Abstract
Background
Self-efficacy (belief in one’s ability to complete activities or manage symptoms) is often poor in people with schizophrenia. Low self-efficacy is associated with negative symptoms and neurocognition which, together, may worsen psychosocial functioning. This study explores causal patterns between these variables by assessing their temporal associations and their combined role in predicting functioning using cross-sectional and longitudinal data.
Methods
This study is a secondary analysis of data from 103 older adults with schizophrenia-spectrum disorders engaged in a randomized controlled trial (Helping Older People Experience Success or Treatment As Usual). Cross-sectional and longitudinal measures included neurocognition, positive and negative symptoms, self-efficacy, and three measures of functioning (Independent Living Skills Survey [ILSS], The Multnomah Community Ability Scale (MCAS), University of California, San Diego Performance-Based Skills Assessment [UPSA]).
Results
Self-efficacy was associated with self-reported functional skills (ILSS) only. The impact of self-efficacy on functioning was partially mediated by negative symptoms. This mediation was also present when predicting functioning at one year, unaffected when depression and positive symptoms were controlled.
Conclusions
This study suggests direct and indirect effects of self-efficacy, via negative symptoms, on functioning in older adults with schizophrenia. Self-efficacy and negative symptoms should be intervention targets to improve functional difficulties in older adults with schizophrenia.
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References
Allott, K., Liu, P., Proffitt, T. M., & Killackey, E. (2011). Cognition at illness onset as a predictor of later functional outcome in early psychosis: Systematic review and methodological critique. Schizophrenia Research, 125(2–3), 221–235. https://doi.org/10.1016/j.schres.2010.11.001.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Publisher.
Andreasen, N. C. (1989). The Scale for the Assessment of Negative Symptoms (SANS): conceptual and theoretical foundations. British Journal of Psychiatry, Suppl(7), 49–58.
Auslander, L. A., Lindamer, L. L., Delapena, J., Harless, K., Polichar, D., Patterson, T. L., et al. (2001). A comparison of community-dwelling older schizophrenia patients by residential status. Acta Psychiatrica Scandinavica, 103(5), 380–386. https://doi.org/10.1034/j.1600-0447.2001.00262.x.
Austin, S. F., Mors, O., Secher, R. G., Hjorthøj, C. R., Albert, N., Bertelsen, M., et al. (2013). Predictors of recovery in first episode psychosis: The OPUS cohort at 10year follow-up. Schizophrenia Research, 150(1), 163–168. https://doi.org/10.1016/j.schres.2013.07.031.
Avery, R., Startup, M., & Calabria, K. (2009). The role of effort, cognitive expectancy appraisals and coping style in the maintenance of the negative symptoms of schizophrenia. Psychiatry Research, 167(1–2), 36–46. https://doi.org/10.1016/j.psychres.2008.04.016.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.
Bandura, A., & Cervone, D. (1983). Self-evaluative and self-efficacy mechanisms governing the motivational effects of goal systems. Journal of Personality and Social Psychology, 45, 1017–1028. https://doi.org/10.1037/0022-3514.45.5.1017.
Barker, S., Barron, N., McFarland, B. H., & Bigelow, D. A. (1994). A community ability scale for chronically mentally ill consumers: Part I. Reliability and validity. Community Mental Health Journal, 30(4), 363–383. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7956112
Bartels, S. J., Mueser, K. T., & Miles, K. M. (1997a). A comparative study of elderly patients with schizophrenia and bipolar disorder in nursing homes and the community. Schizophrenia Research, 27(2–3), 181–190. https://doi.org/10.1016/S0920-9964(97)00080-7.
Bartels, S. J., Mueser, K. T., & Miles, K. M. (1997b). Functional impairments in elderly patients with schizophrenia and major affective illness in the community: Social skills, living skills, and behavior problems. Behavior Therapy, 28(1), 43–63. https://doi.org/10.1016/S0005-7894(97)80033-0.
Bartels, S. J., Pratt, S. I., Mueser, K. T., Forester, B. P., Wolfe, R., Cather, C., et al. (2014). Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness. American Journal of Geriatric Psychiatry, 22(11), 1251–1261. https://doi.org/10.1016/j.jagp.2013.04.013.
Bassani, D. G., Dewa, C. S., Krupa, T., Aubry, T., Gehrs, M., Goering, P. N., & Streiner, D. L. (2009). Factor structure of the Multnomah community ability scale – Longitudinal analysis. Psychiatry Research, 167(1–2), 178–189. https://doi.org/10.1016/j.psychres.2008.01.005.
