title: Predictors of current functioning and functional decline in schizophrenia.
abstract: Positive, negative, and cognitive symptoms of schizophrenia may affect functional outcomes. However, these factors alone do not account for a large percentage of variance in outcomes. We investigated demographic, cognitive, symptom, and functional capacity predictors of current functional status in 280 outpatients with schizophrenia or schizoaffective disorder. Functional decline over the lifespan was also examined in a subset of participants. Stepwise regressions modeled predictors of current functional status and functional decline as measured by the Assessment of Lifespan Functioning Attainment (ALFA). ALFA functional domains included paid employment, independence in living situation, romantic relationships, close friendships, and recreational engagement. More severe depressive symptoms were consistently associated with worse current community integration (lower levels of close friendships and recreational engagement). Better working memory performance was associated with higher rates of current paid employment. There were no consistent modifiable predictors of decline in functioning, but women reported less functional decline in the domains of employment and close friendships than men. Better cognitive performance was associated with less decline in living independence and romantic relationships, but more decline in paid employment and recreational engagement. Increased assessment and treatment of comorbid depressive symptoms may improve functional outcomes in people with schizophrenia.
authors.affiliation: Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA.
authors.forename: Jamie
authors.initials: J
authors.lastname: Joseph
authors.affiliation: Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Kremen
authors.affiliation: Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Franz
authors.affiliation: Psychiatric Genetic Epidemiology & Neurobiology Laboratory, Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams Street, 3710 Neuroscience Research Building, Syracuse, NY 13210, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Glatt
authors.affiliation: Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: van de Leemput
authors.affiliation: Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA.
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Chandler
authors.affiliation: Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA; Institute for Genomic Medicine, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA.
authors.forename: Ming T
authors.initials: MT
authors.lastname: Tsuang
authors.affiliation: Center for Behavioral Genomics, Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA; Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. Electronic address: etwamley@ucsd.edu.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Twamley
mesh_terms: D003071:Cognition; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000175:diagnosis; D018450:Disease Progression; D004651:Employment; D005260:Female; D033062:Friends; D006801:Humans; D016015:Logistic Models; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D012559:Schizophrenia / Q000150:complications / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D012737:Sex Factors; D012919:Social Behavior
keywords: Cognition; Depression; Lifespan functioning; Psychosis