Abstract
In thepost-deinstitutionalization era, everyday community functioning is an important aspect of assessment and treatment of individuals with serious mental illness. The current study focuses on correlates of community functioning among 332 low-income mothers with serious mental illness. Results revealed significant relationships between everyday functioning and a number of demographic, psychiatric, contextual, and mental health treatment variables. Current psychiatric symptoms accounted for the greatest amount of variance and completely mediated the effects of diagnosis and substance abuse history on community functioning; yet contextual variables such as financial worries and social support were also significant predictors, even after controlling for symptoms and other clinical characteristics. Additionally, use of mental health services was a significant moderator of the effect of social stress on community functioning. Implications of results for future research and practice are discussed.
Similar content being viewed by others
References
Dickerson FB. Assessing clinical outcomes: the community functioning of persons with serious mental illness.Psychiatric Services. 1997;48:897–902.
Gross D. Relationships at risk: issues and interventions with the disturbed mother-infant dyad.Perspectives in Psychiatric Care. 1984;21:159–164.
Sands RG. The parenting experience of low-income, single women with serious mental disorders.Families in Society—The Journal of Contemporary Human Services. 1995;76:86–96.
Apfel RJ, Handel MH.Madness and Loss of Motherhood. Washington, DC: American Psychiatric Association Press Inc; 1993.
Cogan J.Assessing the Community Support Services Needs That Women With Psychiatric Disabilities May Have Regarding Relationships. Burlington, Vt: Center for Community Change Through Housing and Support; 1993.
Zemencuk J, Rogosch FA, Mowbray CT. The seriously mentally-ill woman in the role of parent: characteristics, parenting sensitivity, and needs.Psychosocial Rehabilitation Journal. 1995;18:77–92.
Caton CLM, Cournos F, Felix A, et al. Childhood experiences and current adjustment of offspring of indigent patients with schizophrenia.Psychiatric Services. 1998;49:86–90.
McGrath JJ, Hearle J, Jenner L, et al. The fertility and fecundity of patients with psychoses.Acta Psychiatrica Scandinavica. 1999;99:441–446.
Hutchinson G, Bhugra D, Mallett R, et al. Fertility and marital rates in first-onset schizophrenia.Social Psychiatry and Psychiatric Epidemiology. 1999;34:617–621.
Nimgaonkar VL. Reduced fertility in schizophrenia: here to stay?Acta Psychiatrica Scandinavica. 1998;98:348–353.
Bassett AS, Bury A, Hodgkinson KA, Honer WG. Reproductive fitness in familial schizophrenia.Schizophrenia Research. 1996;21:151–160.
Fananas L, Bertranpetit J. Reproductive rates in families of schizophrenic patients in a case-control study.Acta Psychiatrica Scandinavica. 1995;91:202–204.
Nanko S, Moridaira J. Reproductive rates in schizophrenic outpatients.Acta Psychiatrica Scandinavica. 1993;87:400–404.
Nicholson J, Biebel K, Hinden B, et al.Critical Issues for Parents With Mental Illness and Their Families. Worcester, Mass: University of Massachusetts Medical School, Department of Psychiatry, Center for Mental Health Services Research; 2001.
Honey A. Psychiatric vocational rehabilitation: where are the consumers' views?Psychiatric Rehabilitation Journal. 2000;23:270–278.
Tsang H, Lam P, Ng B, et al. Predictors of employment outcome for people with psychiatric disabilities: a review of the literature since the mid '80s.Journal of Rehabilitation. 2000;66:19–31.
Anthony WA, Rogers ES, Cohen M, Davies RR. Relationships between psychiatric symptomology, work skills, and future vocational performance.Psychiatric Services. 1995;46:353–358.
Anthony WA. Characteristics of people with psychiatric disabilities that are predictive of entry into the rehabilitation process and successful employment.Psychosocial Rehabilitation. 1994;17:3–13.
Dion GL, Tohen M, Anthony WA, et al. Symptoms and functioning of patients with bipolar disorder six months after hospitalization.Hospital and Community Psychiatry. 1988;39:652–657.
Glynn SM. Psychopathology and social functioning in schizophrenia. In: Mueser KT, Tarrier S, eds.Handbook of Social Functioning in Schizophrenia. Boston: Allyn & Bacon; 1998:66–78.
Gotlib IH, Lee CM. The social functioning of depressed patients: a longitudinal assessment.Journal of Social and Clinical Psychology. 1989;8:223–237.
Serban G. Mental status, functioning, and stress in chronic schizophrenic patients in community care.American Journal of Psychiatry. 1979;136:948–952.
Weissman MM, Paykel ES, Siegel R, et al. The social role performance of depressed women: comparisons with a normal group.American Journal of Orthopsychiatry. 1971;41:390–405.
