C. (2000) Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders . Australian and New Zealand Journal of Psychiatry, 34, 221—236 .
28.
Jablensky, A. , Sartorius, N. , Ernberg, G. , Anker, M. , Korten, A. , COOPER, J.E., DAY, R. & BERTELSEN, A. (1992) Schizophrenia: manifestations, incidence and course in different cultures: a World Health Organization ten-country study . Psychological Medicine, 1—97 .
29.
Jarman, B. (1983) Identification of underprivileged areas . British Medical Journal, 286, 1705 —1709.
30.
Jarman, B. (1984) Underprivileged areas: validation and distribution of scores . British Medical Journal, 289, 1587—1592 .
31.
Jeffreys, S.E. , Harvey, C.A. , McNaught, A. , Quayle, A.S. , King, M.B. & Bird, A.S. (1997) The Hampstead Schizophrenia Survey 1991. I: prevalence and service use comparisons in an inner London health authority, 1986—1991 . British Journal of Psychiatry, 170, 301—306 .
32.
Kay, S.R. & Murrill, L.M. (1990) Predicting outcome of schizophrenia: significance of symptom profiles and outcome dimensions . Comprehensive Psychiatry, 31, 91—102 .
33.
Krawiecka, M. , Goldberg, D. & Vaughan, M. (1977) A standardized psychiatric assessment scale for rating chronic psychotic patients . Acta Psychiatrica Scandinavica , 55, 299—308 .
34.
Leff, J. (1993) The TAPS Project: evaluating community placement of long-stay psychiatric patients . British Journal of Psychiatry , 162, 1—56 .
35.
Leff, J. , Sartorius, N. , Jablensky, A. , Korten, A. & Ernberg, G. (1992) The International Pilot Study of Schizophrenia: five-year follow-up findings . Psychological Medicine, 22, 131—145 .
36.
Leff, J. & Trieman, N. (2000) Long-stay patients discharged from psychiatric hospitals. Social and clinical outcomes after five years in the community. The TAPS Project 46 . British Journal of Psychiatry, 176, 217—223 .
37.
Lehman, A.F. , Carpenter, W.T. , Goldman, H.H. & Steinwachs, D.M. (1995) Treatment outcomes in schizophrenia: implications for practice, policy and research . Schizophrenia Bulletin, 21, 669—675 .
38.
McGlashan, T.H. (1986) The prediction of outcome in chronic schizophrenia: IV. The Chestnut Lodge follow-up study . Archives of General Psychiatry,43, 167—176 .
39.
McGlashan, T.H. , Carpenter, W.T. & Bartko, J.J. (1988) Issues of design and methodology in long-term follow-up studies . Schizophrenia Bulletin, 14, 569—574 .
40.
McNaught A.S. , Jeffreys, S.E. , Harvey, C.A. , Quayle, A.S. , King, M.B. & Bird, A.S. (1997) The Hampstead Schizophrenia Survey 1991: II. Incidence and migration in inner London . British Journal of Psychiatry , 170, 307—311 .
41.
Meltzer, H.Y. (1995) Multiple-outcome criteria in schizophrenia: an overview of outcome with clozapine . European Psychiatry, 10, 19s—25s .
42.
Munk-Jorgensen, P. & Mortensen, P.B. (1992) Social outcome in schizophrenia: a 13-year follow-up . Social Psychiatry and Psychiatric Epidemiology , 27, 129—134 .
43.
O'Driscoll, C. (1993) The TAPS Project. 7: Mental hospital closure — a literature review of outcome studies and evaluative techniques . British Journal of Psychiatry, 162, 7—17 .
44.
Office Of Population Censuses And Surveys ( 1991) Census 1991. London: HMSO .
45.
Salokangas, R.K.R. (1997) Living situation, social network and outcome in schizophrenia: a five-year prospective follow-up study . Acta Psychiatrica Scandinavica, 96, 459—468 .
46.
Salokangas, R.K.R. (2003) Symptom dimensions and outcome in schizophrenia. WorldPsychiatry, 2, 172—178 .
47.
Shepherd, M. , Watt, D. , Falloon, I. & Smeeton, N. (1989) The natural history of schizophrenia: a fiveyear follow-up study of outcome and prediction in a representative sample of schizophrenics . In Psychological Medicine: Monograph Supplement 15Cambridge: Cambridge University Press .
48.
Spss (1996) SPSS for Windows 7.5Chicago: SPSS .
49.
Strauss, J.S. & Carpenter, W.T. , JR (1977) Prediction of outcome in schizophrenia. III. Five-year outcome and its predictors . Archives of General Psychiatry, 34, 159—163 .
50.
Vetter, P. & Koller, O. (1996) Clinical and psychosocial variables in different diagnostic groups: their interrelationships and value as predictors of course and outcome during a 14-year follow-up . Psychopathology, 29, 159—168 .
51.
Watt, D.C. , Katz, K. & Shepherd, M. (1983) The natural history of schizophrenia: a 5-year prospective follow-up of a representative sample of schizophrenics by means of a standardized clinical and social assessment . Psychological Medicine, 13, 663—670 .
52.
Wykes, T. & Sturt, E. (1986) The measurement of social behaviour in psychiatric patients: an assessment of the reliability and validity of the SBS schedule . British Journal of Psychiatry, 148, 1—11 .
