Social Cognition and Other Determinants of Perceived Social Support in Individuals With Serious Mental Illness.

ABSTRACT: Social support provides protective effects for those with serious mental illness (SMI), but these effects may be attenuated by factors that hinder positive perceptions of support. Improved understanding of social support and its determinants may hold relevance for clinical interventions and provide avenues to promote recovery and improve functioning. The present study is a cross-sectional, correlational analysis investigating the relationships among social cognition (Mayer-Salovey-Caruso Emotional Intelligence Test-Managing Emotions subscale), social anxiety (Liebowitz Social Anxiety Scale), negative symptoms (Scale for the Assessment of Negative Symptoms), and perceived social support (Interpersonal Support Evaluation List) among individuals with SMI. Data were analyzed for 59 participants from a psychosocial rehabilitation treatment study at a public, urban academic-affiliated medical center in the Midwest. Bivariate Pearson correlations revealed statistically significant associations among perceived social support and social cognition (total perceived social support, p < 0.05; appraisal support, p < 0.01), negative symptoms (appraisal support, p < 0.05), and social anxiety (self-esteem support, p < 0.05). Further, multiple linear regression revealed social cognition remained a significant predictor of perceived social support ( p < 0.05) when controlling for social anxiety and negative symptoms. Overall findings suggest a correlative relationship between social cognition and perceived social support. Conclusions, limitations, and future directions are discussed.

Mental health attitudes, norms, beliefs, and experiences with care among young Black men: A theory of planned behavior assessment.

OBJECTIVE: Young Black/African American men (YBM) are at greater risk for trauma and related mental health concerns compared to young non-Hispanic White men but are less likely to receive mental health care when needed. The current study used a Theory of Planned Behavior (TPB)-guided framework to qualitatively explore beliefs, norms, and intentions related to seeking mental health screening and linkage to care (LTC) among YBM exposed to trauma. METHOD: Participants (N = 55, Mage = 23 years) were YBM aged 18-30 recruited from urban community settings in Kansas City, MO, between October 2018 and April 2019 for participation in focus groups. RESULTS: Participants discussed lived experiences with trauma and mental health care, plus salient behavioral beliefs-both positive and negative. Key normative referents were significant others and family members, and participants endorsed greater motivation to seek care with their support. Control beliefs ranged from individual and interpersonal facilitators and barriers to more systemic factors (e.g., availability of providers, cost, lack of access, disparities in incarceration). CONCLUSIONS: Tailored interventions are needed to promote engagement in mental health services among YBM, with strategies that recognize cultural contexts and ongoing needs for general well-being. Recommendations for providers and systems are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Discrepancy between Subjective and Objective Evaluations of Cognitive and Functional Ability among People with Schizophrenia: A Systematic Review.

BACKGROUND: An important aspect of recovery in schizophrenia relates to one's subjective, lived experience. Self-report is a subjective measurement method with yet-uncertain utility in the assessment of functioning among individuals diagnosed with schizophrenia-spectrum disorder. No review to date has comprehensively synthesized existing research to evaluate the degree of correspondence, or lack thereof, between subjective and objective assessments of cognitive and everyday functioning, nor how extant data can inform the use of self-reported information in treatment and research. METHODS: A systematic review was completed to provide a broad perspective of the literature on this topic. Relevant manuscripts were identified via a search strategy using key terms in PubMed and PsycINFO and a review of manuscript bibliographies. Twenty-six studies met the inclusion criteria. RESULTS: These studies show minimal to modest associations between subjective assessments of cognition and everyday functioning and objective assessments of these domains, including informant reports and neuropsychological and behavioral measures. Individuals with schizophrenia appear to overestimate their functioning when compared to objective measures. Depression and greater cognitive ability tend to predict greater correspondence between subjective and objective assessments of cognition and everyday functioning. DISCUSSION: This review discusses how we might understand the low correspondence between subjective and objective measures of functioning and provides recommendations for using and eliciting self-reported information in the pursuit of recovery-centered practices.

Therapeutic alliance in a cognitive rehabilitation programme for people with serious mental illness: A qualitative analysis.

