Disability assessment as an outcome measure: a comparative study of Nigerian outpatients with schizophrenia and healthy control

Akinsulore et al. Ann Gen Psychiatry (2015) 14:40 DOI 10.1186/s12991-015-0079-6 PRIMARY RESEARCH Open Access Disability assessment as an outcome measure: a comparative study of Nigerian outpatients with schizophrenia and healthy control Adesanmi Akinsulore*, Boladale M. Mapayi, Olutayo O. Aloba, Ibidunni Oloniniyi, Femi O. Fatoye and Roger O. A. Makanjuola Abstract Background and objective: Schizophrenia is a chronic mental disorder that leads to disability in several aspects of the individual’s personal, social, and occupational functioning. This study assesses and compares the level of disability among Nigerian outpatients with schizophrenia and healthy controls (HC). Methods: A comparative cross-sectional study among 100 schizophrenia outpatients with an ICD-10 diagnosis and 100 HC was conducted over a 4-month period. They completed a questionnaire containing the Zung’s Self-Rating Depression Scale (SDS), the World Health Organization Disability Assessment Schedule-Second Version (WHODAS-II). Symptoms of schizophrenia were assessed with the Positive and Negative Syndrome Scale (PANSS). Student’s t tests and Chi-square were used to compare patient with schizophrenia and healthy control. Pearson correlation and multiple linear regression analyses were used to assess the relationships of socio-demographic and clinical variable with disability. Results: The patients with schizophrenia reported greater disability than the HC on most of the disability domains of WHODAS-II. They also reported significantly higher mean Zung’s SDS scores than the HC. Depressive symptoms, negative symptoms, and PANSS total were significantly related to all the WHODAS-II domains. The disability summary score was significantly predicted by depressive symptoms, negative and positive symptoms of schizophrenia, number of active symptoms (relapse) of schizophrenia, and marital status [F (5, 94) = 23.90, p < 0.001]. Conclusion: Schizophrenia is a disabling disorder that affects different aspects of a patient’s life. Treatment strategies that target these different aspects may help in reducing disability. Keywords: Schizophrenia, Disability, Outpatients, Outcome, Nigerian Background Outcome measurement in psychiatry is a multidimensional construct that involves several independent domains such as clinical symptoms and disability assessment [1]. Disability is an important outcome measure that involves dynamic interactions between an individual’s health conditions and environment (social *Correspondence: Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile‑Ife, Osun state, Nigeria and attitudinal), quality of life, and the level of stigma experienced by the person [2–4]. Disability is any restriction or the deterioration of the expected functioning of an individual in a particular society by the family or social group or by the affected individual [5]. Therefore, social factors such as gender, unemployment, and family awareness of the nature of illness may influence the evaluation and level of disability in schizophrenia [6]. Disability in schizophrenia affects several aspects of the individual’s personal, social, and occupational functioning [7, 8]. The affected domains of patient’s daily © 2015 Akinsulore et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Akinsulore et al. Ann Gen Psychiatry (2015) 14:40 life include self-care, self-management, vocational and leisure activities, and social relationships [2]. In schizophrenia, disability has been related to four domains of dysfunction which are the positive symptoms, negative symptoms, cognitive impairment, and affective symptoms [9, 10]. Positive symptoms are symptoms such as delusions and hallucinations that are “added on” to a patient’s experience during the course of illness. Also, negative symptoms such as a motivation refer to symptoms that indicate a reduction of normal functioning in the patient. It is reported that positive symptoms of schizophrenia poorly predict future occupational functioning in schizophrenia [11, 12]. On the other hand, negative symptoms of schizophrenia have been significantly associated with disability in family and social functioning [13] and have stronger impact on real-world functioning than other symptoms [14]. Disability in schizophrenia has also been reported to be affected by socio-demographic characteristics (such as sex, marital, and employment status), depressive symptoms and cognitive deficit [2, 15, 16]. Reports from developed countries showed that schizophrenia is quite debilitative resulting in personal disabilities that eventually leads to economic loss [2, 15]. In addition, patients with schizophrenia experience greater severity of disability than the healthy controls (HC) [15, 16]. However, there is paucity of scientific data on disabilities among patients with schizophrenia in Nigeria. The majority of studies of disability in mentally ill Nigerians were conducted among elderly patients with disorders other than schizophrenia [17–19]. Gureje and Bamidele [20] assessed the social, occupational, and residential outcomes of Nigerian patients with schizophrenia and found that substantial proportion of them reported a moderate to severe degree of disability in the area of occupation and social contact. In a recent study, Adegbaju and colleagues [21] compared disability among adult Nigerian patients with bipolar affective disorder and schizophrenia and found that patients with schizophrenia reported greater disability than bipolar patients. However, they did not evaluate the association between disability and severity of schizophrenia symptoms. Therefore, we undertook this study to assess and compare self-reported disability using the World Health Organization Disability Assessment Schedule-Second Version (WHODAS-II) [22] in outpatients with schizophrenia and symptoms of schizophrenia. This study also evaluated the impact of disability on the different domains of patient’s life and provided baseline information on disability level among patients with schizophrenia in Nigeria. In this study, we aimed to assess and compare the level of disability among Nigerian outpatients with schizophrenia and healthy Page 2 of 7 control group as well as identify predictors of disability in schizophrenia. Methods Participants A comparative cross-sectional study conducted in the Mental Health Clinic of the Obafemi Awolowo University Teaching Hospitals Com (...truncated)