title: Predictors of disability: a 5-year cohort study of first-episode schizophrenia.
abstract: BACKGROUND
  There is a dearth of information about the predictors of disability in schizophrenia from low and middle-income countries. This study attempted to investigate the impact of socio-demographic and clinical variables on disability in a cohort of first episode schizophrenia.
  
  
  METHODS
  Patients diagnosed to have DSM IV schizophrenia (n=131) were assessed prospectively for psychopathology, functioning, insight and explanatory models of illness at baseline, 6, 12 and 60 months using standard instruments. Disability was assessed at 5 years. Multiple linear regression was employed to adjust for common confounders.
  
  
  RESULTS
  We could follow-up 95 (72.5%) patients. Sixty-five of these patients (68.4%) achieved remission. Disability scores at 5 years were associated negatively with episodic nature of illness at baseline, functional assessments at 6 and 12 months and return to pre-morbid level function. Disability correlated positively with psychopathology at 6 and 12 months and time spent in psychotic episodes. It was also associated with psychopathology, remission, insight and patient perspectives at the 5th year cross-sectional evaluation. While employment status at recruitment was not associated with disability, it was associated with unemployment at follow-up.
  
  
  CONCLUSIONS
  Disability at 5 years was associated with illness variables - episodic nature of illness at baseline, psychopathology and functioning, duration in psychotic episode and return to pre-morbid function. Patient perspectives about their illness (insight and patient explanatory models) were only associated cross-sectionally at 60 months but not earlier and are more suggestive of a coping response rather than being predictive of outcome. The relationship between unemployment and disability suggests that they are products of the same disease process.
authors.affiliation: College of Nursing, Christian Medical College, Vellore 632004, India.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Johnson
authors.affiliation: College of Nursing, Christian Medical College, Vellore 632004, India.
authors.forename: Manoranjitham
authors.initials: M
authors.lastname: Sathyaseelan
authors.affiliation: College of Nursing, Christian Medical College, Vellore 632004, India.
authors.forename: Helen
authors.initials: H
authors.lastname: Charles
authors.affiliation: Christian Medical College, Vellore 632002, India. Electronic address: ksjacob@cmcvellore.ac.in.
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019989:Persons with Intellectual Disabilities / Q000523:psychology*; D011237:Predictive Value of Tests; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D055815:Young Adult
keywords: Disability; Explanatory models; Insight; Outcome; Predictors; Schizophrenia