Social functioning in schizophrenia: 4 instruments for its assessment

People suffering from schizophrenia perceive their social life in a particular way.

Schizophrenia affects many aspects of people's lives, being related to a distortion of the way reality is perceived.

One of the dimensions of the quality of life that is impaired is what is known as social functioning.

What is social functioning?

Social functioning consists of the person's ability to adapt to his or her social environment and its demands.. This term refers to the ability to relate to other people, as well as to maintain those relationships, enjoy leisure time, take care of ourselves and be able to perform the roles that society expects of us.

In schizophrenia spectrum disorders, impaired social functioning is a central aspect of the problem and can be detected early in the course of the disorder. and can be detected early in the course of the disorder. Moreover, this phenomenon persists even when the acute phase of the disorder has been overcome. On the other hand, the literature shows how certain factors present in patients with schizophrenia spectrum disorders, such as childhood trauma, negative symptoms or certain personality traits, accentuate this deficit in social functioning.

Assessing Social Functioning in Schizophrenia

It is clear then that adequately assessing the social functioning of patients with schizophrenia spectrum disorders is of great importance, as the most effective treatments can be provided. the most effective treatments can be provided for each patient's specific situation..

But it is not only necessary to be able to effectively assess the impairment of social functioning at the level of clinical practice, it is also necessary for research in this field in order to understand in depth the factors and mechanisms that intervene and modulate this impairment.

Psychometric tools

For this assessment there are psychometric tools, such as questionnaires or interviews, which help both the clinician and the researcher to know the degree of deficit in the social functioning of patients.

Here we will name four of the most commonly used instruments and review their features(both in terms of their structure and psychometric characteristics). All of them have been adapted to Spanish and validated in a population with schizophrenia spectrum disorders.

1. Personal and Social Functioning Scale (PSP)

This scale developed by Morosini, Magliano, Brambilla, Ugolini, and Pioli (2000) assesses four areas of the patient's social functioninga) self-care; b) usual social activities; c) personal and social relationships; and d) disruptive and aggressive behaviors. It is scored by the clinician and includes a semi-structured interview to help obtain good information about each of the areas.

In this scale the 4 areas are scored using a 6-point Likert scale, ranging from 1 (absent) to 6 (very severe).. Scores are obtained in each of the 4 areas, such that higher scores indicate worse functioning, and an overall scale score in which higher values reflect better personal and social functioning.

The Spanish version of this instrument, developed by Garcia-Portilla et al. (2011), presents an internal consistency of 0.87 and a test-retest reliability of 0.98. Thus, it is a valid and reliable instrument for measuring social functioning in patients with schizophrenia.

2. Social Functioning Scale (SFS)

The scale developed by Birchwood, Smith, Cochrane, Wetton, and Copestake (1990) assesses social functioning in the last three months of the life of a patient with schizophrenia spectrum disorders. with schizophrenia spectrum disorders, and can be administered either as a self-report questionnaire or as a semi-structured interview.

It consists of 78 items measuring seven subscales: isolation, interpersonal behavior, prosocial activities, leisure time, independence-competence, independence-performance, and employment-occupation. The Spanish version of Torres and Olivares (2005) has high alpha coefficients (between 0.69 and 0.80), making it a valid, reliable and sensitive instrument.

3. Quality of Life Scale (QLS)

This is a semi-structured interview containing 21 items, with a 7-point Likert scale. It was developed by Heinrichs, Hanlon, and Carpenter (1984) and evaluates 4 areas: a) intrapsychic functions; b) interpersonal relationships; c) instrumental role; and d) use of common objects and daily activities.

This scale is used both to measure patients' quality of life and social and occupational functioning.. The Spanish version adapted by Rodríguez, Soler, Rodríguez M., Jarne Esparcia, and Miarons, (1995) is a valid tool, with a high internal consistency (0.963) and reliable.

4. WHO Disability Assessment Questionnaire (WHO-DAS-II)

This questionnaire, with different versions (36, 12 and 5 items), evaluates different areas of functioning: understanding and communicating with the world, ability to cope with the environment, self-care, relationship with others, activities of daily living and participation in society.The questionnaire evaluates different areas of functioning: understanding and communication with the world, ability to manage in the environment, self-care, relationship with other people, activities of daily living and participation in society.

Developed by Vázquez-Barquero et al., (2000), it was later corroborated for its usefulness, validity and reliability in patients with schizophrenia spectrum disorders by Guilera et al., (2012)

Bibliographic references:

• Birchwood, M., Smith, J., Cochrane, R., Wetton, S., & Copestake, S. (1990). The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. The British Journal of Psychiatry : The Journal of Mental Science, 157, pp. 853 - 859. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2289094

• Garcia-Portilla, M. P., Saiz, P. A., Bousoño, M., Bascaran, M. T., Guzmán-Quilo, C., & Bobes, J. (2011). Validation of the Spanish version of the Personal and Social Functioning scale in outpatients with stable or unstable schizophrenia. Revista de Psiquiatría Y Salud Mental, 4(1), pp. 9 - 18.

• Guilera, G., Gómez-Benito, J., Pino, O., Rojo, J. E., Cuesta, M. J., Martínez-Arán, A., ... Rejas, J. (2012). Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophrenia Research, 138(2-3), pp. 240 - 247.

• Heinrichs, D. W., Hanlon, T. E., & Carpenter, W. T. (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10(3), pp. 388 - 398.

• Lemos Giráldez, S., Fonseca Pedrero, E., Paino, M., & Vallina, Ó. (2015). Schizophrenia and other psychotic disorders. Madrid: Sintesis.

• Lysaker, P. H., Meyer, P. S., Evans, J. D., Clements, C. A., & Marks, K. A. (2001). Childhood Sexual Trauma and Psychosocial Functioning in Adults With Schizophrenia. Psychiatric Services, 52(11), 1485-1488.

• Morosini, P. L., Magliano, L., Brambilla, L., Ugolini, S., & Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 101(4), 323-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10782554

• Rodríguez, A., Soler, R. M., Rodríguez M., A., Jarne Esparcia, A. J., & Miarons, R. (1995). Factorial study and adaptation of the Quality of Life Scale in Schizophrenia (QLS). Journal of general and applied psychology: Journal of the Spanish Federation of Psychology Associations. Spanish Federation of Psychology Associations.

• Torres, A., & Olivares, J. M. (2005). Validation of the Spanish version of the Social Functioning Scale. Actas Españolas de Psiquiatría, 33(4), pp. 216 - 220.

• Vázquez-Barquero, J. L., Vázquez Bourgón, E., Herrera Castanedo, S., Saiz, J., Uriarte, M., Morales, F., ... Disabilities, G. C. in. (2000). Spanish language version of a new WHO disability assessment questionnaire (WHO-DAS-II): Initial development phase and pilot study. Actas Españolas de Psiquiatría.