OBJECTIVE: Therapeutic alliance is an important element of evidence-based treatments for people diagnosed with a serious mental illness. Cognitive enhancement therapy (CET) is an efficacious cognitive rehabilitation programme that emphasizes coach-participant relationships. The purpose of this study was to examine experiences of therapeutic alliance among CET participants. DESIGN: We used an exploratory qualitative approach. METHODS: Semi-structured interviews were conducted with 24 participants diagnosed with a serious mental illness. Interview transcripts were analysed by three independent coders using thematic analysis. RESULTS: Four themes related to therapeutic alliance emerged: (1) positive regard; (2) collaboration; (3) authenticity; (4) negative alliance. CONCLUSIONS: Findings suggest that therapeutic alliance is an important component of CET that bolsters the learning environment and ensures a positive group experience. Our qualitative analyses contribute greater understanding of how strong therapeutic relationships impact people with serious mental illnesses participating in evidence-based treatments beyond psychotherapy context.

Implementation and preliminary outcomes of cognitive enhancement therapy for serious mental illness in an outpatient mental health program.

BACKGROUND: Although numerous evidence-based treatments for serious mental illnesses (SMI) exist, the majority are not widely utilized in clinical settings. Cognitive enhancement therapy (CET) has been tested in randomized trials; however, knowledge regarding implementation and outcomes in naturalistic environments is scarce. AIMS: The current study is an uncontrolled, observational study describing implementation and pre- to post-outcomes of CETCleveland®, a community-based version of CET in an outpatient mental health program in the United States. METHOD: We included n = 34 diverse individuals with SMI. Data include qualitative implementation information and participant outcomes, including measures of cognition, symptoms, satisfaction and adherence. RESULTS: Overall, participant satisfaction was positive, and adherence was comparable with previous studies. Implementation information includes training, clinician and setting characteristics, and barriers and solutions. Preliminary outcomes showed that participants significantly improved in areas of neurocognition and symptoms. CONCLUSIONS: Overall, our results demonstrated successful early implementation of CET in a diverse, outpatient mental health program and provided preliminary support for the clinical utilization of CET. We hope these results will promote further access to CET and other evidence-based psychiatric rehabilitation programs in community clinics.

Cognition and daily life functioning among persons with serious mental illness: A cluster analytic examination of heterogeneity on the Test of Grocery Shopping Skills.

OBJECTIVE: To characterize variability in daily life functioning among individuals with serious mental illness based on a naturalistic performance measure of grocery shopping and standard neuropsychological tasks using cluster analytic methods. METHODS: A naturalistic performance measure, the Test of Grocery Shopping Skills (TOGSS), and standard neuropsychological tasks, were completed by 191 participants with serious mental illness. Hierarchical cluster analytic techniques were used to explore functional subgroups based on naturalistic performance measure variables. Multivariate analyses of variance were utilized to compare subgroups on TOGSS variables and neuropsychological measures, respectively. RESULTS: Two distinct functional subgroups emerged from the cluster analysis. On average, participants in cluster one were faster, more efficient, and more accurate compared to cluster two. Based on performance on neuropsychological tasks, cluster one had better verbal memory, visual attention, and processing speed, and executive functioning scores, compared to cluster two. The clusters did not differ on a measure of auditory working memory. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Naturalistic performance measures can assist with characterizing the heterogeneity in real life functioning among people with serious mental illness. Further work to illuminate the relationship between specific cognitive abilities and specific functional abilities is warranted and may assist with targeting effective treatment plans for functional recovery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Profiles of self-evaluation as a metacognitive skill: An indicator of rehabilitation potential among people with schizophrenia.

