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PubMed2004

Exploring social welfare functions and violation of monotonicity: an example from inequalities in health.

The social welfare function (SWF) has been used within the economics literature, to study trade-offs between equality and efficiency. These SWFs are characterised by properties determined by traditional welfare economics. One of these properties, the monotonicity principle is explored in this paper. In the context of health there may be occasions when the monotonicity principle is violated as there may be circumstances where distributional issues dominate efficiency concerns. When this is the case, conventional SWFs are not flexible enough to represent such social preferences. Therefore, we propose a SWF with an alternative specification, which is general enough to accommodate preferences that are not necessarily monotonic. A survey of the Spanish general public was undertaken to estimate preferences regarding equality in health, relative to efficiency in health. The results (with 973 usable responses) give strong support to the existence of public preferences which violate the monotonicity principle, and thus to the usefulness of the alternative specification proposed here.

Attitude to Health↗

PubMed2001

Quality of life outcomes after heart transplantation in individuals bridged to transplant with ventricular assist devices.

BACKGROUND: Increasing numbers of individuals receive ventricular assist devices (VADs) as bridges to heart transplantation. Physical morbidity risks and benefits, and quality of life (QOL) during VAD support have been documented. Effects of pre-transplant VAD support on functional and QOL outcomes after transplantation have received no empirical attention. METHODS: Sixty-three VAD patients who received heart transplants underwent QOL evaluations of physical functioning, emotional and cognitive well-being, and social functioning at 2, 7, and 12 months after transplant (response rate = 95%). Ninety patients who had not received VADs--matched to the VAD group on cardiac-related and sociodemographic characteristics--served as longitudinal controls. RESULTS: Both VAD and non-VAD groups showed similar levels and similar, statistically significant (p < 0.05) improvement in physical functioning (sleep, body care, mobility, ambulation, overall functional status, number of somatic complaints) across the study period. Emotional well-being (elevated depressive, anxiety, and anger symptoms; post-traumatic stress disorder rate) was stable or improved in both groups, and VAD patients showed significantly lower anxiety rates. The VAD patients' post-transplant cognitive status was significantly poorer. The VAD patients were significantly less likely to return to employment; other social functioning measurers (daily concerns, interpersonal activities/involvement, role function) showed mixed effects. Cognitive impairment explained much of the association between VAD support and post-transplant employment. CONCLUSIONS: Although post-transplant physical and emotional recovery is similar in VAD and non-VAD patients, VAD patients retain more cognitive impairment and show mixed changes in social functioning. Increased attention to strategies to maximize VAD patients' cognitive capacity is required to facilitate social reintegration.

Cognition↗

PubMed1999

Quality of life after infrainguinal bypass grafting surgery. Dutch Bypass Oral Anticoagulants or Aspirin (BOA) Study Group.

PURPOSE: The purpose of this study was to compare quality of life in patients with and without various ischemic complications after infrainguinal bypass grafting surgery for occlusive vascular disease. METHODS: A sample of patients (n = 746) randomized in the Dutch BOA study (n = 2645), a multicenter trial that compared the effectiveness of oral anticoagulant therapy with aspirin in the prevention of infrainguinal bypass graft occlusions, was entered in this study. On the basis of clinical outcomes of the trial, the patients were grouped as follows: patients with patent grafts (n = 409); patients with nontreated graft occlusions, subdivided into an asymptomatic group (n = 32) and a symptomatic group (n = 65); patients with subsequent revascularizations (n = 194); patients with amputations (n = 36); and patients with failed secondary revascularizations followed by secondary amputation (n = 38). In case an outcome event occurred, the patients were regrouped accordingly. Every half year, the patients completed a Short Form-36 and a EuroQol questionnaire. A multilevel model was used for repeated measure analysis. RESULTS: The mean follow-up time was 21 months. The quality of life in patients with nontreated asymptomatic occlusions was roughly similar to the quality of life in patients with patent grafts. Patients with symptomatic nontreated occlusions had the lowest outcome with regard to pain as compared with the other groups. Furthermore, physical and social functioning was lower for these patients than for patients with patent grafts. Revascularizations, successful or not, negatively affected pain, social functioning, and physical and emotional role. After successful revascularization, some improvement was observed in pain, physical and social functioning, and general and mental health as compared with the group with nontreated symptomatic occlusions. Amputation deteriorated physical functioning strikingly, especially after failed secondary revascularization. These patients also had the lowest scores of all the groups in the dimensions of social functioning, physical and emotional role, and mental health. EuroQol score showed deterioration of quality of life after all events, except for asymptomatic occlusions. The same patterns emerged if we stratified our analysis according to the indication for the initial operation: claudication or limb salvage. Quality of life was constant over time in all the groups in the observed period. CONCLUSION: Quality of life in patients with asymptomatic occluded grafts is similar to quality of life in patients with patent grafts. Revascularization of symptomatic occluded grafts improves quality of life to a certain extent. Amputation, in particular after failed secondary revascularization, seemed to be the lowest possible outcome. The results of the Short Form-36 and EuroQol measurements were in line with the clinical expectations. The association of disease severity with scores on the instruments supports the construct validity of these outcome measures for an objective assessment of quality of life in controlled studies.

