ANÁLISIS DE CAUSAS Y PLAN DE ACCION
5. ACTIVIDADES PLANIFICADAS
Analysis of the results was done using the Statistical Package for the Social Sciences (SPSS-PC), version 18. First, data were scrutinized for incorrectly filled information and normality of distribution of data, using frequency counts and graphical displays. Thereafter, the results were displayed in frequencies and tables as appropriate. Normally (or fairly normally) distributed data were analyzed by parametric statistics (e.g., t-tests, one-way ANOVA, paired t-test); while non-normally distributed data were analyzed by non-parametric statistic equivalents (e.g., Chi-square). Group comparisons were done using Chi-square test (categorical variables) and t-tests
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(for continuous variables). Repeated measures analysis of variance was used to assess significant differences in change in psychopathology scores across the period of follow-up. Multivariate analyses using step-wise multiple regressions were used to assess predictors of outcome. All tests of significance were two-tailed at the 5% level of significance and confidence interval estimation of 95%.
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CHAPTER FIVE 5.0: RESULTS
5.1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE PARTICIPANTS.
A total of 160 subjects participated in the study.
5.1.1: AGE, GENDER, MARITAL STATUS, LEVEL OF EDUCATION, EMPLOYMENT STATUS, AND CAREGIVER RELATIONSHIP OF THE PARTICIPANTS.
The socio-demographic profile of the participants is presented in table 1.
Age: Participants aged between 21-40 years constituted the majority of the subjects with 41.3%
while those below 20 and above 40 years were 9.4% and 11.2%, respectively. The mean age of the participants was 31.13±12.15 years.
Gender: The number of male and female participants was almost equal (48.8% and 51.2%, respectively).
Marital status: One hundred and six (66.3%) participants were never married while 40 (25.0%) were married and the remaining14 (8.8%) were separated, divorced, or widowed.
Education: Majority of the participants had secondary education (53.8%). Only 4 (2.5%) of the participants did not have any formal education, while 37 (23.1%) and 33(20.6%) had primary and tertiary education, respectively.
Employment status: One hundred and two (63.8%) participants were unemployed while 58 (36.2%) were in one form of employment (i.e., either part-time or full employment).
Caregiver relationships: Majority of the participants were cared for by a first-degree relative (69.4%) while 40.6% were cared for by a friend or others.
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Table 1: Socio-demographic characteristics of the participants
Characteristics Frequency (%) Statistics
Age of participants (years) 31.13±12.15
18-20 21-30 31-40 41-49
15(9.4%) 61(38.1%) 66(41.3%) 18(11.2%) Gender
Male Female
78(48.8%) 82(51.2%) Marital status
Never married Married
Separated/divorced/widowed
106(66.3%) 40(25.0%) 14(8.8%) Level of Education
No formal Primary Secondary Tertiary
4(2.5%) 37(23.1%) 86(53.8%) 33(20.6%) Employment status
Unemployed Employed
102(63.8%) 58(36.2%) Care giver relationships
Parents Sibling Friends Others
47(29.4%) 64(40.0%) 5(3.1%) 44(27.5%)
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5.2: CLINICAL CHARACTERISTICS OF THE PARTICIPANTS.
5.2.1: AGE AT ONSET OF ILLNESS, DURATION OF ILLNESS, MODE OF ONSET, FAMILY HISTORY OF MENTAL DISORDERS, AND MEDICATION PRESCRIBED.
The age at onset, duration of illness in months, mode of onset, family history of mental disorders, and the antipsychotic medication prescribed for the participants are presented in table 2.
Age at onset: Seventy (43.8%) participants had the onset of the illness between the age of 21 to 30. Forty six (28.8%) had the illness between 15 to 20 years while 6 (3.6%) had the onset above the age of 41 years. The mean age at onset was 26.33±12.15.
Duration of illness: Seventy-five (46.9%) participants had duration of illness less than or equal 2years, while 20(12.5%) and 65(40.6%) had the duration of illness of above 2 years to 4 years and more than 4 years, respectively. The mean duration of illness before entering the study, in months, was 63.18±74.15.
Mode of onset: The mode of onset in 67(41.9%) participants was acute while 93(58.1%) had insidious onset.
Family history of mental disorder: Ninety-three (58.1%) participants had family history of mental illness while 64(41.9%) had no family history.
Antipsychotic medication prescribed: Majority of the participants (48.8%) was placed on haloperidol by the managing team. Thirty-nine (24.4%) were on olanzapine while only one person (0.6%) was on chlorpromazine.
