Predictors of social relations in persons with schizophrenia living in the community: a Nordic multicentre study

Neuronal signatures of anger and fear in patients with psychosis

The present study investigated the functional neuroanatomy in response to sentence stimuli related to anger-provoking situations and fear of negative evaluation in patients with psychosis. The tasks consisted of four active conditions, Self-Anger (SA), Self-Fear, Other-Anger (OA), and Other-Fear (OF), and two neutral conditions, Neutral-Anger (NA) and Neutral-Fear (NF). Several relevant clinical measures were obtained. Under all contrasts, significantly higher activation in the left inferior parietal gyrus or superior parietal gyrus and the left middle occipital gyrus or superior occipital gyrus was observed in patients compared to healthy controls (HCs). However, we observed significantly lower activation in the left angular gyrus (AG) and left middle temporal gyrus (MTG) under the OA vs. NA contrast, as well as in the left precuneus and left posterior cingulate gyrus (PCG) under the OF vs. NF contrast in patients. The mean beta values for the significant regions under the SA vs. NA and OF vs. NF contrasts were significantly associated with the total PI and PANSS scores, respectively. These findings indicate that patients with psychosis exhibit hypoactivation in the AG, MTG, precuneus, and PCG compared to HCs. The findings suggest that patients with psychosis are less efficient at recruiting neural responses in those regions for semantic processing and social evaluation.

Predictors of full recovery in patients with early stage schizophrenia spectrum disorders

To promote recovery in psychosis, targeting modifiable factors related to recovery is critical. Using more strict definition of full recovery, we examined predictors for recovery in patients with early stage schizophrenia spectrum disorders (SSD) followed up to 6.5 years. The target subjects were 375 patients with early stage SSD who had been over at least 1-year after registration and evaluated. The criteria for full recovery were having the score of the Positive and Negative Syndrome Scale (PANSS) 8-item ≤ 2 and adequate functional recovery for at least 1-year. We performed univariate Cox and stepwise Cox regression in both total and acute patients. In stepwise Cox regression, several independent predictors for recovery, i.e., negative symptoms of the PANSS, duration of untreated psychosis (DUP) and non-professional job were identified in patients with early stage SSD. In acute patients, other factors such as professional job and subjective well-being under neuroleptics were more important. The present study identified independent predictors for recovery modifiable by various psychosocial intervention and early intervention services. Moreover, it highlights the need of providing different treatment strategies depending on clinical status.

Social contacts, friends and satisfaction with friendships in patients with psychotic, mood and neurotic disorders 1 year after hospitalisation: data from five European countries

BACKGROUND

People with severe mental illness often struggle with social relationships, but differences among diagnostic groups are unclear. We assessed and compared objective and subjective social relationship indicators among patients with psychotic, mood and neurotic disorders one year after hospitalisation in five European countries (Belgium, Germany, Italy, Poland and United Kingdom).

METHODS

The number of social contacts, including family members and friends during the previous week (Social Network Schedule), and satisfaction with the number and quality of friendships (Manchester Short Assessment of Quality of Life Quality) were assessed by face-to-face interview. Linear regression models were used to analyse associations with diagnostic groups.

RESULTS

Participants (n = 2155) reported on average 2.79 ± 2.37 social contacts overall in the previous week, among whom, a mean of 1.65 ± 1.83 (59.2 ± 38.7%) were friends. Satisfaction with friendships was moderate (mean 4.62, SD 1.77). In the univariable model, patients with psychotic disorders reported having less social contact with friends than those with either mood (p < 0.05) or neurotic disorders (p < 0.001), but this difference disappeared when adjusting for socioeconomic and clinical variables (β = - 0.106, 95% CI - 0.273 to 0.061, p = 0.215). Satisfaction with friendships was similar across diagnostic groups in both univariable (β = - 0.066, 95% CI - 0.222 to 0.090, p = 0.408) and multivariable models (β = 0.067, 95% CI - 0.096 to 0.229, p = 0.421). The two indicators showed a weak correlation in the total sample (total social contacts, r_s = 0.266; p < 0.001; friends, r_s = 0.326, p < 0.001).

