Functional Disabilities Evaluated using World Health Organization Disability Assessment Schedule 2.0 in Patients with Chronic Schizophrenia and Its Related Factors

Kyeongwoo Park; Dong-Kyun Lee; Hyeongrae Lee; Chul-Eung Kim; Seunghyong Ryu

doi:10.4306/jknpa.2019.58.1.47

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Park, Lee, Lee, Kim, and Ryu: Functional Disabilities Evaluated using World Health Organization Disability Assessment Schedule 2.0 in Patients with Chronic Schizophrenia and Its Related Factors

Original Article

J Korean Neuropsychiatr Assoc 2019;58(1):47-54.

Published online: 14 January 2019

DOI: https://doi.org/10.4306/jknpa.2019.58.1.47

Functional Disabilities Evaluated using World Health Organization Disability Assessment Schedule 2.0 in Patients with Chronic Schizophrenia and Its Related Factors

Kyeongwoo Park, MA¹, Dong-Kyun Lee, MS¹, Hyeongrae Lee, Phd¹, Chul-Eung Kim, MD, PhD², Seunghyong Ryu, MD¹

¹ Departments of Mental Health Research, Seoul, Korea

²Mental Health Research Institute, National Center for Mental Health, Seoul, Korea

Address for correspondence Seunghyong Ryu, MD Department of Mental Health Research, National Center for Mental Health, 127 Youngmasan-ro, Gwangjin-gu, Seoul 04933, Korea Tel +82-2-2204-0109 Fax +82-2-2204-0393 E-mail seunghyongryu@gmail.com

Received 13 September 2018 Revised 23 November 2018 Accepted 21 December 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

This study examined the functional disabilities of patients with chronic schizophrenia using WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and its related factors.

Methods

The subjects consisted of 86 patients with schizophrenia with more than 10 years’ duration of illness and 40 healthy volunteers. The functional disabilities and psychopathology were evaluated using the WHODAS 2.0 and 18-items Brief Psychiatric Rating Scale (BPRS-18), respectively. This study analyzed the six sub-domains (‘cognition’, ‘mobility’, ‘self-care’, ‘getting along’, ‘life activities’, and ‘participation’) of WHODAS 2.0 and the four sub-scales (‘positive symptoms’, ‘negative symptoms’, ‘affect’, and ‘resistance’) of BPRS-18.

Results

Patients with chronic schizophrenia experienced severe functional disabilities across all six sub-domains of WHODAS 2.0 compared to healthy people. Hierarchical regression showed that ‘negative symptoms’ explained the disabilities in the WHODAS 2.0 sub-domains of ‘cognition’ (p<0.05), ‘self-care’ (p<0.05), ‘getting along’ (p<0.01), and ‘life activities’ (p<0.05). ‘Positive symptoms’ and ‘affect’ explained the disabilities in ‘cognition’ (p<0.01 and p<0.05, respectively) and ‘participation’ (p<0.05 and p<0.01, respectively). ‘Resistance’ was found to be a predictor of ‘getting along’ disabilities (p<0.01).

Conclusion

Negative symptoms mainly accounted for the multiple domains of functional disabilities in the WHODAS 2.0 but residual positive and affective symptoms could also deteriorate the cognition and social participation of patients with chronic schizophrenia. J Korean Neuropsychiatr Assoc 2019;58(1):47-54

Keywords: Schizophrenia, Disability evaluation, Psychopathology

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Fig. 1.

Comparisons of WHODAS 2.0 mean scores between normal and patients of schizophrenia. WHODAS 2.0 : World Health Organization Disability Assessment Schedule 2.0, SD : Standard deviation.

Table 1.

Comparison of descriptive statistics between normal and patients with schizophrenia

Items	Normal (n=40)	Patients with SPR (n=86)	p-value
Items	Mean±SD or n (%)	Mean±SD or n (%)	p-value
Demographic characteristics
Gender			0.25
Male	17 (42.5)	46 (53.5)
Female	23 (57.5)	40 (46.5)
Age	36.88±7.62	40.24±6.01	<0.01
Education	15.08±2.91	12.87±2.59	<0.01
Onset age	–	21.03±5.53	–
Duration of illness	–	19.21±5.53	–
Number of admission	–	4.60±3.58	–
BPRS-18
Total score	–	37.28±9.06	–
Positive symptoms	–	9.77±3.59	–
Negative symptoms	–	9.35±3.02	–
Affect	–	7.73±2.78	–
Resistance	–	5.08±2.05	–

SPR : Schizophrenia, BPRS-18 : 18-item Brief Psychiatric Rating Scale, SD : Standard deviation

Table 2.