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Table 2: Clinical characteristics of the participants
Characteristics Frequency (%) Statistics
Age at onset 26.33 ± 12.15
15-20 21-30 31-40
41 and above
46(28.8%) 70(43.8%) 38(23.8%) 6(3.6%)
Duration of illness in months 63.18 ± 74.15 Less than 12 months
12-24months 25-36months 37-48months Above 48months
48(30.0%) 27(16.9%) 15(9.4%) 5(3.1%) 65(40.6%) Mode of onset
Acute Insidious
67(41.9%) 93(58.1%) Family History of mental illness
Positive Negative
93(58.1%) 67(41.9%) Antipsychotic medication prescribed
Chlorpromazine Trifluoperazine Haloperidol Risperidone Olanzapine Clozapine Aripiprazole
1(0.6%) 29(18.1%) 78(48.8%) 9(5.6%) 39(24.4%) 2(1.3%) 2(1.3%)
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5.3: PROPORTION OF RESPONSE PER PERIOD OF FOLLOW-UP.
The proportion of the participants that met the criteria for response is shown in table 3.
At the 4th week of follow-up 34.6% and 24.5% met the criteria for response using BPRS and SANS criteria, respectively. At the end of follow-up visit at 16 weeks, 62.7% met response criteria using BPRS criteria while 51.7% responded to treatment using SANS criteria.
Table 3: Response using BPRS and SANS criteria
Follow-up period
BPRS Criteria SANS Criteria
Mean total BPRS score (S.D)
> 50% Reduction Mean total SANS score (S.D)
50% Reduction
Baseline 45.30(13.92) - 83.13(31.51) -
4th week 29.61(17.60) 34.6% 62.74(33.99) 24.5%
8th week 22.52(19.76) 50.3% 48.86(36.52) 41.2%
12th week 20.08(17.73) 55.7% 43.57(37.46) 47.6%
16th week 16.88(16.90) 62.7% 39.99(38.26) 51.7%
NB: Response is defined as symptom reduction >50% of baseline scores in BPRS and SANS.
5.4: PROPORTION OF REMISSION PER PERIOD OF FOLLOW-UP.
The proportion of the participants that met the remission criteria in the study is shown in table 4.
Table 5 shows that at the 4th week of follow-up 37(27.4%) had symptom remission using BPRS criteria while 4(30.4%) remitted using SANS criteria. By the 12th week of follow-up more than 50% of the participants had remitted using either BPRS or SANS criteria.
Percent reduction =
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Table 4: Remission per period of follow-up using BPRS and SANS criteria
Follow-up period Remission BPRS SANS
Frequency Percent Frequency Percent 4th week (N = 135) Remission
No Remission
37 98
27.4%
72.6%
41 94
30.4%
69.6%
8th week (N = 125) Remission No Remission
64 61
51.2%
48.8%
62 63
49.6%
50.4%
12th week (N = 115) Remission No Remission
61 54
53.0%
47.0%
60 55
52.2%
47.8%
16th week (N = 113) Remission No Remission
68 45
60.2%
39.8%
65 48
57.5%
42.5%
NB: Remission in BPRS = Scores ≤ 2 in the following BPRS items (Grandiosity, Suspiciousness, unusual thought content, Hallucinatory behaviour, conceptual disorganization, mannerism/posturing, and blunted affect).
Remission in SANS = Scores ≤ 2 in the following SANS items (Affective flattening, Avolition-apathy, Anhedonia-asociality, and Alogia).
5.5: PROPORTION OF RECOVERY PER PERIOD OF FOLLOW-UP.
The proportion of the participants that recovered during the period of follow-up is shown in tables 5(a) and 5(b).
Table 6a shows that of the 37 participants that met the criteria for symptom remission as measured by BPRS, 6(16.1%) had returned to premorbid psychosocial status at the 4th week of follow-up while 31(83.8%) had poor psychosocial functioning. However, at the end of the follow-up visit at 16th week 68 participants had remitted. Out of this number, 50(73.5%) participants had returned to good psychosocial functioning as measured with Global Assessment of Functioning (GAF), while 18(26.5%) were still functioning poorly. This was statistically significant (x2=59.35; df=1; p<0.001).
Table 6b shows that the number of participants that recovered at the 16th week of follow-up was significantly higher than those who did not recover (x2=66.23; df=1; p<0.001).
