VOL22.NO. 4, 1996
Time Use of Unemployed
and Employed Single Male
Schizophrenia Subjects
by Robyn L. Hayes
and W. Kim Halford
Abstract
The poverty and lack of social role
in the lives of many people with
schizophrenia seem similar to those
of people in long-term unemployment, raising the possibility that
there may be some commonalities
in their time use and community
functioning. To test this possibility,
the social anxiety, time use, and
activity participation patterns of 16
male schizophrenia subjects were
compared with those of matched
samples of 16 long-term unemployed and 16 employed male subjects. The unemployed group and
the schizophrenia group participated in less occupational role activity and more passive leisure than
the employed group, but the schizophrenia group participated in less
social life and active leisure and
slept more than both other groups.
The schizophrenia group also perceived less pleasure in "pleasant
events," participated in fewer such
events, and reported more difficulty
in social situations than both other
groups. The results suggest that
unemployment and a lack of social
role make only a modest contribution to low social functioning of
people with schizophrenia and that
a time-use diary is a useful measure
for quantifying the social functioning of people with schizophrenia.
Schizophrenia Bulletin, 22(4):
659-669,1996.
A key problem for many people with
schizophrenia is their severe impairment in social functioning—impairment such as social withdrawal,
anhedonia, and poor role functioning
(Liberman et al. 1989). An inability to
cope effectively in the social environment is thought to be associated with
frequent hospital admissions, symptom exacerbation (Anthony and
Liberman 1986), high use of community health resources (Liberman
1988), and a low quality of life
(Liberman et al. 1989).
One problem for current research
into schizophrenia is how to assess
social dysfunction. While a number
of measures of social and community
functioning already exist for people
with schizophrenia (Wallace 1986;
Vaccaro et al. 1992), almost all existing measures of community functioning involve interviewing patients
regarding their behavior over the
previous week or month. The memory deficits common to this population (Levin et al. 1989) make it likely
that these scales have poor test-retest
reliability and validity.
Some behavioral observation measures of patients' social behaviors are
rated by staff in inpatient settings
(Wallace 1986; Vaccaro et al. 1992),
but such measures do not necessarily
reflect how a person will function in
the community. None of the existing
interview or observational measures
assess how patients use their time on
a day-to-day basis in the community.
Also, most measures use assessments
that are inappropriate for nonpsychiatric populations (e.g., many assess
basic living skills such as hygiene
and grooming), making comparisons
of social functioning with nonpsychiatric groups difficult.
A more direct, reliable, behaviorspecific index that can be used to
compare the social and community
functioning of nonpsychiatric and
schizophrenia populations is
required. We suggest that social functioning can be conceptualized as patterns of time use, and that a selfmonitoring measure could be a sensi-
Reprint requests should be sent to
Dr. R.L. Hayes, Dept. of Occupational
Therapy, University of Queensland,
Queensland 4072, Australia.
SCHIZOPHRENIA BULLETIN
660
tive and valid indicator of the use of
social and life skills.
Time use has been measured with
"time budget" surveys using observation, interviews, and recordkeeping to quantify the duration, frequency, and timing of daily activities
in general populations (Szalai 1972).
Some studies have also recorded the
social dimensions of daily activities
such as where and with whom time
is spent (Szalai 1972; Neulinger 1974).
Time use has been found to vary in
relation to race, sex, stage of life
cycle, marital status, child-care
demands, education, work status,
and income (Landon and Locander
1979; Settle et al. 1979; Henderson
1990; Bittman 1991). Time budgets
have been used to measure quality of
life, social well-being (Andorka
1987), and the effectiveness of rehabilitation programs (Gordon 1987).
Four studies have compared the
time use of patients with schizophrenia with that of other groups (Lindquist 1981; Weeder 1986; Katz et al.
