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Association of clinical factors with socio-occupational functioning among individuals with schizophrenia


1 Department of Psychiatric Social Work, CEIMH, ABVIMS-Dr. RMLH, New Delhi, India
2 Department of Psychiatry, ABVIMS and Dr. RML Hospital, New Delhi, India

Date of Submission20-Jul-2020
Date of Acceptance15-Sep-2022
Date of Web Publication23-Dec-2022

Correspondence Address:
Upendra Singh,
Lecturer, Department of Psychiatric Social Work, ABVIMS and Dr. Ram Manohar Lohia Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ipj.ipj_141_20

   Abstract 


Background: Schizophrenia is assumed to be developing into a marked disability affecting performances in educational and vocational fields for both males and females. It is a psychiatric disorder that has been proven to be associated with poor occupational skills and functioning. This research aimed at studying the clinical correlates of socio-occupational functioning skills of persons with schizophrenia as per the ICD-10, DCR criteria. Materials and methods: The is a cross-sectional descriptive study that included 200 participants diagnosed with schizophrenia, in which sociode mographic and clinical data sheet and Socio-occupational Functioning Scale (SOFS) by Saraswat et al. were used. Results: Mean age of the participants was 34 years, with onset of illness being 24 years of age. The results indicated significant correlation at 0.05 level between the total score of SOFS and age of onset and duration of illness. Conclusion: It can be concluded that for a better treatment outcome in a disorder like schizophrenia, bio-psychosocial model of treatment is necessary.

Keywords: Illness duration, onset, schizophrenia, socio-occupational functioning



How to cite this URL:
Kumari S, Dahuja S, Singh U. Association of clinical factors with socio-occupational functioning among individuals with schizophrenia. Ind Psychiatry J [Epub ahead of print] [cited 2023 Jan 27]. Available from: https://www.industrialpsychiatry.org/preprintarticle.asp?id=364768



It has become an important need of the hour to rehabilitate a person suffering from schizophrenia to his/her functional remission by enhancing his/her socio-occupational functioning. The ability any person shows in different societal roles (homemaker, labor, student, mother, or friend) to fulfill his/her responsibilities and to adapt to changes is understood as social functioning. An individual's experiences and satisfaction have also been considered as a part of social functioning, and his/her ability to fulfill his/her roles, taking care of self, and spending leisure time and getting involved in recreational activities are also a part of it.

Schizophrenia is a severe mental illness that requires long-term treatment. People with schizophrenia experience individual disabilities in social functioning and self-care functioning.[1] Because of cognitive impairment and psychotic symptoms, they face unemployment and social exclusion.[2] Schizophrenia is assumed to be developing into a marked disability affecting performances in educational and occupational fields for both males and females. Schizophrenia is a psychiatric disorder that has been proven to be associated with poor occupational skills and low occupational functioning. Several studies have stated that low occupational functioning is associated with negative symptoms of schizophrenia. Negative symptoms may result in diminishing motivation, initiation, and emotional expressions, resulting in retardation of communication skills and social skills. This long-term illness may result in losing contact with friends and relatives and reciprocal emotional relation with family, inability to continue with job, and becoming isolated and withdrawn. Also, chronic patients of schizophrenia lose their ability to look after themselves. Thus, schizophrenia has multiple features like disability in everyday functioning; lack of social skills, productive activities, and independent living; cognitive impairments; and other comorbidities (physical illness, substance dependence, and side effects of medicines and psychiatric comorbidities like depression and anxiety).[3]

Occupational performances give a very clear picture of the rhythmic balance between being active and having rest and the range and verity of occupational skills and social skills of a person over time.[4] It was found that providing rehabilitation activities during the stay at hospital for patients with schizophrenia helps them in improving their functional independence and quality of life at the time of discharge.[5] A study from India conducted in a psychiatric hospital found that regular occupational training enhances socio-occupational skills and quality of life among male in-patients with schizophrenia.[6] A study from Japan showed that when occupation therapy with supported employment was provided to people with schizophrenia, their social functioning was enhanced and their hospital stay and risk of hospitalization was reduced.[7]

