Tanner Joachim, Zeffiro Thomas, Wyss Daniela, Perron Noelle, Rufer Michel, Mueller-Pfeiffer Christoph
Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Neurometrika, Potomac, MD, United States.
Front Psychiatry. 2019 Feb 13;10:37. doi: 10.3389/fpsyt.2019.00037. eCollection 2019.
Mental illness often interferes with daily functioning and an individual's pattern of psychiatric signs and symptoms may predict risk of future disability. Understanding the linkage between psychiatric symptoms and impaired functioning is critical for accurate rehabilitation planning and legal assessment. Here, we investigated the stability of functional impairment measures over 18 months and their association with psychiatric symptoms. Moreover, we developed a clinical self-report measure that allows estimation of functional impairment levels over 18 month observation periods. Consecutively treated outpatients and daycare patients ( = 155) from several psychiatric units in Switzerland completed the Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, Multidimensional Inventory for Dissociation, Beck Depression Inventory, Brief Symptom Inventory, and WHO Disability Assessment Schedule at baseline, 6, 12, and 18 month follow-up examinations. The association between symptoms functional impairment over time was investigated using longitudinal linear mixed models. Penalized regression was used to identify questionnaire items that best predicted functional impairment. We found high stability in the extent of functional impairment over 18 months. Fear of negative evaluation, fatigue, concentration problems, negative alterations in mood, and dissociative symptoms showed the strongest association with functional impairment measures. The empirically derived scale for functional impairment prediction explained between 0.62 and 0.77 of the variance in disability across various life domains. Given the capability for somatic and mental symptoms associated with social anxiety, depression, and dissociation to predict future disability, these symptoms have strong potential for guiding rehabilitation planning and prognostic evaluation in insurance medicine. The Functional Impairment Prediction Scale may serve as a valuable, empirical-based extension in legal assessments of how work capacity is affected by psychological factors.
精神疾病常常干扰日常功能，个体的精神症状模式可能预示着未来出现残疾的风险。了解精神症状与功能受损之间的联系对于准确的康复规划和法律评估至关重要。在此，我们调查了功能受损指标在18个月内的稳定性及其与精神症状的关联。此外，我们开发了一种临床自我报告测量方法，可用于估计18个月观察期内的功能受损水平。来自瑞士多个精神科单位的连续接受治疗的门诊患者和日间护理患者（n = 155）在基线、6个月、12个月和18个月的随访检查中完成了分离体验量表、躯体形式分离问卷、多维分离量表、贝克抑郁量表、简明症状量表和世界卫生组织残疾评估量表。使用纵向线性混合模型研究症状随时间与功能受损之间的关联。采用惩罚回归来确定最能预测功能受损的问卷项目。我们发现功能受损程度在18个月内具有高度稳定性。对负面评价的恐惧、疲劳、注意力问题、情绪的负面变化以及分离症状与功能受损指标的关联最为强烈。根据经验得出的功能受损预测量表解释了不同生活领域中残疾方差的0.62至0.77。鉴于与社交焦虑、抑郁和分离相关的躯体和精神症状能够预测未来残疾，这些症状在指导保险医学中的康复规划和预后评估方面具有很大潜力。功能受损预测量表可作为一种有价值的、基于经验的扩展，用于法律评估心理因素如何影响工作能力。