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Table 5a: Proportions of recovery per period of follow-up using BPRS and GAF criteria BPRS criteria GAF score criteria
Follow-up period Remission status Good Poor df p-value 4th week Remission (n1 = 37)
No Remission (n2 = 98)
6(16.2%) 2(2.0%)
31(83.8%) 96(98.0%)
9.68 1 0.002 8th week Remission (n1 = 64)
No Remission (n2 = 61)
34(53.1%) 1(1.6%)
30(46.9%) 60(98.4%)
40.27 1 0.000 12th week Remission (n1 = 61)
No Remission (n2 = 54)
43(70.5%) 0(0.0%)
18(29.5%) 54(100.0%)
60.79 1 0.000 16th week Remission (n1 = 68)
No Remission (n2 = 45)
50(73.5%) 0(0.0%)
18(26.5%) 45(100.0%)
59.34 1 0.000 NB: Recovery = maintenance of remission + GAF-score above 61
Good functioning = GAF-score ≥ 61; Poor functioning = GAF-score < 61
Remission in BPRS = Scores ≤ 2 in the following BPRS items (Grandiosity, Suspiciousness, unusual thought content, Hallucinatory behaviour, conceptual disorganization, mannerism/posturing, and blunted affect).
Table 5b: Proportions of recovery per period of follow-up using SANS and GAF criteria
SANS criteria GAF criteria
Follow-up period Good Poor df p-value
4th week follow-up Remission (n1 = 41) No Remission (n2 = 94)
6(14.6%) 2(2.1%)
35(85.4%) 92(97.9%)
8.01 1 0.005 8th week follow-up Remission (n1 = 62)
No Remission (n2 = 63)
33(53.2%) 1(1.6%)
29(46.8%) 62(98.4%)
42.08 1 0.000 12th week follow-up Remission (n1 = 60)
No Remission (n2 = 55)
43(71.7%) 0(0.0%)
17(28.3%) 55(100.0%)
62.96 1 0.000 16th week follow-up Remission (n1 = 65)
No Remission (n2 = 48)
50(76.9%) 0(0.0%)
15(23.1%) 48(100.0%)
66.23 1 0.000 NB: Recovery = maintenance of remission + GAF-score above 61
Good functioning = GAF-score ≥ 61; Poor functioning = GAF-score < 61
Remission in SANS = Scores ≤ 2 in the following SANS items (Affective flattening, Avolition-apathy, Anhedonia-asociality, and Alogia).
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5.5.1: MEAN REDUCTION IN PSYCHOPATHOLOGY ACROSS THE PERIOD OF FOLLOW-UP: Repeated measures ANOVA
Tables 5(c) and 5(d) are the results of the repeated measures analysis of variance, which was used to assess whether there was a significant change (decrease) in the psychopathology across the period of follow-up.
The tables show that there was a highly significant decrease in scores of psychopathological measures (BPRS and SANS) between subsequent follow-up periods. For instance, the mean difference between baseline BPRS score and BPRS score at 4th week was 21.70, while, that between 4th and 8th weeks was 13.76, and so on. Hence, there was a consistent gradient of decrease in psychopathology between subsequent follow-up periods (F=67.57; df= 4, 108; p >0.001).
Table 5c: Pairwise assessment of mean differences in BPRS scores at intervals of assessment
Mean difference in BPRS-scores at 4th week
Mean difference in BPRS-scores at 8th week
Mean difference in BPRS-scores at 12th week
Mean difference in BPRS-scores at
16th week F-stat df p-value BPRS-scores at
Baseline Vs
21.70 35.46 42.37 46.16
67.57 4,108 0.000 BPRS-scores at 4th
week Vs.
13.76 20.67 24.46
BPRS-scores at 8th week Vs.
6.91 10.70
BPRS-scores at 12th
week Vs. 3.78
Table 5d: Pairwise assessment of mean differences in SANS scores at intervals of assessment
Mean difference in SANS-scores at 4th week
Mean difference in SANS-scores at 8th week
Mean difference in SANS-scores at 12th week
Mean difference in SANS-scores at 16th week
F-stat df p-value
SANS-scores at
Baseline Vs. 20.39 34.27 39.56 43.14
40.36 4, 108 0.000 SANS-scores at 4th
week Vs.
13.88 19.17 22.75
SANS-scores at 8th week Vs.
5.28 8.87
SANS-scores at 12th week Vs.
3.58
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5.5.2: ASSOCIATION OF RESPONSE AT WEEK 4, WITH OUTCOME AT WEEK 16 (i.e., response, remission, and recovery at week 16)
Table 5e shows the association of response at week 4, with outcome at week 16. The results show that response at 4th week of follow-up is significantly associated with remission and recovery at 16th week of follow-up.