1988; de Vries and Delespaul 1989)
and are detailed in table 1. The findings of these studies were few and
inconsistent, and major methodological flaws in all four studies limit the
interpretation of their data. The most
important flaws were that the activity
categories used were too broad to be
sensitive to variations in behavior
(Lindquist 1981; Weeder 1986; Katz et
al. 1988), and there were failures to
control for factors such as hospitalization and frequent attendance of
day treatment programs that exerted
a strong influence on time use
(Weeder 1986; de Vries and Delespaul
1989). Furthermore, none of the comparison groups in these previous
studies were matched to the subjects
with schizophrenia for marital or
employment status, and only Katz et
al. (1988) matched subjects for educational attainment. In general, the con-
trols were more likely to be married,
highly educated, and in paid employment than the schizophrenia subjects—all factors likely to effect how
people spend their time. Paid
employment, for example, is likely to
have a profound impact on weekday
time use, yet Weeder's (1986) study
was the only one that considered
weekend and weekday time use separately. Finally, many of the studies
used retrospective recall of how subjects "typically" spend their time
(Lindquist 1981; Weeder 1986; Katz et
al. 1988), which is much less accurate
than monitoring activities soon after
they occur (Australian Bureau of Statistics 1987).
People with schizophrenia (who
are often unemployed) and people in
long-term unemployment share a
number of characteristics. In addition
to the obvious financial impact of
unemployment, the absence of work
has other consequences such as loss
of an externally imposed time structure and routine, absence of regular
activity and a valued social role,
reduced social contact outside the
family, reduced opportunities to use
valued skills and capacities, and
reduced access to a variety of experiences (Jahoda 1981; Kabanoff 1982;
Warr 1984). The loss of such opportunities is often associated with
changes in the time use and socialization patterns of unemployed people
Qahoda 1979; Reid 1990) and might
also affect the social functioning of
patients with schizophrenia. As
noted by Bellack (1986), people with
schizophrenia in the community
often "live vegetative lives in nursing
homes, board and care homes, rundown apartments in decaying rooming houses, or on the street" (p. 210)
and are often unemployed and economically disadvantaged. They also
spend large amounts of time in
sedentary and isolated activities and
small amounts of time in social, occupational, recreational, and instrumental pursuits (Bellack 1986; Weeder
1986).
Many of the negative symptoms of
schizophrenia—such as physical
anergia, anhedonia, asociality, poor
grooming and hygiene (Andreasen
1982), abulia (Andreasen 1985), and
diminished emotional range and
sense of purpose (Mueser et al.
1991)—might also describe poor
social functioning. It is still unclear
whether social dysfunction follows
from negative symptoms or is synonymous with them. Negative symptoms in schizophrenia probably have
multiple causes. Carpenter et al.
(1985) distinguished between "primary, enduring deficit symptoms"
(p. 441) intrinsic to schizophrenia and
"secondary transitory negative
symptoms" (p. 441) resulting from
factors such as depression, negative
self-attitudes, and understimulating
environments. It is important to distinguish the biologically based primary negative symptoms from the
secondary negative symptoms
because social dysfunction with different etiological bases may respond
to different treatments.
The evidence, though inconclusive,
suggests that the absence of a valued
social role and the impoverished
physical environments schizophrenia
patients are discharged to may also
play a role in the course of their illness and their social and community
dysfunction (Wing 1989; Baker and
Douglas 1990). This study explores
that possibility by comparing the
social and community functioning of
schizophrenia subjects with that of
long-term unemployed subjects and
employed subjects.
The aim of this study was to compare the time use of schizophrenia
subjects with the time use of matched
groups of employed and unem-
All inpatients with schizo10 schizophrenia
subjects: 8 male,
phrenia of at least 4 years
2 female
duration
10 "spinal pain"
subjects: 8 male,
2 female
10 "manic" subjects:
2 male, 8 female
10 nonpatient
controls: 4 male,
6 female
Lindquist 1981
All inpatients:
20% no previous
psychiatric history,
11 % previous
ambulatory psychiatric
treatment,
69% previous psychiatric
hospitalization
33 schizophrenia
subjects
17 subjects with
other psychiatric
diagnoses
30 nonpsychiatric
controls
45% of patients
and controls male
Katzetal. 1988
"Extremely ill ambulatory
and hospital populations
who had illness careers
exceeding 10 years"
9 schizophrenia
subjects
7 nonpsychiatric
controls
Sex not specified
Subjects
de Vries and
Delespaul 1989
Study
Schizophrenia
groups
Occupational and
physical therapists
No subject
matching
mentioned
Marital status
significantly
different from
schizophrenia
group
30 controls
matched for sex,
age, years of
education, and
country of birth
"Academic-level
professionals"
Comparison
groups
Method
24-hr log of "typical"
