Performance-based measurement of functional disability in schizophrenia: A cross-national study in the United States and Sweden

Philip D. Harvey, Lars Helldin, Christopher R. Bowie, Robert K. Heaton, Anna Karin Olsson, Fredrik Hjärthag, Torsten Norlander, Thomas L. Patterson

Research output: Contribution to journalArticlepeer-review

104 Scopus citations


Objective: Recent advances in the assessment of disability in schizophrenia have separated the measurement of functional capacity from real-world functional outcomes. The authors examined the similarity of performance-based assessments of everyday functioning, real-world disability, and achievement of milestones in people with schizophrenia in the United States and Sweden. Method: The UCSD Performance-Based Skills Assessment-Brief Version (UPSA-B) and a neuropsychological assessment were administered to schizophrenia patients living in rural areas in Sweden (N=146) and in the New York City area (N=244), and patients' functioning was rated by their case managers. Information from records and case managers was used to determine the frequency of living independently, working, and having ever experienced a stable romantic relationship. Results: Performance on the UPSA-B was essentially identical in the two samples (New York, mean score=13.84; Sweden, mean score=13.30), as were scores on the case manager ratings of everyday activities (New York, mean=49.0; Sweden, mean=48.8). The correlations between UPSA-B score, neuropsychological test performance, and case manager ratings did not differ across the two samples. The proportion of patients who had never had a close relationship and the rate of vocational disability were also nearly identical. However, while 80% of the Swedish patients were living independently, only 46% of the New York patients were. Conclusions: While scores on performance-based measures of everyday living skills were similar in people with schizophrenia across cultures, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to divergent real-world outcomes among individuals who show evidence of the same levels of ability and potential.

Original languageEnglish (US)
Pages (from-to)821-827
Number of pages7
JournalAmerican Journal of Psychiatry
Issue number7
StatePublished - Jul 2009
Externally publishedYes

ASJC Scopus subject areas

  • Psychiatry and Mental health


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