Social Psychiatry
Social Psychiatry 14, 151-157 (1979)
The Social Functioning Schedule - A Brief Semi-Structured Interview
Marina Remington and P. Tyrer
Faculty of Medicine, University of Southampton, England
Summary. A brief interview schedule for assessing
social functioning is described which is particularly
suited for assessing non-psychotic patients. Inter-
rater reliability by the intraclass correlation coeffi-
cient for each part of the schedule ranged from 0.45
to 0.81 on audiotape ratings and from 0.50 to 0.80
with independent interviews. A version of the
schedule for informants gave similar levels of agree-
ment. Ratings from patients and informants taken
independently revealed highly significant agreement
on all sections of the schedule (p < 0.01). The
schedule also clearly discriminated between patients
with personality disorders (with expected problems
in social functioning), those with other psychiatric
diagnoses, and non-patients. Factor analysis applied
to the ratings of 106 neurotic outpatients revealed
four factors, domestic and leisure problems, reduced
performance, domestic worries and occupational dif-
ficulties. The scale is a reliable and valid instrument
for recording social functioning and takes only a
short time to complete.
Introduction
It is now widely recognised that psychological dis-
turbance is multidimensional and inadequately
characterised by sole reference to symptoms.
Increasing emphasis has been given to the impor-
tance of individual functioning within a social
framework. Investigations of therapeutic outcome
have emphasised the distinction between symptoms
and social functioning, suggesting that they may show
different outcomes both with and without treatment
(Freeman and Simmons, 1963; Frank, 1961; Weiss-
man et al., 1974; Malan et al., 1968). It is therefore
important to make independent assessments of
symptoms and social functioning in clinical and
9 by Springer-Verlag 1979
research practice. A number of measures, both self-
reports and interviews, have been published which
assess functioning within various roles (Katz and
Lyerly, 1963; Ellsworth, 1975; Spitzer et al., 1970;
Paykel et al. 1971; Gurland et al., 1972). We
describe here the Social Functioning Schedule (SFS),
a brief semi-structured interview designed for use
with non-psychotic disorders which is easily incorpo-
rated into a clinical or research assessment interview.
In designing the SFS we tried to construct a brief
schedule which embraced all important social roles
and aspects of functioning. An interview format was
chosen as this would be more appropriate for clinical
practice and has been shown to be sensitive and reli-
able in the assessment of symptomatology (Spitzer et
al., 1970; Wing et al., 1974). However, the schedule
was semi-structured to allow the interviewer to use
his skills in eliciting an adequate report from the
patient.
In devising the content of the schedule, use was
made of previous work with interview formats (Pay-
kel et al., 1971; Gurland et al., 1972; Hewett, 1975).
Various items and scoring procedures were tested out
in pilot studies. This, together with previous reports
of social functioning, showed that it is impossible to
divorce the construction of scales from theoretical
concepts concerning what constitutes role perform-
ance.
The terms used to refer to the field such as 'social
attainment' (Feffer and Phillips, 1953), 'social com-
petence' (Phillips and Zigler, 1961), 'social impair-
ment' (Ruesch and Brodsky, 1968), 'social malad-
justment' (Gurland et al., 1972) and 'social adjust-
ment' (Paykel et al., 1971) suggest that there is some
agreed criterion against which an individual's func-
tioning can be measured. In practice normative or
ideal standards are invoked which are rarely made
explicit. In this way it is assumed, for example, that it
0037-7813/79/0014/0151/$01.40
152
is better to have more than a particular number of
friends, to avoid convenience foods, and to have
'developed' interests. Such items assume that norma-
tive data are available or that there is a universally
agreed optimal functioning, which, with rare excep-
tions (Hogarty and Katz, 1971), is not the case.
Offer and Sabshin (1966) have outlined the prob-
lems inherent in the various concepts of normality,
and to avoid these difficulties we abandoned norm-
referenced criteria altogether and eschewed concepts
of social adjustment or attainment which appear to
incorporate them. The alternative of recording social
behaviour alone also raises difficulties. A subject's
report cannot be accepted as a valid judgement of
behaviour and has been shown to have low reliability
and validity (Paul, 1967). An informant, similarly,
cannot be considered an adequate observer of the
patient's behaviour at his workplace.
This approach avoids spurious attempts to elicit
an account of behaviour. It also rejects arbitrary
criteria concerning what constitutes 'adequate' per-
formance. Questions are couched in terms of the kind
of difficulties expressed by disturbed individuals. The
method of inquiry and assessment is similar to that
adopted in interview ratings of symptoms. An inven-
tory of distressing or disturbing events is established,
which are subsequently scaled in terms of frequency
or intensity (Wing et al., 1974), this being accom-
plished without reference to normative criteria. An
interviewer can, for example, establish from the
patient whether he feels he is managing his work well
and from an informant whether the patient complains
that he cannot cope with his job, and such percep-
tions alone constitute social functioning. Norms are
decided by the patient and informants, not imposed
from outside.
Method
Description of Schedule
The schedule is structured around 12 sections which
incorporate functioning both within and outside the
home. These are: employment, household chores,
money, self-care, marital relationship, child care,
patient-child relationships, patient-parent relation-
ships, household relationships, extra-marital rela-
tionships, social contacts, hobbies and spare time
activities. These 12 areas of functioning were chosen
to give a reasonably comprehensive coverage of life
situation for a variety of individuals. Some sections
such as 'social contacts' apply to all individuals,
others such as 'employment' and 'marital relation-
ships' apply to large sections of the population. Areas
M. Remingtonand P. Tyrer: SocialFunctioning Schedule
such as 'household relationships' apply to only a few
individuals, since it refers to those who reside with
friends, acquaintances or relatives other than parents
and children.
Four sections are divided into two sub-sections.
These are employment, household chores, money,
and spare time activities. In each case, questions are
divided into a 'behaviour' sub-section in which the
patient's reports of his own performance are rated
and a 'stress' sub-section in which the patient is asked
to describe feelings such as strain or worry within the
area in question. This division is similar to Paykel et
al.'s (1971) categories of 'behaviour' and 'satisfac-
tions and feelings' and Gurland et al.'s (1972)
'deviant behaviour' and 'distress', although, in con-
trast to previous work, 'behaviour' is not here asses-
sed by reference to optimal or expected standards of
performance, and only rates the patient's reported
management of tasks.
The sections and sub-sections together make 16
potential areas for questions and rating in any indi-
vidual case. Within each section and sub-section a
group of questions is asked. The interview is semi-
structured so that the interviewer may adapt or add
to existing questions in order to elicit an adequate
report.
When the interviewer is satisfied that he has
gained a full description of functioning, the patient's
reports are summarized by rating on an analogue
scale, a continuous horizontal line 10 cm long, rang-
ing from no difficulties at one extreme through inter-
mediate levels of difficulty to severe breakdown in
functioning at the other extreme. The interviewer
makes his rating of reported problems by intersecting
the scale at an appropriate point with a vertical line.
Analogue scales have already been used successfully
in the measurement of mood (Aitken, 1969; Zealley
and Aitken, 1969; Bond and Lader, 1974) and satis-
factory reliability and validity has been achieved
(Folstein and Luria, 1973). Analogue scales were
employed in the SFS as they simplified the task of
rating for the interviewer and offered the possibility
of greater sensitivity to change and between-group
differences than brief categorical scales.
The scales range from 'no difficulties' to 'severe
difficulties' in all cases, and in so doing do not specify
the exact form disturbance must take. In each section
a number of possible problems are explored based on
the results of preliminary interviews with patients. A
report of frequent or intense problems in any or all
areas warrants a high rating. This form of rating has
been shown to be as reliable as more specific,
categorical ratings in the assessment of symptoms
(Remington et al., 1979).
An example of suggested questions and the form
M, Remington and P. Tyrer: Social Functioning Schedule 153