Smith TE, Hull JW, Goodman M, et al. The relative influences of symptoms, insight, and neurocognition on social adjustment in schizophrenia and schizoaffective disorder.The Journal of Nervous and Mental Disease. 1999;187:102–108.
Evans S, Cloitre M, Koesis JH, et al. Social-vocational adjustment in unipolar mood disorders: results of the DSM-IV field trial.Journal of Affective Disorders. 1996;38:73–80.
Bell MD, Lysaker PH. Psychiatric symptoms and work performance among persons with severe mental illness.Psychiatric Services. 1995;46:508–686.
Bell MD, Milstein RM, Lysaker PH. Pay as an incentive in work participation by patients with severe mental illness.Hospital and Community Psychiatry. 1993;44:684–686.
Harding CM, Hall GM. Long-term outcome studies of schizophrenia: do females continue to display better outcome as expected?International Review of Psychiatry. 1997;9:409–418.
Lantz AE, Carlberg CG, Wilson NZ. Mental health treatment outcome by sex, diagnosis, and treatment agency.Professional Psychology: Research and Practice. 1983;14:293–309.
McPherson HM. The impact of severe mental illness on a woman. In: Romans SE, ed.Folding Back the Shadows: A Perspective on Women's Mental Health. Dunedin, NZ: University of Otago Press; 1998:251–261.
Andia AM, Zisook S, Heaton RK, et al. Gender differences in schizophrenia.The Journal of Nervous and Mental Disease. 1995;183:522–528.
Mowbray CT, Chamberlain P. Sex differences among the long-term mentally disabled.Psychology of Women Quarterly. 1986;10:1–9.
Test MA, Burke SS, Wallish LS. Gender differences of young adults with schizophrenic disorders in community care.Schizophrenia Bulletin. 1990;16:331–344.
Lehman AF, Rachuba LT, Postrado LT. Demographic influences on quality of life among persons with chronic mental illness.Evaluation and Program Planning. 1995;18:155–164.
Haas GL, Garrett LS. Gender differences in social functioning. In: Mueser KT, Tarrier N, eds.Handbook of Social Functioning in Schizophrenia. Boston: Allyn & Bacon; 1998:149–180.
Mowbray CT, Bybee D, Harris SN, McCrohan N. Predictors of work status and future work orientation in people with a psychiatric disability.Psychiatric Rehabilitation Journal. 1995;19:17–28.
Gordon RE, Gordon KK. Assessing the elements of biopsychosocial functioning.Hospital and Community Psychiatry. 1991;42:508–512.
Brekke JS, Mathiesen SG. Effects of parental involvement on the functioning of noninstitutionalized adults with schizophrenia.Psychiatric Services. 1995;46:1149–1155.
Tessler RC, Miller JL, Rossi PH. The chronically mentally ill in the community: what accounts for successful client functioning?Research in Community Mental Health. 1984;4:221–244.
Clarkin JF, Hurt SW, Crilly JL. Therapeutic alliance and hospital treatment outcome.Hospital and Community Psychiatry. 1987;38:871–875.
Rogler LH. Increasing socioeconomic inequalities and the mental health of the poor.Journal of Nervous and Mental Disease. 1996;184:719–722.
Bruce ML, Takeuchi DT, Leaf PJ. Poverty and psychiatric status.Archives of General Psychiatry. 1991;48:470–474.
Basic Behavioral Science Task force of the NAMHC. Basic behavioral science research for mental health: vulnerability and resilience.American Psychologist. 1996;51:22–28.
Robins LN, Helzer JE, Croughan J, et al. National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity.Archives of General Psychiatry. 1981;38:381–389.
US Bureau of the Census.Poverty Thresholds: 1996 Population Survey. Washington, DC: US Bureau of the Census; 1996.
Hollingshead AB.Four Factor Index of Social Status [unpublished manuscript]. New Haven, Conn: Department of Sociology, Yale University; 1975.
Skinner HA. The Drug Abuse Screening Test.Addictive Behaviors. 1982;7:363–371.
Shern DL, Wilson NZ, Coen AS. Client outcomes, II: longitudinal client data from the Colorado Treatment Outcome Study.Milbank Quarterly. 1994;72:123–148.
Calsyn RJ. Prediction perceived service need, service awareness, and service utilization.Journal of Gerontological Social Work. 1993;21:59–76.
Rosenheck R, Lam J.Client Access Evaluation Form. West Haven, Conn: Northeast Program Evaluation Center; 1994.
Barrera M. The Arizona Social Support Inteview Schedule. In:Social Networks and Social Support. Beverly Hills, Calif: Sage Publications; 1988:88–93.
Mowbray CT, Jordan LC, Kewalramani A, et al. Analysis of postdischarge change in a dual diagnosis population.Health and Social Work. 1999;24:91–101.
