Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six European centres

Background. This paper focuses on the long-term course of social disability in schizophrenia assessed at first onset, and after 1, 2 and 15 years in incidence cohorts in six European centres in Bulgaria, Germany, Ireland, The Netherlands, the Czech Republic and the United Kingdom. The study population comprises 349 patients comprising 75% of the original cohorts. Methods. Social disability was assessed in a standardized way with the WHO Disability Assessment Schedule. Results. Social disability in schizophrenia appears to be a persistent phenomenon. Its severity decreased overall in the period of follow-up, but this was not so in a small group traced to hospital or sheltered accommodation. Only 17% of subjects had no disability and 24% still suffered from severe disability. The great majority lived with their family, a partner, or alone. A deteriorating course was more frequent than late improvement. Gender, age, onset, duration of untreated psychosis or type of remission during the first 2 years did not predict the long-term outcome of disability. Severity of disability at the first three assessments of the illness contributed significantly to the explanation of its variance at 15 years. Conclusion. Disability generally ameliorates, but less than expected or hoped. It needs continuing attention and care in this era of de-institutionalization

The Intercultural Measuring of Quality of Life in the Elderly: The WHOQOL-OLD Project Die Interkulturelle Erfassung der Lebensqualität im Alter: Das WHOQOL-OLD-Projekt

The WHOQOL-OLD is an international cooperation of 22 research centres under the sponsorship of the WHO for the development of an intercultural instrument for the assessment of quality of life in old age. This article outlines the fundamentals of the WHOQOL-OLD project and presents the current results of the empirical investigations for the German version of WHOQOL-OLD. Since it is an essential aspect of the WHOQOL project to include both the perspective of medical experts and that of lay persons, focus groups were conducted with lay people and health professionals at the outset of the project. The aim of these focus group discussions was to test the dimensional structure of the quality of life concept for elderly adults and to develop facet definitions. The results of the focus groups showed that elderly people associate social, physical as well as environment-related aspects with the term quality of life. The results of the international focus groups are largely identical with those of the German focus groups