Schizophrenia Bulletin Advance Access published online on May 4, 2007
Schizophrenia Bulletin, doi:10.1093/schbul/sbm037
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The Role of Neurocognition and Social Context in Predicting Community Functioning Among Formerly Homeless Seriously Mentally Ill Persons
2 Department of Psychiatry, Harvard Medical School, Massachusetts Mental Health Center, Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Boston, MA, USA
3 Department of Sociology, University of Massachusetts at Boston, Boston, MA, USA
4 Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
5 Graduate Program in Applied Sociology, University of Massachusetts at Boston, Boston, MA, USA
6 State University of New York, Downstate Medical Center, Brooklyn, NY, USA
1 To whom correspondence should be addressed; Department of Psychiatry, Beth Israel Deaconess Medical Center, Landmark Center 2E, 401 Park Drive, Boston, MA 02215, USA; tel: 617-998-5034; fax: 617-998-5007, e-mail: rschutt{at}bidmc.harvard.edu.
Objective: To test the influence of neurocognitive functioning on community functioning among formerly homeless persons with serious mental illness and to determine whether that influence varies with social context, independent of individual characteristics. Methods: In metropolitan Boston, 112 persons in Department of Mental Health shelters were administered a neuropsychological test battery and other measures and then randomly assigned to empowerment-oriented group homes or independent apartments, as part of a longitudinal study of the effects of housing on multiple outcomes. Subjects’ case managers completed Rosen's 5-dimensional Life Skills Inventory at 3, 6, 12, and 18 months and subjects reported on their social contacts at baseline, 6, 12, and 18 months. Subject characteristics are controlled in the analysis. Results: Three dimensions of neurocognitive functioning—executive function, verbal declarative memory, and vigilance—each predicted community functioning. Better executive function predicted improved self-care and less turbulent behavior among persons living alone, better memory predicted more positive social contacts for those living in a group home, and higher levels of vigilance predicted improved communication in both housing types. Conclusion: Neurocognition predicts community functioning among homeless persons with severe mental illness, but in a way that varies with the social context in which community functioning occurs.
Keywords: neurocognition / executive function / community functioning / homeless / housing / social environment
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