The Discrepancy between Subjective and Objective Evaluations of Cognitive and Functional Ability among People with Schizophrenia: A Systematic Review

Abstract

Background: An important aspect of recovery in schizophrenia relates to one’s subjective, lived experience. Self-report is a subjective measurement method with yet-uncertain utility in the assessment of functioning among individuals diagnosed with schizophrenia-spectrum disorder. No review to date has comprehensively synthesized existing research to evaluate the degree of correspondence, or lack thereof, between subjective and objective assessments of cognitive and everyday functioning, nor how extant data can inform the use of self-reported information in treatment and research. Methods: A systematic review was completed to provide a broad perspective of the literature on this topic. Relevant manuscripts were identified via a search strategy using key terms in PubMed and PsycINFO and a review of manuscript bibliographies. Twenty-six studies met the inclusion criteria. Results: These studies show minimal to modest associations between subjective assessments of cognition and everyday functioning and objective assessments of these domains, including informant reports and neuropsychological and behavioral measures. Individuals with schizophrenia appear to overestimate their functioning when compared to objective measures. Depression and greater cognitive ability tend to predict greater correspondence between subjective and objective assessments of cognition and everyday functioning. Discussion: This review discusses how we might understand the low correspondence between subjective and objective measures of functioning and provides recommendations for using and eliciting self-reported information in the pursuit of recovery-centered practices.

How Does Individual Psychotherapy Promote Recovery for Persons with Psychosis? A Systematic Review of Qualitative Studies to Understand the Patient’s Experience

“…Importantly, experiences of psychotherapy for persons with psychosis varied greatly, supporting the idea that recovery is a complex process that can involve both objective outcomes and subjective, personal processes such as understanding oneself and one’s place in the world. It thus seems important when measuring progress and understanding recovery for persons with psychosis to have an integrative approach, by considering both objective, observable outcomes (e.g., reduction in symptoms, psychosocial functioning) and subjective processes (e.g., understanding of oneself and one’s life) [ 24 , 87 ].…”

“…Interviewing patients allows them to speak in their own voice to best contribute to the development and improvement of treatments, and helps investigators compare their own perception of reality and definitions of recovery using the patients’ ideas. Furthermore, subjective and objective measures of functioning can offer different aspects of recovery from the clinician and patient that can be integrated to provide a more comprehensive picture [ 24 ]. Identifying the most salient aspects of treatment for patients may help better distinguish the different mechanisms of change contributing to recovery and further improve treatments.…”