Elsevier

Schizophrenia Research

Volume 104, Issues 1–3, September 2008, Pages 287-293
Schizophrenia Research

Validation of the Personal and Social Performance (PSP) Scale in a German sample of acutely ill patients with schizophrenia

https://doi.org/10.1016/j.schres.2008.04.037Get rights and content

Abstract

In trying to more broadly define outcome in the efficient long-term treatment of patients with schizophrenia it is necessary to consider not only a reduction in psychopathological symptoms but also a successful psychosocial reintegration. Thus, a more exact assessment of psychosocial functioning is needed. Since the GAF (Global Assessment of Functioning) scale and the SOFAS (Social and Occupational Functioning Assessment Scale) are less operationalized and confuse psychosocial facts with psychopathological symptoms, the Personal and Social Performance (PSP) scale was developed [Morosini, P.L., Magliano, L., Brambilla, L., Ugolini, S., Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 1001, 323–329.] containing the four main areas “socially useful activities, personal and social relationships, self-care, as well as disturbing and aggressive behaviour”. Validation of the PSP scale was conducted in a sample of 62 patients with acute schizophrenia. Rating instruments were PSP, GAF, SOFAS, PANSS, CGI, and Mini-ICF-P (Mini-ICF-Rating for Mental Disorders). The results showed good reliability with alpha = .64–.84, high test–retest reliability as well as good inter-rater reliability for the PSP scale. Furthermore, PSP proved good validity with high correlations to GAF (r = .91), SOFAS (r = .91), and Mini-ICF-P (r =  .69). The hypothesis that more critically ill patients would show lower scores on PSP than lesser ill patients was only confirmed for PANSS negative symptoms. Thus, the findings prove the PSP scale to be a reliable and valid instrument for assessing social functioning of patients with schizophrenia during the course of treatment as well as in the acute state.

Introduction

Social functioning is an important outcome parameter for the treatment of patients with schizophrenia because deficits in psychosocial domains are a core feature of schizophrenia. Thus, a more exact assessment is needed to determine patients' level of functioning and its changes during treatment. As the data on existing measures like Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) (Saβ et al., 1996) is not yet satisfactory, the present study evaluates an advanced outcome measurement: We have validated the Personal and Social Performance Scale (PSP) (Morosini et al., 2000) in a sample of acutely ill patients with schizophrenia.

Except for Patrick et al. (2006), who presented first preliminary results for patients with acute schizophrenia, the PSP scale has only been tested in stable schizophrenia to date (Morosini et al., 2000, Gagnon et al., 2006). In these studies, PSP revealed high reliability and validity. As Burns and Patrick (2007) summarized in their recent metaanalysis on existing measures for social functioning, the PSP scale “is proposed as a useful tool in future research” which strengthens the rationale for examining psychometric properties of PSP in different phases of schizophrenia treatment. As patients with schizophrenia were questioned about their expectations for treatment (Ginsberg et al., 2005), it became clear that besides reduction of symptoms, patients want to experience improvement in social functioning, e.g., an increase in daily activities, social contacts, and working opportunities. Progress in psychosocial functioning means successful personal, social, and occupational reintegration (Angermeyer et al., 1999, Franz, 2006, Kilian, 2006).