Zero-order correlations among patients with schizophrenia

Variables	Gender	Age	Education	BPRS-18 total	Positive symptoms	Negative symptoms	Affect	Resistance	WHODAS 2.0 total	Cognition	Mobility	Self-care	Getting along	Life activities	Participation
Gender	1
Age	−0.12	1
Education	0.17	0.04	1
BPRS-18	total	−0.11	−0.11	−0.12	1
Positive symptoms	0.08	−0.08	−0.13	0.80∗∗	1
Negative symptoms	−0.03	−0.16	−0.24∗	0.78∗∗	0.59∗∗	1
Affect	−0.15	0.01	0.06	0.68∗∗	0.32∗∗	0.34∗∗	1
Resistance	−0.21	−0.09	−0.05	0.55∗∗	0.32∗∗	0.21∗	0.26∗	1
WHODAS 2.0 total	−0.26∗	0.08	−0.34∗∗	0.74∗∗	0.57∗∗	0.66∗∗	0.44∗∗	0.35∗∗	1
Cognition	−0.16	0.08	−0.36∗∗	0.66∗∗	0.54∗∗	0.54∗∗	0.38∗∗	0.31∗∗	0.85∗∗	1
Mobility	0.03	0.17	−0.15	0.36∗∗	0.28∗∗	0.30∗∗	0.26∗	0.15	0.59∗∗	0.45∗∗	1
Self-care	−0.18	0.11	−0.19	0.50∗∗	0.39∗∗	0.46∗∗	0.28∗∗	0.21	0.70∗∗	0.55∗∗	0.27∗	1
Getting along	−0.34∗∗	0.11	−0.34∗∗	0.61∗∗	0.44∗∗	0.65∗∗	0.23∗	0.42∗∗	0.85∗∗	0.66∗∗	0.40∗∗	0.53∗∗	1
Life activities	−0.30∗∗	−0.03	−0.20	0.45∗∗	0.35∗∗	0.44∗∗	0.34∗∗	0.05	0.73∗∗	0.54∗∗	0.32∗∗	0.55∗∗	0.52∗∗	1
Participation	−0.14	−0.03	−0.19	0.65∗∗	0.51∗∗	0.48∗∗	0.51∗∗	0.29∗∗	0.73∗∗	0.51∗∗	0.47∗∗	0.31∗∗	0.49∗∗	0.42∗∗	1

^∗ :p<0.05, ∗∗: p<0.01. BPRS-18 : 18-item Brief Psychiatric Rating Scale, WHODAS 2.0 : World Healthc Organization Disability Assessment Schedule 2.0

Table 3.

Predictors of disabilities

Model	Predictors	Disabilities
		Overall		Cognition		Mobility		Self-care		Getting along		Life activities		Participation
		β	R² (∆R²)	β	R² (∆R²)	β	R² (∆R²)	β	R² (∆R²)	β	R² (∆R²)	β	R² (∆R²)	β	R² (∆R²)
Step 1	Gender	−0.17∗	0.13∗∗	−0.06	0.14∗∗	0.12	0.06	−0.13	0.07	−0.23∗∗	0.20∗∗	−0.31∗∗	0.11∗	−0.07	0.05
	Age	0.16∗		0.15		0.23∗		0.16		0.20∗∗		−0.02		0.01
	Education	−0.19∗∗		−0.27∗∗		−0.14		−0.08		−0.15∗		−0.08		−0.13
Step 2	Positive symptoms	0.24∗∗	0.62∗∗ (0.49∗∗)	0.28∗∗	0.50∗∗ (0.36∗∗)	0.09	0.20∗ (0.14∗)	0.16	0.30∗∗ (0.24∗∗)	0.06	0.64∗∗ (0.44∗∗)	0.20	0.35∗∗ (0.23∗∗)	0.29∗	0.44∗∗ (0.39∗∗)
	Negative symptoms	0.41∗∗		0.24∗		0.17		0.33∗		0.57∗∗		0.26∗		0.14
	Affect	0.19∗		0.19∗		0.18		0.09		−0.08		0.19		0.36∗∗
	Resistance	0.11		0.10		0.07		0.05		0.26∗∗		−0.19		0.05

Estimates of the final models are presented. ∗: p>0.05 ∗∗: p>0.01

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