Biosocial Pathways to Functional Outcome in Schizophrenia: A Path Analytic
Model
John S. Brekke
School of Social Work
University of Southern California
University Park MC-0411
Los Angeles CA 90089-0411
United States
Phone: (213) 740-0297
FAX: (213) 740-8905
Email: brekke@usc.edu
Diane D. Kay
University of Southern California
P.O. 2744
Palos Verdes Peninsula CA 90274
U.S.
Phone: (310) 541-3459
FAX: (213)740-8905
Email: dkay@usc.edu
Kimmy S. Kee
University of California at Los Angeles
West LA VA Healthcare
11301 Wilshire Blvd.
Los Angeles CA 90073
U.S.
FAX: (310) 268-4056
Email: kee@ucla.edu
Michael F. Green
UCLA Neuropsychiatric Institute
760 Westwood Plaza, C9-420
Los Angeles CA 90024
U.S.
FAX: (310) 825-6626
EMail: mgreen@ucla.edu
Purpose: Understanding causal pathways to functional outcomes
in schizophrenia is necessary for developing and improving psychosocial
services for diagnosed individuals. The goal of this study was to
examine the utility of a theory-driven model of the relationships between
biosocial factors and functional outcomes for persons diagnosed with schizophrenia.
Methods: 139 individuals in the schizophrenia spectrum
were assessed at baseline in a prospective study as they were admitted
to community-based rehabilitation programs. Measures included (1)
a comprehensive inventory of psychosocial functioning, (2) a battery of
five neurocognitive measures, and (3) an assessment of social cognition
(perception of emotion). An a priori biosocial path model was tested
using path analysis. The model included neurocognition, perception
of emotion, social competence, and social support as predictors of functional
outcome. This model was then used to predict global functional outcome
as well as distinct functional domains of independent living, work, and
social functioning.
Results: The path model explained from 11% to 20% of the
variance in functional outcomes at baseline, with large effect sizes.
Total, direct, and indirect effects were modeled. While the model’s
fit indices were excellent when predicting both global outcome and specific
functional domains, there were important variations in the path coefficients
when applying the model across functional domains.
Implications for practice: The findings across functional
domains highlighted the importance of attending to specificity effects
in understanding the causal pathways to functional outcome. Integrating
evidence of associations among neurocognition, social cognition, and social
factors will help to develop models that can guide further research on
the causal factors related to functional outcomes. This effort will
contribute to better specification of interventions through understanding
the mechanisms leading to functional change. It will provide more
precise target areas for rehabilitative change in schizophrenia, and lend
new evidence for improving our best practice models.