CONCLUSION

While objective and subjective social relationship indicators appear to be weakly correlated concepts, there is no variation in either indicator across diagnostic groups when confounders are taken into account among patients with severe mental illness. Interventions specifically targeting social relationships are needed, but they do not necessitate diagnosis-specific adaptations.

Factors limiting romantic relationship formation for individuals with early psychosis

BACKGROUND

Although many young adults with early psychosis (EP) desire to engage in a romantic relationship, many report having difficulties in engaging in such a relationship. However, almost no research has been conducted on factors potentially explaining impairments in their ability to form romantic relationships.

AIM

To compare an EP single young adult sample with single students or students in stable romantic relationships on factors that can cause difficulties in romantic relationship initiation processes METHODS: Cross-sectional study comparing these three groups (n = 83) on self-esteem, attachment, social functioning and perceived difficulties in dating.

RESULTS

No significant group differences were found on self-esteem, although lack of confidence was the second most frequent reason evoked by EP participants when asked why they were single. EP participants had greater attachment preoccupation than students involved in a relationship. Single EP individuals rated their social interaction abilities higher compared with single students, but did not engage in social interactions more often. Both single EP participants and single students had more negative perceptions of their intimacy abilities and fewer intimacy behaviours compared with participants involved in a relationship.

CONCLUSIONS

Potential interventions to improve EP young adult's capacity to engage in romantic relationships could target perception of their interaction skills, preoccupation about being loved, negative perception of their intimacy abilities, frequency of intimacy related behaviours and lack of confidence.

Social inclusion and relationship satisfaction of patients with a severe mental illness

BACKGROUND

Research suggests that patients with a severe mental illness (SMI) are among the most social excluded in society. However, comparisons of social network composition and relationship satisfaction between SMI patients and a control group are rare.

AIMS

Our aim was to compare differences in size, satisfaction and composition of the social network between patients with SMI and a control group. Potential sociodemographic and clinical risk factors in relation to social network size in SMI patients were explored.

METHODS

The sample consisted of a control group ( N = 949) and SMI patients ( N = 211) who were under treatment in Dutch mental health care institutions. In these groups, network size, relationship satisfaction, sociodemographic and clinical (patients only) characteristics were assessed.

RESULTS

Social network size was 2.5 times lower in SMI patients, which was also reflected in a lower relationship satisfaction. The composition of the social network of SMI patients differs from that of controls: patients' network seems to consist of a smaller part of friends. Different risk factors were associated with the impoverishment of the social network of family, friends and acquaintances of patients with SMI.

CONCLUSION

SMI patients have very small networks compared to controls. This may be a problem, given the ongoing emphasis on outpatient treatment of SMI patients and self-dependence. This outcome advocates for more attention to social isolation of SMI patients and involvement of family in the treatment and aftercare of SMI patients.

Family Functioning in First-Episode and Chronic Psychosis: The Role of Patient's Symptom Severity and Psychosocial Functioning

The aim of the present study was to assess the relationship between illness-related characteristics, such as symptom severity and psychosocial functioning, and specific aspects of family functioning both in patients experiencing their first episode of psychosis (FEP) and chronically ill patients. A total of 50 FEP and 50 chronic patients diagnosed with schizophrenia or bipolar disorder (most recent episode manic severe with psychotic features) and their family caregivers participated in the study. Family functioning was evaluated in terms of cohesion and flexibility (FACES IV Package), expressed emotion (FQ), family burden (FBS) and caregivers' psychological distress (GHQ-28). Patients' symptom severity (BPRS) and psychosocial functioning (GAS) were assessed by their treating psychiatrist within 2 weeks from the caregivers' assessment. Increased symptom severity was associated with greater dysfunction in terms of family cohesion and flexibility (β coefficient -0.13; 95 % CI -0.23, -0.03), increased caregivers' EE levels on the form of emotional overinvolvement (β coefficient 1.03; 95 % CI 0.02, 2.03), and psychological distress (β coefficient 3.37; 95 % CI 1.29, 5.45). Family burden was found to be significantly related to both symptom severity (β coefficient 3.01; 95 % CI 1.50, 4.51) and patient's functioning (β coefficient -2.04; 95 % CI -3.55, -0.53). No significant interaction effect of chronicity was observed in the afore-mentioned associations. These findings indicate that severe psychopathology and patient's low psychosocial functioning are associated with poor family functioning. It appears that the effect for family function is significant from the early stages of the illness. Thus, early psychoeducational interventions should focus on patients with severe symptomatology and impaired functioning and their families.