24-hour period
before hospital
admission
Completed in
!^-hr units
Activities were
ranked according to the amount
of physical activity
required to perform them
24-hour log of
"typical weekday
before admission"
Completed in 1 -hr
units
Activity categories:
ADL, work, play/
recreation, and
rest/sleep
Time sampling—
10 times a day
for 6 days
Recorded use of
time and context
Coding categories
"alone" and "not
alone"
Table 1. Summary of time-use comparison studies with schizophrenia subjects
Schizophrenia
group and "spinal
pain" group were
significantly less
physically active
than "manic" and
control groups
Only significant
differences: schizophrenia subjects
spent more time
than controls in
ADL and more time
in play/recreation
No significant difference between
groups in time
spent alone
Results
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662
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ployed nonpsychiatric subjects. It
was hypothesized that unemployed
people have different patterns of time
use and social functioning than people in full-time employment. It was
further hypothesized that schizophrenia subjects with the dual disadvantages of psychopathology and
unemployment would have different
patterns of time use and social functioning than both unemployed and
employed people. The patterns of
time use and social functioning were
predicted to be similar to those
described by Jahoda (1979) and Reid
(1990) for unemployed subjects and
similar to those described by Bellack
(1986) and Weeder (1986) for schizophrenia subjects. That is, relative to
employed subjects, unemployed and
schizophrenia subjects would spend
less time in occupational roles, social
life and active leisure, domestic activities, and personal care and more
time in passive leisure and sleeping,
more time at home, and more time
alone or with family members.
Time budgets generally measure
quantity not quality of time use. It
may be, as Jahoda (1982) argued, that
absence of formal employment
denies access to certain types of experience important for psychological
well-being. The quality of activity
participated in by unemployed people, their ability to enjoy activity, or
their comfort in interpersonal situations could deteriorate over time.
Anhedonia, the inability to experience enjoyment in usually pleasurable social, recreational, and instrumental activities, has been associated
with both schizophrenia (Harrow et
al. 1977) and depression (Lewinsohn
1975). Therefore, unemployment and
schizophrenia were also predicted to
be associated with higher levels of
social difficulty and lower levels of
pleasure from activity participation.
663
VOL. 22, NO. 4, 1996
Methods
Subjects. The subjects were three
matched groups each of 16 male Caucasian subjects (total n = 48); a group
with a DSM-III-R (American Psychiatric Association 1987) diagnosis of
schizophrenia, an unemployed group
with no reported history of mental
illness, and a group in full-time
employment with no reported history of mental illness. No subjects
were currently living with a partner
in a marital or common law relationship, as marital status has been found
to influence time use (Landon and
Locander 1979).
Sixteen males who were categorized as "long-term unemployed"
Qackson and Crooks 1993) (i.e., they
had been unemployed for at least 6
months) were selected from two government employment offices. An
unemployment period of 6 months or
more is likely to be sufficient time for
time-use patterns to have been influenced by unemployment (Jackson
and Crooks 1993). The unemployed
subjects were then matched to schizophrenia subjects who were attending either a psychiatric day hospital,
a psychiatry outpatient department,
or a community psychiatry clinic.
Schizophrenia subjects were selected
who were stabilized on antipsychotic
medication and were not significantly troubled by psychotic symptoms, which was operationalized as a
score of 3 or less on the "hallucinatory behavior," "unusual thought
content," and "bizarre behavior"
items of the Brief Psychiatric Rating
Scale (Lukoff et al. 1986). Their mean
score on the Schedule for the Assessment of Negative Symptoms
(Andreasen 1982) was 64. Both schizophrenia and unemployed subjects
were then matched to employed
males who were recruited from government offices and work depots.
The subjects were all recruited from a
similar catchment area.
Subjects were matched for age and
educational level. All subjects were
within 6 years of age of their
matched partners. There were no significant differences in age between
the three groups. Subjects' mean age
was 28.6 years (standard deviation
[SD] = 7.5). The schizophrenia group
had had schizophrenia for a mean of
5.13 years (SD = 4.27), and the unemployed group had been unemployed
for a mean of 1.34 years (SD = 0.88).
Educational level was categorized
according to the highest level of education achieved. In each group, five
subjects had completed 10 years of
education, eight had completed 12
years, and three had completed university degrees. Thirteen (81%) of the
schizophrenia subjects had never
married and three (19%) were either
separated or divorced. Fourteen
(87.5%) of each the unemployed and
the employed subjects had never
married, and two (12.5%) of each
were either separated or divorced.