Beck, A. T., & Rector, N. A. (2005). Cognitive approaches to schizophrenia: Theory and therapy. Annual Review of Clinical Psychology, 1(1), 577–606. https://doi.org/10.1146/annurev.clinpsy.1.102803.144205.
Bismark, A. W., Thomas, M. L., Tarasenko, M., Shiluk, A. L., Rackelmann, S. Y., Young, J. W., & Light, G. A. (2018). Relationship between effortful motivation and neurocognition in schizophrenia. Schizophrenia Research, 193(2018), 69–76. https://doi.org/10.1016/j.schres.2017.06.042.
Bowie, C. R., Leung, W. W., Reichenberg, A., McClure, M. M., Patterson, T. L., Heaton, R. K., & Harvey, P. D. (2008). Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biological Psychiatry, 63(5), 505–511. https://doi.org/10.1016/j.biopsych.2007.05.022.
Cardenas, V., Abel, S., Bowie, C. R., Tiznado, D., Depp, C. A., Patterson, T. L., et al. (2013). When functional capacity and real-world functioning converge: The role of self-efficacy. Schizophrenia Bulletin, 39(4), 908–916. https://doi.org/10.1093/schbul/sbs004.
Carpenter, W. T., & Strauss, J. S. (1991). The prediction of outcome in schizophrenia IV: Eleven-year follow-up of the Washington IPSS cohort. The Journal of Nervous and Mental Disease, 179(9), 517–525.
Chang, W. C., Kwong, V. W. Y., Hui, C. L. M., Chan, S. K. W., Lee, E. H. M., & Chen, E. Y. H. (2017). Relationship of amotivation to neurocognition, self-efficacy and functioning in first-episode psychosis: A structural equation modeling approach. Psychological Medicine, 47(4), 755–765. https://doi.org/10.1017/S0033291716003044.
Chino, B., Nemoto, T., Fujii, C., & Mizuno, M. (2009). Subjective assessments of the quality of life, well-being and self-efficacy in patients with schizophrenia: Regular article. Psychiatry and Clinical Neurosciences, 63(4), 521–528. https://doi.org/10.1111/j.1440-1819.2009.01995.x.
Corrigan, P. W., Larson, J. E., & Rüsch, N. (2009). Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 8(2), 75–81. https://doi.org/10.1002/j.2051-5545.2009.tb00218.x.
de Leon, C. F. M., Seeman, T. E., Baker, D. I., Richardson, E. D., & Tinetti, M. E. (1996). Self-efficacy, physical decline, and change in functioning in community-living elders: A prospective study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 51B(4), S183–S190. https://doi.org/10.1093/geronb/51b.4.s183.
Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Examiner’s manual, Delis Kaplan executive function system. San Antonio: Psychological Corporation.
Dickinson, D., Ramsey, M. E., & Gold, J. M. (2007). Overlooking the obvious. A meta-analytic comparison of digit symbol coding tasks and other cognitive measures in schizophrenia. Archives of General Psychiatry, 64(5), 532–542. https://doi.org/10.1001/archpsyc.64.5.532.
Dong, Y., & Peng, C.-Y. J. (2013). Principled missing data method the researchers. Springer Plus, 2(222), 1–17.
Emmerson, L. C., Granholm, E., Link, P. C., McQuaid, J. R., & Jeste, D. V. (2009). Insight and treatment outcome with cognitive-behavioral social skills training for older people with schizophrenia. Journal of Rehabilitation Research and Development, 46(8), 1053–1058. https://doi.org/10.1682/JRRD.2009.04.0042.
Evans, J. D., Negron, A. E., Palmer, B. W., Paulsen, J. S., Heaton, R. K., & Jeste, D. V. (1999). Cognitive deficits and psychopathology in institutionalized versus community-dwelling elderly schizophrenia patients. Journal of Geriatric Psychiatry and Neurology, 12(1), 11–15. https://doi.org/10.1177/089198879901200104.
Fortuna, K. L., Lohman, M. C., Bruce, M. L., & Bartels, S. J. (2018). Utility of functioning measures in the prediction of independent living status in older adults with serious mental illness. International Journal of Geriatric Psychiatry, 33(2), 423–431. https://doi.org/10.1002/gps.4764.
