Factors Associated With Real-Life Functioning in Persons With Schizophrenia in a 4-Year Follow-up Study of the Italian Network for Research on Psychoses
Authors: Armida Mucci, Silvana Galderisi, Dino Gibertoni, Alessandro Rossi, Paola Rocca, Alessandro Bertolino, Eugenio Aguglia, Mario Amore, Antonello Bellomo, Massimo Biondi, Giuseppe Blasi, Claudio Brasso, Paola Bucci, Bernardo Carpiniello, Alessandro Cuomo, Liliana Dell’Osso, Giulia Maria Giordano, Carlo Marchesi, Palmiero Monteleone, Cinzia Niolu, Lucio Oldani, Mauro Pettorruso, Maurizio Pompili, Rita Roncone, Rodolfo Rossi, Elena Tenconi, Antonio Vita, Patrizia Zeppegno, Mario Maj, Giuseppe Piegari, Carmen Aiello, Francesco Brando, Luigi Giuliani, Davide Palumbo, Chiara Coccia, Marco Papalino, Vitalba Calia, Raffaella Romano, Stefano Barlati, Giacomo Deste, Paolo Valsecchi, Federica Pinna, Alice Lai, Silvia Lostia di Santa Sofia, Maria Salvina Signorelli, Laura Fusar Poli, Teresa Surace, Giovanni Martinotti, Chiara Montemitro, Silvia Fraticelli, Mario Altamura, Eleonora Angelini, Antonella Elia, Pietro Calcagno, Martino Belvederi Murri, Simone Cattedra, Francesca Pacitti, Dalila Talevi, Valentina Socci, Laura Giusti, Anna Salza, Silvia Mammarella, Andrea de Bartolomeis, Angela Favaro, Enrico Collantoni, Paolo Meneguzzo, Matteo Tonna, Paolo Ossola, Maria Lidia Gerra, Carla Gramaglia, Valeria Binda, Eleonora Gambaro, Claudia Carmassi, Barbara Carpita, Ivan Mirko Cremone, Giulio Corrivetti, Giammarco Cascino, Gianfranco Del Buono, Roberto Brugnoli, Anna Comparelli, Valentina Corigliano, Antonio Buzzanca, Nicoletta Gerardi, Marianna Frascarelli, Andrea Fagiolini, Arianna Goracci, Simone Bolognesi, Alberto Siracusano, Giorgio Di Lorenzo, Michele Ribolsi, Cristiana Montemagni, Cecilia Riccardi, Elisa Del Favero
Journal: JAMA Psychiatry (2021)

The goal of schizophrenia treatment has shifted from symptom reduction and relapse prevention to functional recovery; however, recovery rates remain low. Prospective identification of variables associated with real-life functioning domains is essential for personalized and integrated treatment programs.To assess whether baseline illness-related variables, personal resources, and context-related factors are associated with work skills, interpersonal relationships, and everyday life skills at 4-year follow-up.This multicenter prospective cohort study was conducted across 24 Italian university psychiatric clinics or mental health departments in which 921 patients enrolled in a cross-sectional study were contacted after 4 years for reassessment. Recruitment of community-dwelling, clinically stable persons with schizophrenia was conducted from March 2016 to December 2017, and data were analyzed from January to May 2020.Psychopathology, social and nonsocial cognition, functional capacity, personal resources, and context-related factors were assessed, with real-life functioning as the main outcome. Structural equation modeling, multiple regression analyses, and latent change score modeling were used to identify variables that were associated with real-life functioning domains at follow-up and with changes from baseline in these domains.In total, 618 participants (427 male [69.1%]; mean [SD] age, 45.1 [10.5] years) were included. Five baseline variables were directly associated with real-life functioning at follow-up: neurocognition with everyday life (β, 0.274; 95% CI, 0.207-0.341; P < .001) and work (β, 0.101; 95% CI, 0.005-0.196; P = .04) skills; avolition with interpersonal relationships (β, -0.126; 95% CI, -0.190 to -0.062; P < .001); positive symptoms with work skills (β, -0.059; 95% CI, -0.112 to -0.006; P = .03); and social cognition with work skills (β, 0.185; 95% CI, 0.088-0.283; P < .001) and interpersonal functioning (β, 0.194; 95% CI, 0.121-0.268; P < .001). Multiple regression analyses indicated that these variables accounted for the variability of functioning at follow-up after controlling for baseline functioning. In the latent change score model, higher neurocognitive abilities were associated with improvement of everyday life (β, 0.370; 95% CI, 0.253-0.486; P < .001) and work (β, 0.102; 95% CI, 0.016-0.188; P = .02) skills, social cognition (β, 0.133; 95% CI, 0.015-0.250; P = .03), and functional capacity (β, 1.138; 95% CI, 0.807-1.469; P < .001); better baseline social cognition with improvement of work skills (β, 0.168; 95% CI, 0.075-0.261; P < .001) and interpersonal functioning (β, 0.140; 95% CI, 0.069-0.212; P < .001); and better baseline everyday life skills with improvement of work skills (β, 0.121; 95% CI, 0.077-0.166; P < .001).Findings of this large prospective study suggested that baseline variables associated with functional outcome at follow-up included domains not routinely assessed and targeted by intervention programs in community mental health services. The key roles of social and nonsocial cognition and of baseline everyday life skills support the adoption in routine mental health care of cognitive training programs combined with personalized psychosocial interventions aimed to promote independent living.