Department of Psychiatry, McGill University, Montreal, Canada.
Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Canada.
Can J Psychiatry. 2023 Oct;68(10):766-779. doi: 10.1177/07067437231153796. Epub 2023 Feb 6.
Most cross-cultural psychosis research has focused on a limited number of outcomes (generally symptom-related) and perspectives (often clinician-/observer-rated). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to patient-reported measures of social, recreational, and independent functioning. Addressing this gap, this study aimed to compare these outcomes in first-episode psychosis at a high-income site and a lower middle-income site.
Patients receiving similarly designed early intervention for psychosis in Chennai, India ( = 164) and Montreal, Canada ( = 140) completed the self-reported Social Functioning Scale-Early Intervention, which measures prosocial, recreation, and independence-performance functioning. Their case managers rated expected independence-performance functioning. Both sets of assessments were done at entry and Months 6, 18, and 24. Linear mixed model analyses of differences between sites and over time were conducted, accounting for other pertinent variables, especially negative symptoms.
Linear mixed models showed that prosocial, recreation, and independence-performance functioning scores were significantly higher in Montreal than Chennai and did not change over time. Expected independence-performance was also higher in Montreal and increased over time. Negative symptoms and education independently predicted prosocial, recreation, and expected independence-performance functioning. When added to the model, expected independence-performance predicted actual independence-performance and site was no longer significant. At both sites, prosocial and recreation scores were consistently lower (<40%) than independence-performance (40-65%).
This is the first cross-cultural investigation of prosocial, recreation, and independent functioning in early psychosis. It demonstrates that these outcomes differ by socio-cultural context. Differing levels of expectations about patients, themselves shaped by cultural, illness, and social determinants, may contribute to cross-cultural variations in functional outcomes. At both sites, social, recreational, and independent functioning were in the low-to-moderate range and there was no improvement over time, underscoring the need for effective interventions specifically designed to impact these outcomes.
大多数跨文化精神病学研究都集中在有限的结果（通常与症状相关）和视角（通常是临床医生/观察者评估）上。目前尚不清楚一些中低收入国家所谓的精神病治疗效果较好是否扩展到患者报告的社会、娱乐和独立功能方面。为了填补这一空白，本研究旨在比较高收入地区和中低收入地区首发精神病患者的这些结果。
在印度钦奈（Chennai，印度）（ = 164）和加拿大蒙特利尔（Montreal，加拿大）（ = 140）接受类似早期干预的精神病患者完成了自我报告的早期干预精神病社会功能量表（Social Functioning Scale-Early Intervention），该量表测量亲社会、娱乐和独立功能表现。他们的病例经理评估了预期的独立功能表现。两组评估均在入组时以及第 6、18 和 24 个月进行。进行了站点间和随时间变化的线性混合模型分析，考虑了其他相关变量，尤其是阴性症状。
线性混合模型显示，亲社会、娱乐和独立功能表现评分在蒙特利尔显著高于钦奈，且随时间变化无变化。预期的独立功能表现也更高，并且随时间增加。阴性症状和教育独立预测亲社会、娱乐和预期独立功能表现。当加入模型时，预期独立功能表现预测实际独立功能表现，站点不再具有统计学意义。在两个站点，亲社会和娱乐评分始终低于（<40%）独立功能表现（40-65%）。
这是首次对早期精神病中亲社会、娱乐和独立功能的跨文化研究。它表明这些结果因社会文化背景而异。对患者的不同期望，以及由文化、疾病和社会决定因素塑造的期望，可能导致功能结果的跨文化差异。在两个站点，社会、娱乐和独立功能均处于低至中等水平，且随时间无改善，这突显了需要专门针对这些结果的有效干预措施。
