This study investigated disability in patients with schizophrenia using WHODAS-II and compared their level disability with the HC. It also studied the effects of symptoms of schizophrenia (measured with the PANSS) and of depression (measured with Zung’s SDS) on the levels of disability reported by patients with schizophrenia. The results of the study showed that patients with schizophrenia reported significant greater disability when compared with the HC on the total DSS and scores on each of the disability domains of the WHODAS-II except in the “getting around” domain. These findings are consistent with previous observations from the developed countries [
15,
16]. The finding on “getting around” domain is understandable given that our sample was taken from stable outpatients. Participation in the society is the disability domain most closely related to symptoms of schizophrenia. The patients also reported the greatest disability severity in this domain reflecting the level of loneliness and psychological distress associated with schizophrenia. It is possible that this may be as a result of several factors such poor social skills, lack of motivation, and self-stigma. Therefore, psychosocial interventions (e.g., social skills training) addressing these factors may help in improving patients community participation as well as their level of disability. In addition, future qualitative studies may want to assess factors that promote and prevent community participation among patients with schizophrenia as this may reveal some factors that standardized instruments did not assess.
Table 5
The socio-demographic and clinical variables independently associated with the disability scores by regression analysis
Zung SDS | 0.412 | 0.075 | 0.434 | 5.462*** |
PANSS negative | 1.396 | 0.350 | 0.294 | 3.993*** |
Marital status | −5.648 | 1.867 | −0.215 | −3.025** |
No of active symptoms of schizophrenia (relapse) | 1.716 | 0.549 | 0.225 | 3.126** |
PANSS positive | 0.599 | 0.240 | 0.185 | 2.499* |
Most of the patients were unmarried and this finding is consistent with that of Lane et al. [
31] who reported an over-representation of the unmarried (never married, separated, and divorced) over married in patients with schizophrenia. The higher rate of the unmarried among the patients in this study probably reflects the effects of schizophrenia on interpersonal and intimate relationships [
32]. Employment status is an important measure of disability in schizophrenia [
33] and the estimates of unemployment in people with schizophrenia in developed countries have been reported to range between 70 and 85 % [
34]. In contrast, the unemployment rate in patients with schizophrenia in Ethiopia (a developing country in Africa) was 45.3 % [
35] which is close to the 37.0 % reported in this study. The differences in the rates of employment can be explained by the fact that jobs are less complicated in the developing countries when compared to jobs in developed countries [
36]. Despite the fact that a good percentage of patients were employed, this study has shown that they were poorly remunerated and this makes them to be economically disadvantaged in the community. Therefore, establishing employment programs for patients may help in reducing their level of disability. In this study, the severity of symptoms of schizophrenia was found to be significantly associated with the patients’ levels of disability. There is evidence that negative symptoms are much more related to disability than positive symptoms in schizophrenia [
2,
37,
38]. The severity of positive symptoms correlated with the patients’ abilities to understand and communicate, get along, engage in life activities, and participate in the society, whereas the negative symptoms were significantly related to all the domains of WHODAS-II. Therefore, our study also supported that negative symptoms are much more closely related to disability than positive symptoms of schizophrenia. We found that severity of the depressive symptoms was significantly related to all of the WHODAS-II domains and had the strongest association with the disability summary score. This result is consistent with the findings of other studies [
16,
39]. Regression analysis predicting the severity of disability indicated that depressive symptoms, negative and positive symptoms of schizophrenia, number of active symptoms (relapse) of schizophrenia, and marital status were significant predictors. Marital status has been shown to be an independent predictor of outcome in studies both in the developed and developing countries [
40,
41]. The finding that the number of episodes of active symptoms (relapses) of schizophrenia is predictor of disability indicates the disruptive effect of psychotic symptoms on the patient’s life. Therefore, prevention of relapses will have significant therapeutic and socio-economic implications. This study has some limitations. First, the study was conducted in a single hospital; therefore, the results obtained may not be representative of the schizophrenic patients’ disability scene in Nigeria. Second, the study was cross-sectional: a longitudinal design would have permitted one to learn more about the nature and course, as well as determine the temporal relationship between symptoms of schizophrenia, depression, and level of disability in patients with schizophrenia. Third, we did not validate the self-reported disability with any objective measure and this may have introduced some response biases. Therefore, combination of self-report and objective measure would have been appropriate and truly capture patients level of disability. However, in rehabilitation, assessment of self-reported disability is a valid method as it can be used to explore and understand complex needs of the patients. In addition, WHODAS-II has been shown to be a valid and reliable self-reported instrument for disability assessment that been used extensively in various countries and across different diseases of which mental illness was included [
16]. Fourth, some important socio-demographic variables such as family support and type of residence were not studied.