Social interaction among people with psychiatric disabilities--does attending a day centre matter?

BACKGROUND

Engaging in social interaction has, for people with psychiatric disabilities, been shown to enhance well-being and the experience of meaning and to generally prevent the worsening of mental illness.

AIM

The aim of the study was to investigate how day centre attendees differed from non-attendees regarding different aspects of social interaction and to investigate how occupational factors, including day centre attendance, and previously known predictors were related to social interaction in the study sample as a whole.

METHODS

A total of 93 day centre attendees and 82 non-attendees with psychiatric disabilities were examined regarding social interaction, subjective perception of occupation, activity level, sense of self-mastery and socio-demographic and clinical variables. Data were analysed with non-parametric statistics, mainly logistic regression.

RESULTS

Social support was mainly provided by informal caregivers such as family members. The day centre attendees had more social relations but did not experience better quality or closeness in their relationships than non-attendees. Important factors for social interaction were subjective perceptions of daily occupation, being married/cohabiting, self-mastery and severity of psychiatric symptoms.

CONCLUSION

Alternative ways of enhancing social interactions in the community is needed, targeting the group's feeling of satisfaction and value in daily life together with self-mastery.

Perceived emotional support in remission: results from an 18-month follow-up of patients with early episode psychosis

PURPOSE

Serious mental illness is known for the damage that it inflicts on the social network and social support of patients. Although many studies have used relapse and rehospitalisation as outcomes, recent research has emphasized the importance of a fuller definition of recovery that includes social function. In this study, our goal is to investigate the association of social support with sustained remission in patients with early episode psychosis.

METHODS

A secondary analysis of remission and social support was performed with 123 of 144 patients enrolled in the Lambeth Early Onset randomized clinical trial who ever achieved symptom-free status in 18 months of follow-up. Social support was measured by hours of family contact, perceived support, and network size at 6 months into an early intervention treatment program. Consensus judgments made by clinicians on symptom status at each of 18 months of follow-up were analyzed for consecutive months spent in remission. Direct and mediated effects of social support on remission were calculated using Poisson regression and path analysis, respectively.

RESULTS

114 of 123 patients achieved remission after about 7 months on average [mean 6.81 (SD 4.17)]. In univariate models, perceived emotional support predicted longer time spent in remission, while moderate family contact predicted shorter remission duration. Perceived practical support was not associated with remission. Perceived emotional support mediated the association between family contact and remission and between network size and remission. These results are not totally attributable to a specialized early intervention treatment.

CONCLUSION

Structural measures of support probably contribute to the maintenance of remission through the patient's perception of emotional support.

Validation of the modified DUKE-UNC Functional Social Support Questionnaire in patients with schizophrenia

PURPOSE

The modified DUKE-UNC Functional Social Support Questionnaire (FSSQ) is considered a psychometric instrument to assess the social support in patients with schizophrenia. However, it has not been validated in this patient population. This issue is addressed here by examining the tool's psychometric properties in a clinical sample of patients with schizophrenia.

METHODS

Two hundred and forty-one patients from ten Adult Mental Health Centres (AMHC) meeting the following inclusion criteria were included: (1) International Classification of Diseases-10 (ICD-10) diagnosis of schizophrenia; (2) Global Assessment of Functioning (GAF) scores ≤50; (3) Illness duration of more than 2 years; and (4) Clinical stability. Patients were evaluated at baseline and at 1-year follow-up for clinical and psychosocial variables.

