Emotion Perception and Social Functioning in Serious Mental Illness: Differential Relationships Among Inpatients and Outpatients

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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
Results
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.
In outpatients, there was a significant positive
relationship between performance on the VEIT and
the Social Competence subscale of the MCAS (r
.351, p lt .05). However, scores on the BLERT and
FEIT were not significantly correlated with MCAS
Social Competence. The only neurocognitive
variable that was found to be significantly
correlated with MCAS Social Competence was the
NAB Naming task (r .370, p lt .05). This
relationship was not significantly different than
the relationships between MCAS Social Competence
and BLERT (Steigers Z .957, p gt .05), FEIT
(Steigers Z .377, p gt .05), or VEIT (Steigers
Z .112, p gt .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
(Pearsons r .482, p lt .05), and this
relationship was significantly stronger than the
relationship between the FEIT and NOSIE Social
Interest (Steigers Z 1.98, p lt .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 (Steigers Z 1.67, p lt
.05). Additionally, inpatient performance on the
BTFR was associated with NOSIE Social Interest
(r .517, p lt .01) this relationship was
significantly stronger than the relationship
between NOSIE Social Interest and BLERT
(Steigers Z 1.86, p lt .5), FEIT (Steigers Z
2.838, p lt .01), and VEIT (Steigers Z 1.77, p
lt .05).

Method
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 individuals 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.

Table 1. Intercorrelations Among Affect
Perception, Neurocognition, and Social
Functioning in Outpatients
Measure 1 2 3 4 5
BLERT -- -- -- -- --
FEIT 0.41 -- -- -- --
VEIT 0.75 0.52 -- -- --
NAB Naming 0.55 0.43 0.41 -- --
MCAS 0.22 0.31 0.35 0.37 --
Table 2. Intercorrelations Among Affect
Perception, Neurocognition, and Social
Functioning in Inpatients
Measure 1 2 3 4 5 6 7
BLERT -- -- -- -- -- -- --
FEIT 0.45 -- -- -- -- -- --
VEIT 0.51 0.34 -- -- -- -- --
BTFR 0.16 0.49 0.15 -- -- -- --
RBANS Story Memory -0.27 0.14 0.20 0.34 -- -- --
RBANS Story Recall -0.32 0.13 0.04 0.31 0.83 -- --
NOSIE-30 0.04 -0.07 0.06 0.52 0.48 0.41 --

Discussion
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.