Agreement between clients with schizophrenia and mental health workers on clients' social quality of life: The role of social cognition and symptoms

Objective: Studies have showed that therapists and mental health workers of persons with schizophrenia tend to estimate their patients’ social quality of life (SQoL) as poorer than the clients’ own estimation. This study explores the hypothesis that this discrepancy is related to clients’ social cognition and symptomatology. Design: Cross-sectional assessment of both clients and their mental health workers. Methods: Ninety persons with schizophrenia and 12 persons who were formal care providers participated in the study. All responded to a parallel version (client and clinician) of social quality-of-life scales. Clients’ emotion identification, theory of mind and symptoms were also assessed. Results: Low social cognitive abilities of persons with schizophrenia, as well as negative symptomatology and having children, may be related to the negative bias of mental health workers, with regard to their client's SQoL. Conclusions: While more severe levels of negative symptoms and more deficits of social cognition were related to reduced levels of agreement, paradoxically, a relatively normative family life that includes parenting was also related to lower levels of agreement. Practitioner points: Attention should be given to low agreement between clients with schizophrenia and clinicians with regard to the client's quality of life, as it is central to alliance and outcome. Clinicians tend to estimate clients’ social quality of life as poorer than the clients’ own estimation when those clients have low social cognition, high negative symptomatology and children. There is a need to identify additional factors that contribute to agreement and alliance in therapy. Longitudinal assessment during therapy can trace the process of construction of agreement.