Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres.
BACKGROUND
This paper focuses on the long-term course of social disability in schizophrenia assessed at first onset, and after 1, 2 and 15 years in incidence cohorts in six European centres in Bulgaria, Germany, Ireland, The Netherlands, the Czech Republic and the United Kingdom. The study population comprises 349 patients comprising 75% of the original cohorts.


METHODS
Social disability was assessed in a standardized way with the WHO Disability Assessment Schedule.


RESULTS
Social disability in schizophrenia appears to be a persistent phenomenon. Its severity decreased overall in the period of follow-up, but this was not so in a small group traced to hospital or sheltered accommodation. Only 17% of subjects had no disability and 24% still suffered from severe disability. The great majority lived with their family, a partner, or alone. A deteriorating course was more frequent than late improvement. Gender, age, onset, duration of untreated psychosis or type of remission during the first 2 years did not predict the long-term outcome of disability. Severity of disability at the first three assessments of the illness contributed significantly to the explanation of its variance at 15 years.


CONCLUSIONS
Disability generally ameliorates, but less than expected or hoped. It needs continuing attention and care in this era of de-institutionalization.
Wiersma
D
D
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, The Netherlands.
Wanderling
J
J
Dragomirecka
E
E
Ganev
K
K
Harrison
G
G
An Der Heiden
W
W
Nienhuis
F J
FJ
Walsh
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003431:Cross-Cultural Comparison; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D012928:Social Desirability