OBJECTIVE: The purpose of this study is to identify subgroups of people with schizophrenia on the basis of self-assessment accuracy (metacognition) and examine group differences in rehabilitation potential. METHOD: Participants were 51 individuals with schizophrenia-spectrum disorders recruited from community mental health centers. Data from a self-report measure of cognition and a neuropsychological battery were compared and utilized to place participants in 3 accuracy groups: overestimators, accurate estimators, and underestimators. A multivariate analysis of variance was used to compare performance between accuracy groups on an index of rehabilitation potential. RESULTS: Three distinct profiles of metacognitive ability were identified. The analysis found that participants who underestimated their cognitive functioning had the highest scores on an index of rehabilitation potential (learning potential), and those who overestimated their functioning had the lowest. No significant differences in diagnostic or sociodemographic variables were found among accuracy groups. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Results suggest that there are differences in the way people with schizophrenia evaluate their cognition and, further, these metacognitive profiles are associated with differences in the ability to learn new tasks quickly. Thus, identifying subgroups of individuals based on metacognitive processing may help identify those most likely to benefit from cognitive remediation and other rehabilitative therapies. Future research should explore the link between metacognitive ability and rehabilitation potential in greater detail. Future investigations should also clarify the implications that underestimation of ability has for overall recovery and quality of life in people with schizophrenia. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Relationships among functional capacity, cognition, and naturalistic skill performance in people with serious mental illness.

There has been increasing interest in understanding real-world outcomes for individuals with serious mental illnesses (SMI). This study examined domain-specific skill knowledge, functional capacity, and neurocognition as predictors of naturalistic grocery shopping skill performance in forty-eight individuals with SMI. Participants completed measures of skill knowledge and general functional capacity (UCSD Performance-Based Skill Assessment - brief) as well as measures of neurocognition and symptoms. The Test of Grocery-Shopping Skills (TOGSS) assessed naturalistic shopping. TOGSS was significantly correlated with functional capacity, shopping skill knowledge, and neurocognition, but not symptoms. Multiple regression analysis was conducted with variables entered in 2 blocks. Skill knowledge and functional capacity were entered in block 1. Neurocognitive measures were entered in block 2 using forward entry. Skill knowledge was not a significant predictor of TOGSS when accounting for functional capacity and neurocognition. Functional capacity predicted TOGSS over and above skill knowledge and remained significant after accounting for the effects of neurocognition. Our findings indicate that functional capacity was associated with skill assessment under naturalistic conditions. Further, there was some, but not complete, overlap between neurocognitive and functional capacity predictors of naturalistic skill performance. Further development of naturalistic assessments may hold promise for interventions targeting real-world function.

Comparison of performance-based assessment and real world skill in people with serious mental illness: Ecological validity of the Test of Grocery Shopping Skills.

Valid functional measures are essential for clinical and research efforts that address recovery and community functioning in people with serious mental illness. Although there is a great deal of interest in functional assessment, there is limited research supporting how well current evaluation methods provide a true assessment of real world functioning or naturalistic behavior. To address this gap in the literature, the present study examined the performance of individuals with serious mental illness (i.e., diagnosis of schizophrenia-spectrum, bipolar disorder, or other depression/anxiety diagnoses and accompanying functional disability) on the Test of Grocery Shopping Skills (TOGSS), a performance-based naturalistic task. We compared TOGSS performance to two dimensions of real world functioning: directly observed real world grocery shopping and ratings of community functioning. Results indicated that the TOGSS was significantly associated with real life grocery shopping, in terms of both shopping accuracy (r = 0.424) and time (r = 0.491). Further, self-report and observer-rated methods of assessing real world shopping behaviors were significantly correlated (r = 0.455). To our knowledge, this is one of the first studies to directly compare a performance-based naturalistic skill assessment with carefully observed real world performance of that skill in people with serious mental illness. These findings support the feasibility and ecological validity of performance-based naturalistic assessment with the TOGSS.

Measuring learning potential in people with schizophrenia: A comparison of two tasks.

Learning potential measures utilize dynamic assessment methods to capture performance changes following training on a cognitive task. Learning potential has been explored in schizophrenia research as a predictor of functional outcome and there have been calls for psychometric development in this area. Because the majority of learning potential studies have utilized the Wisconsin Card Sorting Test (WCST), we extended this work using a novel measure, the Rey Osterrieth Complex Figure Test (ROCFT). This study had the following aims: 1) to examine relationships among different learning potential indices for two dynamic assessment tasks, 2) to examine the association between WCST and ROCFT learning potential measures, and 3) to address concurrent validity with a performance-based measure of functioning (Test of Grocery Shopping Skills; TOGSS). Eighty-one adults with schizophrenia or schizoaffective disorder completed WCST and ROCFT learning measures and the TOGSS. Results indicated the various learning potential computational indices are intercorrelated and, similar to other studies, we found support for regression residuals and post-test scores as optimal indices. Further, we found modest relationships between the two learning potential measures and the TOGSS. These findings suggest learning potential includes both general and task-specific constructs but future research is needed to further explore this question.

