University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Schizophr Res. 2012 May;137(1-3):190-5. doi: 10.1016/j.schres.2012.02.002. Epub 2012 Mar 2.
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.
尽管有多项证据表明精神分裂症患者在自我报告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。作为更大的 Validating Assessments of Everyday Real-World Outcomes (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,该量表包括评估社会功能、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,并评估了精神病症状。此外,一位朋友、亲戚或临床医生信息员使用 SLOF 进行了访谈,一位访谈员可以访问患者和信息员提供的所有信息(不包括基于表现的数据),生成了实际日常功能的“最佳估计”评分。患者与访谈员的判断相比,明显(p<.001)高估了他们的职业功能和日常活动。患者的 NP 和 FC 表现和日常功能水平较低,与高估他们的功能一致。患者的自我报告与任何基于表现的测量都没有相关性,而访谈员的判断与患者的 NP 和 FC 测量结果显著相关(p<.005)。在回归分析中,调整了访谈员对功能的评估,出现了几个自我和访谈员判断差异的预测因素。较高水平的抑郁症状与自我报告中的低估相关(p<.001)。妄想、怀疑、自大和不良关系都与访谈员的判断相比,明显(p<.001)与功能高估相关。NP 和 FC 表现较差也与日常功能的高估有关,但在多变量回归模型中这些结果没有统计学意义。与精神分裂症、其他神经精神疾病和非临床人群中的先前研究一致,较高水平的抑郁与自我评估的准确性提高有关。同样,基于表现的测量和日常功能评估的分数较低也预测了功能的高估。因此,即使考虑到基线分数较差,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,筛选患者自我报告功能的能力是可能的,但基于表现的功能评估提供了一种偏见较小的评估方法。