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Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres

Published online by Cambridge University Press:  17 October 2000

D. WIERSMA ,
J. WANDERLING ,
E. DRAGOMIRECKA ,
K. GANEV ,
G. HARRISON ,
W. AN DER HEIDEN ,
F. J. NIENHUIS  and
D. WALSH
D. WIERSMA
Affiliation:
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, Groningen, The Netherlands
J. WANDERLING
Affiliation:
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, Groningen, The Netherlands
E. DRAGOMIRECKA
Affiliation:
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, Groningen, The Netherlands
K. GANEV
Affiliation:
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, Groningen, The Netherlands
G. HARRISON
Affiliation:
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, Groningen, The Netherlands
W. AN DER HEIDEN
Affiliation:
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, Groningen, The Netherlands
F. J. NIENHUIS
Affiliation:
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, Groningen, The Netherlands
D. WALSH
Affiliation:
Department of Social Psychiatry, WHO Collaborating Centre, University of Groningen, Groningen, The Netherlands
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Abstract

Background. This paper focuses on the long-term course of social disability in schizophrenia assessed at first onset, and after 1, 2 and 15 years in incidence cohorts in six European centres in Bulgaria, Germany, Ireland, The Netherlands, the Czech Republic and the United Kingdom. The study population comprises 349 patients comprising 75% of the original cohorts.

Methods. Social disability was assessed in a standardized way with the WHO Disability Assessment Schedule.

Results. Social disability in schizophrenia appears to be a persistent phenomenon. Its severity decreased overall in the period of follow-up, but this was not so in a small group traced to hospital or sheltered accommodation. Only 17% of subjects had no disability and 24% still suffered from severe disability. The great majority lived with their family, a partner, or alone. A deteriorating course was more frequent than late improvement. Gender, age, onset, duration of untreated psychosis or type of remission during the first 2 years did not predict the long-term outcome of disability. Severity of disability at the first three assessments of the illness contributed significantly to the explanation of its variance at 15 years.

Conclusion. Disability generally ameliorates, but less than expected or hoped. It needs continuing attention and care in this era of de-institutionalization.

Type
Research Article
Information
Psychological Medicine , Volume 30 , Issue 5 , September 2000 , pp. 1155 - 1167
Copyright
© 2000 Cambridge University Press

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