title: From neurocognition to community participation in serious mental illness: the intermediary role of dysfunctional attitudes and motivation.
abstract: BACKGROUND
  Evidence for a relationship between neurocognition and functional outcome in important areas of community living is robust in serious mental illness research. Dysfunctional attitudes (defeatist performance beliefs and asocial beliefs) have been identified as intervening variables in this causal chain. This study seeks to expand upon previous research by longitudinally testing the link between neurocognition and community participation (i.e. time in community-based activity) through dysfunctional attitudes and motivation.
  
  
  METHODS
  Adult outpatients with serious mental illness (N = 175) participated, completing follow-up assessments approximately 6 months after initial assessment. Path analysis tested relationships between baseline neurocognition, emotion perception, functional skills, dysfunctional attitudes, motivation, and outcome (i.e. community participation) at baseline and follow-up.
  
  
  RESULTS
  Path models demonstrated two pathways to community participation. The first linked neurocognition and community participation through functional skills, defeatist performance beliefs, and motivation. A second pathway linked asocial beliefs and community participation, via a direct path passing through motivation. Model fit was excellent for models predicting overall community participation at baseline and, importantly, at follow-up.
  
  
  CONCLUSIONS
  The existence of multiple pathways to community participation in a longitudinal model supports the utility of multi-modal interventions for serious mental illness (i.e. treatment packages that build upon individuals' strengths while addressing the array of obstacles to recovery) that feature dysfunctional attitudes and motivation as treatment targets.
authors.affiliation: Department of Rehabilitation Sciences,College of Public Health,Temple University,Philadelphia,PA,USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Thomas
authors.affiliation: Department of Psychology,School of Science,Indiana University-Purdue University Indianapolis,Indianapolis,IN,USA.
authors.forename: L
authors.initials: L
authors.lastname: Luther
authors.affiliation: Department of Psychology,University of Texas Southwestern Medical Center,Dallas,TX,USA.
authors.forename: L
authors.initials: L
authors.lastname: Zullo
authors.affiliation: Department of Psychiatry,Perelman School of Medicine,University of Pennsylvania,Philadelphia,PA,USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Beck
authors.affiliation: Department of Psychiatry,Perelman School of Medicine,University of Pennsylvania,Philadelphia,PA,USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Grant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001290:Attitude; D003256:Community Participation / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation / Q000502:physiology*; D011618:Psychotic Disorders / Q000523:psychology; D055815:Young Adult
keywords: Cognitive theory; community integration; path analysis; recovery; schizophrenia