Table 5e: Association of response at week 4, with outcome at week 16
Criteria Response at 4th week GAF-score at 16th week Statistical difference Good Poor df p-value
BPRS Response (n1 =107) 50(46.7%) 57(53.3%) 4.22 1 0.040 No Response (n2 =5) 0(0.0%) 5(100.0%)
SANS Response (n1 =71) 47(66.2%) 24(33.8%) 37.31 1 0.000 No Response (n2 =42) 3(7.1%) 39(92.9%)
Remission at 16th week Remitted No Remission
BPRS
Response (n1 =107) 67(62.6%) 40(37.4%) 7.79 1 0.005 No Response (n2 =5) 0(0.0%) 5(100.0%)
SANS
Response (n1 =71) 61(85.9%) 10(14.1%) 63.03 1 0.000
No Response (n2 =42) 4(9.5%) 38(90.5%) Response at 16th week Response No Response
BPRS Response (n1 =107) 106(99.1%) 1(0.9%) 0.05 1 0.828 No Response (n2 =5) 5(100.0%) 0(0.0%)
SANS Response (n1 =71) 68(95.8%) 3(4.2%) 43.30 1 0.000 No Response (n2 =5) 17(40.5%) 25(59.5%)
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5.6: ASSOCIATION OF SOCIO-DEMOGRAPHIC FACTORS WITH OUTCOME MEASURES.
5.6.1: ASSOCIATION OF THE SEX OF THE PARTICIPANTS WITH MEASURES OF CLINICAL OUTCOME.
The association of the sex of the participants with the measures of clinical outcome is presented in tables 6(a), 6(b), and 6(c).
Table 6a shows the mean BPRS score of 45.06±8.58 for male participants at the baseline assessment. This was almost equal to that of the female participants (45.52±9.89). However, at the 16 week of follow-up, female participants had lower mean BPRS score of 15.41±17.09 compared with 18.33±18.66 scored by males. This was not statistically significant (t=0.868;
df=111; p=0.387).
Table 6a: Association of Sex of the participants and BPRS scores
Follow-up period Gender Mean ± S.D t-statistic df P-value BPRS at baseline Male
Female
45.06 ± 8.58 45.52 ± 9.89
-0.314 158 0.754 BPRS at 4th week Male
Female
29.68 ±16.73 29.54 ± 14.93
0.052 132 0.959
BPRS at 8th week Male Female
24.46 ± 20.02 20.57 ± 16.36
1.194 124 0.235
BPRS at 12th week Male Female
21.60 ± 18.87 18.53 ± 17.51
0.906 113 0.367
BPRS at 16th week Male Female
18.33 ±18.66 15.41 ± 17.09
0.868 111 0.387
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Table 6b shows the mean SANS score of 86.41±27.52 for male participants at the baseline assessment. This was higher than that of the female participants (80.01±29.81). This was not statistically significant. At 16th week of follow-up, female participants had lower mean SANS score of 35.86±40.00 compared with 44.05±45.34 scored by males. This was not statistically significant (t=1.018; df=111; p=0.311).
Table 6b: Association of Sex of the participants and SANS scores
Follow-up period Gender Mean ± S.D t-statistic df P-value SANS at baseline Male
Female
86.41 ± 27.52 80.01 ± 29.81
1.409 158 0.161
SANS at 4th week Male Female
64.55 ± 35.38 60.85 ± 32.58
0.632 132 0.529
SANS at 8th week Male Female
53.73 ± 40.19 43.98 ± 36.64
1.422 124 0.157
SANS at 12th week Male Female
47.19 ± 44.96 39.89 ± 38.47
0.934 113 0.352
SANS at 16th week Male Female
44.05 ± 45.34 35.86 ± 40.00
1.018 111 0.311
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Table 6c shows that of the 78 male participants at the baseline, 1(1.3%) had mild symptom severity, while 77(98.7%) of the male participants had severe symptoms. This is compared with 82(100.0%) of the female participants who had clinically severe symptoms at baseline. At the end of follow-up at 16th week, more females had mild symptoms (64.8%) compared with males (52.6%). This was not statistically significant (x2=1.696; df=1; p=0.193).
Table 6c: Association of Sex of the Participants and CGI-severity Follow-up period Gender Mild
(%)
Severe (%)
df p-value Baseline Male (n1 =78)
Female (n2 =82)
1(1.3%) 0(0.0%)
77(98.7%) 82(100.0%)
1.06 1 0.304 4th week follow-up Male (n1 =69)
Female (n2 =66)
20(29.0%) 27(40.9%)
49(71.0%) 39(59.1%)
2.11 1 0.146 8th week follow-up Male (n1 =63)
Female (n2 =63)
30(47.6%) 39(61.9%)
33(52.4%) 24(38.1%)
2.60 1 0.107 12th week follow-up Male (n1 =58)
Female (n2 =57)
31(53.4%) 38(66.7%)
27(46.6%) 19(33.3%)
2.09 1 0.148 16th week follow-up Male (n1 =57)
Female (n2 =54)
30(52.6%) 35(64.8%)
27(47.4%) 19(35.2%)
1.70 1 0.193 Note: Mild = CGI score ≤3; Severe = CGI score > 3
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5.6.2: ASSOCIATION OF THE SEX OF THE PARTICIPANTS WITH MEASURES OF FUNCTIONAL OUTCOME.