RESULTS

The factor analysis revealed two factors that explained 54.15 % of the variance. Internal consistency was excellent for the total FSSQ (0.87 at baseline and 0.88 at 1 year follow-up) and ranged between adequate and excellent for FSSQ domains. Correlations between FSSQ scores and those of global functioning, psychiatric symptoms, disability and quality of life ranged between small and large. There were significant differences between groups of patients with schizophrenia in FSSQ scores. Patients with higher levels of somatic complaints and patients who were disabled scored significantly lower in some or all FSSQ scores. After 1-year follow-up, patients improved in overall functioning and there was a decrease in psychiatric symptoms. There were mainly small significant associations between changes in FSSQ scores from baseline to 1-year follow-up and changes in the rest of the test scores, and AMHC visits between baseline and 1-year follow-up.

CONCLUSIONS

The FSSQ scores are reliable and valid, which suggests that the instrument is appropriate for the assessment of perceived social support in patients with schizophrenia.

Experiencing community: perspectives of individuals diagnosed as having serious mental illness

OBJECTIVE

Community integration is recognized as a crucial component of recovery from serious mental illness. Although the construct of community integration can be measured with structured instruments, little is known about the subjective and experiential meaning of community and community involvement for persons with serious mental illness.

METHODS

In 2010, 30 individuals with serious mental illness treated in two public mental health clinics completed semistructured interviews that elicited the places and people that they associate with the experience of community and the larger meaning of community in their lives.

RESULTS

Participants described four experiences as integral to their concepts of community: receiving help, minimizing risk, avoiding stigma, and giving back. Participants looked for communities that provide reliable support, and they described the need to manage community contact in order to protect themselves and others from their symptoms and from discrimination. Most participants experienced communities centered on mental health treatment or mentally ill peers as providing opportunities for positive engagement.

CONCLUSIONS

The experience of having a serious mental illness shapes preferences for and perceptions of community in pervasive ways. Participants described community involvement not as a means to move away from illness experiences and identities but as a process that is substantially influenced by them. Mental health communities may help individuals with serious mental illness to both manage their illness and recognize and enjoy a sense of community. The findings indicate the need for further research on the relationship between community integration and outcome in serious mental illness.

Friends and symptom dimensions in patients with psychosis: a pooled analysis

BACKGROUND

Having friends is associated with more favourable clinical outcomes and a higher quality of life in mental disorders. Patients with schizophrenia have fewer friends than other mentally ill patients. No large scale studies have evaluated so far what symptom dimensions of schizophrenia are associated with the lack of friendships.

METHODS

Data from four multi-centre studies on outpatients with schizophrenia and related disorders (ICD F20-29) were included in a pooled analysis (N = 1396). We established whether patients had close friends and contact with friends by using the equivalent items on friendships of the Manchester Short Assessment of Quality of Life or of the Lancashire Quality of Life Profile. Symptoms were measured by the Brief Psychiatric Rating Scale or by the identical items included in the Positive and Negative Syndrome Scale.

RESULTS

Seven hundred and sixty-nine patients (55.1%) had seen a friend in the previous week and 917 (65.7%) had someone they regarded as a close friend. Low levels of negative symptoms and hostility were significantly associated with having a close friend and contact with a friend. Overall, almost twice as many patients with absent or mild negative symptoms had met a friend in the last week, compared with those with moderate negative symptoms.

CONCLUSIONS

Higher levels of negative symptoms and hostility are specifically associated with the lack of friendships in patients with psychotic disorders. These findings suggest the importance of developing effective treatments for negative symptoms and hostility in order to improve the probability of patients with schizophrenia to have friends.

Understanding the social costs of psychosis: the experience of adults affected by psychosis identified within the second Australian National Survey of Psychosis

BACKGROUND

Social inclusion is a key priority of the Fourth National Mental Health Plan for Australia (2009-2014), with strong evidence for its protective impact on mental health. Social integration has been associated with enhanced well-being for people with mental illnesses such as psychosis.

OBJECTIVE

To explore the impact of psychosis on an individual's social and community participation.

METHOD

The second Australian national survey of psychosis was conducted across seven Australian sites. Semi-structured interviews with adults living with psychosis assessed mental health status, social and role functioning, life satisfaction and future goals. The cohort comprised 1825 adults with a psychotic illness (59.6% were male; 42.4% were aged 18-34 years; 31.5% had 12 years or more of education) of whom 32.7% had been employed in the past year.

