Cognitive functioning and functional ability in women with schizophrenia and homelessness

Jayakumar Menon; Suvarna Jyothi Kantipudi; Aruna Mani; Rajiv Radhakrishnan

doi:10.1016/j.scog.2024.100338

Cognitive functioning and functional ability in women with schizophrenia and homelessness

Schizophr Res Cogn. 2024 Nov 12:39:100338. doi: 10.1016/j.scog.2024.100338. eCollection 2025 Mar.

Authors

Jayakumar Menon^{1

2}, Suvarna Jyothi Kantipudi^{1

3}, Aruna Mani¹, Rajiv Radhakrishnan^{4

5}

Affiliations

¹ Department of Psychiatry, SRMC & RI, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India.
² Clinical Lead, Anbagam-TERDOD, India.
³ School of Public Health, University of California, Berkeley, United States of America.
⁴ Department of Psychiatry, Radiology and Biomedical Imaging, Yale School of Medicine, United States of America.
⁵ Yale Institute for Global Health, United States of America.

Abstract

Background: Studies of schizophrenia and homelessness are minimal from the Indian subcontinent. Women with schizophrenia and homelessness in India remain a highly vulnerable group and there is no data to date regarding their clinical characteristics. Cognitive impairment in schizophrenia remains a major factor determining outcomes in schizophrenia. We examined the cognitive functioning of women with schizophrenia and homelessness (WSH) and compared it to an age-matched group of women with schizophrenia living with their family (WSF).

Methods: 36 women with schizophrenia and homelessness, and 32 women with schizophrenia who were living with family were evaluated for psychopathology using Scale for Assessment of Positive Symptoms (SAPS)/ Scale for assessment of negative symptoms (SANS) scales. Cognitive function was assessed using Montreal Cognitive Assessment (MOCA)/Rowland Universal Dementia Scale (RUDAS), and Frontal Assessment Battery (FAB), disability using World Health Organization - Disability assessment Scale (WHO-DAS) and psychosocial factors using a semi-structured proforma. The groups were compared using t-tests and chi-square for continuous and categorical variables respectively.

Results: Women with schizophrenia and homelessness were found to have significantly lower cognitive functioning, and much higher disability. Cognition and disability for women with schizophrenia and homelessness differed by 2-3 standard deviations with the mean for women living with family (i.e. z scores). Women with schizophrenia experiencing homelessness (WSH group) exhibited higher literacy levels and previous work experience compared to their counterparts. Those with family support are likely to face reduced pressures to work or earn, which further suggests that premorbid levels of functioning may not be the primary factors influencing the differences observed in cognitive assessments.

Conclusions: The study demonstrates significantly higher cognitive dysfunction in women with homelessness and schizophrenia, raising the possibility of much higher cognitive dysfunction being a predictor for homelessness in Indian women with schizophrenia.

Keywords: Cognitive impairment; Disability; Extreme phenotype; Homelessness; Negative symptoms; Positive symptoms; Schizophrenia.