Predictors of the accuracy of self assessment of everyday functioning in people with schizophrenia.
Predictors of the accuracy of self assessment of everyday functioning in people with schizophrenia.
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DOI：
10.1016/j.schres.2012.02.002
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发表时间：
2012-05
影响因子：
4.5
通讯作者：
Harvey, Philip D.
中科院分区：
文献类型：
--
作者：
Sabbag, Samir;Twamley, Elizabeth W.;Vella, Lea;Heaton, Robert K.;Patterson, Thomas L.;Harvey, Philip D.
尽管多种证据表明精神分裂症患者在自我报告的日常功能和认知表现方面存在严重问题，但自我报告方法仍然广泛用于评估功能。本研究试图确定自我报告准确性的预测因素，包括准确的自我评估和对当前功能的高估。作为更大规模的日常现实世界结果验证评估 (VALERO) 研究的一部分，195 名精神分裂症患者被要求使用特定功能水平 (SLOF) 量表自我报告他们的日常功能，其中包括评估社会功能、日常活动和职业功能的子量表。他们还接受了神经心理学（NP）表现和功能能力（FC）的评估，并接受了精神病症状学评估。此外，一位朋友、亲戚或临床医生信息提供者接受了 SLOF 的采访，访问者可以访问患者和信息提供者提供的所有信息（不包括基于表现的数据），从而生成实际日常功能的“最佳估计”评级。与访谈者的判断相比，患者显着高估了他们的职业功能和日常活动（p<.001）。患者的 NP 和 FC 表现以及日常功能水平较低始终与对其功能的高估有关。患者自我报告与任何基于表现的测量均不相关，而访谈者的判断与患者在 NP 和 FC 测量上的表现显着相关 (p<.005)。在回归分析中，根据面试官的功能评分进行调整，出现了自我判断与面试官判断之间差异的几个预测因素。较高水平的抑郁症状与自我报告中较少的高估有关 (p<.001)。与面试官的判断相比，妄想、多疑、自大和关系不佳都与对功能的高估显着相关（p<.001）。较差的 NP 和 FC 表现也与对日常功能的高估有关，但这些结果在多元回归模型中并不具有统计显着性。与之前对精神分裂症、其他神经精神疾病和非临床人群的研究一致，抑郁程度越高，自我评估的准确性越高。同样，基于绩效的衡量和日常功能判断的较低分数也预示着对功能的高估。因此，即使考虑到较差的基线分数，我们也确定了日常功能错误估计的双向预测因素。这些数据表明，筛选患者自我报告其功能的能力是可能的，但基于表现的功能测量提供的评估偏差较小。
Despite multiple lines of evidence suggesting that people with schizophrenia have substantial problems in self-reporting everyday functioning and cognitive performance, self-report methods are still widely used to assess functioning. This study attempted to identify predictors of accuracy in self report, both in terms of accurate self-assessment and over-estimation of current functioning. As part of the larger Validating Assessments of Everyday Real-World Outcomes (VALERO) study, 195 patients with schizophrenia were asked to self report their everyday functioning with the Specific Levels of Functioning (SLOF) scale, which includes subscales assessing social functioning, everyday activities, and vocational functioning. They were also assessed with measures of neuropsychological (NP) performance and functional capacity (FC), and were assessed for psychiatric symptomatology. In addition, a friend, relative or clinician informant was interviewed with the SLOF, and an interviewer with access to all information provided by the patient and informant (exclusive of performance-based data) generated “best estimate” ratings of actual, everyday functioning. Patients significantly (p<.001) overestimated their vocational functioning and everyday activities compared to the interviewer judgments. Lower levels of NP and FC performance and everyday functioning on the part of patients were consistently associated with overestimation of their functioning. Patient self-reports were not correlated with any performance-based measures, while interviewer judgments were significantly correlated with patients’ performance on NP and FC measures (p<.005). In regression analyses, adjusting for interviewer ratings of functioning, several predictors of the discrepancy between self and interviewer judgments emerged. Higher levels of depressive symptoms were associated with less overestimation in self-reports (p<.001). Delusions, suspiciousness, grandiosity and poor rapport were all significantly (p<.001) associated with over-estimation of functioning compared to interviewer judgments. Poorer NP and FC performance were also associated with over-estimation of everyday functioning, but these results were not statistically significant in multivariate regression models. Consistent with previous studies in schizophrenia, other neuropsychiatric conditions and non-clinical populations, higher levels of depression were associated with increased accuracy in self-assessment. Similarly, lower scores on performance-based measures and judgments of everyday functioning also predicted over-estimation of functioning. Thus, we identified bi-directional predictors of mis-estimation of everyday functioning, even when poor baseline scores were considered. These data suggest that it may be possible to screen patients for their ability to self-report their functioning, but that performance-based measures of functioning provide a less biased assessment.
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DOI：
10.1176/appi.ajp.2009.09010106
发表时间：
2009-07
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Harvey PD;Helldin L;Bowie CR;Heaton RK;Olsson AK;Hjärthag F;Norlander T;Patterson TL
通讯作者：
Patterson TL
影响因子：
17.7
作者：
Green, Michael F.;Schooler, Nina R.;Marder, Stephen R.
通讯作者：
Marder, Stephen R.
影响因子：
6.6
作者：
Harvey, Philip D.;Velligan, Dawn I.;Bellack, Alan S.
通讯作者：
Bellack, Alan S.
影响因子：
168.9
作者：
Murray, CJL;Lopez, AD
通讯作者：
Lopez, AD
影响因子：
1.9
作者：
McKibbin, C;Patterson, TL;Jeste, DV
通讯作者：
Jeste, DV