RESULTS

Most adults indicated experiencing loneliness (80.1%) and a need for more friends (48.1%). Men were more likely to have never had a long-term relationship (59.4% M, 33.2% F). Even though women were more likely to experience anxiety in social situations [(χ(2)(1) = 8.95, p < 0.01)], they were more likely to have attended a social activity in the past year [χ(2)(2) = 11.84, p < 0.01]. Just over half of the survey participants (56.7%) reported having daily or nearly daily contact with family members. In the past year, 69% had not attended any social activity and 43% described stigma as a barrier. Although 63.2% showed significant impairment in social functioning, only 29.5% had received help for this in the last year. Social isolation and loneliness were rated as major challenges by 37.2% of the cohort.

CONCLUSIONS

Social isolation and dysfunction experienced by people with psychosis have not decreased since the last Australian national survey of people with psychosis. Alongside education and employment, social functioning and participation must be addressed to improve social inclusion for people with psychosis. Programs targeting social opportunities (befriending, peer support), social anxiety and social functioning for all stages of psychosis are warranted.

The Impact of Illness Identity on Recovery from Severe Mental Illness

The impact of the experience and diagnosis of mental illness on one's identity has long been recognized; however, little is known about the impact of illness identity, which we define as the set of roles and attitudes that a person has developed in relation to his or her understanding of having a mental illness. The present article proposes a theoretically driven model of the impact of illness identity on the course and recovery from severe mental illness and reviews relevant research. We propose that accepting a definition of oneself as mentally ill and assuming that mental illness means incompetence and inadequacy impact hope and self-esteem, which further impact suicide risk, coping, social interaction, vocational functioning, and symptom severity. Evidence supports most of the predictions made by the model. Implications for psychiatric rehabilitation services are discussed.

Anger and functioning amongst inpatients with schizophrenia or schizoaffective disorder living in a therapeutic community

AIMS

This study explored the functional correlates of anger amongst therapeutic community inpatients.

METHODS

The sample consisted of 44 subjects diagnosed with schizophrenic/schizoaffective disorder who were involved in a community treatment program. Assessment involved administration of the Health of Nation Outcome Scales and the Global Assessment of Functioning as well as self-evaluations using the Social Adaptation Self-evaluation Scale. Psychopathology was assessed with the Positive and Negative Symptoms Scale. Angry feelings and coping skills were self-assessed with the State-Trait Anger Expression Inventory and the Symptom Checklist-90 Hostility Scale. Multiple regression analyses correlated anger with functioning, controlling for psychopathology.

RESULTS

Angry feelings related to self-harm, hyperactivity, physical problems, and to global weight independently from Positive and Negative Symptoms Scale scores. They also predicted interest and pleasure in housekeeping, quality of social relationships and relational exchanges.

CONCLUSIONS

Results showed that angry feelings were not merely derivations of schizophrenic psychopathology; rather, they were independently related to self-damaging behaviors, to attentional demands towards the staff, to agreement to community tasks and to low quality of social relationships. Indeed, anger was related to adaptation's level in a therapeutic community setting demonstrated by subjects with psychoses and it may represent an indirect measure of their experienced quality of life. Therapeutic and management approaches to anger amongst subjects with schizophrenia are discussed.

Predicting social isolation among geriatric psychiatry patients

BACKGROUND

This exploratory study examines factors associated with isolation from informal social ties among geriatric psychiatry inpatients. Specifically, it examines the associations of diagnoses, psychiatric history, and measures of current functioning with social isolation.

METHODS

Analyses rely upon data derived from the Resident Assessment Instrument-Mental Health (RAI-MH), which is a patient focused, multidimensional, comprehensive assessment instrument designed to be a component of a larger, integrated health information system linking mental health with home care, long-term care, acute care, rehabilitation, and palliative care.

RESULTS

Controlling for age, multivariate results show that being married or widowed was associated with a lower odds of being isolated. Mood disorders were also associated with a lower odds of isolation, while a history of a personality disorder and a personal biography of institutionalization were both clearly associated with an increased odds for isolation. Although significant bivariate predictors in the multivariate model, both schizophrenic and organic diagnoses failed to reach statistical significance. In addition, patients hospitalized at an earlier age and/or predicted to have a longer stay on the current admission were much less likely to have contact with informal supports. Of the study variables indexing functional status, only activities of daily living (ADLs) remained a significant predictor for isolation in the final multivariate model.

