title: The convergence between self-reports and observer ratings of financial skills and direct assessment of financial capabilities in patients with schizophrenia: more detail is not always better.
abstract: Despite multiple lines of evidence suggesting that people with schizophrenia tend to overestimate their ability to perform everyday tasks such as money management, self-report methods are still widely used to assess functioning. In today's technology driven financial world patients are faced with increasingly complex financial management tasks. To meet these challenges adequate financial skills are required. Thus, accurate assessments of these abilities are critical to decisions regarding a patient's need for support such as a financial trustee. As part of the larger VALERO study, 195 patients with schizophrenia were asked to self-report their everyday financial skills (five common financial tasks) with the Independent Living Skills Survey (ILSS). They were also assessed with performance-based measures of neuro-cognition and functional capacity with a focus on financial skills. In addition, a friend, relative, or clinician informant was interviewed with the ILSS and a best estimate rating of functioning was generated. Scores on the performance-based measures of financial skills and neuropsychological tests were uncorrelated with self-reported financial activities. Interviewer and all informant judgments of financial abilities were also minimally correlated with performance on functional skill tests. Discrete financial skills appear to be challenging for clinicians to rate with accuracy without the use of direct assessments. Direct assessment of financial skills seems prudent when making determinations about the need for guardianship or other financial supervision.
authors.affiliation: University of Miami Miller School of Medicine, United States; Miami VA Medical Center, United States. Electronic address: philipdharvey1@cs.com.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Harvey
authors.affiliation: University of Miami Miller School of Medicine, United States.
authors.forename: Laura
authors.initials: L
authors.lastname: Stone
authors.affiliation: University of Miami Miller School of Medicine, United States.
authors.forename: David
authors.initials: D
authors.lastname: Lowenstein
authors.affiliation: University of Miami Miller School of Medicine, United States.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Czaja
authors.affiliation: UCSD Medical Center, United States.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Heaton
authors.affiliation: UCSD Medical Center, United States; San Diego VA Medical Center, United States.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Twamley
authors.affiliation: UCSD Medical Center, United States.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D005376:Financial Management; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D057566:Self Report; D013223:Statistics as Topic
references.citation: J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57
references.pmid: 9881538
references.citation: Schizophr Res. 2011 Sep;131(1-3):250-5
references.pmid: 21620682
references.citation: Schizophr Bull. 2000;26(3):631-58
references.pmid: 10993403
references.citation: J Int Neuropsychol Soc. 2008 May;14(3):479-88
references.pmid: 18419846
references.citation: Am J Psychiatry. 2006 Mar;163(3):426-32
references.pmid: 16513863
references.citation: Schizophr Bull. 2011 Mar;37(2):334-43
references.pmid: 19525354
references.citation: Schizophr Bull. 2007 Nov;33(6):1364-72
references.pmid: 17341468
references.citation: J Int Neuropsychol Soc. 2004 May;10(3):317-31
references.pmid: 15147590
references.citation: Am J Psychiatry. 2011 Nov;168(11):1195-201
references.pmid: 21572166
references.citation: Am J Psychiatry. 2009 Jul;166(7):821-7
references.pmid: 19487393
references.citation: Schizophr Bull. 2006 Jan;32(1):81-91
references.pmid: 16293810
references.citation: Am J Psychiatry. 2006 Mar;163(3):418-25
references.pmid: 16513862
references.citation: Schizophr Bull. 2013 Jan;39(1):102-11
references.pmid: 21765165
references.citation: Am J Psychiatry. 2011 Apr;168(4):400-7
references.pmid: 21285142
references.citation: Schizophr Bull. 2000;26(1):119-36
references.pmid: 10755673
references.citation: J Psychiatr Res. 2007 Dec;41(12):1012-8
references.pmid: 17014866
references.citation: Schizophr Bull. 2007 Sep;33(5):1138-48
references.pmid: 17493956
references.citation: Schizophr Bull. 2001;27(2):235-45
references.pmid: 11354591
references.citation: Am J Psychiatry. 2008 Feb;165(2):203-13
references.pmid: 18172019
references.citation: Neurosci Biobehav Rev. 2011 Jan;35(3):573-88
references.pmid: 20620163
references.citation: Schizophr Res. 2009 Nov;115(1):82-7
references.pmid: 19775869
references.citation: Biol Psychiatry. 2008 Mar 1;63(5):505-11
references.pmid: 17662256
references.citation: J Psychiatr Res. 2012 Dec;46(12):1546-52
references.pmid: 22979993
references.citation: Psychol Aging. 2006 Jun;21(2):333-52
references.pmid: 16768579
references.citation: Schizophr Res. 2012 May;137(1-3):190-5
references.pmid: 22386735