Aged↗

PubMed2004

Testing the performance of the ENRICHD Social Support Instrument in cardiac patients.

BACKGROUND: Previous investigations suggest an important role of social support in the outcomes of patients treated for ischemic heart disease. The ENRICHD Social Support Instrument (ESSI) is a 7-item self-report survey that assesses social support. Validity and reliability of the ESSI, however, has not been formally tested in patients undergoing percutaneous coronary intervention (PCI). METHODS: The ESSI, along with the Short Form-36 (SF-36), was sequentially administered to a cohort of 271 patients undergoing PCI. The test-retest reliability was examined with an intra-class correlation coefficient by comparing scores among 174 patients who completed both instruments 5 and 6 months after their procedure. Internal reliability was assessed using Cronbach's alpha at the time of patients' baseline procedure. The concurrent validity of the ESSI was assessed by comparing scores between depressed (MHI-5 score < 44) vs. non-depressed patients. The correlation between the ESSI and the SF-36 Social Functioning sub-scale, an accepted measure of social functioning, was also examined. RESULTS: Test-retest reliability showed no significant differences in mean scores among ESSI questionnaires administered 1 month apart (27.8+/-1.4 vs 27.8+/-1.5, p = 0.98). The intra-class correlation coefficient was 0.94 and Cronbach's alpha was 0.88. Mean ESSI scores were significantly lower among depressed vs. non-depressed patients (24.6+/-1.7 vs 27+/-1.4, p < 0.018) and a positive albeit modest correlation with social functioning was seen (r = 0.19, p = 0.002). CONCLUSION: The ESSI appears to be a valid and reliable measure of social support in patients undergoing treatment for coronary artery disease. It may prove to be a valuable method of controlling for patient variability in outcomes studies where the outcomes are related to patients' social support.

Adult↗

PubMed2001

Social behavior functions and related anatomical characteristics of vasotocin/vasopressin systems in vertebrates.

The neuropeptide arginine vasotocin (AVT; non-mammals) and its mammalian homologue, arginine vasopressin (AVP) influence a variety of sex-typical and species-specific behaviors, and provide an integrational neural substrate for the dynamic modulation of those behaviors by endocrine and sensory stimuli. Although AVT/AVP behavioral functions and related anatomical features are increasingly well-known for individual species, ubiquitous species-specificity presents ever increasing challenges for identifying consistent structure-function patterns that are broadly meaningful. Towards this end, we provide a comprehensive review of the available literature on social behavior functions of AVT/AVP and related anatomical characteristics, inclusive of seasonal plasticity, sexual dimorphism, and steroid sensitivity. Based on this foundation, we then advance three major questions which are fundamental to a broad conceptualization of AVT/AVP social behavior functions: (1) Are there sufficient data to suggest that certain peptide functions or anatomical characteristics (neuron, fiber, and receptor distributions) are conserved across the vertebrate classes? (2) Are independently-evolved but similar behavior patterns (e.g. similar social structures) supported by convergent modifications of neuropeptide mechanisms, and if so, what mechanisms? (3) How does AVT/AVP influence behavior - by modulation of sensorimotor processes, motivational processes, or both? Hypotheses based upon these questions, rather than those based on individual organisms, should generate comparative data that will foster cross-class comparisons which are at present underrepresented in the available literature.

Animals↗

PubMed1996

The social dysfunction index (SDI) for patients with schizophrenia and related disorders.

