Social functioning in schizophrenia

The schizophrenia it affects many aspects of people's lives, as it is related to a distortion of the way reality is perceived.

One of the dimensions of the quality of life that are diminished is what is known as social functioning.

What is social functioning?

Social functioning consists of the person's ability to adapt to their social environment and its demands. This term refers to the ability to relate to other people, as well as to maintain such relationships, enjoy free time, take care of ourselves and be able to develop the roles that society expects of U.S.

In schizophrenia spectrum disorders, the deterioration of social functioning is a central aspect of the problem and it can be detected early in the course of the disorder. In addition, 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 disorders of the schizophrenia spectrum, such as childhood trauma, negative symptoms, or certain personality traits, accentuate this deficit in social functioning.

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Assessing social functioning in schizophrenia

It is therefore clear that an adequate assessment of the social functioning of patients with schizophrenia spectrum disorders is of great importance, since thus the most effective treatments can be provided for the specific situation of each patient.

But it is not only necessary to be able to effectively evaluate the deterioration of social functioning at the level of clinical practice, it is also necessary for research in this area and thus be able to understand in depth what are the factors and mechanisms that intervene and modulate this deterioration.

Psychometric tools

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

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

1. Personal and Social Functioning Scale (PSP)

This scale developed by Morosini, Magliano, Brambilla, Ugolini, and Pioli (2000) assesses four areas of the patient's social functioning: a) self-care; b) regular social activities; c) personal and social relationships; and d) disruptive and aggressive behaviors. It is scored by the clinician and includes a semi-structured interview to help obtain good information on each of the areas.

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

The Spanish version of this instrument, developed by Garcia-Portilla et al., (2011), presents an internal consistency of 0.87 and a test-retest reliability of 0.98. Therefore, it is a valid and reliable instrument to measure social functioning in patients with schizophrenia.

2. Social Functioning Scale (SFS)

The scale developed by Birchwood, Smith, Cochrane, Wetton, and Copestake (1990) assesses social functioning in the last three months of the patient's life with schizophrenia spectrum disorders, and can be administered both as a self-reported questionnaire and as a semi-structured interview.

It consists of 78 items where seven subscales are measured: isolation, interpersonal behavior, prosocial activities, free time, independence-competence, independence-performance and employment-occupation. The Spanish version of Torres and Olivares (2005) presents high alpha coefficients (between 0.69 and 0.80), making it a valid, reliable and sensitive instrument.

3. Quality of life scale (QLS)

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

This scale It is used both to measure the quality of life of patients, as well as the social and occupational functioning. The Spanish version adapted by Rodríguez, Soler, Rodríguez M., Jarne Esparcia, and Miarons, (1995) is a valid tool, with a high internal consistency (0.963) and reliable.

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

This questionnaire, with different versions (36, 12 and 5 items), assesses different areas of functioning: understanding and communication with the world, ability to handle the environment, personal care, relationship with other people, activities of daily life and participation in society.

Developed by Vázquez-Barquero et al., (2000), its usefulness was later confirmed, validity and reliability in patients with schizophrenia spectrum disorders by Guilera et al., (2012)

Bibliographic references:

Birchwood, M., Smith, J., Cochrane, R., Wetton, S., & Copestake, S. (1990). The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programs with schizophrenic patients. The British Journal of Psychiatry: The Journal of Mental Science, 157, pp. 853 - 859. Recovered from http://www.ncbi.nlm.nih.gov/pubmed/2289094

Garcia-Portilla, M. P., Saiz, P. A., Bousoño, M., Bascaran, M. T., Guzmán-Quilo, C., & Bobes, J. (2011). Validation of the Spanish version of the Personal and Social Functioning scale in outpatients with stable or unstable schizophrenia. Journal of Psychiatry and Mental Health, 4 (1), pp. 9 - 18.

Guilera, G., Gómez-Benito, J., Pino, O., Rojo, J. E., Cuesta, M. J., Martínez-Arán, A.,… Rejas, J. (2012). Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophrenia Research, 138 (2–3), pp. 240 - 247.

Heinrichs, D. W., Hanlon, T. E., & Carpenter, W. T. (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10 (3), pp. 388 - 398.

Lemos Giráldez, S., Fonseca Pedrero, E., Paino, M., & Vallina, Ó. (2015). Schizophrenia and other psychotic disorders. Madrid: Synthesis.

Lysaker, P. H., Meyer, P. S., Evans, J. D., Clements, C. A., & Marks, K. TO. (2001). Childhood Sexual Trauma and Psychosocial Functioning in Adults With Schizophrenia. Psychiatric Services, 52 (11), 1485–1488.

Morosini, P. L., Magliano, L., Brambilla, L., Ugolini, S., & Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 101 (4), 323–9. Recovered from http://www.ncbi.nlm.nih.gov/pubmed/10782554

Rodríguez, A., Soler, R. M., Rodríguez M., A., Jarne Esparcia, A. J., & Miarons, R. (1995). Factorial study and adaptation of the Quality of Life Scale in Schizophrenia (QLS). Journal of general and applied psychology: Journal of the Spanish Federation of Psychological Associations. Spanish Federation of Psychological Associations.

Torres, A., & Olivares, J. M. (2005). Validation of the Spanish version of the Social Functioning Scale. Actas Españolas de Psiquiatría, 33 (4), pp. 216 - 220.

Vázquez-Barquero, J. L., Vázquez Bourgón, E., Herrera Castanedo, S., Saiz, J., Uriarte, M., Morales, F.,… Disabilities, G. C. on. (2000). Spanish-language version of a new WHO disability assessment questionnaire (WHO-DAS-II): Initial phase of development and pilot study. Spanish Acts of Psychiatry.