Kanner A, Coyne J, Schaefer C, et al. Comparison of two models of stress management: hassles and uplifts versus major life events.Journal of Behavioral Medicine. 1981;4:1–39.
Lazarus R, Folkman S.Stress, Appraisal, and Coping. NY: Springer; 1984.
Brugha TS, Cragg D. The list of life threatening experiences: the reliability and validity of the Brief Life Events Questionnaire.ACTA Psychiatrica Scandinaica. 1990;82:77–81.
Bollen K, Lennox R. Conventional wisdom on measurement: a structural equation perspective.Psychological Bulletin. 1991;110:305–314.
Levin SS, Taylor RJ, Chatters LM. A multidimensional measure of religious involvement for African-Americans.Sociological Quarterly. 1995;36:157–173.
Wallace CJ. Functional assessment in rehabilitation.Schizophrenia Bulletin. 1986;12:604–624.
Weissman MM. The assessment of social adjustment: a review of techniques.Archives of General Psychiatry. 1975;32:357–365.
Bybee D, Mowbray CT. Effectiveness of supported education models for people with severe disorders. Poster presented at: The NIMH International Conference on Mental Health Services Research; September 1995; Bethesda, Md.
Aiken LS, West SG.Multiple Regression: Testing and Interpreting Interactions. Newbury Park, Calif: Sage; 1991.
Mowbray CT, Oyserman D, Bybee D, Callahan J, Maclarlane P. Diagnostic differences among women with long-term, serious mental illness.Psychological Services. In press.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations.Journal of Personality and Social Psychology. 1986;51:1173–1182.
Jackson AP. Black, single, working mothers in poverty: preferences for employment, well-being, and perceptions of preschool-age children.Social Work. 1993;38:26–34.
Anderson NB, Armstead CA. Toward understanding the association of socioeconomic status and health: a new challenge for the biopsychosocial approach.Psychosomatic Medicine. 1995;57:213–225.
Mondanaro J.Chemically Dependent Women: Assessment and Treatment. Lexington, Mass: Lexington Books; 1989.
Seeman MV. Narratives of twenty to thirty year outcomes in schizophrenia.Psychiatry: Interpersonal and Biological Processes. 1998;61:249–261.
Williams CC, Collins AA. Defining new frameworks for psychosocial intervention.Psychiatry. 1999;62:61–78.
Lehman AF. Quality of care in mental health: the case of schizophrenia.Health Affairs. 1999;18:52–65.
Benn R.A Statewide Definition of Eligibility Under P.L. 99-457, Part H: A Final Research Report. Detroit, Mich: Merrill-Palmer Institute, Wayne State University; 1991.
D'Ercole A. Single mothers: stress, coping, and social support.Journal of Community Psychology. 1988;16(special issue):41–54.
Hendryx MS, Ahern MM. Mental health functioning and community problems.Journal of Community Psychology. 1997;25:147–157.
Wijnberg MH, Reding KM. Reclaiming a stress focus: the hassles of rural, poor single mothers.Families in Society. 1999;80:506–515.
Weissman MM, Leaf PJ, Bruce ML. Single parent women: a community study.Social Psychiatry. 1987;22:29–36.
Steffens PD, Schumm WR. Economic and social-psychological factors as a function of social functioning status among low-income women in Kansas.Psychological Reports. 1999;84:657–661.
Sullivan WP. Recoiling, regrouping, and recovering: first-person accounts of the role of spirituality in the course of serious mental illness.New Directions for Mental Health Services. 1998;80:25–33.
Walters J, Neugeboren B. Collaboration between mental health organizations and religious institutions.Psychiatric Rehabilitation Journal. 1995;19:51–57.
Harding CM, Keller AB. Long-term outcome of social functioning. In: Mueser KT, Tarrier N, eds.Handbook of Social Functioning in Schizophrenia. Boston: Allyn & Bacon; 1998:134–148.
Pancheri P, Romiti R, Marconi PL, et al. Reproductivity in schizophrenia and mood disorders: a retrospective study.New Trends in Experimental and Clinical Psychiatry. 1990;6:29–44.
Mowbray CT, Schwartz S, Bybee D, et al. Mothers with mental illness: stressors and resources for parenting and living.Families & Society. 2000;81:118–129.
Holstein AR, Harding CM. Omissions in assessment of work roles: implications for evaluating social functioning and mental illness.American Journal of Orthopsychiatry. 1992;62:469–474.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bybee, D., Mowbray, C.T., Oyserman, D. et al. Variability in community functioning of mothers with serious mental illness. The Journal of Behavioral Health Services & Research 30, 269–289 (2003). https://doi.org/10.1007/BF02287317
Issue Date:
DOI: https://doi.org/10.1007/BF02287317