The social dysfunction index (SDI) is a new measure designed to assess social dysfunction in schizophrenia and other severe mental illnesses. It is intended to serve clinical and research purposes. Raters can be readily trained and there is low respondent burden with its use. Good psychometric properties were identified in three studies (sample sizes 33, 67 and 113). The SDI assesses a wide and comprehensive range of social functioning. It includes objective assessment of dysfunction and subjective client assessment of satisfaction with functioning. It produces a summary score, a satisfaction score and a score for each of the nine components of social functioning assessed. Internal consistency is good (alpha = 0.80). Inter-rater reliability is high (r = 0.96). Use of the component scores was confirmed by factor analysis. There is modest correlation with other measures of social functioning. Evidence of construct validity is demonstrated by findings of differences in social dysfunction between subjects who lived independently vs. those who lived in boarding homes; differences between subjects who were unemployed vs. subjects who were employed; and independence of social functioning from both age and education.

Adult↗

PubMed2000

Functional and social discomfort during orthodontic treatment--effects on compliance and prediction of patients' adaptation by personality variables.

During the course of treatment orthodontic patients frequently endure a number of functional complaints and are anxious about their appearance. The aims of this longitudinal study were to follow the progress of patients' adaptation to discomfort, to elucidate the putative relationship between the type of appliance worn and functional and social discomfort experienced, to study potential predictability by their attitude to treatment and to evaluate the effects of discomfort as predictors of patients' compliance. Eighty-four patients undergoing either removable, functional, or fixed appliance treatment monitored their complaints during the first 7 days of treatment and rated them retrospectively 14 days, and 3 and 6 months after appliance insertion. The most frequent complaints were impaired speech, impaired swallowing, feeling of oral constraint and lack of confidence in public. A significant reduction in the number of complaints was observed between 2 and 7 days after insertion of the appliance. No further differences were revealed after longer periods of appliance wear. The type of appliance had an effect on impaired speech and swallowing. Patients' expectations of favourable treatment performance and appreciation of dental aesthetics were predictive of reported feeling of oral constraint and lack of confidence in public. There was a relationship between the complaints and acceptance of the appliance, as well as between lack of confidence in public and compliance with treatment. The results of this study highlight the importance of patients' attitudes to treatment and of functional and social discomfort associated with appliance wear for the theory and practice of the management of orthodontic patients, and the necessity for early intervention by clinicians.

Adaptation, Physiological↗

PubMed2005

Quality of life assessment before and after lumbar disc surgery.

BACKGROUND: Although operative treatment for lumbar disc herniation is a commonly performed neurosurgical procedure, no reports have described whether health-related quality of life before surgery affects the operative treatment outcome. This prospective study assessed health-related quality of life before and after surgery and evaluated the predictor variables affecting outcomes. METHODS: Subjects were 45 consecutive candidates for lumbar disc herniation surgery who gave informed consent. The Medical Outcomes Study Short Form 36 (SF-36) and 15-point Japanese Orthopaedic Association (JOA) score were evaluated before and after surgery, and the magnitude of the effect was calculated. The possible predictor variables for outcomes were physical functioning, role physical, bodily pain, general health, vitality, social functioning; role emotional and mental health from the SF-36 subscales; subjective symptoms and clinical signs from the JOA scores; and the patient's age, sex, occupation, and history of low back pain and/or leg pain. RESULTS: Four patients were excluded from the analyses because they were lost to follow-up within 1 year after operation. All subscales of the SF-36 and JOA scores increased significantly at 6 months and 1 year of follow-up with a maximum effect size in bodily pain and a minimal in general health. Operation results were 29 good, 11 fair, and 1 poor. The selected predictor variables affecting the outcomes were patient age and social functioning on SF-36. CONCLUSIONS: Surgery for lumbar disc herniation improved health-related quality of life. Patients <50 years old with a <60 score in social functioning on SF-36 were considered good candidates.

Adult↗

PubMedDate not supplied

Role of serotonin and noradrenaline in social dysfunction: a review of data on reboxetine and the Social Adaptation Self-evaluation Scale (SASS).