CONCLUSIONS

The analyses demonstrate the detrimental effects of an earlier life experience with mental illness. Having an earlier age of illness onset may lead to a potentially greater impairment in establishing and maintaining informal social ties throughout the life course into older age. These analyses reinforce the need for comprehensive assessment of patients on admission and over time.

Changes in social network diversity and perceived social support after psychiatric hospitalization: results from a longitudinal study

BACKGROUND

There is a large empirical basis for the importance of social networks and support for people with a mental illness. However, only a few studies have examined the predictors, changes and correlations of these constructs within a longitudinal framework.

AIM

To analyze changes in social network diversity as measured by the number of social roles and perceived social support over the course of three years after a psychiatric hospitalization while controlling for sociodemographic and clinical variables. A further aim was to inquire whether some social roles are perceived as being more supportive than others.

METHOD

Random coefficient models were applied to the data of a longitudinal study on the life circumstances of people with affective disorders or schizophrenia (N = 183).

RESULTS

The majority of participants had relatives, friends and co-workers, while a markedly smaller proportion had a spouse/partner or children. Social network diversity increased during the time period observed while the perception of social support did not change. Being male, without a job (competitive or sheltered), or having a low income predicted less diverse networks. Partners and friends were perceived as most supportive. Persons without a close friendship perceived less overall support, but only at baseline (hospitalization), while persons with a job on the competitive labor market felt better supported.

CONCLUSIONS

Social disintegration in the course of mental illness that is found in some studies has no equivalent in our study in what concerns network diversity and perceived support. According to our results, characteristics of vocational and economic integration are of much greater relevance, as they enhance or hinder access to social participation.

Residential area and social contacts in schizophrenia. Results from the European Schizophrenia Cohort (EuroSC)

BACKGROUND

Social isolation is associated with poor prognosis in schizophrenia. We aim to determine the effect of rural or urban residence on frequency of social and family contacts.

METHOD

We analysed data from the European Schizophrenia Cohort, a two-year follow-up study of 1,208 patients in Britain, France and Germany. Frequency of contact was elicited with Lehman's Quality of Life Inventory. Between-effect error component regression models adjusted the effects of living environment for country, age, gender, education, schizophrenia symptoms and global functioning.

RESULTS

Across all living conditions, contact with family occurred more frequently than contact with others. Family visits, social visits and planned social activities were less common in urban compared to rural settings, whereas no significant differences were found for social and family telephone calls and time spent with a spouse. Patients living with a partner had more family, but fewer social contacts, while women had more contact by phone. Family and social contacts across all categories decreased with age. Employment increased social contacts, but did not affect visits or phone calls within the family. Schizophrenia symptoms, particularly negative symptoms, and impaired global functioning decreased all aspects of social and family contacts.

DISCUSSION

Contrasting with results of previous studies, we found rural living was associated with greater frequency of social contacts in patients suffering from schizophrenia. Beyond living environment, our findings stress the importance both of an adequate control of negative symptoms and of employment opportunities for schizophrenia patients in order to enhance their social networks.

Social network among people with persistent mental illness: associations with sociodemographic, clinical and health-related factors

BACKGROUND

Social interaction is crucial for whether a person will successfully accomplish important life tasks.

AIM AND METHOD

This study investigated the importance of sociodemographic, clinical and self-perceived health-related factors for social interaction among 103 individuals with persistent mental illness, mainly psychoses, visiting an outpatient unit.

RESULTS

Bivariate analyses pointed to several relationships, especially between the health-related variables and both quantitative and qualitative aspects of the social network. In multivariate analyses, higher levels of quality of life, self-esteem, being a cohabitant, and living in a house were related to higher ratings on different aspects of the social network. Older age was associated with fewer close relationships but more adequate social integration.

CONCLUSIONS

The social network appeared to be a function of both self-perceptions and sociodemographic influences. The influence is probably dynamic and, for example, just as a better quality of life may lead to more social interaction, a more developed social network probably promotes better quality of life. Therefore, interventions in mental health care that target social interaction constitute a powerful resource and should be part of the support for people with severe and persistent mental illness.

