Crutzen Stijn, Burger Simone R, Visser Ellen, Ising Helga K, van der Gaag Mark, Castelein Stynke
Lentis Psychiatric Institute, Lentis Research, Groningen, The Netherlands.
Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 2025 Feb;60(2):387-397. doi: 10.1007/s00127-024-02715-0. Epub 2024 Jul 30.
For many individuals with a psychotic disorder societal recovery is not accomplished. Research on societal recovery trajectories is mostly focussed on patients with a first episode psychosis. The present study aims to identify distinct societal trajectories in those with long duration of illness, through the identification of patient subgroups that are characterized by homogeneous trajectories.
Longitudinal data were used from an ongoing dynamic cohort in which people with a psychotic disorder receive yearly measurements to perform a latent class growth analysis. Societal functioning was assessed with the Functional Recovery tool, consisting of three items (1) daily living and self-care, (2) work, study and housekeeping, and (3) social contacts. Furthermore, logistic regression was used to compare subgroups with similar societal recovery at baseline, but distinct trajectories.
A total of 1476 people were included with a mean treatment time of 19 years (SD 10.1). Five trajectories of functioning were identified, a high stable (24.5%), a medium stable (28.3%), a low stable (12.7%), a high declining (11.2%) and a medium increasing subgroup (23.3%). Predictors for not deteriorating included happiness, recent hospitalisation, being physically active, middle or higher education and fewer negative symptoms. Predictors for improving included fewer positive and negative symptoms, fewer behavioural problems and fewer physical and cognitive impairments.
While the majority of individuals show a stable trajectory over four years, there were more patients achieving societal recovery than patients deteriorating. Predictors for improvement are mainly related to symptoms and behavioural problems, while predictors for deteriorating are related to non-symptomatic aspects such as physical activity, happiness and level of education.
对于许多患有精神障碍的个体而言，社会康复并未实现。关于社会康复轨迹的研究大多集中在首次发作精神病患者身上。本研究旨在通过识别具有同质轨迹特征的患者亚组，确定病程较长者的不同社会轨迹。
使用来自一个正在进行的动态队列的纵向数据，在该队列中，患有精神障碍的人每年接受测量以进行潜在类别增长分析。社会功能通过功能恢复工具进行评估，该工具由三个项目组成：（1）日常生活和自我护理，（2）工作、学习和家务，以及（3）社会交往。此外，使用逻辑回归比较在基线时具有相似社会康复但轨迹不同的亚组。
共纳入1476人，平均治疗时间为19年（标准差10.1）。确定了五种功能轨迹，即高稳定组（24.5%）、中稳定组（28.3%）、低稳定组（12.7%）、高下降组（11.2%）和中增长组（23.3%）。未恶化的预测因素包括幸福感、近期住院、身体活动、中等或高等教育程度以及较少的阴性症状。改善的预测因素包括较少的阳性和阴性症状、较少的行为问题以及较少的身体和认知障碍。
虽然大多数个体在四年内显示出稳定的轨迹，但实现社会康复的患者多于病情恶化的患者。改善的预测因素主要与症状和行为问题有关，而恶化的预测因素与非症状方面有关，如身体活动、幸福感和教育水平。
