Identifying subgroups based on self-assessment of ability in patients with schizophrenia and its relationship with vocational outcomes

Abstract

Background/Objectives People with schizophrenia have defective self-assessment of ability (i.e., loss of introspective accuracy [IA]). Although previous studies grouped people according to the degree of IA, the clinical features of these subgroups have not been clarified. Additionally, the determinants of outcomes depending on self-assessment remain unknown. We aimed to identify the clinical features that can help distinguish these subgroups and whether the determinants of vocational outcomes differed between the groups. Methods The self-assessment ability of 100 people with schizophrenia was examined and categorized as accurate, over-, or under-estimators. Multiple discriminant analysis was also performed. After demonstrating statistical validity, the relative effects of positive and negative symptoms, cognitive function, and level of IA on vocational outcomes were also examined for each subgroup. Results The symptoms that particularly explained the differences between these subgroups were positive and negative (expressing factors) symptoms: p < .001. Using the determinants of vocational outcomes in each subgroup, the over-estimator subgroup was characterized by positive symptoms: p = .025, the under-estimator group, by the underestimation of their own ability: p = .042, and the accurate estimator group, by cognitive function: p = .006. Conclusion Reduced IA can be a core mediator of various symptoms. Thus, tailoring the target and strategy of interventions for vocational outcomes according to the accuracy and quality of IA is important in clinical settings.

The Discrepancy between Subjective and Objective Evaluations of Cognitive and Functional Ability among People with Schizophrenia: A Systematic Review

“…It is notable that, compared to papers examining cognitive ability, more papers that examined everyday functioning found greater concordance between subjective and objective measures [27,32,35,37]. More concrete skills, such as personal hygiene [26] or employment and daily activities among those currently employed or living independently [29], tended to be estimated more accurately than more abstract skills like interpersonal functioning.…”

“…They found that participants with SSDs reported significantly higher social functioning scores than caregivers and researchers. Okada [37] also looked at social functioning by dividing participants into over-estimation, accurate estimation, and under-estimation groups based on the degree of discrepancy between the SFS and the Life Assessment Scale for Mental Illness. In this study, 31% of participants over-estimated their social functioning, 41% were concordant with informants in their self-estimations, and 28% under-estimated their functioning.…”