Gallagher, M. W., Payne, L. A., White, K. S., Shear, K. M., Woods, S. W., Gorman, J. M., & Barlow, D. H. (2013). Mechanisms of change in cognitive behavioral therapy for panic disorder: The unique effects of self-efficacy and anxiety sensitivity. Behaviour Research and Therapy, 51(11), 767–777. https://doi.org/10.1016/j.brat.2013.09.001.
Granholm, E., Auslander, L. a., Gottlieb, J. D., McQuaid, J. R., & McClure, F. S. (2006). Therapeutic factors contributing to change in cognitive-behavioral group therapy for older persons with schizophrenia. Journal of Contemporary Psychotherapy, 36(1), 31–41. https://doi.org/10.1007/s10879-005-9004-7.
Granholm, E., Holden, J., Link, P. C., McQuaid, J. R., & Jeste, D. V. (2013). Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: Defeatist performance attitudes and functional outcome. The American Journal of Geriatric Psychiatry, 21(3), 1–17. https://doi.org/10.1016/j.jagp.2012.10.014.Randomized.
Granholm, E., Holden, J., Link, P. C., & McQuaid, J. R. (2014). Randomized clinical trial of cognitive behavioral social skills training for schizophrenia: Improvement in functioning and experiential negative symptoms. Journal of Consulting and Clinical Psychology, 82(6), 1173–1185. https://doi.org/10.1016/j.cortex.2009.08.003.Predictive.
Granholm, E., Ruiz, I., Gallegos-Rodriguez, Y., Holden, J., & Link, P. C. (2016). Pupillary responses as a biomarker of diminished effort associated with defeatist attitudes and negative symptoms in schizophrenia. Biological Psychiatry, 15(80), 581–588. https://doi.org/10.1016/j.physbeh.2017.03.040.
Grant, P. M., & Beck, A. T. (2009). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin, 35(4), 798–806. https://doi.org/10.1093/schbul/sbn008.
Green, P. (2007). The pervasive influence of effort on neuropsychological tests. Physical Medicine and Rehabilitation Clinics of North America, 18(1), 43–68. https://doi.org/10.1016/j.pmr.2006.11.002.
Green, M. F., Kern, R. S., & Heaton, R. K. (2004). Longitudinal studies of cognition and functional outcome in schizophrenia: Implications for MATRICS. Schizophrenia Research, 72, 41–51. https://doi.org/10.1016/j.schres.2004.09.009.
Gupta, S., Steinmeyer, C., Frank, B., Lockwood, K., Lentz, B., & Schultz, K. (2003). Older patients with schizophrenia: Nature of dwelling status and symptom severity. American Journal of Psychiatry, 160(2), 383–384. https://doi.org/10.1176/appi.ajp.160.2.383.
Harvey, P. D., Howanitz, E., Parrella, M., White, L., Davidson, M., Mohs, R. C., et al. (1998). Symptoms, cognitive functioning, and adaptive skills in geriatric patients with lifelong schizophrenia: A comparison across treatment sites. American Journal of Psychiatry, 155(8), 1080–1086. https://doi.org/10.1176/ajp.155.8.1080.
Hill, K., & Startup, M. (2013). The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: The mediating role of self-efficacy. Psychiatry Research, 206(2–3), 151–157. https://doi.org/10.1016/j.psychres.2012.09.056.
Ikebuchi, E. (2015). Negative symptoms revisited – Toward the recovery of persons with schizophrenia. Seishin Shinkeigaku Zasshi = Psychiatria et Neurologia Japonica, 117(3), 179–194.
Kramer, A. O., Casaletto, K. B., Umlauf, A., Staffaroni, A. M., Fox, E., You, M., et al. (2020). Robust normative standards for the California Verbal Learning Test (CVLT) ages 60–89: A tool for early detection of memory impairment. The Clinical Neuropsychologist, 34(2), 384–405. https://doi.org/10.1080/13854046.2019.1619838.Robust.
Kurtz, M. M., & Mueser, K. T. (2008). A meta-analysis of controlled research on social skills training for schizophrenia. Journal of Consulting and Clinical Psychology, 76(3), 491–504. https://doi.org/10.1037/0022-006X.76.3.491.
Kurtz, M. M., & Wexler, B. E. (2006). Differences in performance and learning proficiency on the Wisconsin Card Sorting Test in schizophrenia: Do they reflect distinct neurocognitive subtypes with distinct functional profiles? Schizophrenia Research, 81(2–3), 167–171. https://doi.org/10.1016/j.schres.2005.09.003.