The majority of the schizophrenia
subjects either lived with a family
member (7, 44%) or in hostel accommodation (5, 31%). Three (19%) lived
alone, and one lived in shared
accommodation. Fifty percent of the
unemployed subjects lived in shared
accommodation, and 50-percent lived
alone. Fifty percent of the employed
group lived with a family member,
six (38%) lived alone, and two (13%)
lived in shared accommodation.
Measures. The three measures used
were the Time-Use Diary (TUD; Australian Bureau of Statistics 1987), the
Adapted Pleasant Events Schedule
(APES; Wilson, unpublished questionnaire), and the Social Situations
Questionnaire (SSQ; Bryant and
Trower 1974). The TUD is an adaptation of a measure developed by the
Australian Bureau of Statistics (1987)
based on established, internationally
used time-use surveys (e.g., Szalai
1972). The TUD is a self-monitoring
instrument in which respondents
record at the end of the day how they
spent their time for each 5-minute
segment for the 24 hours of that day.
Most activities take longer than 5
minutes, and the subject records
when an activity commenced and
finished to the nearest 5-minute
period. Completion of the diary takes
approximately 15 minutes per day,
and recording is continued for 1
week.
Diary entries were coded using
three dimensions: (1) where the subjects spent their time; (2) who they
were with; and (3) the activity they
were engaged in. The categories of
place were: at home, traveling, or
elsewhere. Who they were with was
classified into family or family and
others, people other than family, or
alone. Activities were classified into
six categories: (1) occupational roles
(including paid employment, voluntary employment, day hospital attendance, and educational activities); (2)
sleeping; (3) domestic activities and
purchasing; (4) personal care (including eating, drinking, and medical
care); (5) social life and active leisure;
and (6) passive leisure. The resultant
scores were the number of hours per
day spent on each category on weekdays and weekends. The TUD was
administered and coded by a
research assistant. One-third of the
diaries were randomly selected and
coded by a second research assistant
to check reliability. A high level of
interrater agreement was achieved
for all categories (r = 0.89-1.00).
The APES is an adaptation of the
Pleasant Events Schedule (PES;
MacPhillamy and Lewinsohn 1982).
The PES, devised for use with people
with depression, measures ability to
SCHIZOPHRENIA BULLETIN
664
experience pleasure and levels of
participation in activities commonly
regarded as pleasurable. The 100item APES is much quicker to administer than the 320-item PES and uses
Australian activities and terminology.
The APES contains a list of 100
potentially pleasurable activities that
respondents rate according to how
often they have participated in them
in the previous month and how pleasurable they thought the activities
were or would be. "Frequency of participation" is rated "0-has not happened," "1-happened 1-4 times," or
"2-happened 5 or more times." The
scores are summed to give a score of
how active the person has been in the
previous month. The "perceived
pleasure" of activities is rated "0neutral or not pleasant," "1-somewhat pleasant," or "2-very pleasant"
and summed to give a score of capacity to enjoy activities. The sum of the
cross-products of these two sets of
ratings indicates "obtained pleasure"
or how rewarding life has been for
that time period. Besides measuring
anhedonia, the APES is a brief retrospective report of time use to parallel
the more detailed TUD.
The SSQ is a measure of self-perception of social difficulty. It contains
a list of 30 different social situations
ranging from minimal contact such
as "walking down the street" to more
intimate situations such as "going
out with a person of the opposite
sex." Respondents use a 5-point scale
to rate how difficult it is for them to
be in each situation. The scale ranges
from "0 = no difficulty" to "4 =
avoidance if possible." The 30 situation scores are summed to give an
SSQ total.
Procedure. Each subject completed
the assessment protocol over two sessions. In the first session, a research
assistant discussed the purpose of the
study and the subjects signed a consent form. The subjects then completed the APES and SSQ, were interviewed to collect biographical data,
and given detailed instruction on
how to fill in the TUD. Before being
allowed to take the TUD home to
complete, each subject was required
to complete the TUD for the previous
24 hours in front of the research
assistant to demonstrate ability to use
the TUD independently. The completed diaries were collected in the
second session about 7 days later.
The research assistant checked the
diaries for unclear or missing data
and, where necessary, subjects were
interviewed for clarification of information in the diary.
