Schizophrenia Bulletin Advance Access originally published online on August 2, 2006
Schizophrenia Bulletin 2006 32(4):776-785; doi:10.1093/schbul/sbl013
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Schizophrenia Patients With Cognitive Deficits: Factors Associated With Costs
2 King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF UK
3 Personal Social Services Research Unit, London School of Economics Health and Social Care, London School of Economics, London, WC2A 2AE UK
1To whom correspondence should be addressed; Centre for the Economics of Mental Health, PO Box 24, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK; tel: +44-20-7848-0589, fax: +44-20-7701-7600, e-mail: a.patel{at}iop.kcl.ac.uk.
Cognitive deficits in people with schizophrenia are associated with poor functioning and lower quality of life. Because few studies have examined their relationship with service use or costs, it is unclear whether effective cognitive remediation interventions have potential for economic impacts. This study examined associations between cognition and costs among people with schizophrenia. Baseline data collected between 1999 and 2002 from a randomized controlled trial of cognitive remediation therapy were analyzed. A total of 85 participants were recruited from a London mental health trust if they had a diagnosis of schizophrenia, evidence of cognitive/social functioning difficulties, and at least 1 year since first contact with psychiatric services. Cognition levels, social functioning, symptoms, sociodemographic characteristics, and retrospective use of health/social care and other resources were measured. Average public sector costs were estimated to be £15 078 ($23 824) for a 6-month period. Associations between health/social care costs and type and severity of cognition were examined using structural equation models. No significant relationships were found between cognition and costs in a model based on 3 independent constituent components of cognition (cognitive shifting, verbal working memory, and response inhibition), although a model with covarying cognition components fitted the observed data well. A model with cognition as a single construct both fitted well and showed a significant relationship. In people with schizophrenia and severe cognitive impairment, improvements in either overall cognition or specific cognitive components may impact on costs. Further investigation in larger samples is needed to confirm this finding and to explore its generalizability to those with less severe deficits.
Keywords: service utilization / structural equation models / remediation