The association of sex of the participants with the measures of psychosocial functional outcome is presented in tables 7(a) and 7(b).
Table 7a shows the association of psychosocial functioning as measured by mean WHODAS score of the participants. The table shows that at the baseline assessment, males had higher mean WHODAS score of 140.21±20.14 compared with females (129.99±24.37). This was statistically significant (p<0.004). However, by the end the follow-up period, there was no significant difference in the mean WHODAS score between male and female participants.
Table 7a: Association of sex of the participants and WHODAS scores
Follow-up period Gender Mean ± S.D t-statistic df P-value WHODAS at baseline Male
Female
140.21 ± 20.14 129.99 ± 24.37
2.882 158 0.004
WHODAS at 4th week Male Female
107.53 ± 33.86 97.39 ± 34.27
1.723 132 0.087
WHODAS at 8th week Male Female
98.35 ± 41.72 83.05 ± 39.72
2.084 124 0.039
WHODAS at 12th week Male Female
91.81 ± 46.92 79.12 ± 40.31
1.556 113 0.122
WHODAS at 16th week Male Female
86.53 ± 47.55 75.46 ± 40.52
1.332 111 0.186
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Table 7b shows the association of psychosocial functioning as measured by GAF score of the participants. The table shows that at the baseline assessment male participants had lower mean GAF score of 20.50±12.07 compared with female participants (26.00±14.82). This was statistically significant (p<0.001). However, by the end the follow-up period, there was no significant difference in the mean GAF score between male and female participants.
Table 7b: Association of Sex of the Participants and GAF scores
Follow-up period Gender Mean ± S.D t-statistic df P-value GAF score at baseline Male
Female
20.50 ± 12.07 26.00 ± 14.82
-2.564 158 0.001
GAF score at 4th week Male Female
33.49 ± 18.34 37.69 ± 19.33
-1.296 133 0.197
GAF score at 8th week Male Female
40.95 ± 23.33 49.13 ± 23.02
-1.981 124 0.050
GAF score at 12th week Male Female
45.91 ± 28.62 53.79 ± 25.63
-1.554 113 0.123
GAF score at 16th week Male Female
48.46 ± 29.84 58.68 ± 28.32
-1.866 111 0.065
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5.6.3: ASSOCIATION OF LEVEL OF EDUCATION OF THE PARTICIPANTS WITH MEASURES OF CLINICAL OUTCOME.
The association of the level of education of the participants with the measures of clinical outcome is presented in tables 8(a) and 8(b).
Table 8a shows the association of the level of education of the participants with a measure of clinical outcome (BPRS). It shows that the mean BPRS score of those who had no formal education was higher (47.00±2.45), compared with 46.01±9.14 and 44.39±9.79 scored by participants that had secondary and tertiary education, respectively. This was not statistically significant. However, at the 16th week of follow-up, there was a statistically significant difference among the different levels of education, such that those that had tertiary education had the lowest mean BPRS score (6.91±12.52) compared with 39.00±0.00 scored by those who had no formal education (P < 0.005). In fact, from week 4, there was consistently a gradient in the fall of BPRS scores vs. increasing level of education.
Table 8a: Association of the level of education of the participants and BPRS scores
Follow-up period Education Mean S.D F-stat. df p-value
Total BPRS at baseline No formal Primary Secondary Tertiary
47.00 44.27 46.01 44.39
2.45 9.53 9.14 9.79
0.469 3,156 0.704
Total BPRS at 4th week No formal Primary Secondary Tertiary
44.00 33.73 29.97 23.55
0.00 17.08 15.51 13.73
2.535 3,130 0.060
Total BPRS at 8th week No formal Primary Secondary Tertiary
38.00 27.03 24.29 12.26
0.00 22.60 16.69 12.50
4.217 3, 122 0.007
Total BPRS at 12th week No formal Primary Secondary Tertiary
42.00 24.66 20.92 11.09
0.00 18.92 18.71 12.38
3.185 3, 111 0.027
Total BPRS at 16th week No formal Primary Secondary Tertiary
39.00 23.59 16.93 6.91
0.00 19.25 17.40 12.52
4.545 3, 109 0.005
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Table 8b shows that at the baseline assessment of the participants, those who had primary and secondary education had higher SANS score of 86.78±31.95 and 86.01±26.63, respectively. This was compared with participants who had no formal education scored 75.00±31.58 and those with tertiary education who scored 72.52±28.88. Subsequently, at each month of follow-up, there was a significant difference such that the higher the level education of the participants the lower the mean the SANS score. As noted for BPRS, from week 4, there was consistently a gradient in the fall of SANS scores vs. increasing level of education.