Kurtz, M. M., Moberg, P. J., Mozley, L. H., Hickey, T., Arnold, S. E., Bilker, W. B., & Gur, R. E. (2001). Cognitive impairment and functional status in elderly institutionalized patients with schizophrenia. International Journal of Geriatric Psychiatry, 16(6), 631–638. https://doi.org/10.1002/gps.394.
Kurtz, M., Olfson, R., & Rose, J. (2013). Self-efficacy and functional status in schizophrenia: Relationship to insight, cognition and negative symptoms. Schizophrenia Research, 145(1), 69–74. https://doi.org/10.1007/s10995-015-1800-4.Alcohol.
Lepage, M., Bodnar, M., & Bowie, C. R. (2014). Neurocognition: Clinical and functional outcomes in schizophrenia. Canadian Journal of Psychiatry, 59(1), 5–12. https://doi.org/10.1177/070674371405900103.
Leung, W. W., Bowie, C. R., & Harvey, P. D. (2008). Functional implications of neuropsychological normality and symptom remission in old outpatients with schizophrenia: A cross-sectional study. Journal of the International Neuropsychological Society, 14(3), 479–488. https://doi.org/10.1017/S1355617708080600.Functional.
Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. (1997). Center for epidemiologic studies depression scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12(2), 277–287. https://doi.org/10.1037/0882-7974.12.2.277.
Liberman, R. P., Mueser, K. T., Wallace, C. J., Jacobs, H. E., Eckman, T., & Massel, H. K. (1986). Training skills in the psychiatrically disabled: Learning coping and competence. Schizophrenia Bulletin, 12(4), 631–647. https://doi.org/10.1093/schbul/12.4.631.
Luther, L., Coffin, G. M., Firmin, R. L., Bonfils, K. A., Minor, K. S., & Salyers, M. P. (2018). A test of the cognitive model of negative symptoms: Associations between defeatist performance beliefs, self-efficacy beliefs, and negative symptoms in a non-clinical sample. Psychiatry Research, 269(1), 278–285. https://doi.org/10.1016/j.physbeh.2017.03.040.
Mausbach, B. T., Moore, R., Bowie, C., Cardenas, V., & Patterson, T. L. (2009). A Review of instruments for measuring functional recovery in those diagnosed with psychosis. Schizophrenia Bulletin, 35(2), 307–318. https://doi.org/10.1093/schbul/sbn152.
Mausbach, B. T., Depp, C. A., Bowie, C. R., Harvey, P. D., McGrath, J. A., Thronquist, M. H., et al. (2011). Sensitivity and specificity of the UCSD Performance-based Skills Assessment (UPSA-B) for identifying functional milestones in schizophrenia. Schizophrenia Research, 132(2–3), 165–170. https://doi.org/10.1016/j.schres.2011.07.022.
McDermott, B. E. (1995). Development of an instrument for assessing self-efficacy in schizophrenia spectrum disorders. Journal of Clinical Psychology, 51(3), 320–331.
McKnight, P. E., McKnight, K. M., Sidani, S., & Figueredo, A. J. (2007). Missing data: A gentle introduction. New York: The Guilford Press.
Michon, H. W. C., van Weeghel, J., Kroon, H., & Schene, A. H. (2005). Person-related predictors of employment outcomes after participation in psychiatric vocational rehabilitation programmes. Social Psychiatry and Psychiatric Epidemiology, 40(5), 408–416. https://doi.org/10.1007/s00127-005-0910-5.
Mitchell, T. R., Hopper, H., Daniels, D., George-falvy, J., & James, L. R. (1994). Predicting self-efficacy and performance during skill acquisition: Carlos Albizu virtual library. Journal of Applied Psychology, 79(4), 506–517.
Morimoto, T., Matsuyama, K., Ichihara-Takeda, S., Murakami, R., & Ikeda, N. (2012). Influence of self-efficacy on the interpersonal behavior of schizophrenia patients undergoing rehabilitation in psychiatric day-care services. Psychiatry and Clinical Neurosciences, 66(3), 203–209. https://doi.org/10.1111/j.1440-1819.2012.02332.x.
Mueser, K. T., Bellack, A. S., Morrison, R. L., & Wixted, J. T. (1990). Social competence in schizophrenia: Premorbid adjustment, social skill, and domains of functioning. Journal of Psychiatric Research, 24(1), 51–63. https://doi.org/10.1016/0022-3956(90)90024-K.
