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Multicenter Study
. 2021 May 1;78(5):550-559.
doi: 10.1001/jamapsychiatry.2020.4614.

Factors Associated With Real-Life Functioning in Persons With Schizophrenia in a 4-Year Follow-up Study of the Italian Network for Research on Psychoses

Armida Mucci  1 , Silvana Galderisi  1 , Dino Gibertoni  2 , Alessandro Rossi  3 , Paola Rocca  4 , Alessandro Bertolino  5 , Eugenio Aguglia  6 , Mario Amore  7 , Antonello Bellomo  8 , Massimo Biondi  9 , Giuseppe Blasi  5 , Claudio Brasso  4 , Paola Bucci  1 , Bernardo Carpiniello  10 , Alessandro Cuomo  11 , Liliana Dell'Osso  12 , Giulia Maria Giordano  1 , Carlo Marchesi  13 , Palmiero Monteleone  14 , Cinzia Niolu  15 , Lucio Oldani  16 , Mauro Pettorruso  17 , Maurizio Pompili  18 , Rita Roncone  19 , Rodolfo Rossi  3 , Elena Tenconi  20 , Antonio Vita  21   22 , Patrizia Zeppegno  23 , Mario Maj  1 ; Italian Network for Research on Psychoses
Collaborators, Affiliations
Multicenter Study

Factors Associated With Real-Life Functioning in Persons With Schizophrenia in a 4-Year Follow-up Study of the Italian Network for Research on Psychoses

Armida Mucci et al. JAMA Psychiatry. .

Abstract

Importance: The goal of schizophrenia treatment has shifted from symptom reduction and relapse prevention to functional recovery; however, recovery rates remain low. Prospective identification of variables associated with real-life functioning domains is essential for personalized and integrated treatment programs.

Objective: To assess whether baseline illness-related variables, personal resources, and context-related factors are associated with work skills, interpersonal relationships, and everyday life skills at 4-year follow-up.

Design, setting, and participants: This multicenter prospective cohort study was conducted across 24 Italian university psychiatric clinics or mental health departments in which 921 patients enrolled in a cross-sectional study were contacted after 4 years for reassessment. Recruitment of community-dwelling, clinically stable persons with schizophrenia was conducted from March 2016 to December 2017, and data were analyzed from January to May 2020.

Main outcomes and measures: Psychopathology, social and nonsocial cognition, functional capacity, personal resources, and context-related factors were assessed, with real-life functioning as the main outcome. Structural equation modeling, multiple regression analyses, and latent change score modeling were used to identify variables that were associated with real-life functioning domains at follow-up and with changes from baseline in these domains.

Results: In total, 618 participants (427 male [69.1%]; mean [SD] age, 45.1 [10.5] years) were included. Five baseline variables were directly associated with real-life functioning at follow-up: neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P < .001) and work (β, 0.101; 95% CI, 0.005-0.196; P = .04) skills; avolition with interpersonal relationships (β, -0.126; 95% CI, -0.190 to -0.062; P < .001); positive symptoms with work skills (β, -0.059; 95% CI, -0.112 to -0.006; P = .03); and social cognition with work skills (β, 0.185; 95% CI, 0.088-0.283; P < .001) and interpersonal functioning (β, 0.194; 95% CI, 0.121-0.268; P < .001). Multiple regression analyses indicated that these variables accounted for the variability of functioning at follow-up after controlling for baseline functioning. In the latent change score model, higher neurocognitive abilities were associated with improvement of everyday life (β, 0.370; 95% CI, 0.253-0.486; P < .001) and work (β, 0.102; 95% CI, 0.016-0.188; P = .02) skills, social cognition (β, 0.133; 95% CI, 0.015-0.250; P = .03), and functional capacity (β, 1.138; 95% CI, 0.807-1.469; P < .001); better baseline social cognition with improvement of work skills (β, 0.168; 95% CI, 0.075-0.261; P < .001) and interpersonal functioning (β, 0.140; 95% CI, 0.069-0.212; P < .001); and better baseline everyday life skills with improvement of work skills (β, 0.121; 95% CI, 0.077-0.166; P < .001).

Conclusions and relevance: Findings of this large prospective study suggested that baseline variables associated with functional outcome at follow-up included domains not routinely assessed and targeted by intervention programs in community mental health services. The key roles of social and nonsocial cognition and of baseline everyday life skills support the adoption in routine mental health care of cognitive training programs combined with personalized psychosocial interventions aimed to promote independent living.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Mucci reported receiving personal fees from Gedeon Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka Pharmaceutical, Pfizer, and Laboratoires Pierre Fabre outside the submitted work; and having a pending patent for the treatment of schizophrenia. Dr Galderisi reported receiving personal fees from Angelini Pharma, Gedeon Richter-Recordati, Innova Pharma-Recordati Group, Janssen Pharmaceutica NV, Lundbeck Italia, Millennium Pharmaceutical, and Sunovion Pharmaceuticals outside the submitted work. Dr Bertolino reported receiving grants and personal fees from Lundbeck and receiving personal fees from Janssen and from Otsuka during the conduct of the study. Dr Blasi reported receiving personal fees from Lundbeck outside the submitted work. Dr Carpiniello reported receiving personal fees and nonfinancial support from ACRAF Angelini, Janssen, Lundbeck, and Otsuka; and receiving personal fees from Bausch & Lomb and from Pfizer outside the submitted work. Dr Cuomo reported receiving personal fees from Angelini Pharma, GlaxoSmithKline, Lundbeck, Otsuka Pharmaceutical, and Pfizer outside the submitted work. Dr Pompili reported receiving personal fees from Allergan, Angelini Pharma, FB Health Janssen, Lundbeck, and Otsuka Pharmaceutical. Dr Vita reported receiving grants from Boehringer Ingelheim and Takeda; receiving grants and personal fees from Janssen-Cilag, Lundbeck, and Otsuka Pharmaceutical; and receiving personal fees from Angelini, Innova Pharma, Pfizer, and Recordati outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Factors Associated With Real-Life Functioning at Follow-up
Final structural equation model. Ellipses represent latent variables; rectangles, observed variables; t0, baseline; and t1, follow-up. Solid lines denote positive associations; dashed lines, negative associations. Line thickness is proportional to the strength of the association. Numbers above each real-life functioning domain represent the variance explained by the model. Facial emotion indicates the Facial Emotion Identification Test; TASIT, The Awareness of Social Inference Test; and MSCEIT, Mayer-Salovey-Caruso Emotional Intelligence Test.
See this image and copyright information in PMC

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