title: Performance-based measurement of functional disability in schizophrenia: a cross-national study in the United States and Sweden.
abstract: OBJECTIVE
  Recent advances in the assessment of disability in schizophrenia have separated the measurement of functional capacity from real-world functional outcomes. The authors examined the similarity of performance-based assessments of everyday functioning, real-world disability, and achievement of milestones in people with schizophrenia in the United States and Sweden.
  
  
  METHODS
  The UCSD Performance-Based Skills Assessment-Brief Version (UPSA-B) and a neuropsychological assessment were administered to schizophrenia patients living in rural areas in Sweden (N=146) and in the New York City area (N=244), and patients' functioning was rated by their case managers. Information from records and case managers was used to determine the frequency of living independently, working, and having ever experienced a stable romantic relationship.
  
  
  RESULTS
  Performance on the UPSA-B was essentially identical in the two samples (New York, mean score=13.84; Sweden, mean score=13.30), as were scores on the case manager ratings of everyday activities (New York, mean=49.0; Sweden, mean=48.8). The correlations between UPSA-B score, neuropsychological test performance, and case manager ratings did not differ across the two samples. The proportion of patients who had never had a close relationship and the rate of vocational disability were also nearly identical. However, while 80% of the Swedish patients were living independently, only 46% of the New York patients were.
  
  
  CONCLUSIONS
  While scores on performance-based measures of everyday living skills were similar in people with schizophrenia across cultures, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to divergent real-world outcomes among individuals who show evidence of the same levels of ability and potential.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Woodruff Memorial Building, 101 Woodruff Circle, Suite 4000, Atlanta, GA 30322, USA. philip.harvey@emory.edu
authors.forename: Philip D
authors.initials: PD
authors.lastname: Harvey
authors.forename: Lars
authors.initials: L
authors.lastname: Helldin
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Bowie
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Olsson
authors.forename: Fredrik
authors.initials: F
authors.lastname: Hjärthag
authors.forename: Torsten
authors.initials: T
authors.lastname: Norlander
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
mesh_terms: D002391:Catchment Area, Health; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009519:New York City / Q000453:epidemiology; D012559:Schizophrenia / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology