Predictors of Real-World Functioning Improvement in a Sample of Psychiatric Outpatients

Objective: the aim was to identify in 511 outpatients, with diagnoses of schizophrenia, major depressive disorder (MDD), bipolar disorders (BD), and borderline personality disorder (BPD), what clinical variables predict the improvement of real-world functioning during 12 months of usual treatment. Methods: sociodemographic variables were evaluated. Patients were assessed at baseline and endpoint with: Clinical Global Impression Scale - Severity (CGI-S); Satisfaction Profile (SAT-P), Drug Attitude Inventory-10 (DAI-10), and Personal and Social Performance (PSP). Statistical analysis was performed with Chi-square test and Pearson’s correlation. Significant variables were included in a multiple regression analysis. Dependent variable was the difference of PSP after one year (ΔPSP). P ≤ 0.05 was significant. Results: in the total sample, ΔPSP was related to age of onset, SAT-P and psychotherapy and inversely related to suicide attempts and CGI-S. In schizophrenia, ΔPSP was related to SAT-P and DAI-10 and inversely related to CGI-S. In MDD, ΔPSP was related to SAT-P and psychotherapy and inversely related to suicide attempts and CGI-S. In BD, ΔPSP was related to SAT-P and inversely related to CGI-S. In BPD, only psychotherapy was related to ΔPSP. Conclusion: Symptoms severity predicted a worse community functioning in the total sample and in each group, except for BPD. Suicide attempts were inversely associated to functional improvement in the total sample and depression. Quality of life was related to the change of functioning in each group, except for BPD. Patients with MMD and BPD receiving psychotherapy gained a better functional improvement. Attitude to pharmacotherapy was related to functional improvement only in schizophrenia.