Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres

Background. This paper focuses on the long-term course of social disability in schizophrenia assessed at first onset, and after 1, 2 and 15 years in incidence cohorts in six European centres in Bulgaria, Germany, Ireland, The Netherlands, the Czech Republic and the United Kingdom. The study populati...

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Bibliographic Details
Published in:Psychological medicine 2000-09, Vol.30 (5), p.1155-1167
Main Authors: WIERSMA, D., WANDERLING, J., DRAGOMIRECKA, E., GANEV, K., HARRISON, G., AN DER HEIDEN, W., NIENHUIS, F. J., WALSH, D.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Adult and adolescent clinical studies
Aged
Biological and medical sciences
Cohort analysis
Cohort Studies
Cross-Cultural Comparison
Disability Evaluation
Europe
Female
Follow-Up Studies
Humans
Male
Medical sciences
Middle Aged
Outcome Assessment (Health Care)
Patients
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Psychoses
Schizophrenia
Schizophrenia - diagnosis
Schizophrenia - rehabilitation
Schizophrenic Psychology
Social Adjustment
Social Desirability
Social functioning
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Summary:Background. This paper focuses on the long-term course of social disability in schizophrenia assessed at first onset, and after 1, 2 and 15 years in incidence cohorts in six European centres in Bulgaria, Germany, Ireland, The Netherlands, the Czech Republic and the United Kingdom. The study population comprises 349 patients comprising 75% of the original cohorts. Methods. Social disability was assessed in a standardized way with the WHO Disability Assessment Schedule. Results. Social disability in schizophrenia appears to be a persistent phenomenon. Its severity decreased overall in the period of follow-up, but this was not so in a small group traced to hospital or sheltered accommodation. Only 17% of subjects had no disability and 24% still suffered from severe disability. The great majority lived with their family, a partner, or alone. A deteriorating course was more frequent than late improvement. Gender, age, onset, duration of untreated psychosis or type of remission during the first 2 years did not predict the long-term outcome of disability. Severity of disability at the first three assessments of the illness contributed significantly to the explanation of its variance at 15 years. Conclusion. Disability generally ameliorates, but less than expected or hoped. It needs continuing attention and care in this era of de-institutionalization.
ISSN:0033-2917
1469-8978
DOI:10.1017/S0033291799002627