The performance of people with schizophrenia on a well-validated scale of functional capacity in the domains of everyday living skills was essentially identical between samples in rural Sweden and New York City.
Case manager ratings of the ability of these patients to function in terms of everyday living skills were also essentially identical for the two samples.
The correlation between the different domains of the functional outcomes construct—cognitive abilities, functional capacity, and case manager ratings of real-world functioning—was essentially identical in these two samples as well.
Differences in performance on neuropsychological tests were modest, and the correlations between neuropsychological performance and measures of functional capacity and real-world outcomes were also essentially the same in the two countries.There are essentially no differences in the ability to live independently (in terms of both functional capacity assessments and case manager ratings), yet outcomes appear markedly more favorable in the Swedish sample.
There was essentially no difference in performance scores between U.S. and Swedish patients who lived in restricted settings,
which suggests that the complete inability to live independently may not be influenced by social service systems. In contrast, there was a clear functional capacity performance gradient associated with residential outcomes in the U.S. sample.These findings have several implications for improvements in real-world outcomes following cognitive-enhancement or skills-development treatments. Equivalent improvements in ability lead to very different changes in real-world functional outcomes depending on other characteristics of the environment.
The health care system in Trollhättan is more generous with compensation than U.S. health care systems, with disability compensation in this part of Sweden at approximately US$1,000 per month.
Moreover, the cost of living is markedly lower in Trollhättan (where a two-bedroom apartment costs approximately US$650 per month) than in New York City and its environs.
Also, the local health authority provides disabled schizophrenia patients with 93% of their monthly rent, up to US$800 per month.The requirements associated with finding and paying for an apartment in the New York City metropolitan area are daunting for healthy individuals and much more challenging for individuals with disabling psychiatric symptoms and chronic unemployment.
These differences in social support for people with mental illness have a clear and strong signal in terms of real-world functional outcomes. In contrast, other social and vocational milestones appear to occur with similar frequency in the
Given that these data suggest negligible differences in the ability to perform everyday living skills in the assessment setting and marked differences in residential outcomes, it appears likely that residential outcomes, like employment outcomes, may be driven by factors other than performing ability
Research has shown that interventions that modify level of social support lead to functional gains in people with schizophrenia .
Research will need to continue to address the impact of social and cultural support mechanisms on outcomes,
and multinational treatment studies will need to carefully consider the potential impact of these differences in social support
for individuals with schizophrenia,
both for the outcomes of treatment - and for the selection of potential study participants.