Emotion Perception and Social Functioning in Serious Mental Illness: Differential Relationships Among Inpatients and Outpatients Melissa Tarasenko, Petra Kleinlein, Kee-Hong Choi, Charlie A. Davidson, Elizabeth Cook, and William D. Spaulding University of Nebraska-Lincoln Introduction Method Results Discussion It is well known that people with serious mental illness (SMI) often demonstrate impairments in facial and vocal emotion perception. However, less is known about the precise impact that these deficits have on the social functioning of people with SMI. Previous studies have found associations between facial affect perception and personal appearance, social skills, social behavior, and community participation (Couture et al., 2006). However, only a small minority of studies have specifically examined the relationship between social functioning and vocal affect perception, and even fewer have analyzed the integration of facial and vocal emotion cues. Furthermore, although the relationship between affect perception and social functioning has been examined in both inpatient and outpatient samples, no previous studies have compared these relationships across levels of functioning. Therefore, the present study aims to analyze facial, vocal, and integrated emotion perception as they relate to performance on standard measures of social functioning that are unique to both inpatient and outpatient populations. It is hypothesized that, within each group, lower facial, vocal, and integrated emotion perception scores will correlate with lower staff ratings of social competence and social interest. It is also expected that the relationship between affect perception and social functioning will be significantly stronger than the relationship between neurocognition and social functioning. Participants: Data for the inpatient sample was collected from participants in a long-term psychiatric rehabilitation program in the Midwest. Outpatient data was collected from adult day programs in the Midwest that serve individuals who require minimal assistance in activities associated with community living. Participation in both of these types of programs reflects differing levels of community functioning. Criteria for inclusion in the study include a current DSM-IV-TR diagnosis of schizophrenia or schizoaffective disorder, no concurrent substance abuse or dependence, no mental retardation, no organic brain injuries, and a stable medication regimen. Affect Perception Measures: Face/Voice Emotion Identification Test (FEIT/VEIT; Kerr and Neale, 1993): The FEIT consists of still photographs of faces, adopted from Ekman (1976) and Izard (1971) that convey happiness, sadness, anger, fear, surprise, and shame, while the VEIT consists of 21 recorded neutral statements that are vocalized to convey the emotions of happiness, sadness, anger, fear, surprise, or shame. In each test, participants are told to choose one of the six emotions that they believe is being depicted by the stimuli. Bell-Lysaker Emotion Recognition Task (BLERT; Bell et al., 1997): The BLERT is comprised of 21 video clips that feature a male actor making neutral statements about a job. The participant is instructed to determine whether the actor is portraying happiness, sadness, anger, fear, surprise, disgust, or no emotion based on his facial expression and affective prosody. Neurocognitive Measures: Benton Test of Facial Recognition (BTFR; Benton et al., 1983): This task uses pictures of faces to assess visuospatial processing. During administration of the BTFR, each participant is shown a neutral target face along with a set of six neutral test faces. He or she is then instructed to choose either one or three of the six faces that matches the target face. Neuropsychological Assessment Battery – Screening Module (NAB-Screener; Stern and White, 2003): The NAB-Screener is a battery of tests that assess an individual’s functioning within the domains of Attention, Memory, Executive Functions, Language, and Spatial Ability. This battery was administered to the outpatient group only. Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998): The RBANS is comprised of 12 neuropsychological tests that assess functioning in the domains of attention, immediate memory, delayed memory, language, and visuospatial/constructional ability. This battery was administered to inpatients. Social Functioning Measures: Multnomah Community Ability Scale (MCAS; Barker et al., 1994): The MCAS is a measure of global functioning for individuals with SMI who live in the community. It is intended to be completed by case managers or other staff who are familiar with the participants. The MCAS assesses functioning in a variety of areas, although the Social Competence domain was the only domain included in this analysis. Nurses’ Observation Scale for Inpatient Evaluation (NOSIE-30; Honigfeld et al., 1966): The NOSIE-30 assesses global functioning of individuals with SMI in inpatient settings. The NOSIE-30 sub-domain of Social Interest was included in this analysis. Measure12345 BLERT-- FEIT0.41*-- VEIT0.75**0.52**-- NAB Naming0.55**0.43**0.41**-- MCAS *0.37*-- Measure BLERT-- FEIT0.45*-- VEIT0.51** BTFR * RBANS Story Memory RBANS Story Recall **-- NOSIE **0.48*0.41*-- In outpatients, there was a significant positive relationship between performance on the VEIT and the Social Competence subscale of the MCAS (r =.351, p.05), FEIT (Steiger’s Z =.377, p >.05), or VEIT (Steiger’s Z =.112, p >.05). In inpatients, there were no significant correlations between scores on NOSIE Social Interest and scores on the BLERT, FEIT, or VEIT. However, the RBANS Story Memory task was correlated with NOSIE Social Interest (Pearson’s r =.482, p <.05), and this relationship was significantly stronger than the relationship between the FEIT and NOSIE Social Interest (Steiger’s Z = 1.98, p <.05). Another significant correlation was found between NOSIE Social Interest and RBANS Story Recall (r =.407, p =.05). This correlation was significantly stronger than the correlation between NOSIE Social Interest and FEIT (Steiger’s Z = 1.67, p <.05). Additionally, inpatient performance on the BTFR was associated with NOSIE Social Interest (r =.517, p <.01); this relationship was significantly stronger than the relationship between NOSIE Social Interest and BLERT (Steiger’s Z = 1.86, p <.5), FEIT (Steiger’s Z = 2.838, p <.01), and VEIT (Steiger’s Z = 1.77, p <.05). Table 1. Intercorrelations Among Affect Perception, Neurocognition, and Social Functioning in Outpatients Table 2. Intercorrelations Among Affect Perception, Neurocognition, and Social Functioning in Inpatients Contrary to our hypothesis, affect perception abilities were only associated with social competence in the outpatient group. Verbal fluency was also significantly correlated with social competence in the outpatient group. Additionally, contrary to our second hypothesis, the strength of relationship between vocal affect perception and social competence was not significantly different than the strength of relationship between verbal fluency and social competence. In inpatients, there were no significant correlations between affect perception and staff ratings of social interest. However, visuospatial processing and verbal recall were significantly correlated with social interest. These findings suggest that the social functioning of inpatients, whose overall level of functioning is relatively low, might benefit more greatly from interventions that target cognitive deficits, whereas people who are functioning at a relatively high level (i.e. outpatients) might benefit equally from interventions that target sociocognitive or neurocognitive deficits.