D. Wiersma et al., Social disability in schizophrenia: its development and prediction over 15years in incidence cohorts in six European centres, PSYCHOL MED, 30(5), 2000, pp. 1155-1167
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 i
ncidence cohorts in six European centres in Bulgaria, Germany, Ireland, The
Netherlands, the Czech Republic and the United Kingdom. The study populati
on 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 phen
omenon. 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, a
ge, 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 si
gnificantly to the explanation of its variance at 15 years.
Conclusion. Disability generally ameliorates, but less than expected or hop
ed. It needs continuing attention and care in this era of de-institutionali
zation.