State anxiety as a moderator of real world grocery shopping performance among people with serious mental illness.

Anxiety is frequently overlooked as a factor when examining task performance among individuals with serious mental illness. Given the known effects of anxiety on performance in general populations, it is important to examine anxiety and performance within a serious mental illness population. This study examined state anxiety during a grocery-shopping task among 106 individuals diagnosed with a serious mental illness. Results indicate that state anxiety may impact task performance through its relationship with knowledge about grocery-shopping skills. These data suggest the need to examine further the impact of anxiety on task performance in serious mental illness. Furthermore, the identification and treatment of anxiety in persons with SMI may serve to improve functional outcomes and rehabilitation efforts.

Perceptions of factors associated with weight management in obese adults with schizophrenia.

OBJECTIVE: Individuals with serious mental illnesses are at increased risk of obesity, although the behavioral factors contributing to excess weight are not well understood. We report on the eating behavior, physical activity, and body image of obese adults with and without schizophrenia spectrum disorders. METHODS: Twenty-two obese adults diagnosed with schizophrenia or schizoaffective disorder were compared to demographically matched obese adults without psychiatric diagnoses on their responses to a comprehensive assessment of several psychosocial and behavioral domains relevant to obesity and weight management. RESULTS: The schizophrenia group, compared to controls, reported more difficulty with several eating behaviors that were self-identified as contributing to increased weight. They also reported more enjoyment of physical activity and greater satisfaction with body weight and shape compared to controls. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Clinically relevant group differences were identified that should be considered when designing ecologically valid weight management assessments and interventions for individuals diagnosed with serious mental illnesses. Health care providers are encouraged to assess an individual's weight management strengths and barriers through available assessment tools and home visits, as well as offer specific environmental and behavioral changes to manage hunger and modify eating patterns.

Health-related quality of life and overall life satisfaction in people with serious mental illness.

Quality of life (QoL) in people with schizophrenia and other serious mental illnesses (SMI) is an important outcome goal, yet there is no consistent definition of the construct. We examined three aspects of QoL in persons with SMI: overall life satisfaction, physical health-related QoL (HRQoL), and mental HRQoL. This study had two primary aims: first, to examine whether there are differences in physical and mental HRQoL in persons with SMI, and, second, to investigate the cognitive, clinical, and functional correlates of the three QoL indicators. Participants were 48 persons with SMI who completed assessments of QoL, cognition, functional capacity, psychiatric symptomatology, and medical comorbidity. Results indicate that participants experience similar levels of physical and mental HRQoL, and these two constructs are not related to one another. Physical HRQoL is associated with less medical comorbidity, while mental HRQoL is associated with negative and depressive symptoms. Overall life satisfaction was associated with fewer psychiatric symptoms and less medical comorbidity. This study adds to the important literature defining distinct domains of QoL and supports the necessity of addressing both physical and mental health factors as they relate to recovery and well-being among persons with SMI.

Patterns of association between performance in a natural environment and measures of executive function in people with schizophrenia.

This study examined the relationships between a set of real-world performance measures and a set of executive function measures with a sample of community based individuals with schizophrenia (N=80). Participants were given a battery of cognitive tests and were evaluated with a real-world performance measure, the Test of Grocery Shopping Skills (TOGSS). Using canonical correlation analysis, executive functions of planning, problem solving, working memory, and task persistence were significantly related to grocery shopping efficiency and accuracy. Two canonical variates with moderate correlations (0.547 and 0.519) explain that 30% of the variance in the executive function and grocery shopping measures was shared. These results identify patterns of association between executive function performance and the independent living skill of grocery shopping indicating the Test of Grocery Shopping Skills may be considered a sensitive measure of executive function performance in a real-world setting.

Learning potential as a predictor of skill acquisition in people with serious mental illness.