Empirically, it has been shown, that psychopathology and quality of life are only moderately correlated. Naber et al. (2002) reported no significant correlation between quality of life and positive symptomatology and only a marginal relation between quality of life and negative symptomatology. These results strengthen the claim that patient-relevant outcome parameters like social functioning and quality of life should be assessed equally along with psychopathology during treatment, as important indications of further treatment needs and treatment outcome. Nasrallah et al. (2005) point out four different goals of outcome variables of which the fourth realm, “health and wellness”, implies the patient-relevant outcome parameters discussed above: quality of life, social and occupational functioning, and autonomy. Currently, the choice of existing measures is not satisfactory. To assess the potential for occupational rehabilitation, we discuss the use of the Mini-ICF-P — a mini version of the International Classification of Functioning, Disability and Health for Mental Disorders (ICF). This is “a short observer rating instrument for the assessment of disabilities, especially with regard to occupational functioning” (Linden & Baron, 2005). With a differentiated profile of 12 central dimensions of disabilities in functioning chosen from the ICF, the Mini-ICF-P can assess in which areas and to which extent limitations in health can lead to disabilities in functioning. Given this, it can be deduced in which domain focused aid is necessary to help the patient with daily duties and, especially, to achieve occupational rehabilitation. For the evaluation of functioning in general, the GAF is a simple and short instrument. However, the disadvantage of this scale lies in its incorporation of psychopathological aspects, confusing them with the psychosocial factors. Upon this criticism, the SOFAS was developed — however this includes no clear operational instructions for rating the severity of disability. Against this background, Morosini et al., (2000) developed the Personal and Social Performance Scale (PSP scale) in a rehabilitation centre for patients with schizophrenia. Compared to GAF and SOFAS, the PSP scale offers several advantages. Without mixing psychopathological with psychosocial aspects, there is a more exact and specific operationalization of the occupational, social, and personal functioning domains. In addition, the rater can assess one global score and four subscores of the main area's socially useful activities including; work and study, personal and social relationships, self-care, and disturbing and aggressive behaviours. The distribution in four subdimensions creates a higher specific expressiveness of the PSP scale in comparison to the GAF and SOFAS scales. Furthermore, its quick practicability ought to be mentioned.

After developing a German version of the PSP, we sought to validate the PSP scale in a reasonably large sample of acutely ill patients with schizophrenia. Similar to Morosini et al., (2000), we expected good internal consistency of PSP including its four subdimensions, good test–retest reliability, and inter-rater reliability. Further, we anticipated positive correlations between PSP, GAF, and SOFAS as well as between PSP and the recently developed Mini-ICF-P. In addition, we hypothesized negative correlations between PSP and scores on psychopathology.

Section snippets

Subjects

62 inpatients (32 males, 30 females) diagnosed with schizophrenia (N = 41) or schizoaffective disorder (N = 21) according to ICD-10 criteria were included. The majority of 34 patients were diagnosed with paranoid-hallucinatory schizophrenia. The other half could be subtyped as hebephrenic (N = 5), catatonic (N = 2), schizoaffective, depressive type (N = 18), and schizoaffective, bipolar type (N = 3). All participants were recruited in the Dept. of Psychiatry, Ruhr University Bochum. Patients' mean age was

Reliability

At the first time of measurement, at the beginning of the patients' clinical treatment, the reliability of the PSP scale containing its four subdimensions was satisfactory with <alpha> = .64–.80. Cronbach's alpha revealed even higher scores for the PSP rating at the end of the inpatient treatment with <alpha> = .73–.84 (see Table 2).

Highly significant positive correlations could be found for the PSP total score and its subdimensions at the first time of measurement in relation to the scores at the

Discussion

The aim of the present study was to validate the Personal and Social Performance Scale (PSP, German version) in a sample of acutely ill patients with schizophrenia and schizoaffective disorders. We found good psychometric properties which present the PSP scale as a reliable and valid instrument for assessing social functioning of patients with schizophrenia. Therefore, the PSP scale is also suitable for evaluating, not only inpatients with stable schizophrenia, but also the functioning of

Role of funding source

Janssen-Cilag had no special role in the study design; in the collection, analysis and interpretation of data; in the writing of the article; and in the decision to submit the paper for publication. Dr. Hargarter is employee of Janssen-Cilag and scientist within the Medical Department. He helped in regard to the whole study idea and to finish the paper.

Contributors

G. Juckel and M. Brüne designed the study. G. Juckel, D. Tegeler, L. Hargarter, H. Witthaus, and M. Brüne wrote the first draft of the manuscript. D. Schaub, N. Fuchs, H. Witthaus, U. Naumann, and I. Uhl recruited the patients and collected all data. The data were analyzed by G. Juckel and D. Tegeler. All authors contributed to and have approved the final manuscript.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgement

This study was partially supported by an unrestricted educational grant from the Janssen Cilag Ltd. Germany.

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