At the time of admission, the occupational status of an individual can predict the functional outcomes.[8] Defining and predicting functional outcome in schizophrenia and schizophrenia spectrum disord ers.[9] Although these studies have geographic and cultural limitations, it is not always that people with schizophrenia have poor occupational skills. It also cannot be definitely stated that negative symptoms predict the quality of occupational functioning in individuals with schizophrenia. There might be many more other variables and factors that have an effect, and hence predict the quality of occupational functioning in individuals with schizophrenia. A study of the prevalence rate of schizophrenia by the World Health Organization revealed that during 2017, 20 million people around the world suffered from schizophrenia.[10] India currently has more than 1 billion inhabitants and about every sixth person living in India needs support for mental health.[11] About 0.64% of the total population of India is suffering from schizophrenia. With a treatment gap of 75.5%,[11] the picture becomes very clear that about 69% of people suffering from schizophrenia are not receiving holistic treatment and care.[12] This paucity of mental health services in India thus generates the concern to assess the associated clinical factors that can predict quality of occupational functioning skills among individuals with schizophrenia. The current study is an attempt to assess the association of clinical factors with occupational functioning skills of people with schizophrenia.


   Materials and Methods Top


Research design – The study was a cross-sectional descriptive study.

Selection procedure – After getting ethical permission from the Institute Ethics Committee, this study was conducted in the in-patient and out-patient wards of the Department of Psychiatry, Dr. Ram Manohar Lohia (RML) Hospital, New Delhi. A total of 200 participants were selected by using purposive sampling technique. Participants diagnosed with schizophrenia according to the criteria of international classification of diseases (ICD-10), diagnostic criteria for research-V (DCR)[13] with a duration of illness more than 2 years and able to read and write Hindi (an Indian language) were included in the study. Participants having any comorbid psychiatric or severe physical illness or history of substance dependence were excluded from the study.

Measures – In the current study, a self-prepared sociodemographic and clinical data sheet was used. It was especially designed to serve the purpose of the study, majorly focusing on clinical variables like age of onset, duration of illness, adherence, first contact with treatment, current treatment status, and distance from a tertiary center.

To gather data, the Socio-occupational Functioning Scale (SOFS)[14] was used. The scale was developed by Saraswat et al., in 2006. SOFS focuses on the individual's level of socio-occupational functioning and rates adaptive living skills, social appropriateness, and interpersonal skills at the time of evaluation. It is a 5-point Likert-type scale. It consists of 14 items, and the level of functioning is rated based on an interview. Higher the score, higher is the socio-occupational functioning.

Statistical analysis – Statistical Package for Social Sciences (SPSS)[15] version 21 was used. Descriptive statistics such as mean, standard deviation, and percentage were used to describe the socio-demographic and clinical profile of the participants. Mean and standard deviation were used to describe the continuous data, while percentage was used to describe the categorical data of the research. Pearson's correlation was used for statistical analysis of data because the study aimed at studying the association between clinical correlates and socio-occupational functioning among persons diagnosed with schizophrenia.


   Results Top


[Figure 1] shows that the mean age of the participants was 34.145 years with a standard deviation of 7.195. Mean duration of marital life of the participants was 7.41 ± 7.952 years. Mean age of onset of schizophrenia in the participants was 24.085 ± 6.798 years. Mean duration of illness was 9.28 ± 5.957 years. Mean distance from the psychiatric hospital was 1.17 ± 0.717 km.
Figure 1: Mean and SD of sociodemographic and clinical characteristics of the participants. SD = standard deviation

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The study [Figure 2] comprised 50% of male and 50% of female participants. Of these, 33% participants had received secondary education (10 years of education) and formed the majority of the sample. Also, 24.5% participants had received 15 years of education up to graduation, followed by 22% participants having only 5 years of education (primary) and a mere 9% of participants having postgraduation or above. Moreover, 27.5% of participants were unemployed, 3.5% were involved in agriculture, 10.5% were students, 16.5% owned their business and were self-employed, 9% were salaried, either working in government or a private setup, and 33% were homemakers. Also, 58% participants were married, 37% were single or never married, and only 5% participants were either separated or divorced.
Figure 2: Demographic details of the participants