Twenty-five individuals with serious mental illness completed a grocery shopping skills intervention and a test-train-test version of the Wisconsin Card Sorting Test (WCST), which yielded indices of static performance and learning potential. WCST learning potential predicted skill acquisition beyond the static index of traditional WCST performance.

The prevalence of night eating syndrome and binge eating disorder among overweight and obese individuals with serious mental illness.

The prevalence of night eating syndrome (NES) and binge eating disorder (BED) was assessed among overweight and obese, weight-loss-seeking individuals with serious mental illness (SMI). Sixty-eight consecutive overweight (BMI > or = 25 kg/m(2)) and obese (BMI > or = 30 kg/m(2)) individuals with SMI (mean age = 43.9 years; mean BMI = 37.2 kg/(2); 67.6% Caucasian, 60.3% female) who were enrolled in a group behavioral weight loss treatment program were assessed at baseline for NES and BED with clinician-administered diagnostic interviews. Using conservative criteria, 25.0% met criteria for NES, 5.9% met criteria for BED, and only one participant met criteria for both NES and BED. This is the first study to find that obese individuals with SMI, compared with previously studied populations, are at significantly greater risk for NES, but are not at greater risk for BED. Stress, sleep, and medication use might account for the high prevalence of NES found in this population.

Correlates of insider and outsider conceptualizations of recovery.

OBJECTIVE: The concept of recovery can be based on the self report of the individual experiencing the phenomenon ("insider" perspective) or objectively measured by clinicians and researchers ("outsider perspective"). The purpose of this study was to examine the relations among insider (hope and empowerment) and outsider (symptoms and cognition) variables of recovery. METHODS: 66 individuals with schizophrenia, bipolar disorder or major depression were administered the Brief Psychiatric Rating Scale, a battery of cognitive measures, The Hope Scale and The Empowerment Scale. RESULTS: For symptoms, depression and anxiety had the strongest relationships with hope and empowerment. Cognition was associated with a subset of activist oriented empowerment subscales. There were strong relationships among the hope and empowerment measures but few relationships among symptoms and cognition. CONCLUSIONS: Relationships exist between insider and outsider conceptualizations of recovery in that symptoms and cognition are associated with some aspects of hope and empowerment.

Learning proficiency on the Wisconsin Card Sorting Test in people with serious mental illness: what are the cognitive characteristics of good learners?

Although it is widely accepted that schizophrenia and other serious mental illnesses (SMI) are associated with neurocognitive difficulties, there is great variability in neurocognitive functioning across individuals. In recent years, a growing number of schizophrenia studies have utilized the concept of learning potential to explore individual variation in cognition. Learning potential refers to the ability to benefit from instruction and is measured by assessing test performance before and after training. The present study was intended to explore the cognitive characteristics associated with learning potential in people with serious mental illness. Sixty individuals with schizophrenia, bipolar or major (unipolar) depression completed a learning potential assessment using the Wisconsin Card Sorting Test (WCST) and a battery of standard cognitive measures. Based on established criteria for WCST learner subgroups, participants were categorized as high achievers, learners or non-retainers. There were several significant cognitive differences among the three learner subgroups. Most notably, individuals who were categorized as learners on the WCST showed significantly better verbal and working memory compared to non-retainers. Secondary analyses revealed that the three SMI diagnostic groups (depression, bipolar, schizophrenia) were similar in learning potential and did not differ on any of the standard cognitive measures. This study provides support for learning potential classification in schizophrenia as well as other serious mental illnesses, and indicates that learning potential may specifically be related to verbal and working memory abilities.

Knowledge of grocery shopping skills as a mediator of cognition and performance.

OBJECTIVE: Cognitive impairments in serious mental illness are associated with poorer community outcomes; yet the mechanisms through which cognition limits functioning are unknown. This study examined knowledge of grocery shopping skills as a mediator of cognition and performance of grocery shopping skills. METHODS: Fifty-one individuals with serious mental illness were administered measures of cognition, as well as measures of knowledge and performance of grocery shopping skills. RESULTS: When knowledge of grocery shopping skills was introduced as a mechanism through which cognition influences performance, almost perfect mediation was achieved (slope of the regression dropped from B=.32 to B=.03). CONCLUSIONS: The search for mediators can improve our understanding of how cognition influences community functioning.