Context and Expectations Matter: Social, Recreational, and Independent Functioning among Youth with Psychosis in Chennai, India and Montreal, Canada.

IF 3.3 3区 医学 Q2 PSYCHIATRY
Srividya N Iyer, Thara Rangaswamy, Sally Mustafa, Nicole Pawliuk, Greeshma Mohan, Ridha Joober, Norbert Schmitz, Howard Margolese, Ramachandran Padmavati, Ashok Malla
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引用次数: 0

Abstract

Objectives: Most cross-cultural psychosis research has focused on a limited number of outcomes (generally symptom-related) and perspectives (often clinician-/observer-rated). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to patient-reported measures of social, recreational, and independent functioning. Addressing this gap, this study aimed to compare these outcomes in first-episode psychosis at a high-income site and a lower middle-income site.

Methods: Patients receiving similarly designed early intervention for psychosis in Chennai, India (N = 164) and Montreal, Canada (N = 140) completed the self-reported Social Functioning Scale-Early Intervention, which measures prosocial, recreation, and independence-performance functioning. Their case managers rated expected independence-performance functioning. Both sets of assessments were done at entry and Months 6, 18, and 24. Linear mixed model analyses of differences between sites and over time were conducted, accounting for other pertinent variables, especially negative symptoms.

Results: Linear mixed models showed that prosocial, recreation, and independence-performance functioning scores were significantly higher in Montreal than Chennai and did not change over time. Expected independence-performance was also higher in Montreal and increased over time. Negative symptoms and education independently predicted prosocial, recreation, and expected independence-performance functioning. When added to the model, expected independence-performance predicted actual independence-performance and site was no longer significant. At both sites, prosocial and recreation scores were consistently lower (<40%) than independence-performance (40-65%).

Conclusion: This is the first cross-cultural investigation of prosocial, recreation, and independent functioning in early psychosis. It demonstrates that these outcomes differ by socio-cultural context. Differing levels of expectations about patients, themselves shaped by cultural, illness, and social determinants, may contribute to cross-cultural variations in functional outcomes. At both sites, social, recreational, and independent functioning were in the low-to-moderate range and there was no improvement over time, underscoring the need for effective interventions specifically designed to impact these outcomes.

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背景和期望很重要:印度金奈和加拿大蒙特利尔精神病青年的社会、娱乐和独立功能。
目的:大多数跨文化精神病研究都关注有限的结果(通常与症状相关)和观点(通常由临床医生/观察者评分)。目前尚不清楚在一些中低收入国家,所谓的精神病优越结果是否延伸到患者报告的社交、娱乐和独立功能指标。为了解决这一差距,本研究旨在比较高收入地区和中低收入地区首发精神病的这些结果。方法:在印度金奈接受类似设计的精神病早期干预的患者(N = 164)和加拿大蒙特利尔(N = 140)完成了自我报告的社会功能量表早期干预,该量表测量亲社会、娱乐和独立表现功能。他们的案例经理对预期的独立性绩效进行了评估。这两组评估都是在入学时和第6、18和24个月完成的。对不同地点和时间的差异进行了线性混合模型分析,考虑了其他相关变量,尤其是负面症状。结果:线性混合模型显示,蒙特利尔的亲社会、娱乐和独立表现功能得分显著高于金奈,并且没有随时间变化。蒙特利尔的预期独立表现也更高,并随着时间的推移而增加。负面症状和教育独立预测亲社会、娱乐和预期独立表现功能。当添加到模型中时,预期的独立性能预测了实际的独立性能,站点不再重要。在这两个位置,亲社会和娱乐得分一直较低(结论:这是首次对早期精神病患者的亲社会、娱乐和独立功能进行跨文化调查。研究表明,这些结果因社会文化背景而不同。对患者的不同期望水平可能会导致功能结果的跨文化差异,而患者自身也受文化、疾病和社会决定因素的影响,社会、娱乐和独立功能处于低到中等范围,随着时间的推移没有改善,这突出表明需要专门为影响这些结果而设计的有效干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
2.50%
发文量
69
审稿时长
6-12 weeks
期刊介绍: Established in 1956, The Canadian Journal of Psychiatry (The CJP) has been keeping psychiatrists up-to-date on the latest research for nearly 60 years. The CJP provides a forum for psychiatry and mental health professionals to share their findings with researchers and clinicians. The CJP includes peer-reviewed scientific articles analyzing ongoing developments in Canadian and international psychiatry.
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