Social impairment is a common feature of depressive illness, often causing substantial and clinically meaningful dysfunction. Although the depressive symptoms and social impairment are linked, the naturalistic course and response to treatment of these two aspects of depression do not necessarily correlate. A variety of self-report and clinician-administered assessment scales which are specific for the measurement of social functioning and have good psychometric properties have been developed in the past 40 years. The most recent of these instruments is the Social Adaptation Self-evaluation Scale (SASS), a 21-item scale designed in 1989 to assess patient response to antidepressant treatment. SASS was used in two clinical trials comparing reboxetine, the new selective noradrenaline reuptake inhibitor (selective NRI), with fluoxetine. While no difference in efficacy was detectable by traditional assessments of symptoms, reboxetine proved to be significantly more effective than fluoxetine in improving social functioning in patients with depression. Reboxetine was also more effective than fluoxetine in rectifying social functioning in the subset of patients who remitted from an episode of major depression. Specifically, reboxetine improved patient motivation, energy and self-perception. These results indicate that antidepressant therapy can achieve more than symptom relief in depression. It is speculated that there may be a difference in the roles played by serotonin and noradrenaline in social functioning.

Antidepressive Agents↗

PubMed1994

The medical, social, and functional profile of Parkinson's disease patients.

The study looked at the medical, social, and functional aspects of 34 patients with idiopathic Parkinson's Disease (PD). Eighty-five percent were above 55 years and 35% were over 70 years. Twenty-four (71%) were males. Most patients had Stage II disease. Overall functional state of the patient correlated closely with the stage of Parkinson's disease. Patients were likely to be dependent if their disease severity was stage III or more. Eighteen (53%) patients would require a carer to be present at least part of the day and 3 (9%) patients would require a carer most of the time. Domestic chores such as meal preparation, housework, and shopping were also affected in most of those who were previously active in these tasks. Ten patients had given up work due to their Parkinson's disease. The lack of knowledge of the disease was shown both in the carers and the patients. Twenty-nine of the patients had no knowledge of the disease, and only one carer had superficial knowledge of the disease. The major social problems associated with the disease were loss of social contact, behavioural problems, family members under strain and communication problems within the family. Since Parkinson's Disease is a chronic illness, with associated disabilities, it is important that the physician should aim for a multidisciplinary approach. Patient and carer education should be given emphasis, and the many everyday functional problems addressed. Advice on life-style management and aids to overcome disabilities may help improve quality of life of the patient and reduce carer's stress.

Activities of Daily Living↗

PubMed1999

Distinguishing between quality of life and health status in quality of life research: a meta-analysis.

Despite the increasing acceptance of quality of life (QOL) as a critical endpoint in medical research, there is little consensus regarding the definition of this construct or how it differs from perceived health status. The objective of this analysis was to understand how patients make determinations of QOL and whether QOL can be differentiated from health status. We conducted a meta-analysis of the relationships among two constructs (QOL and perceived health status) and three functioning domains (mental, physical, and social functioning) in 12 chronic disease studies. Instruments used in these studies included the RAND-36, MOS SF-20, EORTC QLQ-30, MILQ and MQOL-HIV. A single, synthesized correlation matrix combining the data from all 12 studies was estimated by generalized least squares. The synthesized matrix was then used to estimate structural equation models. The meta-analysis results indicate that, from the perspective of patients, QOL and health status are distinct constructs. When rating QOL, patients give greater emphasis to mental health than to physical functioning. This pattern is reversed for appraisals of health status, for which physical functioning is more important than mental health. Social functioning did not have a major impact on either construct. We conclude that quality of life and health status are distinct constructs, and that the two terms should not be used interchangeably. Many prominent health status instruments, including utility-based questionnaires and health perception indexes, may be inappropriate for measuring QOL. Evaluations of the effectiveness of medical treatment may differ depending on whether QOL or health status is the study outcome.

Health Status↗

PubMed1996

Clinical and psychosocial variables in different diagnostic groups: their interrelationships and value as predictors of course and outcome during a 14-year follow-up.

A 14-year follow-up study was conducted on 214 patients from the diagnostic groups schizophrenia, affective psychosis, and neurosis to determine the relationships between various clinical and psychosocial variables and to assess their value as predictors of long-term course and outcome. Particular emphasis was placed on ascertaining the interrelationships between the variables within the individual diagnostic groups. The results indicate that for schizophrenia, severity of disease at discharge from index hospitalization was the principal predictor of the number and duration of further hospitalizations. Furthermore, it predicted the severity of illness and social functioning at follow-up. For affective psychosis, the Global Assessment Scale score predicted the number and duration of further hospitalizations. Severity of illness, social functioning, and age at first hospitalization were predictors of occupational development. For neurotic disorders, severity of disease and social adjustment at discharge from index hospitalization were each predictors of themselves at final follow-up. In addition, age at first hospitalization was an important predictor of most course and psychosocial variables. Among the endogenous course variables within the schizophrenic group, the number and duration of further hospitalizations had a substantial bearing on severity of illness and social functioning at follow-up. For affective psychoses, indicators of occupational development and number of hospitalizations had an impact on severity of illness and social functioning at follow-up. Our findings reveal a good overall predictive value for the clinical and psychosocial variables within each of the diagnostic categories studied.