Results
It has become conventional in many
journals to analyze multiple measures taken across groups with multivariate analysis of variance
(MANOVA), usually predicated on
the assumption that this obviates
problems with inflation of the Type I
error rate resulting from multiple
analyses of related data. Recent analytic reviews of this practice highlight
that the use of MANOVA does not
influence the Type I error rate for
subsequent univariate analyses
(Huberty and Morris 1989). Furthermore, this convention leads to substantial increases in Type II error rate.
Since the hypotheses of this study
were univariate, the time-use measures were each analyzed using a
two-way analysis of variance
(ANOVA) of group (schizophrenia,
unemployed, employed) by part of
the week (weekend, weekdays), with
repeated measures on the last factor.
The means, SDs, and results for the
ANOVAs for the time-use data are
presented in table 2. The SSQ and
APES categories were analyzed with
a one-way ANOVA across groups.
There were significant differences
between the groups on where and
with whom they spent their time,
and there were significant interactions between group and day of the
week. The schizophrenia and unemployed groups spent significantly
more time at home than the
employed group during the week,
but there were no significant differences on weekends. The schizophrenia group spent significantly less
time traveling than the unemployed
group during the week, but there
were no other significant group differences, and the schizophrenia
group spent significantly more time
with their family and less time with
others than the other two groups.
The employed group spent more
time on occupational functioning
during the week than the other two
groups, but the schizophrenia and
unemployed groups did not differ
significantly from each other on this
variable. The schizophrenia group
spent more time sleeping than both
groups on weekdays and more time
sleeping than the employed group on
the weekends. The schizophrenia
group also spent more time with
family than the unemployed group
on weekdays and more time than
both groups on weekends. The
unemployed group spent more time
during the week on domestic activities and purchasing than the
employed group, and there were no
differences between the schizophrenia group and the other groups in
time spent in personal care. The
schizophrenia group spent less time
in social life and active leisure than
the other two groups on weekends.
The unemployed group spent significantly more time in social life and
active leisure than either other group
during the week. Both the schizo-
9.44
(1.47)
a
2.49
(1.72)
a
2.84a
(3.23)
14.23
(5.81)
5.46
(2.15)
a
ad
5.87
(2.75)
4.31"
(2.21)
2.32
(1.03)
b
2.32a
(1.26)
1.54bf
(0.50)
2.05 ae
(0.38)
2.16ac
(2.0)
1.06b
(0.44)
7.80
(0.66)
b
8.96
(1.61)
b
1.26abf
(2.67)
10.86"'
(4.18)
d
6.18=
(3.49)
2.84=
(2.2)
2.02=d
(1.09)
(1.44)
1.22 cd
10.42=
(1.48)
0.59=
(1.15)
5.63=
(5.82)
14.58=
(6.5)
0.98=d
(0.99)
1.73abe
(0.68)
d
17.46=
(6.19)
d
4.94=
(1.87)
4.90bd
(2.6)
2.05ce
(0.58)
1.43=
(0.93)
9.63
(1.53)
cd
1.00=
(1.32)
1.39de
(3.4)
13.75
(5.87)
ce
1.58=
(0.95)
16.42
(4.99)
ce
5.565
5.455
4.62
(3.08)
0.67
4.22d
(2.48)
0.87
7.551
35.283
5.102
2.23
3.632
6.171
'p < 0.005.
p < 0.05.
3
p< 0.001.
4
p<0.1.
5
p<0.01.
2
3.80 4
16.323
2.21
1.42
72.18 3
119.563
10.491
0.08
4.53 2
2.05
5.525
4.23 2
2.12
6.891
2.74 4
36.31 3
2.07
1.13
1.00
3.372
Fvalues {df= 2,45)
Groups Days Interaction
2.04='
(0.89)
2.15=
(1.48)
9.10
(1.2)
d
1.17=
(2.13)
1.87df
(3.34)
11.45='
(5.62)
1.69ce
(1.04)
15.58=
(5.35)
Schizophrenia Unemployed Employed
group
group
group
11.76"
(1.78)
7.72"
(1.2)
1.84a
(0.96)
2.43
(2.41)
a
0.31 " e
(0.99)
15.18
(4.53)
ae
2.07"
(1.00)
16.27
(3.03)
ae
Employed
group
Weekend days
Note.—df= degrees of freedom; ANOVAs = analyses of variance; values with different superscript letters are significantly different (p < 0.05).
