Clinicians are often asked to assess functional impairment in psychiatric patients for vocational, academic, or benefits-related purposes, but this is often no simple task.
To determine whether psychiatric symptoms were predictive of functional impairment, investigators recruited 155 adult psychiatric outpatients or day treatment patients in Switzerland. The mean age was 36; 68% were women; on average, 12 years of education, 23% were receiving public welfare and 19% were receiving disability payments. Participants were diagnosed with structured interviews for axis I, axis II, and dissociative disorders.
They did not have psychosis, psychiatric disorders due to medical conditions, intellectual disability, and substance intoxication/withdrawal. Every six months, patients completed rating scales assessing general psychiatric symptoms, depression, somatic symptoms, and dissociation, and WHO’s Disability Assessment Schedule II (WHODAS-II), which assesses six dimensions:
3. Life activities
4. Participation in society
5. Abilities to get along with people and to understand and communicate.
Over the 18-month follow-up, functional impairment ratings were generally stable in completers (41%). Of the 290 items in the psychiatric-rating scales, 47 accounted for about two thirds to three quarters of variance across the six WHODAS dimensions.
These items — primarily encompassing somatic and psychological symptoms associated with social anxiety, depression, and dissociation — were extracted for a new scale to predict functional status. Although fewer than half of participants completed all follow-ups, completers and dropouts had closely similar clinical and sociodemographic characteristics.
The stability of the impairment ratings suggests that functional disability endures and that disability assessments in routine psychiatric office practice may be valid for a considerable time. The study also highlights the benefits of measurement-based practice.
In a study by Bellino et al (2018), the aim was to identify what clinical variables predict the improvement of real-world functioning during 12 months of usual treatment. They assessed 511 outpatients, with diagnoses of schizophrenia, major depressive disorder (MDD), bipolar disorders (BD), and borderline personality disorder (BPD).
Symptoms severity predicted a worse community functioning in the total sample and in each group, except for borderline personality disorder (BPD). Suicide attempts were inversely associated to functional improvement in the total sample and depression. Quality of life was related to the change of functioning in each group, except for BPD.
Patients with major depressive disorder and BPD receiving psychotherapy gained a better functional improvement. Attitude to pharmacotherapy was related to functional improvement only in schizophrenia. Whether practitioners find that psychiatric symptom scores have additional predictive value compared with WHODAS remains to be seen. An updated version, WHODAS 2.0, is packaged for functional assessment with DSM-5.
ROLE OF THE MEDIA IN SUICIDE PREVENTION
The role of the media has been identified as a critical component in suicide prevention. Traditional media’s influence on facilitating suicide contagion, or imitative behaviour, has been well documented. This phenomenon has been linked to the mechanism of suicide contagion, whereby exposure to suicide facilitates suicidal behaviour in another.
Increases in suicide following exposure have been documented following celebrity suicides, news reports, and fictional portrayals of suicide. The youth appear particularly susceptible to this. In an effort to mitigate the potential for suicide contagion, several countries have successfully implemented media reporting guidelines to help facilitate the safe reporting of suicide.
These guidelines have been largely shaped by evidence that has linked increased rates of suicide to media content including:
- Prominent and ongoing coverage of a suicide death
- Sensationalised language
- Stories glorifying the suicide act
- Detailed descriptions of the method of suicide.
By contrast, content that promotes help-seeking behaviour and includes messages of hope and recovery is believed to be protective.