Social functioning in schizophrenia: 4 instruments for its evaluation

Schizophrenia affects many aspects of people’s lives, being linked to a distortion of the way reality is viewed.

One of the dimensions of the quality of life that is diminished is what is called social functioning.

What is social functioning?

Social functioning consists of the person’s ability to adapt to their social environment and their requirements. This term refers to the ability to build relationships with other people, as well as to maintain these relationships, to enjoy free time, to take care of ourselves and to be able to develop the roles that society expects of us. .

In schizophrenia spectrum disorders, the deterioration of social functioning is a central aspect of the problem and can be detected in the early stages of the course of the disorder. Moreover, this phenomenon persists even when the acute phase of it has been overcome. On the other hand, the literature shows how certain factors present in patients with schizophrenic spectrum disorders, such as childhood trauma, negative symptoms or certain personality traits, accentuate this deficit in social functioning.

Assessment of social functioning in schizophrenia

It is therefore clear that a correct assessment of the social functioning of patients with schizophrenic spectrum disorder is of great importance, because thus the most effective treatments for each patient’s specific situation can be provided.

But it is not only necessary to be able to effectively assess the deterioration of social functioning at the level of clinical practice, which is also for research in this field and thus to be able to understand in depth what are the factors and mechanisms involved. And modulate this deterioration.

Psychometric tools

For this assessment, there are psychometric tools, such as questionnaires or interviews, which help both the clinician and the researcher to know the degree of impairment of the social functioning of the patients.

Here we will name four of the most used instruments and review their characteristics., (Both by its structure and by its psychometric characteristics). All have been adapted to Spanish and validated in populations with schizophrenic spectrum disorders.

1. Social and personal functioning scale (PSP)

This scale developed by Morosini, Magliano, Brambilla, Ugolini and Pioli (2000) assesses four areas of the patient’s social functioning: A) personal care; b) usual social activities; c) personal and social relationships; and d) disruptive and aggressive behavior. It is graded by the clinician and includes a semi-structured interview to help get the right information about each of the areas.

On this scale the 4 domains are scored using a 6-point Likert scale, ranging from 1 (absent) to 6 (very severe). Scores are obtained in each of the 4 domains, so that higher scores indicate poorer performance, and an overall score on the scale where higher values ​​reflect better personal and social functioning.

The Spanish version of this instrument, developed by Garcia-Portilla et al., (2011), has an internal consistency of 0.87 and a test-retest reliability of 0.98. It is therefore a valid and reliable instrument for measuring the social functioning of patients with schizophrenia.

2. Social Functioning Scale (SFS)

The scale developed by Birchwood, Smith, Cochrane, Wetton and Copestake (1990) assesses social functioning during the last three months of the patient’s life suffering from schizophrenia spectrum disorder, and can administer both as a self-reported questionnaire and as part of a semi-structured interview.

It includes 78 items where 7 subscales are measured: isolation, interpersonal behavior, prosocial activities, leisure, independence-competition, independence-performance and job-profession. The Spanish version of Torres and Olivares (2005) has high alpha coefficients (between 0.69 and 0.80), so it is a valid, reliable and sensitive instrument.

3. Quality of Life Scale (QLS)

This is a semi-structured interview containing 21 items, with a 7-point Likert scale. It was developed by Heinrichs, Hanlon and Carpenter (1984) and assesses 4 areas: a) intrapsychic functions; b) interpersonal relationships; c) instrumental role; and d) the use of common objects and daily activities.

this scale it is used both to measure the quality of life and the socio-professional functioning of patients. The Spanish version adapted by Rodríguez, Soler, Rodríguez M., Jarne Esparcia and Miarons, (1995) is a valid tool, of great internal consistency (0963) and reliable.

4. WHO Disability Assessment Questionnaire (WHO-DAS-II)

This questionnaire, with different versions (36, 12 and 5 items), assesses different areas of operation: understanding and communicating with the world, Ability to manage in the environment, personal care, relationships with others, activities of daily living and participation in society.

Developed by Vázquez-Barquero et al., (2000), its utility, validity and reliability were subsequently corroborated in patients with schizophrenic spectrum disorders by Guilera et al. (2012)

Bibliographical references:

  • Birchwood, M., Smith, J., Cochrane, R., Wetton, S. and Copestake, S. (1990). The scale of social functioning. The development and validation of a new social adjustment scale for use in family intervention programs with schizophrenic patients. The British Journal of Psychiatry: The Journal of Mental Science, 157, pages 853 – 859. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2289094
  • Garcia-Portilla, MP, Saiz, PA, Bousoño, M., Bascaran, MT, Guzmán-Quilo, C., and Bobes, J. (2011). Validation of the Spanish version of the personal and social functioning scale in ambulatory patients with stable or unstable schizophrenia. Journal of Psychiatry and Mental Health, 4 (1), pp. 9-18.
  • Guilera, G., Gómez-Benito, J., Pino, O., Rojo, JE, Cuesta, MJ, Martínez-Arán, A., … Rejas, J. (2012). Usefulness of the World Health Organization Disability Assessment Program II in schizophrenia. Schizophrenia Research, 138 (2-3), pages 240 to 247.
  • Heinrichs, DW, Hanlon, TE and Carpenter, WT (1984). The quality of life scale: an instrument for assessing schizophrenic deficit syndrome. Schizophrenia Bulletin, 10 (3), pages 388-398.
  • Lemos Giráldez, S., Fonseca Pedrero, E., Paino, M. and Vallina, Ó. (2015). Schizophrenia and other psychotic disorders. Madrid: Synthesis.
  • Lysaker, PH, Meyer, PS, Evans, JD, Clements, CA and Marks, KA (2001). Childhood sexual trauma and psychosocial functioning in adults with schizophrenia. Psychiatric Services, 52 (11), 1485-1488.
  • Morosini, PL, Magliano, L., Brambilla, L., Ugolini, S. and Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Work Performance Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 101 (4), 323-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10782554
  • Rodriguez, A., Soler, RM, Rodriguez M., A., Jarne Esparcia, AJ, and Miarons, R. (1995). Factorial study and adaptation of the schizophrenia quality of life scale (QLS). Journal of General and Applied Psychology: Journal of the Spanish Federation of Psychological Associations. Spanish Federation of Psychological Associations.
  • Torres, A. and Olivares, JM (2005). Validation of the Spanish version of the social functioning scale. Actas Españolas de Psiquiatría, 33 (4), pp. 216-220.
  • Vázquez-Barquero, JL, Vázquez Bourgon, E., Herrera Castanedo, S., Saiz, J., Uriarte, M., Morales, F., … Handicap, GC in. (2000). Spanish version of a new WHO disability assessment questionnaire (WHO-DAS-II): Initial phase of development and pilot study. Spanish acts of psychiatry.

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