What Do People With Schizophrenia Do All Day? Ecological Momentary Assessment of Real-World Functioning in Schizophrenia
What Do People With Schizophrenia Do All Day? Ecological Momentary Assessment of Real-World Functioning in Schizophrenia
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DOI：
10.1093/schbul/sbz070
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发表时间：
2020-03-01
影响因子：
6.6
通讯作者：
Harvey, Philip D.
中科院分区：
文献类型：
--
作者：
Granholm, Eric;Holden, Jason L.;Harvey, Philip D.
精神分裂症是全世界残疾的主要原因。随着新的功能治疗方法的测试，越来越需要证明现实世界的功能收益。生态瞬时评估（EMA）可以提供一个更生态有效的措施的功能。在这项研究中，基于智能手机的EMA被用来向精神分裂症参与者（N = 100）和对照组（N = 71）发出信号，每天7次，持续7天，以回答有关社会互动和功能行为的简短问卷。研究发现，两组患者的依从性都很好，平均完成了85%的调查，只有3%的精神分裂症患者因依从性差而被排除在外。四周的重测信度很高（r = 0.83的总生产行为）。与对照组相比，精神分裂症患者的总生产活动显著减少（d = 1.2），社交活动减少（d = 0.3），非生产性行为增加（d = 1.0;看电视，休息），在家的时间增加（d = 0.8）。在精神分裂症组，独立生活的参与者表现出更好的功能EMA相对于参与者在支持住房（D = 0.8）和参与者从事职业活动表现出更好的功能比个人不从事职业活动（D = 0.55）。适度的相关性，发现EMA和在实验室自我报告的功能活动在社区进行的措施，但EMA和功能能力或潜力的措施之间没有。本研究证明了EMA方法评估精神分裂症患者功能的可行性、敏感性、可靠性和有效性。EMA为精神分裂症患者在现实世界中的实际行为提供了一个急需的衡量标准。这些结果还表明，能力指数和实际的现实世界功能之间可能存在重要的脱节。
Schizophrenia is a major cause of disability worldwide. As new treatments for functioning are tested, the need grows to demonstrate real-world functioning gains. Ecological momentary assessment (EMA) may provide a more ecologically valid measure of functioning. In this study, smartphone-based EMA was used to signal participants with schizophrenia (N = 100) and controls (N = 71) 7 times a day for 7 days to respond to brief questionnaires about social interactions and functioning behaviors. Excellent adherence was found, with both groups completing an average of 85% of surveys and only 3% of participants with schizophrenia excluded for poor adherence. Four-week test-retest reliability was high (r = .83 for total productive behaviors). Relative to controls, participants with schizophrenia reported significantly less total productive activity (d = 1.2), fewer social interactions (d = 0.3), more nonproductive behaviors (d = 1.0; watching TV, resting), and more time at home (d = 0.8). Within the schizophrenia group, participants living independently showed better functioning on EMA relative to participants in supported housing (d = 0.8) and participants engaged in vocational activities showed better functioning than individuals not engaged in vocational activities (d = 0.55). Modest correlations were found between EMA and an in-lab self-report measure of functioning activities performed in the community, but not between EMA and measures of functional capacity or potential. This study demonstrated the feasibility, sensitivity reliability, and validity of EMA methods to assess functioning in schizophrenia. EMA provides a much-needed measure of what individuals with schizophrenia are actually doing in real-world contexts. These results also suggest that there may be important disjunctions between indices of abilities and actual real-world functioning.