Social Vulnerability and Community Functioning: Challenges for those with Schizophrenia-spectrum Diagnoses

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 6. Mental Health

Abstract

People who have been diagnosed with schizophrenia and schizoaffective disorder are at increased risk for homelessness and incarceration. These social vulnerabilities may precede the diagnosis and increase its likelihood, but they also are more likely to occur after the diagnosis when supportive mental health services are unavailable or unused. Whenever they occur, they are likely to reflect and worsen the cognitive and social deficits associated with the diagnosis and to diminish quality of life. We recruited 186 adults with schizophrenia or schizoaffective disorder from 15 sites and assessed their social vulnerability, symptomatology, social cognition and neurocognition, social functioning, and quality of life. We use structural equation modeling to identify the direct and indirect associations of social vulnerability and cognition with three dimensions of quality of life (interpersonal functioning, instrumental functioning, motivation). Social vulnerability was associated with poorer interpersonal functioning due to its association with lower levels of social cognition, which in turn were associated with poorer interpersonal functioning. More negative symptoms and being male were also associated with poorer interpersonal functioning. Instrumental functioning was associated only with role performance. Motivation was associated independently with neurocognition, negative symptoms (inversely), and relations with primary family members, as well as with being Black and identifying as Hispanic (inversely). In summary, social vulnerability was associated with worse interpersonal functioning due to its association with poorer social cognition and with lower levels of motivation due to its association with worse neurocognition and negative symptoms. Cognitive remediation programs and psychosocial programs that improve social cognition should lessen the detrimental effects of social vulnerability on community functioning.  

Authors

• Russell K. Schutt, Beth Israel Deaconess Medical Center

• Michael Steve Rejtig, University of Massachusetts-Boston

• Shaun Eack, University of Pittsburgh

• Kim Mueser, Boston University

• Raquelle Mesholam-Gately, Beth Israel Deaconess Medical Center

• Sarah Pratt, Dartmouth-Hitchock Medical Center

• Jonathan Delman, University of Massachusetts Medical School

• Meghan Santos, Dartmouth-Hitchock Medical Center

• Matthew Killam, Beth Israel Deaconess Medical Center

• Matcheri Keshavan, Harvard Medical School