Table 1. Relationship between patient and informant assessment of social functioning

Section N r Patient Informant

Mean SD Mean SD t-Test

W o r k - behaviour 39 0.62 a 6.59 15.25 6.95 15.22 0.17

Work - stress 40 0.66 a 20.07 24.04 14.65 19.51 2.07 b
Chores - behaviour 52 0.62 a 16.52 24.67 16.71 21.99 0.07
Chores - stress 51 0.50 a 13.86 20.25 7.51 15.26 2.48 b
Financial problems - behaviour 72 0.66 a 6.45 14.96 9.30 16.99 1.81
Financial problems - stress 73 0.68 a 13.18 19.73 10.30 19.19 1.57
Self care 72 0.54 a 12.79 18.01 14.86 35.70 0.79
Marital relationship 51 0.80 a 33.34 22.69 28.49 21.92 2.08 b
Child care 22 0.58 a 8.36 12.92 2.45 11.51 2.47 b
Patient-child relationships 48 0.57 a 18.75 19.85 19.02 16.91 0.59
Patient-parent relationships 51 0.66 a 22.31 21.19 21.98 20.91 0.14
Social contacts 73 0.72 a 29.32 21.24 25.86 21,88 1.84
Spare time - behaviour 70 0.54 a 22.24 25.97 16.73 22.03 1.99
Spare time - stress 72 0.45 a 30.65 26.92 23.00 25,94 2.34 b
Mean score 73 0.72 ~ 18.73 12.95 16.25 13,05 2.16 b