Table 8b: Association of the level of education of the participants and SANS scores
Follow-up period Education Mean S.D F-stat. df p-value
Total SANS at baseline No formal Primary Secondary Tertiary
75.00 86.78 86.01 72.52
31.58 31.95 26.63 28.88
2.130 3,156 0.099
Total SANS at 4th week No formal Primary Secondary Tertiary
76.00 74.85 61.82 50.79
0.00 39.40 30.57 32.37
2.768 3,131 0.044
Total SANS at 8th week No formal Primary Secondary Tertiary
73.00 62.56 51.00 26.48
0.00 44.36 34.49 32.60
5.002 3,122 0.003
Total SANS at 12th week No formal Primary Secondary Tertiary
75.00 63.52 41.61 22.35
0.00 48.02 37.69 33.96
4.845 3,111 0.003
Total SANS at 16th week No formal Primary Secondary Tertiary
77.00 61.03 37.20 18.31
0.00 48.97 38.04 35.21
5.051 3, 109 0.003
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5.6.4: ASSOCIATION OF THE LEVEL OF EDUCATION OF THE PARTICIPANTS WITH THE MEASURES OF FUNCTIONAL OUTCOME.
The association of the level of education of the participants with the measures of functional outcome is presented in tables 9(a) and 9(b).
Table 9a shows the association of the level of education with measures of psychosocial functional outcome. The table shows that the mean WHODAS score for the participants with no formal education at baseline was 128.25±12.74. Participants that had primary and secondary education at the baseline scored 139.05±27.89 and 135.37±20.24, respectively. While those who had tertiary education scored 130.15±20.15. Subsequently, at each month of follow-up, there was a significant difference such that the higher the level education of the participant the lower the mean WHODAS score.
Table 9a: Association of the level of education of the participants and WHODAS scores
Follow-up period Education Mean S.D F-stat. df p-value
Total WHODAS at baseline No formal Primary Secondary Tertiary
128.25 139.05 135.37 130.15
12.74 27.89 20.24 24.15
1.001 3,156 0.394
Total WHODAS at 4th week No formal Primary Secondary Tertiary
107.00 116.91 101.41 88.32
0.00 37.65 30.32 35.16
3.787 3,130 0.012
Total WHODAS at 8th week No formal Primary Secondary Tertiary
116.00 104.31 92.80 65.88
0.00 47.99 36.43 34.83
4.759 3,119 0.004
Total WHODAS at 12th week No formal Primary Secondary Tertiary
116.00 105.17 85.50 59.48
0.00 47.06 40.64 37.28
5.306 3,111 0.002
Total WHODAS at 16th week No formal Primary Secondary Tertiary
119.00 101.34 80.18 54.95
0.00 48.93 39.97 37.21
5.378 3, 109 0.002
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Table 9b shows the association of the level of education and the GAF-scores. The table shows that by the 8th week of follow-up, that participants that had tertiary education had scored above 50 in the GAF-score, while those who had no formal education scored below 50.
Table 9b: Association of the level of Education of the participants and GAF scores
Follow-up period Education Mean S.D F-stat. df p-value
GAF-score at baseline No formal Primary Secondary Tertiary
30.50 19.11 22.18 30.12
10.00 14.82 13.21 12.09
4.693 3,156 0.004
GAF-score at 4th week No formal Primary Secondary Tertiary
35.50 28.21 35.35 44.36
0.00 21.74 15.94 19.45
4.024 3,131 0.009
GAF-score at 8th week No formal Primary Secondary Tertiary
35.50 38.28 42.30 60.13
0.00 26.12 19.66 23.41
5.508 3,122 0.001
GAF-score at 12th week No formal Primary Secondary Tertiary
35.50 38.59 49.10 66.52
0.00 28.78 25.29 24.04
5.093 3,111 0.002
GAF-score at 16th week No formal Primary Secondary Tertiary
35.50 40.62 53.00 72.82
0.00 30.07 26.94 26.44
5.810 3, 109 0.001
In other words, the consistent gradient in the fall of psychopathological scores vs. increasing level of education was matched by a consistent rise in psychosocial functioning with increasing level of education.
57
5.6.5: ASSOCIATION OF MARITAL STATUS OF THE PARTICIPANTS WITH MEASURES OF CLINICAL OUTCOME.
