Skip to main content Accessibility help

Activities of daily living, social functioning and their determinants in persons with psychotic disorder

  • S. Viertiö (a1), A. Tuulio-Henriksson (a1) (a2), J. Perälä (a1), S.I. Saarni (a1), S. Koskinen (a3), M. Sihvonen (a4), J. Lönnqvist (a1) and J. Suvisaari (a1)...



The determinants of everyday functioning in persons with psychotic disorder have not been widely studied in community dwelling samples. Our aim was to investigate limitations in everyday functioning among subjects with psychotic disorders in a population-based study.


Everyday functioning was assessed in a nationally representative sample of 7112 persons aged 30+ using interviewer observations and self-reports, while verbal fluency and memory were also measured. Diagnostic assessment of DSM-IV psychotic disorders was based on SCID interview and case-note data. Lifetime-ever diagnoses of psychotic disorder were classified into schizophrenia (n = 61), other non-affective psychotic disorders (ONAP) (n = 79) and affective psychoses (n = 45).


Non-affective psychotic disorder was significantly associated with limitations in everyday functioning, as well as with deficits in verbal fluency and memory. Negative symptoms, depression, age, gender, verbal memory deficits, and reduced visual acuity were predictors of limitations in everyday functioning even after controlling for sociodemographic factors and chronic medical conditions, and difficulties in social functioning were also related to expressive speech problems.


Persons with schizophrenia and ONAP have significantly more problems in everyday functioning than the general population. One significant predictor of problems was reduced visual acuity, which at least in some situations could be easily corrected.


Corresponding author

*Corresponding author. Tel.: +358 20 610 8784; fax: +358 20 610 7191. E-mail address:


