Assessing functional disability in schizophrenia patients receiving the Management and Treatment Services for Psychosis in China: Implications for community mental health services

Wei Zhou; Huimin Han; Xi Xiao; Yao Wang; Xinyi Zhao; Shuiyuan Xiao

doi:10.1016/j.ajp.2024.104319

Assessing functional disability in schizophrenia patients receiving the Management and Treatment Services for Psychosis in China: Implications for community mental health services

Asian J Psychiatr. 2024 Nov 19:103:104319. doi: 10.1016/j.ajp.2024.104319. Online ahead of print.

Authors

Wei Zhou¹, Huimin Han², Xi Xiao³, Yao Wang⁴, Xinyi Zhao⁵, Shuiyuan Xiao⁶

Affiliations

¹ Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, Hunan, China. Electronic address: weizhou86@163.com.
² Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, Hunan, China.
³ Changsha Psychiatric Hospital, Changsha, Hunan, China.
⁴ Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
⁵ School of Health Humanities, Peking University, Beijing, China.
⁶ Xiangya School of Public Health, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.

PMID: 39602843
DOI: 10.1016/j.ajp.2024.104319

Abstract

Background: The Management and Treatment Services for Psychosis (MTSP), as a core of China's community mental health services, has served over 4 million long-term schizophrenia patients. However, the functioning and disability status of these patients is underreported. This study aims to assess their functional disability and investigate the daily influencing factors, to better inform future service planning and provision.

Methods: This cross-sectional survey was conducted at the MTSP Service Points in 12 communities in Changsha, Hunan Province. The World Health Organization Disability Assessment Schedule II (WHODAS 2.0) was used to measure functional disability in 457 patients with schizophrenia. The mean disability summary score was compared to population norms and published outpatient samples, and domain-specific scores were compared pairwise. Between-group comparisons and multivariate linear regression were conducted to investigate the influence of socio-demographic, clinical, and service utilization factors on patients' functional disability.

Results: Participants had a mean disability summary score of 29.1, exceeding the 94th percentile of the population distribution and higher than outpatient counterparts. Self-care was the least impaired domain, while social participation was the most impaired. Service non-utilization, including delay of first treatment (B = 2.684, P = 0.048) and last-year treatment non-adherence (B = 7.515, P < 0.001), was significantly associated with functional impairment. However, multivariate linear regression also revealed a positive relationship between the duration of receiving the MTSP (B = 0.868, P = 0.003) and disability.

Conclusions: Despite receiving the MTSP, community patients with schizophrenia exhibited severe functional impairment. To facilitate functional recovery, the MTSP should enhance its quality and diversify service scope, including more social functioning training, service utilization assistance, accessing social resources, and fostering an inclusive community environment.

Keywords: China; Community mental health services; Functional disability; Schizophrenia.