Performance-based assessment of functional skills in severe mental illness: results of a large-scale study in China

Performance-based assessments of everyday living skills have been shown to be highly correlated with cognitive functioning in schizophrenia and bipolar disorder, as well as being predictive of deficits in real-world outcomes such as independent living and employment. In this study, we expand our assessments of impairments in everyday living skills to China, evaluating people with schizophrenia, bipolar disorder, and major depression, and comparing their performance to that of healthy controls. Samples of people with schizophrenia (n = 272), bipolar disorder (n = 61), major depression (n = 50), and healthy controls (n = 284) were examined with the Chinese version of the UCSD performance-based assessment, brief version (UPSA-B). Performance was compared across the groups and the association between age, gender, educational attainment, marital status, and UPSA-B scores was evaluated. When the performance on the UPSA was compared across the groups, with education as a covariate, significant effects of both diagnosis (F = 86.3, p < .001) and education were found (F = 228.3, p < .001). Sex and age did not contribute significantly when age and education were considered. Post-hoc comparisons revealed that total UPSA-B scores were lowest in the schizophrenia patients, followed by the patients with major depression. Patients with bipolar disorder did not differ from the healthy comparison subjects on overall performance. Scores for all groups were lower than previously reported in western samples (e.g., HC mean = 64). While diagnostic differences in UPSA-B scores are similar to those previously seen in western samples, the education effect is considerably more substantial. These data suggest that in developing countries educational attainment may be strongly associated with levels of adaptive outcomes and the utilization and interpretation of functional capacity measures be adjusted accordingly.