Passive leisure
Social life and
active leisure
Domestic activities 1.28abd
and purchasing
(0.95)
abd
Personal care
2 Q2
(1.1)
Sleeping
Occupational
role
Time with family
or family and
others
Time alone
1.30ad
(0.61)
Time traveling
abd
18.18
(2.45)
ad
Schizophrenia Unemployed
group
group
Weekdays
Means, standard deviations (SDs), and two-way ANOVAs of time-use data
Time at home
Activity
Table 2.
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SCHIZOPHRENIA BULLETIN
666
phrenia and unemployed groups
spent more time in passive leisure
during the week than the employed
group, but there were no significant
group differences in weekends.
Overall, the employed and unemployed groups differed primarily on
weekdays when the employed group
spent more time away from home
and in occupational roles and less
time in passive leisure and social life
and active leisure. The employed and
unemployed groups differed little in
time use on weekends. The schizophrenia group showed similar numbers of similarities and differences to
the employed and unemployed
groups on weekdays and weekends.
The schizophrenia group spent more
weekend time than both other
groups in passive leisure, more time
sleeping, and more time with family.
The schizophrenia group and the
unemployed group spent more time
in passive leisure than the employed
group during the week, but spent
less time than the unemployed group
in social life and active leisure across
the whole week.
Table 3 presents the means, SDs,
and results for the ANOVAs on the
SSQ and APES measures. On the
APES, the schizophrenia group rated
participation in pleasant events as
significantly less pleasurable than
either of the other two groups. The
schizophrenia group also reported
engaging in these activities significantly less often than the other
groups. There were no significant differences between the employed and
unemployed groups on these measures, though there was a trend for
the employed group to report more
participation than the unemployed
group (p < 0.05). The employed
group reported the highest rate of
pleasure obtained from pleasant
events, the unemployed group fell in
the middle, and the schizophrenia
Table 3. Means, standard deviations (SDs), and one-way ANOVAs
of the APES and SSQ
Measures
Schizophrenia Unemployed Employed
group
group
group
F values
(df= 2,45)
APES
78.19a
(38.21)
105.56b
(36.74)
118.56b
(28.74)
5.61 1
Frequency of
participation
35.38a
(15.88)
52.19b
(21.43)
66.50b
(18.76)
10.962
Obtained pleasure
48.06a
(27.70)
80.94b
(36.69)
113.19C
(32.30)
16.132
47.31 a
(24.70)
24.50b
(9.70)
19.19b
(7.94)
13.972
Perceived pleasure
Social Situation
Questionnaire
Note.—til = degrees of freedom; ANOVAs = analyses of variances; values with different superscript letters are significantly different (p < 0.05); APES = Adapted Pleasant Events Schedule (Wilson, unpublished questionnaire); SSQ = Social Situations Questionnaire (Bryant and Trower 1974).
'p<0.01.
p< 0.001.
2
group reported the lowest rate. On
the SSQ, the schizophrenia group
reported much more difficulty in
common social situations than either
of the other two groups, which did
not differ from each other.
Discussion
The hypotheses were broadly supported. The schizophrenia group
spent more time than both groups
with family and sleeping and less
time in social life and active leisure.
The schizophrenia group also spent
more weekday time than the
employed group at home and in passive leisure and less time in occupational roles and traveling. However,
contrary to the predictions, the schizophrenia and unemployed groups
spent similar amounts of weekday
time at home, alone, in occupational
roles, passive leisure, domestic activities and purchasing, and personal
care. The schizophrenic group was
similar to the employed group in
weekday time spent in social life and
active leisure, domestic activities and
purchasing, personal care, and time
with family. When comparing weekend or nonwork time only, there were
none of the predicted differences between unemployed and employed
subjects. The weekday/weekend differences for the employed group
were more marked than for the schizophrenia and unemployed groups.
The schizophrenia group, as predicted, perceived less pleasure in
pleasant events, participated in fewer
of them, and obtained less pleasure
from them than both other groups.
Although the employed group
reported spending less time in social
life and active leisure and passive
leisure than the unemployed group
on the TUD, the employed group
obtained higher scores on all categories of the APES; the "obtained
pleasure" score was significant and
the "frequency of participation"
neared significance. Thus, the
employed group reported engaging
667
VOL22.NO. 4, 1996
in a wider range of activities but
spending less time in those activities
than the unemployed group. This
may be because the employed group
had more money, enabling them to
choose from a wider range of recreational activities. The schizophrenia
group reported the highest levels of
social difficulty on the SSQ, with no
difference between the unemployed
and employed groups.
