title: Assessment of Lifespan Functioning Attainment (ALFA) scale: A quantitative interview for self-reported current and functional decline in schizophrenia.
abstract: Schizophrenia has been characterized as a disorder with poor outcomes across various functional domains, especially social and occupational functioning. Although these outcomes have been investigated based on patients' current functioning, few studies have considered the assessment of functional outcomes across the lifespan in schizophrenia. We developed a novel and brief scale of adulthood lifespan functioning, the Assessment of Lifespan Functioning Attainment (ALFA). We assessed current functioning and percentage of pre- and post-psychosis onset engagement for five functional domains including paid employment, living independently, romantic partnerships, close friendships, and recreational engagement with others. Pre-to post-psychosis functional decline was observed for all domains, with paid employment having the greatest decline (d = 2.68) and living independently having the least decline (d = .59). Our exploratory factor analysis suggests that a single factor accounted for the most variance in Pre-Psychosis Functioning in ALFA domains. Two factors explain the majority of variance in Post-Psychosis Functioning and Pre-to-Post Psychosis Decline: a sociability factor (close friendships and recreational engagement with others) and an independence factor (paid employment, living independently, romantic relationships). To our knowledge, this is the first study to report on a self-reported quantitative assessment of adult lifespan functioning in schizophrenia. The ALFA scale may be a useful tool for future research on functional outcomes in schizophrenia.
authors.affiliation: Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Joseph
authors.affiliation: Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, USA; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Kremen
authors.affiliation: Psychiatric Genetic Epidemiology & Neurobiology Laboratory (PsychGENe Lab), Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, 3710 Neuroscience Research Building, Institute for Human Performance, Syracuse, NY 13210, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Glatt
authors.affiliation: Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Franz
authors.affiliation: Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, USA.
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Chandler
authors.affiliation: Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, USA.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Liu
authors.affiliation: Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, USA.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Johnson
authors.affiliation: Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, USA; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161, USA.
authors.forename: Ming T
authors.initials: MT
authors.lastname: Tsuang
authors.affiliation: Center for Behavior Genomics, Department of Psychiatry, School of Medicine, University of California San Diego, 9500 Gilman Drive #0603, La Jolla, CA 92093-0603, USA; Center of Excellence for Stress and Mental Health, Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive (116A), San Diego, CA 92161, USA. Electronic address: etwamley@ucsd.edu.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Twamley
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology*; D004651:Employment; D005260:Female; D006801:Humans; D057187:Independent Living; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011618:Psychotic Disorders / Q000209:etiology*; D011788:Quality of Life; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D057566:Self Report; D013223:Statistics as Topic
keywords: Employment; Functional outcome; Psychosis; Social functioning