The association between the marital status of the participants and measures of clinical outcome is presented in tables 10(a) and 10(b).
Table 10a shows that there was no statistical difference in total BPRS score between levels of marital status at the baseline of the study (F =1.357; df=2,157; p=0.260). However, at the 16th week of follow-up, participants who were never married had a mean BPRS score of 16.87±18.14. Participants who were married had a score of 11.25±14.74, while participants who were separated, divorced, or widowed had the highest BPRS score at the end of the follow-up period (39.57±4.28). This was statistically significant (p=0.001).
Table 10a: Association of the marital status of the participants and BPRS scores
Follow-up period Marital status Mean S.D F-stat. df p-value
BPRS at baseline Never married Married
Separated/widowed
45.04 44.65 49.14
9.55 8.81 7.63
1.357 2,157 0.260
BPRS at 4th week Never married Married
Separated/widowed
29.01 27.33 46.00
15.42 15.53 13.97
4.981 2,131 0.008
BPRS at 8th week Never married Married
Separated/widowed
22.40 18.76 39.25
18.80 16.31 12.04
4.245 2,123 0.016
BPRS at 12th week Never married Married
Separated/widowed
19.83 15.32 42.00
18.18 16.49 6.71
6.643 2,112 0.002
BPRS at 16th week Never married Married
Separated/widowed
16.87 11.25 39.57
18.14 14.74 4.28
7.890 2, 110 0.001
58
Table 10b shows the association of the marital status of the participants with a measure of clinical outcome (SANS-score). It shows that apart from the baseline assessment, marital status of the participants were significantly associated with the mean SANS score, such that the married participants had the least mean SANS score at each month of follow-up while participants that were separated, divorced, or widowed had the highest scores.
Table 10b: Association of the marital status of the participants and SANS scores
Follow-up period Marital status Mean S.D F-stat. df p-value
SANS at baseline Never married Married
Separated/widowed
85.71 74.58 88.07
26.46 34.64 24.27
2.438 2,157 0.091
SANS at 4th week Never married Married
Separated/widowed
63.54 54.15 88.75
32.77 35.67 29.62
3.558 2,132 0.031
SANS at 8th week Never married Married
Separated/widowed
50.51 34.39 91.00
39.02 31.91 25.53
7.953 2,123 0.001
SANS at 12th week Never married Married
Separated/widowed
43.84 28.39 101.29
42.36 31.42 15.99
9.812 2,112 0.000
SANS at 16th week Never married Married
Separated/widowed
40.63 23.79 97.71
43.53 31.94 12.23
9.689 2, 110 0.000
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5.6.6: ASSOCIATION OF MARITAL STATUS OF THE PARTICIPANTS WITH THE MEASURES OF FUNCTIONAL OUTCOME.
The association between the marital status of the participants with measures of functional outcome is presented in tables 10(c) and 10(d).
Table 10e shows that at the baseline assessment, marital status was not significantly associated with the measure of psychosocial functioning (WHODAS). However, at subsequent visits, participants’ marital status was significantly associated with the functional status.
Table 11f shows the association of the marital status with scores in the Global Assessment of Functioning (GAF). It shows that married participants had the highest mean GAF score at each month of follow-up. This was statistically significant.
Table 10c: Association of the marital status of the participants and WHODAS scores
Follow-up period Marital status Mean S.D F-stat. df p-value
WHODAS at baseline Never married
Married
Separated/widowed
136.81 130.35 134.21
21.21 26.56 24.14
1.165 2,157 0.315
WHODAS at 4th week Never married Married
Separated/widowed
103.94 91.39 132.13
33.03 35.50 25.60
5.086 2,132 0.007
WHODAS at 8th week Never married Married
Separated/widowed
93.55 71.97 135.88
40.83 33.30 35.17
9.566 2,123 0.000
WHODAS at 12th week Married Never married Separated/widowed
86.39 69.43 140.00
44.51 35.64 18.98
8.150 2,112 0.000
WHODAS at 16th week Never married Married
Separated/widowed
82.65 62.04 139.14
44.81 33.31 17.61
10.015 2, 110 0.000
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Table 10d: Association of the marital status of the participants and GAF scores
Follow-up period Marital status Mean S.D F-stat. df p-value
GAF score at baseline Never married Married
Separated/widowed
21.62 27.79 23.36
11.47 17.29 16.72
2.977 2,157 0.054
GAF score at 4th week Never married Married
Separated/widowed
35.15 40.77 18.56
17.60 20.68 17.13
4.775 2,132 0.010
GAF score at 8th week Never married Married
Separated/widowed
43.66 54.15 22.13
22.74 22.60 16.21
7.087 2,123 0.001
GAF score at 12th week Married Never married Separated/widowed
49.32 59.50 16.79
27.45 23.04 13.47
7.682 2,112 0.001
GAF score at 16th week Never married Married
Separated/widowed
51.78 67.59 16.79
28.88 24.61 13.47
10.253 2,110 0.000
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5.7: ASSOCIATION OF SOCIAL SUPPORT WITH MEASURES OF OUTCOME.