Mueser, K. T., Pratt, S. I., Bartels, S. J., Swain, K., Forester, B., Cather, C., & Feldman, J. (2010). Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness. Journal of Consulting and Clinical Psychology, 78(4), 561–573. https://doi.org/10.1037/a0019629.
Mueser, K. T., Gottlieb, J. D., & Gingerich, S. (2013). Social skills and problem-solving training. The Wiley Handbook of Cognitive Behavioral Therapy, I, 243–272. https://doi.org/10.1002/9781118528563.wbcbt12.
Nakamura, H., Watanabe, N., & Matsushima, E. (2014). Structural equation model of factors related to quality of life for community-dwelling schizophrenic patients in Japan. International Journal of Mental Health Systems, 8(1), 1–12. https://doi.org/10.1186/1752-4458-8-32.
Newman, S. C., Bland, R. C., & Thompson, A. H. (2012). Long-term course and outcome in schizophrenia: A 34-year follow-up study in Alberta, Canada. Psychological Medicine, 42(10), 2137–2143. https://doi.org/10.1017/S0033291712000177.
Palmer, B. W., Heaton, R. K., Gladsjo, J. A., Evans, J. D., Patterson, T. L., Golshan, S., & Jeste, D. V. (2002). Heterogeneity in functional status among older outpatients with schizophrenia: Employment history, living situation, and driving. Schizophrenia Research, 55(3), 205–215. https://doi.org/10.1016/S0920-9964(01)00218-3.
Pajares, F., & Graham, L. (1999). Self-efficacy, motivation constructs, and mathematics performance of entering middle school students. Contemporary Educational Psychology, 24, 124–139.
Patterson, T. L., Goldman, S., McKibbin, C. L., Hughs, T., & Jeste, D. V. (2001). UCSD performance-based skills assessment: Development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin, 27(0680), 235–245.
Pinkham, A. E., Harvey, P. D., & Penn, D. L. (2018). Social cognition psychometric evaluation: Results of the final validation study. Schizophrenia Bulletin, 44(4), 737–748. https://doi.org/10.1093/schbul/sbx117.
Pratt, S. I., Mueser, K. T., Smith, T. E., & Lu, W. (2005). Self-efficacy and psychosocial functioning in schizophrenia: A mediational analysis. Schizophrenia Research, 78(2–3), 187–197. https://doi.org/10.1016/j.schres.2005.02.014.
Pratt, S. I., Bartels, S. J., Mueser, K. T., & Forester, B. (2008). Helping older people experience success: An integrated model of psychosocial rehabilitation and health care management for older adults with serious mental illness. American Journal of Psychiatric Rehabilitation, 11(1), 41–60. https://doi.org/10.1080/15487760701853193.
Preacher, K., & Hayes, A. (2008). Assessing mediation in communication research. In A. F. Hayes, M. D. Slater, & L. B. Snyder (Eds.), The Sage sourcebook of advanced data analysis methods for communication research (pp. 13–54). Thousand Oaks: Sage.
Probst, T., Dehoust, M., Brütt, A. L., Schulz, H., Pieh, C., & Andreas, S. (2018). Mentalization and self-efficacy as mediators between psychological symptom severity and disabilities in activities and participation in psychotherapy patients. Psychopathology, 51(1), 38–46. https://doi.org/10.1159/000485980.
Radloff, L. S. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
Rector, N. A. (2004). Dysfunctional attitudes and symptom expression in schizophrenia: Differential associations with paranoid delusions and negative symptoms. Journal of Cognitive Psychotherapy, 18(2), 163–173. https://doi.org/10.1891/jcop.18.2.163.65959.
Rector, N. A., Beck, A. T., & Stolar, N. (2005). The negative symptoms of schizophrenia: A cognitive perspective. Canadian Journal of Psychiatry, 50(5), 247–257.
Schaefer, J., Giangrande, E., Weinberger, D. R., & Dickinson, D. (2013). The global cognitive impairment in schizophrenia: Consistent over decades and around the world. Schizophrenia Research, 150(1), 42–50. https://doi.org/10.1016/j.schres.2013.07.009.
Schafer, J. L., & Graham, J. W. (2002). Missing data: Our view of the state of the art. Psychological Methods, 7(2), 147–177. https://doi.org/10.1037/1082-989X.7.2.147.