Adult↗

PubMed1994

Psychosocial counseling to improve quality of life in HIV infection.

Psychosocial interventions such as cognitive behavioral stress management (CBSM), may enhance coping and social support which contribute to an improvement of quality of life factors such as emotional functioning, social functioning, and sense of well-being, for HIV-infected men during several phases of HIV spectrum disease. These phases include the acutely stressful period immediately following notification of HIV+ status, the adjustment period following this news, and the process of dealing with chronic symptomatic HIV infection. Normalization of some aspects of immunological status were found to accompany some of these psychosocial changes in the short-run. Longer-term follow-up indicated relationships between psychosocial factors and improved immunological status and physical functioning up to 2 years later. Factors such as an increased use of active coping strategies, including relaxation exercises, use of more functional appraisals and elicitation of social support, and decreased use of denial/avoidance coping strategies, may be key predictors of longer-term emotional well-being, social functioning, and physical functioning in HIV-infected populations. Special issues need to be addressed in emerging models of quality of life assessment in HIV populations. For example, the way resurgence of stigmatization and self-doubt affects sense of identity and well-being need to be addressed in quality of life research as well as in psychosocial interventions. Loss of employment and its financial and existential consequences are also factors which impact sense of self and well-being, and need to be addressed both in research as well as in interventions. The effect of repeated HIV-related bereavements upon an individual's social network and the emotional, social, and physical sequelae of bereavement have implications for HIV quality of life research as well. Quality of survival time has become a paramount issue in the context of HIV spectrum disease. Examining the relationships among coping strategies, social support, emotional well-being, realistic appraisals of one's functioning in comparison to their aspirations, and the influence of psychosocial functioning on disease course are central missions of our research program.

Adult↗

PubMed2026

Mechanisms of impact of mental health peer support in high-, middle- and low-income settings: mediation analysis of the UPSIDES randomised controlled trial.

AIMS: While there is growing evidence for the effectiveness of peer support (PS) in improving psychosocial outcomes among individuals with severe mental health conditions, the mechanisms through which these effects occur remain insufficiently understood. This study examines whether social inclusion, hope and empowerment mediate the relationship between PS, personal recovery and health and social functioning. METHODS: Data were collected from 565 adults with severe mental health conditions who participated in the multicentre UPSIDES randomised controlled trial across six sites in Germany, Uganda, Tanzania, India and Israel. Participants in the intervention group received structured PS from trained peer workers over a 6- to 8-month period. Standardised, self-report measures of social inclusion, hope, empowerment and personal recovery, as well as clinician-rated health and social functioning, were administered at baseline, 4 months, end of intervention (8 months) and 12-month follow-up. Cross-lagged panel modelling was used to explore longitudinal associations and mediating pathways. RESULTS: The cross-lagged models showed strong autoregressive effects across all variables, indicating high temporal stability. There were no significant direct effects of PS on recovery or health and social functioning. However, mediation analysis identified significant indirect effects of PS on personal recovery via social inclusion (β = 0.114, 95% confidence interval [CI] [0.049, 0.194], P < 0.05) and hope (β = 0.037, 95% CI [0.001, 0.086], P < 0.05). Similar indirect effects were observed for health and social functioning (via social inclusion: β = -0.035, 95% CI [-0.064, -0.013]; via hope: β = -0.026, 95% CI [-0.052, -0.006]; both P < 0.05). CONCLUSIONS: Findings suggest that PS affects recovery-related outcomes primarily through intermediate mechanisms of enhanced hope and social inclusion. These results support theoretical models positing indirect pathways of change in PS interventions and highlight the value of targeting social and psychological domains when designing and implementing PS in mental health services. Individuals with lower baseline levels of hope and social inclusion may particularly benefit from PS.

Humans↗

PubMed2006

Quality of life after hyperthermic isolated limb perfusion for locally advanced extremity soft tissue sarcoma.