The time devoted to occupational
roles during weekdays by the
employed sample is used differently
by the unemployed and schizophrenia samples. The unemployed group
spent more time in social life and
active leisure, while the schizophrenia group spent more time in passive
leisure and sleeping. Such findings of
passivity are consistent with the negative symptoms of anhedonia, asociality, avolition, and apathy
(Andreasen 1982). Anecdotally, a
number of unemployed subjects
reported spending large amounts of
time in pursuits such as creative writing, tinkering with computers, gardening, and active involvement in
music groups. Such interests require
skills that generally take time to
develop. It could be that the typical
onset of schizophrenia in late adolescence or early adulthood curtails the
development of skills required for
such pursuits. Cognitive disabilities
associated with schizophrenia such
as deficits in attention, information
processing, concept attainment,
social judgments, and memory
(Asarnow and MacCrimmon 1981;
Braff and Saccuzzo 1982; Cutting and
Murphy 1988; Goldberg et al. 1990)
impede the skills required for a range
of recreational pursuits.
Some observed group differences
in time use probably are attributable
to differences in living environments.
For example, none of the unemployed group was living with family
members, while 44 percent of the
schizophrenia group were, so it is not
surprising that the schizophrenia
group had much more contact with
family members. In contrast, 50 percent of the employed group were living with a family member, yet they
still spent less time on weekends
with family members and more time
with others than the schizophrenia
group. Because of the different living
conditions of the three groups, it is
not possible to determine whether
the higher family focus of the schizophrenia group was related to their illness or to unemployment.
Apart from the negative symptoms
such as asociality and avolition, there
are a number of other possible reasons why the schizophrenia group
spent less time with others than the
employed group: insufficient money
to go out with others, a higher need
for family support, or a choice not to
interact with nonfamily members.
Such a choice could be a coping strategy to deal with positive symptoms,
lack of appropriate social skills, or
interpersonal anxiety. The higher levels of social discomfort in the schizophrenia group measured by the SSQ
suggest that interpersonal anxiety
could be a contributing factor.
Subject matching was based on the
assumption that all subjects without
paid employment would be similarly
financially disadvantaged. This is not
necessarily the case. As Bruce et al.
(1991) observed, the financial position of individuals is more than just
their own income; the economic and
environmental conditions of the
entire household should also be considered when determining their economic status. We therefore could
have overestimated the financial
restrictions on our schizophrenia
subjects because so many of them,
relative to the unemployed group,
lived with family members.
Another variable that was not controlled for was the length of time
since experiencing paid employment.
The unemployed group's mean
length of unemployment was 1.34
years, whereas the mean length of illness for the schizophrenia group was
5.13 years. Some of the passivity of
the schizophrenia group could have
resulted from social factors associated with a much longer estrangement from the work force.
One limitation of the TUD measure
is that it measures the amount of time
spent in different activities but not
the quality of those activities. For
example, two people could spend
equal amounts of time in self-care,
but one person might be more competent at that activity and, as a result,
be better groomed than the less capable person. Future studies should
consider measuring the quality of
activity participation and better ways
to match for economic status and
length of unemployment.
Our results suggest that schizophrenia does have an impact on time
use above and beyond that caused by
unemployment. It could be as Strauss
(1985) suggested that "genetic, other
biological, and many psychosocial
factors may interact over time in
important ways to generate negative
symptoms" (p. 459). The characteristic passive lifestyle of patients with
schizophrenia could be the cumulative effect of a chronic schizophrenic
illness, negative symptomatology,
cognitive deficits, and developmental
differences such as time use and
recreational skills deficits that evolve
over time between groups with and
without schizophrenia. However, it is
clear that unemployment and lack of
social role make only a modest contribution to the low social functioning of people with schizophrenia.
The TUD's ability to discriminate
between how, where, and with
668
whom unemployed, employed, and
schizophrenia subjects spend their
time suggests that it could be valuable in schizophrenia research, both
as a measure of social and community functioning and for evaluating
the impact of psychosocial treatments
that target these areas.
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Robyn L. Hayes, Ph.D., is Lecturer in
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of Occupational Therapy, University
of Queensland, Queensland, Australia. W. Kim Halford, Ph.D., is Professor, School of Applied Psychology,
Griffith University, Nathan Campus,
Queensland, Australia.