5.7.1: ASSOCIATION OF SOCIAL SUPPORT WITH MEASURES OF CLINICAL OUTCOME.
The association of the participants’ perceived social support with the measures of clinical outcome is presented in tables 11(a), 11(b), and 11(c).
Table 11a shows that at the baseline assessment of the participants, that those who had satisfactory perceived social support had almost equal score on mean BPRS with those without satisfactory social support. However, in the subsequent follow-up visits, perceived social support was significantly associated with lower scores in BPRS measure of clinical severity.
Table 11a: Association of perceived social support with BPRS scores
Follow-up period Social support Mean ± S.D t-stat. df P-value BPRS score at baseline Satisfactory
Non-satisfactory
45.56 ± 8.05 46.10 ± 9.37
-0.122 122 0.783 BPRS score at 4th week Satisfactory
Non-satisfactory
21.04 ± 15.40 32.08 ± 15.47
-3.235 121 0.002 BPRS score at 8th week Satisfactory
Non-satisfactory
10.60 ± 10.44 25.91 ± 18.79
-3.913 119 0.000 BPRS score at 12th week Satisfactory
Non-satisfactory
7.87 ± 10.31 23.26 ± 18.55
-3.825 112 0.000 BPRS score at 16th week Satisfactory
Non-satisfactory
4.61 ± 8.55 20.02 ± 18.31
-3.919 111 0.000 NB: Satisfactory = Multi-dimensional Scale of Perceived Social Support (MSPSS) score > 65 Non-satisfactory = Multi-dimensional Scale of Perceived Social Support (MSPSS) score < 65
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Table 11b shows that at each month of follow-up having satisfactory perceived social support was significantly association with lower mean SANS scores.
Table 11b: Association of perceived social support with SANS scores
Follow-up period Social support Mean ± S.D t-stat. df P-value SANS score at baseline Satisfactory
Non-satisfactory
75.11 ± 31.88 88.34 ± 26.18
-2.211 122 0.029 SANS score at 4th week Satisfactory
Non-satisfactory
41.70 ± 30.49 68.69 ± 32.76
-3.841 122 0.002 SANS score at 8th week Satisfactory
Non-satisfactory
21.04 ± 21.22 56.76 ± 38.83
-4.421 119 0.000 SANS score at 12th week Satisfactory
Non-satisfactory
13.91 ± 23.61 51.33 ± 42.32
-4.074 112 0.000 SANS score at 16th week Satisfactory
Non-satisfactory
11.48 ± 23.14 47.28 ± 43.68
-3.789 111 0.000 NB: Satisfactory = Multi-dimensional Scale of Perceived Social Support (MSPSS) score > 65 Non-satisfactory = Multi-dimensional Scale of Perceived Social Support (MSPSS) score < 65
Table 11c shows that at the end of follow-up period at 16th week, of the 23 participants that had satisfactory perceived social support, 23(100.0%) of them improved on the clinical rating of improvement while 55(61.1%) of the 90 participants that had non-satisfactory perceived social support improved in their symptom. This was statistically significant (x2=12.96; df=1; p<0.001).
Table 11c: Association of Perceived Social Support with CGI-improvement
Social support
CGI -improvement
Follow-up period Improved Not
improved
df p-value 4th week Satisfactory (n1 =27)
Non-satisfactory (n2 =96)
23(85.2%) 50(52.1%)
4(14.8%) 46(47.9%)
9.57 1 0.002 8th week Satisfactory (n1 =25)
Non-satisfactory (n2 =96)
24(96.0%) 60(62.5%)
1(4.0%) 36(37.5%)
10.49 1 0.001 12th week Satisfactory (n1 =23)
Non-satisfactory (n2 =91)
23(100.0%) 52(57.1%)
0(0.0%) 39(42.9%)
14.98 1 0.000 16th week Satisfactory (n1 =23)
Non-satisfactory (n3 =90)
23(100.0%) 55(61.1%)
0(0.0%) 35(38.9%)
12.96 1 0.000 Note: Improved = CGI score ≤ 3; Not Improved = CGI score > 3
Satisfactory = Multi-dimensional Scale of Perceived Social Support (MSPSS) score > 65 Non-satisfactory = Multi-dimensional Scale of Perceived Social Support (MSPSS) score < 65