BACKGROUND: Quality of life (QoL) and posttraumatic stress symptoms (PTSS) were studied in patients with soft tissue sarcoma (STS) of the extremities treated with isolated limb perfusion and delayed resection, with or without adjuvant irradiation. METHODS: Forty-one patients received a questionnaire that included the RAND-36 and Impact of Event Scale. RESULTS: Thirty-nine STS survivors (16 [41%] male and 23 [59%] female; median age, 59 years; range, 15-78 years) participated in the questionnaire survey (response rate, 95%). The median age at perfusion was 49 years (range, 14-72 years). No significant differences were found in mean scores between STS survivors and the reference group with the exception of a worse physical functioning. Patients with amputations showed significantly worse physical and social functioning and more role limitations than patients whose limbs were saved. Eleven patients (28%) had a PTSS score of 0, and eight patients (20.5%) had a score>or=26, which suggested the need for psychological counseling. None of these eight patients had lost a limb. Patients who indicated that the choice of treatment was made by the surgeon rather than collaboratively showed significantly decreased social functioning, more role limitations, and intrusion. Greater treatment satisfaction was significantly related to better social functioning, more vitality, better general health perception, less intrusion, avoidance, and total Impact of Event Scale scores. CONCLUSIONS: Even though STS survivors' QoL was different from that of a reference group only in physical functioning, one fifth of the patients had PTSS. An amputation, the physician's decision rather than the patient's decision for the perfusion treatment and a low satisfaction with the performed treatment negatively influenced QoL.

Adolescent↗

PubMed2003

Effects of pain on functioning and well-being in older adults with osteoarthritis of the knee.

The effects of pain on functioning and well-being were examined in 367 older adults with osteoarthritis (OA) of the knee. The relationship of OA-related pain to depressive symptoms and perceived health was hypothesized to be direct as well as mediated by physical and social functioning. Results showed that OA-related pain was related to poorer physical and social functioning, had a direct effect on depressive symptoms, and direct and indirect effects on perceived health. Lower social functioning was related to more depressive symptoms, and both lower social and physical functioning predicted worse perceived health. Thus, distinguishing between physical and social functioning when examining the costs of OA-related pain is useful. Moreover, existing pain-psychological well-being models can be generalized to perceived health.

Activities of Daily Living↗

PubMed1990

Comparability of information provided by elderly cancer patients and surrogates regarding health and functional status, social network, and life events.

Stressful life events may adversely affect health, but these effects may be mitigated by a strong social support network. The elderly should be a focus for investigation in this area, but epidemiologic studies in the elderly are often complicated by the need to rely upon information collected from surrogates. We assessed the degree to which 622 elderly cancer patients and surrogates agreed in their answers to questions about life events, social network, and health and functional status. We compared spouses, friends, and children as surrogates by evaluating (1) their agreement with index subjects and (2) the proportion of surrogates of each type who could not answer one or more questions. Agreement for most items on health and functional status was at least moderately good, but agreement was more inconsistent for questions about social network and major life events. Agreement was higher when factual information was solicited than when the question regarded more personal information or attitudes. For questions about health status, social network, and life events, spouses agreed more closely with index subjects than did children or friends. For questions about functional status, however, agreement did not vary consistently by respondent type. We found no consistent effects of the index subject's age or cognitive status on levels of agreement, nor did we find evidence of bias in the surrogates' responses.

Activities of Daily Living↗

PubMed1999

Thought disorder and psychosocial functioning in schizophrenia: the concurrent and predictive relationships.

Recent findings have linked impairments in social performance among individuals with schizophrenia to deficits in cognition. However, one component of cognition, thought disorder (TD), has received little attention in its association with social functioning. The current investigation examined the cross-sectional and predictive relationships between bizarre-idiosyncratic thought and psychosocial functioning throughout the early course of schizophrenia and compared these relationships to those observed among individuals with affective disorders (i.e., bipolar disorder, manic type, and major depression without psychotic features). Participants were assessed on TD, work, and social functioning using standardized procedures across three follow-ups over an 8-year period. The cross-sectional relationships between TD and impairment in work performance were generally significant. TD also significantly predicted subsequent work functioning years later. Less support was found for the relationship between TD and social functioning. Finally, the relationship between TD and work performance appeared to be more consistent over time for the subjects with schizophrenia compared to those with affective disorders. The results suggest that techniques which minimize TD may have implications for occupational functioning among persons with chronic psychiatric disorders.

Adaptation, Psychological↗