Accuracy of self-assessment of real-life functioning in schizophrenia
Authors: Rocca Paola , Brasso Claudio , Montemagni Cristiana , Bellino Silvio , Rossi Alessandro , Bertolino Alessandro , Gibertoni Dino , Aguglia Eugenio , Amore Mario , Andriola Ileana , Bellomo Antonello , Bucci Paola , Buzzanca Antonino , Carpiniello Bernardo , Cuomo Alessandro , Dell’Osso Liliana , Favaro Angela , Giordano Giulia Maria , Marchesi Carlo , Monteleone Palmiero , Oldani Lucio , Pompili Maurizio , Roncone Rita , Rossi Rodolfo , Siracusano Alberto , Vita Antonio , Zeppegno Patrizia , Galderisi Silvana , Maj Mario ,   the Italian Network for Research on Psychoses, Bozzatello Paola , Badino Cristina , Giordano Benedetta , Di Palo Piergiuseppe , Calia Vitalba , Papalino Marco , Barlati Stefano , Deste Giacomo , Ceraso Anna , Pinna Federica , Olivieri Benedetta , Manca Daniela , Piegari Giuseppe , Brando Francesco , Giuliani Luigi , Aiello Carmen , Poli Laura Fusar , Concerto Carmen , Surace Teresa , Altamura Mario , Malerba Stefania , Padalino Flavia , Calcagno Pietro , Murri Martino Belvederi , Amerio Andrea , Pacitti Francesca , Socci Valentina , Lucaselli Alessia , Giusti Laura , Salza Anna , Ussorio Donatella , Iasevoli Felice , Gramaglia Carla , Gambaro Eleonora , Gattoni Eleonora , Tenconi Elena , Collantoni Enrico , Meneguzzo Paolo , Ossola Paolo , Tonna Matteo , Gerra Maria Lidia , Carmassi Claudia , Carpita Barbara , Cremone Ivan Mirko , Corrivetti Giulio , Cascino Giammarco , Marciello Francesca , Brugnoli Roberto , Comparelli Anna , Corigliano Valentina , Girardi Nicoletta , Accinni Tommaso , Carlone Luca , Fagiolini Andrea , Goracci Arianna , Bolognesi Simone , Di Lorenzo Giorgio , Niolu Cinzia , Ribolsi Michele 
Published: February 2021

A consensus has not yet been reached regarding the accuracy of people with schizophrenia in self-reporting their real-life functioning. In a large (n = 618) cohort of stable, community-dwelling schizophrenia patients we sought to: (1) examine the concordance of patients’ reports of their real-life functioning with the reports of their key caregiver; (2) identify which patient characteristics are associated to the differences between patients and informants. Patient-caregiver concordance of the ratings in three Specific Level of Functioning Scale (SLOF) domains (interpersonal relationships, everyday life skills, work skills) was evaluated with matched-pairttests, the Lin’s concordance correlation, Somers’D, and Bland–Altman plots with limits of agreement (LOA). Predictors of the patient-caregiver differences in SLOF ratings were assessed with a linear regression with multivariable fractional polynomials. Patients’ self-evaluation of functioning was higher than caregivers’ in all the evaluated domains of the SLOF and 17.6% of the patients exceeded the LOA, thus providing a self-evaluation discordant from their key caregivers. The strongest predictors of patient-caregiver discrepancies were caregivers’ ratings in each SLOF domain. In clinically stable outpatients with a moderate degree of functional impairment, self-evaluation with the SLOF scale can become a useful, informative and reliable clinical tool to design a tailored rehabilitation program.