Schizophrenia affects many aspects of people’s lives, as it is related to a distortion in the way reality is perceived.

One of the dimensions of the quality of life that are diminished is what is known as social functioning .

What is social functioning?

Social functioning consists of the capacity of the person to adapt to his/her social environment and demands . This term refers to the capacity to relate to other people, as well as to maintain these relationships, enjoy free time, take care of ourselves and be able to develop the roles that society expects of us.

In schizophrenia spectrum disorders, impaired social functioning is a central aspect of the problem and can be detected in the early stages of the course of the disorder. Moreover, this phenomenon persists even when the acute phase of the disorder has been overcome. On the other hand, the literature shows how certain factors present in patients with schizophrenia spectrum disorders, such as childhood trauma, negative symptoms or certain personality traits, accentuate this deficit in social functioning.

Assessing social functioning in schizophrenia

It is therefore clear that the proper assessment of the social functioning of patients with schizophrenia spectrum disorders is of great importance, since it can provide the most effective treatments for the specific situation of each patient .

But it is not only necessary to be able to effectively assess the deterioration of social functioning at the level of clinical practice, it is also necessary for research in this area to be able to understand in depth which factors and mechanisms intervene and modulate this deterioration.

Psychometric tools

For this evaluation there are psychometric tools, such as questionnaires or interviews, which help both the clinician and the researcher to know the degree of deficit in the social functioning of the patients.

Here we will name four of the most used instruments and review their characteristics , both in terms of their structure and their psychometric characteristics. All of them have been adapted to Spanish and validated in a population with schizophrenia spectrum disorders.

1.Social and Personal Performance Scale (PSP)

This scale developed by Morosini, Magliano, Brambilla, Ugolini, and Pioli (2000) evaluates four areas of the patient’s social functioning : a) self-care; b) habitual social activities; c) personal and social relationships; and d) disruptive and aggressive behaviors. It is scored by the clinician and includes a semi-structured interview to help obtain good information on each of the areas.

On this scale the 4 areas are scored using a 6-point Likert scale, ranging from 1 (absent) to 6 (very severe) . Scores are obtained in each of the 4 areas, so that higher scores indicate poorer functioning, and an overall scale score in which higher values reflect better personal and social functioning.

The Spanish version of this instrument, developed by Garcia-Portilla et al., (2011), has an internal consistency of 0.87 and a test-retest reliability of 0.98. Therefore, it is a valid and reliable instrument to measure social functioning in patients with schizophrenia.

2.Social Functioning Scale (SFS)

The scale developed by Birchwood, Smith, Cochrane, Wetton, and Copestake (1990) assesses social functioning in the last three months of the life of the patient with schizophrenia spectrum disorders, and can be administered both in the form of a self-report questionnaire and a semi-structured interview.

It consists of 78 items where seven subscales are measured: isolation, interpersonal behavior, prosocial activities, free time, independence-competence, independence-execution and employment-occupation. The Spanish version of Torres and Olivares (2005) has high alpha coefficients (between 0.69 and 0.80) and is therefore a valid, reliable and sensitive instrument.

3.Quality of Life Scale (QLS)

This is a semi-structured interview containing 21 items, with a 7-point Likert scale. It was developed by Heinrichs, Hanlon, and Carpenter (1984) and evaluates 4 areas: a) intrapsychic functions; b) interpersonal relationships; c) instrumental role; and d) use of common objects and daily activities.

This scale is used to measure both the quality of life of patients and their social and occupational functioning . The Spanish version adapted by Rodríguez, Soler, Rodríguez M., Jarne Esparcia, and Miarons, (1995) is a valid tool with a high internal consistency (0.963) and reliability.

4.WHO Disability Assessment Questionnaire (WHO-DAS-II)

This questionnaire, with different versions (36, 12 and 5 items), evaluates different areas of functioning: understanding and communication with the world , ability to manage in the environment, personal care, relationship with other people, activities of daily living and participation in society.

Developed by Vázquez-Barquero et al., (2000), its usefulness, validity and reliability in patients with schizophrenia spectrum disorders was later corroborated by Guilera et al., (2012)

Bibliographic references:

  • Birchwood, M., Smith, J., Cochrane, R., Wetton, S., & Copestake, S. (1990). The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. The British Journal of Psychiatry : The Journal of Mental Science, 157, pp. 853 – 859. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2289094
  • Garcia-Portilla, M. P., Saiz, P. A., Bousoño, M., Bascaran, M. T., Guzmán-Quilo, C., & Bobes, J. (2011). Validation of the Spanish version of the Personal and Social Functioning scale in outpatients with stable or unstable schizophrenia. Journal of Psychiatry and Mental Health, 4(1), pp. 9 – 18.
  • Guilera, G., Gómez-Benito, J., Pino, O., Rojo, J. E., Cuesta, M. J., Martínez-Arán, A., … Rejas, J. (2012). Utility of the World Health Organization Disability Assessment Schedule II in schizophrenia. Schizophrenia Research, 138(2-3), pp. 240 – 247.
  • Heinrichs, D. W., Hanlon, T. E., & Carpenter, W. T. (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin, 10(3), pp. 388 – 398.
  • Lemos Giráldez, S., Fonseca Pedrero, E., Paino, M., & Vallina, Ó. (2015). Schizophrenia and other psychotic disorders. Madrid: Sintesis.
  • Lysaker, P. H., Meyer, P. S., Evans, J. D., Clements, C. A., & Marks, K. A. (2001). Childhood Sexual Trauma and Psychosocial Functioning in Adults With Schizophrenia. Psychiatric Services, 52(11), 1485-1488.
  • Morosini, P. L., Magliano, L., Brambilla, L., Ugolini, S., & Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Scandinavian Psychiatric Act, 101(4), 323-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10782554
  • Rodríguez, A., Soler, R. M., Rodríguez M., A., Jarne Esparcia, A. J., & Miarons, R. (1995). Factorial study and adaptation of the Quality of Life Scale in Schizophrenia (QLS). Journal of general and applied psychology: Journal of the Spanish Federation of Psychology Associations. Spanish Federation of Psychology Associations.
  • Torres, A., & Olivares, J. M. (2005). Validation of the Spanish version of the Social Functioning Scale. Actas Españolas de Psiquiatría, 33(4), pp. 216 – 220.
  • Vázquez-Barquero, J. L., Vázquez Bourgón, E., Herrera Castanedo, S., Saiz, J., Uriarte, M., Morales, F., … Disabilities, G. C. en. (2000). Spanish version of a new WHO disability assessment questionnaire (WHO-DAS-II): Initial phase of development and pilot study. Spanish Proceedings of Psychiatry.