a p < 0.01
b p < 0.05

of rating is given in the Appendix. Administration of
the full schedule requires 10-20min, depending on
the range and severity of problems reported.
Instructions about the applicability of sections are
given in the schedule. Ratings are made of problems
occurring within the past month, and this is made
clear to the patient in initial instructions and in the
form of specific questions. The schedule is, however,
easily adapted to cover differing time periods. A
similar schedule, modified for use with an informant,
has been constructed. This incorporates additional
specific items within each section which are rated on
three-point scales prior to the more global analogue
rating. The section on extra-marital relationships is
omitted as inappropriate for use with the majority of
informants. (Copies of the full schedule are obtain-
able on request).
Reliability
Inter-rater agreement was assessed using both
audiotape and independent interviews. The patients
assessed were seen as part of a study of day- and out-
patient care (Tyrer and Remington, 1979). Consecu-
tive interviews were performed by a consultant
psychiatrist (PT) and a research interviewer, also a
trained clinical psychologist (MR). All interviews
were conducted on the same day. Twenty-one sets of
interviews were established, and 21 audiotapes were
also taken with different patients by the research
interviewer. These were subsequently rated by a
psychiatrist (PT) and a research psychologist not
trained in psychological medicine. The patients were
all suffering from anxiety states, phobic or depressive
neurosis. The 42 patients (29 female, 13 male) had a
mean age of 35 years (range 19-60 years).
The results from audiotape ratings and indepen-
dent interviews were assessed separately, as the latter
is a more stringent test of reliability. Inter-rater
agreement was calculated by the intraclass correla-
tion coefficient (Rx) (Bartko, 1966, 1974) with the
aid of a computer programme developed by Cicchetti
et al., (1976). This programme also assesses whether
bias is present between raters.
Results
The overall intraclass correlation coefficient (RI) for
the audiotape ratings was 0.62, averaged over all
scales and all rater pairings. There was little differ-
ence between the average levels of agreement of the
three rater pairings. With one exception, all scales
revealed significant and acceptable reliability, with RI
values ranging from 0.45 to 0.81. The section on
child care showed near zero correlation, but only six
cases were rated. Some significant bias resulted on
five of the sixteen scales, although this was small in
amount (less than or equal to 12 scale points).
In this case, the independent interviews showed
no decrement in reliability relative to the audiotape
ratings. An overall R~ value of 0.62 was found again
with significant values ranging from 0.50 to 0.80. A
non-significant value of 0.15 was found for work
behaviour. Rater bias was significant on two scales,
but again mean differences were small (less than or
equal to 15 scale points).
The reliability of the SFS for informants was
154 M. R e m i n g t o n a n d P. Tyrer: Social Functioning Schedule

Table 2. Factor analysis of data on Social Functioning Schedule hold relationships was not examined due to lack of
from 106 psychiatric patients
cases. Rater pairs were omitted from analysis when
% Factor one or both ratings was absent. In most cases both
of total N loading ratings were omitted because the item was inappli-
variance cable to the patient, but in a small but significant
number of cases no rating was made on the informant
Factor 1: Domestic and leisure
problems
version as he or she felt unable to make a report of
Spare time - stress 106 0.85 the area of functioning in question.
Spare time - behaviour 106 0.70 All the correlations between the ratings of patient
Self-care 29.7 106 0.63 and informant in each role area were significant,
Patient-child relationships 67 0.49
ranging from 0.45 to 0.80, indicating satisfactory
Chores - behaviour 82 0.47
agreement between the two schedules, and also
Factor 2: R e d u c e d performance showing that a patient's perception of social function-
Child care 36 0.84 ing is often shared by an informant. Comparisons
W o r k - behaviour 10.0 68 0.66 between mean scores by t-tests reveal six small but
Chores - behaviour 82 0.49
significant differences. These occurred in the mean
Factor 3: D o m e s t i c worries scores of child care, marital relationships and three
Chores - stress 82 0.74 out of four of the 'stress' sub-sections. In each case,
Financial problems - behaviour 7.0 105 0.59 informants achieved lower scores suggesting a tend-
Financial problems - stress 106 0.57
ency to under-report the problems perceived by the
Factor 4: Occupational problems patient (Table 1).
W o r k - stress 5.4 68 0.64
W o r k - behaviour 68 0.52
Factor Analysis
Only Sections loading above 0.45 on each factor are illustrated.
A factor analysis was performed on the data from the
schedule obtained with 106 patients referred to an
out-patient clinic and whom had been diagnosed as
assessed by audiotape ratings. Nine interviews with having anxiety states, depressive or phobic neuroses.
the patient's spouse were conducted by the research The SFS was administered immediately following the
interviewer, which were subsequently rated by the psychiatric interview. The section on household rela-
research psychologist and a medical student taking an tionships was omitted due to insufficient cases. Inter-
option in psychiatry. An overall R I value of 0.69 was correlations among the remaining fifteen sections
found with a range from 0.48 to 0.88. were computed and a Varimax rotated factor analysis
performed which produced four factors, accounting
Relationship Between Patient for all the variance in the data. These were domestic
and Informant Assessment of Social Functioning and leisure problems (Factor 1), reduced perform-
ance (Factor 2), domestic worries (Factor 3), and
The relationship between the two versions of the occupational problems (Factor 4). Sections loading
social functioning schedule was investigated using above 0.45 on these factors are shown (Table 2).
data collected as part of a study of day- and out- Two of the 'behaviour' sub-sections, chores and
patient care. Patients were assessed on the schedule work, loaded on two factors.
four months after entering treatment. Where pos-
sible, a suitable informant was also interviewed
Validity
within one week using the alternative version of the
schedule, resulting in 73 pairs. In the great majority As a test of validity, the ability of the schedule to
of cases [49] the informant was the patient's spouse. discriminate between groups of individuals with dif-
Fourteen were parents, three were children and the ferent diagnoses was examined. Three groups were
remainder were close friends of the patient. chosen, one with a clinical diagnosis of personality
Table 1 shows the Pearson product-moment cor- disorder in whom social functioning was poor, one
relations and comparison of means of the patient and with other psychiatric diagnoses apart from personal-
informant versions of the schedule for each section ity disorder (mainly psychotic patients seen for
(on the analogue scales) and for the mean social maintenance therapy) in whom milder disturbance of
functioning score across all sections. The section on social function was expected, and a third group who
extra-marital relationships is omitted as inappropri- were the spouses or close relatives of psychiatric
ate from the informant schedule, and that for house- patients. All subjects were seen in an out-patient
M. Remington and P. Tyrer: Social Functioning Schedule 155