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[Figure 3] shows that out of the total participants 94% reported treatment adherence. 80% were continuously taking their treatment, 15.5% participants had irregular treatment, and only 4.5% participants had not yet started their treatment. Majority of the participants (60.5%) had their very first contact with a psychiatrist for treatment of their first episode, while 35% went to a faith healer, 1.5% went to a physician, and 3% sought traditional medicine for their first episode of psychosis.
Figure 3: Clinical details of the participants

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[Table 1] shows the correlation between SOFS and the age of onset and duration of illness among the participants. The obtained scores on SOFS indicate that there was a statistically significant correlation at 0.05 level between the age of onset and clothing and dressing (r = 0.181) and the total SOFS score (r = 0.142). There was a significant correlation at 0.01 level between neatness and maintenance activities (r = 0.205) and the age of onset. There was a significant negative correlation between the duration of illness and SOFS scores on various domains. There was a significant negative correlation at 0.05 level between the duration of illness and eating, feeding, and diet (r = −0.142), neatness and maintenance activities (r = −0.141), conversational skills (r = −0.148), social appropriateness/politeness (r = −0.176), work (r = −0.164), and total SOFS score (r = −0.150).
Table 1: Association of total duration of illness and age of onset with SOFS

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   Discussion Top


The research aimed at studying the clinical correlates (age of onset and duration of illness) of socio-occupational functioning skills of persons with schizophrenia as per the ICD-10, DCR criteria.[13] The study was conducted at the Centre of Excellence in Mental Health, ABVIMS and Dr. RML Hospital, New Delhi.

Looking at the results, it is very evident that early age of onset of schizophrenia is correlated with various domains of SOFS. The study found that early age of onset affected negatively the occupational skills like clothing and dressing skills of the participants. Occupational skills like maintaining personal hygiene and grooming and maintaining neatness and activities were poor among the participants with an early age of onset. These findings support the statement that individuals with an early onset of schizophrenia have association of frontal cognitive disability, limiting rehabilitation programs and causing very poor prognosis.[15]

Research findings also indicate that longer duration of illness is associated with various domains of SOFS. They indicated that participants who had longer duration of illness showed poor occupational skills in their daily living activities. Participants suffering from schizophrenia for longer durations had poor performance in maintaining their eating, feeding, and diet habits. They also showed poor skills in maintaining personal hygiene and grooming themselves.

Due to longer duration of illness, participants were having problems in conversational skills, like starting a conversation, maintaining conversation, entering a group of people, and so on. Participants also had poor emotional regulations as they were not able to respond in socially appropriate manners when they suffered from schizophrenia for a longer duration. Chronic duration of illness was also associated with poor work quality and poor money and financial management among the participants. Similar studies shown that poor social and occupational functioning is more prominent in a person with schizophrenia than with other major psychiatric disorders. One study has reported that almost 75% of individuals with schizophrenia show social impairments over a year.[16] Kirkpatrick et al.[17] reported in their study schizophrenic symptoms to be strong predictors of a poor prognosis, impaired social outcome, and occupational functioning.

The results of the study clearly show that early onset of schizophrenia is related to poor overall socio-occupational functioning of the individual suffering from schizophrenia. Duration of illness is related to the severity of symptoms and poor occupational functioning.[18] Early onset also means long duration of illness, which is also related to overall poor socio-occupational skills, as shown by the results of the study. The correlation at 0.05 level of significance makes it evident that there lies an association between the two variables, thus proving that clinical factors like age of onset and duration of illness of a person with schizo phrenia are related to overall socio-occupational functioning of the person. A person suffering from schizophrenia also experiences difficulties in maintaining his/her daily living activities and shows social and emotional withdrawal and, at times, retardation in motor activities. Also, some studies suggest that early onset is associated with severe functional impairment in an individual with schizophrenia.[19],[20],[21]

