Dimensions of Social Adjustment in Schizophrenia: A Factor Analysis

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Newer and more effective treatments for schizophrenia are forcing greater attention to the definition of treatment outcome. Investigators are challenged to document the impact of drug and psychosocial treatments on a range of characteristics including social and occupational functioning, subjective quality of life, family burden, and cost (Atkisson et al., 1992; Meltzer et al., 1993). An obvious question involves whether and how outcome in one area is related to outcome in another area. Brekke (1992) reported a factor analysis using different measures of social adjustment in a cohort of individuals with schizophrenia, and found that instrumental, social, and illness domains of adjustment were relatively independent. Although this finding is consistent with notions originally put forth by Strauss and Carpenter (1977; Carpenter and Strauss, 1991), it is the only recent report examining the interrelationships between different outcome measures in this population.Our group is conducting a study of recovery processes in schizophrenia, which involves longitudinal assessments of symptoms, neurocognition, and social adjustment beginning with the stabilization of a psychotic exacerbation. The study population is chronic, with frequent relapses and many years of impaired functioning. We were faced with the question of defining the most import aspects of "social adjustment" for this population, and made an a priori decision to look at three domains: treatment compliance; basic social behaviors (communication skills, the ability to maintain friendships); and subjective quality of life. We could not, however, agree on a hypothesis regarding how functioning in these three domains might be related. Following Brekke's (1992) strategy, we here report a factor analysis of outcome variables from this study.MethodsSubjects completed assessment batteries at 3-month intervals for up to 2 years immediately after inpatient treatment for an acute exacerbation. The data reported herein are from initial assessments of the first 46 individuals recruited into the project. Subjects were recruited upon admission to an outpatient continuing day treatment program, and all had been hospitalized for treatment of an acute symptom exacerbation within the 30-day period before recruitment. Written, informed consent was obtained for all subjects after the procedures were fully explained; no one under the age of 18 was included in the study. All subjects were interviewed with the Structured Clinical Interview for DSM-IV to establish axis I diagnoses. Twenty-six (57%) of the subjects received a diagnosis of schizophrenia, and 20 (43%) were diagnosed with schizoaffective disorder. Twenty-nine (63%) were male, and 94% were Caucasian. The mean age was 39 years (SD = 12 years), the mean age of illness onset was 18 years (SD = 7.9 years), and subjects had an average of 7.7 prior hospitalizations (SD = 3.5).A factor analysis was conducted using data from instruments assessing social adjustment in the three dimensions identified a priori: treatment compliance, social behavior, and quality of life. Treatment compliance was measured using 100-point visual analog scales, with a score of 0 signifying no compliance and 100 meaning perfect compliance. Each subject received two ratings, one each for compliance with medication and with nonmedication treatments.Social behavior and quality of life ratings were obtained with the Social Behavior Scale (SBS; Wykes and Sturt, 1986) and the Quality of Life Interview (Lehman, 1988). The SBS assesses behavioral capacities felt to determine overall adjustment in individuals with chronic schizophrenia. We were interested in the communication skills subscale, which documents subjects' abilities to initiate and maintain conversations. The Quality of Life Interview (QOLI) was developed by Lehman to assess individuals' objective performance and subjective satisfaction with their circumstances, resources, and interpersonal relations.

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