Cross-sectional assessment of the factors associated with occupational functioning in patients with schizophrenia

BACKGROUND Studies from other countries indicate that occupational skills training can improve the social functioning and the quality of life of patients with schizophrenia but there is little research about the relationship of occupational skills and the functional status of patients in China. AIM Use a translated Chinese version of the Comprehensive Occupational Therapy Evaluation scale to evaluate occupational functining in inpatients and recently discharged patients with schizophrenia and assess the relationship of occupational functioning to demographic, clinical and cognitive measures. METHODS Thirty-five inpatiens and 29 recently discharged outpatients with schizophrenia were evaluated by trained clinicals using the COTE, the Positive and Negative Syndrome Scale (PANSS) and a neuropsychological battery that included the Wisconsin Card Sorting Test (WCST), the Continuous Perfomance Test (CPT), the digit symbol-coding subtest from the Wechsler Adult Intelligence Scale (WAIS), and Trail Making Test Parts A and B (TMT-A, TMT-B). RESULTS The total score on the COTE and the three COTE dimensional scores (evaluating general behavior, interpersonal communication and task behavior) were all strongly correlated with the PANSS total score and the PANSS positive symptom, negative symptom and general pathology subscale scores (ranked correlation coefficients range from 0.40 to 0.90). The correlationship of the COTE measures was significantly greater with the PANSS negative symptom score than with the PANSS positive symptom score. The COTE scores were also significantly correlated with the Continuous Performance Test measures, the WAIS digit symbol-coding test scores and some, but not all, of the measures derived from the TMT-A, the TMT-B, and the WCST. Mutiple regression analyses found that the four COTE measures of occupational functioning were most strongly associated with either the PANSS total score or the PANSS negative symptom score and secondarily associated with time to complete TMT-B, the CPT measure on number of omissions, and the respondent's years of education. CONCLUSION Occupational functioning measures of inpatients and recently discharged outpatients with schizophrenia are closely related to the severity of psychiatric symptoms and, to a lesser extent, with cognitive functioning measures and duration of education.