Do recent-onset schizophrenia patients experience a "social network crisis"?

It has been proposed that the onset of schizophrenia creates a social network crisis, resulting in a dramatic deterioration of social resources during the period immediately following a first hospitalization from essentially normal pre-hospitalization levels. To evaluate this proposal, recent onset patients (n = 89) completed comprehensive assessments that examined their social networks in the 12 months prior to first hospitalization and, in a subset of patients (n = 34), at a 15-month follow-up. Cross-sectional relationships to social functioning and symptoms were examined at both time points. Compared to existing research, at the initial assessment patients were characterized by several network disturbances, including small network size, a high proportion of family members, and highly dense interconnections among network members; these disturbances generally remained moderately to highly stable at follow-up. Smaller social networks were related to poor current and premorbid social functioning and aspects of clinical functioning, particularly at the 15-month follow-up assessment. Thus, this first repeated assessment of social network characteristics in the early course of schizophrenia does not support the social network crisis concept. Instead, results suggest that functionally relevant social network disturbances often exist by the time of first hospitalization in schizophrenia.

Structure of needs among persons with schizophrenia

BACKGROUND

The importance of needs assessment for service development has been widely recognised. Several studies have focused on the associations between ratings of needs by patients and staff and have found clear differences, especially concerning the unmet needs.

METHODS

The present study is part of a Nordic Multicentre study that investigates the life and care of outpatients with a schizophrenia group illness in all the Nordic countries. The aim of this paper is to study the patterns of needs as identified by patients and staff according to the Camberwell Assessment of Needs (CAN). Quality of life, level of functioning, and psychiatric symptoms were assessed.

RESULTS

The sample includes 300 patients, 194 (65%) men and 106 (35%) women. The factor analysis identified five factors for patients and four factors for staff in the questionnaire on ratings of needs. In four of the five patient-related factors a meaningful interpretation was possible, and the factors were named skills, illness, coping, and substance abuse. The staff-related factors were named skills, impairment, symptom, and substance abuse. There were significant associations between the sum scores constructed from the factors and measures of functioning level and symptoms.

CONCLUSIONS

It seems that the sum factor reflecting secondary needs was the most important of the identified factors among both patient and staff ratings. The item-by-item comparisons in previous studies have emphasised differences between patient and staff ratings, but our analysis of the structure of needs also found similarities in the structures and in the associations between the identified sum scores and measures of symptoms, functioning level, and quality of life.

Living situation, subjective quality of life and social network among individuals with schizophrenia living in community settings

OBJECTIVE

To investigate the relationships between characteristics of the living situation in the community and subjective quality of life and social network among community-based individuals with schizophrenia.

METHOD

A total of 418 individuals with schizophrenia from 10 sites were interviewed with regard to quality of life, psychopathology, social network and needs for care. Characteristics of the living situation investigated were: living alone or not, living with family or not, and having an independent or a sheltered housing situation.

RESULTS

An independent housing situation was related to a better quality of life concerning living situation and living with the family to a better quality of life concerning family relations. An independent housing situation was associated with a better social network regarding availability and adequacy of emotional relations.

CONCLUSION

People with schizophrenia with an independent housing situation have a better quality of life associated with more favorable perceptions of independence, influence, and privacy. Their social network is better irrespective of whether they live alone or not, or with family or not.

Efficacy of day care treatment against readmission in patients with schizophrenia: A comparison between out-patients with and without day care treatment

The present study examined the efficacy of day care (DC) treatment against readmission to a mental hospital. Subjects were 65 out-patients with chronic schizophrenia after discharge. Day care treatment was defined as positive if patients were under DC treatment constantly for 4 months or more with a frequency of at least one visit per week. Information regarding demographic and disease-related factors was obtained from medical records at the time of discharge. Logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI) with adjustment for confounding variables. The modestly preventive efficacy of DC treatment against readmission was observed within 2 years after discharge (adjusted OR 0.52; 95% CI 0.12-2.35). The present findings suggest that DC treatment may be preventive against readmission for schizophrenic out-patients.