In a similar study, it was seen that nearly 45% participants diagnosed with schizophrenia reported to have below-average well-being, which was associated with longer duration of illness, poor drug adherence, and low cognitive functioning.[22] A longer duration of illness was associated with impairment of individual capability and functioning.[23] One study found statistically significant association between lower age of onset and more relapses, poorer socio-occupational functioning, and poor global outcomes.[24]


   Conclusion Top


The study concludes that clinical correlates like age of onset and duration of illness are associated with poor socio-occupational skills among persons with schizophrenia. Thus, it is an utmost necessity of the hour that individuals diagnosed with schizophrenia receive a holistic treatment approach, where rehabilitation is given much importance apart from psychological medicine for better outcome.

Limitation

• The research focuses on only two clinical variables.

• Limited age group was taken into consideration for measuring the variables.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Wykes T, Reeder C, Landau S, Everitt B, Knapp M, Patel A, et al. Cognitive remediation therapy in schizophrenia: Randomised controlled trial. Br J Psychiatry 2007;190:421-7.  Back to cited text no. 1
    
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International First Episode Vocational Recovery (iFEVR) Group. Meaningful lives: Supporting young people with psychosis in education, training and employment: An international consensus statement. Early Interv Psychiatry 2010;4:323-6.  Back to cited text no. 2
    
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GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392:1789-858.  Back to cited text no. 10
    
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Lora A, Kohn R, Levav I, McBain R, Morris J, Saxena S. Service availability and utilization and treatment gap for schizophrenic disorders: A survey in 50 low- and middle-income countries. Bull World Health Organ 2012;90:47-54, 54A-B.  Back to cited text no. 12
    
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Kirkpatrick B, Fenton WS, Carpenter WT, Marder SR. The NIMH-MATRICS consensus statementon negative symptoms. Schizophr Bull 2006;32:214-9.  Back to cited text no. 17
    
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Liu SK, Hsieh MH, Huang TJ, Liu CM, Liu CC, Hua MS, et al. Patterns and clinical correlates of neuropsychologic deficits in patients with schizophrenia. J Formos Med Assoc 2006;105:978–91.  Back to cited text no. 18
    
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Basso MR, Nasrallah HA, Bornstein RA. Cognitive deficits d istinguish patients with adolescent- and adult-onset schizophrenia. Neuropsychiatry Neuropsychol Behav Neurol 1997;10:107–12.  Back to cited text no. 19
    
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Ito S, Nemoto T, Tsujino N, Ohmuro N, Matsumoto K, Matsuoka H, et al. Differential impacts of duration of untreated psychosis (DUP) on cognitive function in first-episode schizophrenia according to mode of onset. Eur Psychiatry 2015;30:995–1001.  Back to cited text no. 20
    
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Linke M, Jankowski KS, Ciołkiewicz A, Jędrasik-Styła M, Parnowska D, Gruszka A, et al. Age or age at onset? Which of them really matters for neuro and social cognition in schizophrenia? Psychiatry Res 2015;225:197–201.  Back to cited text no. 21
    
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Gopalakrishnan R, Behere RV, Sharma PS, Sharma PS. Factors affecting well-being and socio-occupational functioning in schizophrenia patients following an acute exacerbation: A hospital based observational study. Indian J Psychol Med 2015;37:423-8.  Back to cited text no. 22
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23.
Bajs M, Janović S, Bajs M, Dordević V, Jevtović S, Radonić E, et al. Correlation of cognitive functions with some aspects of illness, treatment and social functioning in recurrently hospitalized schizophrenic patients. Coll Antropol 2011;35(Suppl 1):39–44.  Back to cited text no. 23
    
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Immonen J, Jääskeläinen E, Korpela H, Miettunen J. Age at onset and the outcomes of schizophrenia: A systematic review and meta-analysis. Early Interv Psychiatry 2017;11:453-60.  Back to cited text no. 24
    


    Figures

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