Cognitive functioning and functional ability in women with schizophrenia and homelessness

Abstract

Background

Studies of schizophrenia and homelessness are minimal from the Indian subcontinent. Women with schizophrenia and homelessness in India remain a highly vulnerable group and there is no data to date regarding their clinical characteristics. Cognitive impairment in schizophrenia remains a major factor determining outcomes in schizophrenia. We examined the cognitive functioning of women with schizophrenia and homelessness (WSH) and compared it to an age-matched group of women with schizophrenia living with their family (WSF).

Methods

36 women with schizophrenia and homelessness, and 32 women with schizophrenia who were living with family were evaluated for psychopathology using Scale for Assessment of Positive Symptoms (SAPS)/ Scale for assessment of negative symptoms (SANS) scales. Cognitive function was assessed using Montreal Cognitive Assessment (MOCA)/Rowland Universal Dementia Scale (RUDAS), and Frontal Assessment Battery (FAB), disability using World Health Organization - Disability assessment Scale (WHO-DAS) and psychosocial factors using a semi-structured proforma. The groups were compared using t-tests and chi-square for continuous and categorical variables respectively.

Results

Women with schizophrenia and homelessness were found to have significantly lower cognitive functioning, and much higher disability. Cognition and disability for women with schizophrenia and homelessness differed by 2–3 standard deviations with the mean for women living with family (i.e. z scores). Women with schizophrenia experiencing homelessness (WSH group) exhibited higher literacy levels and previous work experience compared to their counterparts. Those with family support are likely to face reduced pressures to work or earn, which further suggests that premorbid levels of functioning may not be the primary factors influencing the differences observed in cognitive assessments.

Conclusions

The study demonstrates significantly higher cognitive dysfunction in women with homelessness and schizophrenia, raising the possibility of much higher cognitive dysfunction being a predictor for homelessness in Indian women with schizophrenia.