Hide All
[1]Andreasen, N.The scale for the assessment of positive symptoms (SAPS). Iowa City: The University of Iowa; 1984.
[2]Andreasen, N.C.Negative symptoms in schizophrenia. Definition and reliability. Arch Gen Psychiatry. 1982; 39: 784788.
[3]Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., Erbaugh, J.An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561571.
[4]Bowie, C.R., Reichenberg, A., Patterson, T.L., Heaton, R.K., Harvey, P.D.Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry. 2006; 163: 418425.
[5]Bowie, C.R., Twamley, E.W., Anderson, H., Halpern, B., Patterson, T.L., Harvey, P.D.Self-assessment of functional status in schizophrenia. J Psychiatr Res. 2007; 41: 10121018.
[6]Chopra, P.K., Couper, J.W., Herrman, H.The assessment of patients with long-term psychotic disorders: application of the WHO Disability Assessment Schedule II. Aust N Z J Psychiatry. 2004; 38: 753759.
[7]DeSisto, M.J., Harding, C.M., McCormick, R.V., Ashikaga, T., Brooks, G.W.The Maine and Vermont three-decade studies of serious mental illness. I. Matched comparison of cross-sectional outcome. Br J Psychiatry. 1995; 167: 331338.
[8]Green, M.F.What are the functional consequences of neurocognitive deficits in schizophrenia?. Am J Psychiatry. 1996; 153: 321330.
[9]Harvey, P.D., Howanitz, E., Parrella, M., White, L., Davidson, M., Mohs, al.Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: a comparison across treatment sites. Am J Psychiatry. 1998; 155: 10801086.
[10]Harvey, P.D., Koren, D., Reichenberg, A., Bowie, C.R.Negative symptoms and cognitive deficits: what is the nature of their relationship?. Schizophr Bull. 2006; 32: 250258.
[11]Harvey, P.D., Velligan, D.I., Bellack, A.S.Performance-based measures of functional skills: usefulness in clinical treatment studies. Schizophr Bull. 2007; 33: 11381148.
[12]Heistaro, S.Methodology report. Health 2000 Survey. Helsinki: Publications of the National Public Health Institute KTL/B 26; 2008.
[13]Jin, H., Zisook, S., Palmer, B.W., Patterson, T.L., Heaton, R.K., Jeste, D.V.Association of depressive symptoms with worse functioning in schizophrenia: a study in older outpatients. J Clin Psychiatry. 2001; 62: 797803.
[14]Kattainen, A., Salomaa, V., Härkänen, T., Jula, A., Kaaja, R., Kesäniemi, al.Coronary heart disease: from a disease of middle-aged men in the late 1970s to a disease of elderly women in the 2000s. Eur Heart J. 2006; 27: 296301.
[15]Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., Jaffe, M.W.Studies of illness in the aged. The index of Adl: a standardized measure of biological and psychosocial function. JAMA. 1963; 185: 914919.
[16]Kendler, K.S., Karkowski-Shuman, L., O’Neill, F.A., Straub, R.E., MacLean, C.J., Walsh, D.Resemblance of psychotic symptoms and syndromes in affected sibling pairs from the Irish Study of High-Density Schizophrenia Families: evidence for possible etiologic heterogeneity. Am J Psychiatry. 1997; 154: 191198.
[17]Klapow, J.C., Evans, J., Patterson, T.L., Heaton, R.K., Koch, W.L., Jeste, D.V.Direct assessment of functional status in older patients with schizophrenia. Am J Psychiatry. 1997; 154: 10221024.
[18]Kurz, X., Scuvee-Moreau, J., Rive, B., Dresse, A.A new approach to the qualitative evaluation of functional disability in dementia. Int J Geriatr Psychiatry. 2003; 18: 10501055.
[19]Laes, J.R., Sponheim, S.R.Does cognition predict community function only in schizophrenia? A study of schizophrenia patients, bipolar affective disorder patients, and community control subjects. Schizophr Res. 2006; 84: 121131.
[20]Laitinen, A., Sainio, P., Koskinen, S., Rudanko, S.L., Laatikainen, L., Aromaa, A.The association between visual acuity and functional limitations: findings from a nationally representative population survey. Ophthalmic Epidemiol. 2007; 14: 333342.
[21]Lawton, M.P., Brody, E.M.Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969; 9: 179186.
[22]Leary, J., Johnstone, E.C., Owens, D.G.Social outcome. Br J Psychiatry Suppl. 13–20 1991 4446.
[23]McWhinnie, J.R.Disability assessment in population surveys: results of the O.E.C.D. Common Development Effort. Rev Epidemiol Sante Publique. 1981; 29: 413419.
[24]Morris, J.C., Heyman, A., Mohs, R.C., Hughes, J.P., van Belle, G., Fillenbaum, al.The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology. 1989; 39: 11591165.
[25]Patterson, T.L., Klapow, J.C., Eastham, J.H., Heaton, R.K., Evans, J.D., Koch, al.Correlates of functional status in older patients with schizophrenia. Psychiatry Res. 1998; 80: 4152.
[26]Perälä, J., Suvisaari, J., Saarni, S.I., Kuoppasalmi, K., Isometsä, E., Pirkola, al.Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry. 2007; 64: 1928.
[27]R. Development Core Team R: A language and environment for statistical computing. 2. 6. 1 ed.Vienna, Austria: R Foundation for Statistical Computing; 2008.
[28]Research Triangle Institute, SUDAAN Language Manual Release 9. 0. Research Triangle Park, NC: Research Triangle Institute; 2004.
[29]Saarni, S.E., Saarni, S.I., Fogelholm, M., Heliövaara, M., Perälä, J., Suvisaari, al.Body composition in psychotic disorders: a general population survey. Psychol Med. 2008 110.
[30]Sainio, P., Koskinen, S., Heliövaara, M., Martelin, T., Härkänen, T., Hurri, al.Self-reported and test-based mobility limitations in a representative sample of Finns aged 30+. Scand J Public Health. 2006; 34: 378386.
[31]Sciolla, A., Patterson, T.L., Wetherell, J.L., McAdams, L.A., Jeste, D.V.Functioning and well-being of middle-aged and older patients with schizophrenia: measurement with the 36-item short-form (SF-36) health survey. Am J Geriatr Psychiatry. 2003; 11: 629637.
[32]Siegel, S.J., Irani, F., Brensinger, C.M., Kohler, C.G., Bilker, W.B., Ragland, al.Prognostic variables at intake and long-term level of function in schizophrenia. Am J Psychiatry. 2006; 163: 433441.
[33]Simon, G.E., Bauer, M.S., Ludman, E.J., Operskalski, B.H., Unutzer, J.Mood symptoms, functional impairment, and disability in people with bipolar disorder: specific effects of mania and depression. J Clin Psychiatry. 2007; 68: 12371245.
[34]Suvisaari, J., Perälä, J., Saarni, S.I., Härkänen, T., Pirkola, S., Joukamaa, al.Type 2 diabetes among persons with schizophrenia and other psychotic disorders in a general population survey. Eur Arch Psychiatry Clin Neurosci. 2008; 258: 129136.
[35]Viertiö, S., Laitinen, A., Perälä, J., Saarni, S.I., Koskinen, S., Lönnqvist, al.Visual impairment in persons with psychotic disorder. Soc Psychiatry Psychiatr Epidemiol. 2007; 42: 902908.
[36]Viertiö, S., Sainio, P., Koskinen, S., Perälä, J., Saarni, S.I., Sihvonen, al.Mobility limitations in persons with psychotic disorder: findings from a population-based survey. Soc Psychiatry Psychiatr Epidemiol. 2009; 44: 325332.


Activities of daily living, social functioning and their determinants in persons with psychotic disorder

  • S. Viertiö (a1), A. Tuulio-Henriksson (a1) (a2), J. Perälä (a1), S.I. Saarni (a1), S. Koskinen (a3), M. Sihvonen (a4), J. Lönnqvist (a1) and J. Suvisaari (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

Activities of daily living, social functioning and their determinants in persons with psychotic disorder

  • S. Viertiö (a1), A. Tuulio-Henriksson (a1) (a2), J. Perälä (a1), S.I. Saarni (a1), S. Koskinen (a3), M. Sihvonen (a4), J. Lönnqvist (a1) and J. Suvisaari (a1)...
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *