title: Predictors of levels of functioning among Chinese people with severe mental illness: a 12-month prospective cohort study.
abstract: OBJECTIVE
  The aim of the study was to identify the predictors of functioning in Chinese people with serious mental illness.
  
  
  BACKGROUND
  Mental healthcare services for people suffering from serious mental illness are delivered to not only minimise their psychiatric symptoms but also enhance their levels of functioning in the community. Yet, there is insufficient research directed towards the associated or predictive factors that may influence different aspects of functioning, particularly in terms of patients' psychosocial variables.
  
  
  METHODS
  A longitudinal, prospective cohort study design was adopted.
  
  
  METHODS
  A clustered random sample of 395 of 611 outpatients with serious mental illness completed the same set of questionnaires at baseline and at 12 months. Changes in patients' functioning as measured by self-maintenance, social functioning and community living skills were recorded over 12 months. Potential relationships between their level of functioning and symptom severity, self-esteem, self-efficacy, perceived negative familial response, negative self-stigma towards mental illness, re-hospitalisation rate and socio-demographic characteristics were investigated.
  
  
  RESULTS
  Most participants reported moderate to moderately high levels of overall functioning, self-efficacy, self-stigma and perceived negative familial response at baseline and there were significant observed correlations between these variables. Results of multiple regression models indicated that while symptom severity predicted functioning in patients with psychotic and affective disorders, a negatively perceived familial response only predicted negative changes in social functioning of the patients with psychotic disorders (β = -0·25). In addition, improvements in self-efficacy (β = 0·23) and reduction in self-stigma (β = -0·15) positively predicted changes in the community living skills of patients with affective disorders.
  
  
  CONCLUSIONS
  The findings indicate the significance of psychiatric patients' symptom management and factors such as self-efficacy and self-stigma to predict their functioning over a 12-month follow-up.
  
  
  CONCLUSIONS
  Mental healthcare services should consider giving priority to self-stigma reduction and empowerment to manage illness especially in this population of patients and their families, thus effectively enhancing their self-care ability to cope with their illness and/or difficult life situations.
authors.affiliation: School of Nursing, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
authors.forename: Wai-Tong
authors.identifier: http://orcid.org/0000-0001-5321-5791
authors.initials: WT
authors.lastname: Chien
authors.affiliation: School of Nursing, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
authors.forename: Claire K K
authors.initials: CK
authors.lastname: Lam
authors.affiliation: Chinese Medicine Department, Hospital Authority Hong Kong, Lok Fu, Hong Kong SAR, China.
authors.forename: Bacon F L
authors.initials: BF
authors.lastname: Ng
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D044466:Asian People / Q000523:psychology*; D015331:Cohort Studies; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D011618:Psychotic Disorders / Q000208:ethnology / Q000523:psychology*; D012648:Self Care; D012649:Self Concept; D012917:Social Adjustment; D057545:Social Stigma; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: expressed emotion; functioning; prospective cohort study; self-stigma; severe mental illness