Stone, W. S., Giuliano, A. J., Tsuang, M. T., Braff, D. L., Cadenhead, K. S., Calkins, M. E., et al. (2011). Group and site differences on the California Verbal Learning Test in persons with schizophrenia and their first-degree relatives: Findings from the Consortium on the Genetics of Schizophrenia (COGS). Schizophrenia Research, 128(1–3), 102–110. https://doi.org/10.1016/j.schres.2011.01.005.
Torgalsbøen, A. K., Mohn, C., Czajkowski, N., & Rund, B. R. (2015). Relationship between neurocognition and functional recovery in first-episode schizophrenia: Results from the second year of the Oslo multi-follow-up study. Psychiatry Research, 227(2–3), 185–191. https://doi.org/10.1016/j.psychres.2015.03.037.
Turner, D. T., McGlanaghy, E., Cuijpers, P., Van Der Gaag, M., Karyotaki, E., & MacBeth, A. (2018). A meta-analysis of social skills training and related interventions for psychosis. Schizophrenia Bulletin, 44(3), 475–491. https://doi.org/10.1093/schbul/sbx146.
Valentijn, S. A. M., Hill, R. D., Van Hooren, S. A. H., Bosma, H., Van Boxtel, M. P. J., Jolles, J., & Ponds, R. W. H. M. (2006). Memory self-efficacy predicts memory performance: Results from a 6-year follow-up study. Psychology and Aging, 21(1), 165–172. https://doi.org/10.1037/0882-7974.21.2.165.
Vaskinn, A., Ventura, J., Andreassen, O. A., Melle, I., & Sundet, K. (2015). A social path to functioning in schizophrenia: From social self-efficacy through negative symptoms to social functional capacity. Psychiatry Research, 228(3), 803–807. https://doi.org/10.1016/j.psychres.2015.05.019.
Ventura, J., Lukoff, D., Nuechterlein, K. H., Liberman, R. P., Green, M., & Shaner, A. (1993). Appendix 1: Brief psychiatric rating scale BPRS expanded version 4.0 scales, anchorpoints and administration manual. International Journal of Methods in Psychiatric Research, 3, 227–243.
Ventura, J., Hellemann, G. S., Thames, A. D., Koellner, V., & Nuechterlein, K. H. (2009). Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: A meta-analysis. Schizophrenia Research, 113(2–3), 189–199. https://doi.org/10.1016/j.schres.2009.03.035.
Ventura, J., Subotnik, K. L., Ered, A., Gretchen-Doorly, D., Hellemann, G. S., Vaskinn, A., & Nuechterlein, K. H. (2014). The relationship of attitudinal beliefs to negative symptoms, neurocognition, and daily functioning in recent-onset schizophrenia. Schizophrenia Bulletin, 40(6), 1308–1318. https://doi.org/10.1093/schbul/sbu002.
Wallace, C. J., Liberman, R. P., Tauber, R., & Wallace, J. (1997). The independent living skills survey: A comprehensive measure of the community functioning of severely and persistently mentally 111 individuals. Schizophrenia Bulletin, 26(3), 631–658.
White, L., Harvey, P. D., Parella, M., Knobler, H., Powchik, P., & Davidson, M. (1994). Empirical assessment of the factorial structure of clinical symptoms in schizophrenic patients: Symptom structure in geriatric and nongeriatric samples. New Trends in Experimental and Clinical Psychiatry, 10, 75–83.
Wykes, T., Steel, C., Everitt, B., & Tarrier, N. (2008). Cognitive behavior therapy for schizophrenia: Effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin, 34(3), 523–537. https://doi.org/10.1093/schbul/sbm114.
Zlomuzica, A., Preusser, F., Schneider, S., & Margraf, J. (2015). Increased perceived self-efficacy facilitates the extinction of fear in healthy participants. Frontiers in Behavioral Neuroscience, 9, 1–12. https://doi.org/10.3389/fnbeh.2015.00270.
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Dr. Browne is funded by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship in Geriatrics. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the United States Government or Department of Veterans Affairs.
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Wright, A.C., Browne, J., Cather, C. et al. Does Self-Efficacy Predict Functioning in Older Adults with Schizophrenia? A Cross-Sectional and Longitudinal Mediation Analysis. Cogn Ther Res 45, 136–148 (2021). https://doi.org/10.1007/s10608-020-10171-8
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DOI: https://doi.org/10.1007/s10608-020-10171-8