Table 3. Mean section and factor scores for personality disordered, non-personality disordered patients and controls

Personality Neurosis/
Section disorder (A) Psychosis (B) Normal (C) t-test
Mean SD Mean SD Mean SD Av.B Av.C Bv.C

Chores - behaviour 30.00 32.68 5.22 10.44 5.67 11.85 2.58 b 3.15 b 1.00
Chores - stress 24.50 22.48 6.22 11.23 5.89 12.00 2.36 b 1.80 b 0.06
Financial problems - behaviour 28.00 29.47 3.57 7.81 2.36 6.25 2.75 a 2.99 a 0.42
Financial problems - stress 18.07 24.13 14.21 19.24 10.36 15.94 0.76 1.33 0.53
Self-care 36.64 22.92 3.57 9.61 4.71 9.38 4.87 a 4.86 a 0.07
Marital relationship 40.22 12.28 32.00 30.62 30.17 14.55 1.74 1.34 0.10
Patient-child relationships 38.38 23.87 6.38 12.30 10.73 13.68 2.56 b 1.51 1.25
Patient-parent relationships 37.56 18.18 15.25 14.37 16.22 21.36 1.11 2.62 b 0.24
Social contacts 45.64 24.52 24.93 16.77 " 11.93 11.34 2.46 b 4.18 a 2.26 b
Spare time - behaviour 42.86 29.02 13.29 15.65 6.07 16.32 3.14 a 4.78 a 1.03
Spare time - stress 44.50 28.92 17.57 20.52 6.64 14.57 2.81 a 4.35 a 1.37
Mean score 33.65 15.29 13.41 7.60 9.16 6.58 4.35 a 5.08 a 1.26
Factor

Domestic and leisure problems 37.62 21.46 10.3l 8.86 6.50 8.02 4.08 a 4.90 a 1.05
Reduced performance 22.00 31.12 3.58 10.41 2.58 9.29 2.58 b 2.06 b 0.18
Domestic worries 24.24 17.99 9.30 10.62 5.91 8.44 2.55 b 3.67 a 0.80

a p < 0.01
b p < 0.05

clinic by PT and selected so that each triad of patients
in the diagnostic groups was matched for age (to
within 5 years) and sex. There were 14 cases in each
group. Following psychiatric interview, subjects were
referred to a research interviewer (MR), blind as to
the psychiatric status of the interviewee, who
administered the Social Functioning Schedule. Occa-
sionally the patient or non-patient status of the inter-
viewee was revealed by his response to questions, but
this is not considered to have significantly biased rat-
ings, and the interviewer was unaware of the nature
or degree of psychiatric disturbance in the patient.
The three groups were compared on section scores,
mean scores and factor scores. Factor scores for each
case were obtained by calculating the mean of those
sections contributing to a factor, excluding those sec-
tions which were not rated. Table 3 shows the mean
scores for each group and assessments of the differ-
ences between groups by paired t-test. The sections
on employment, child care, extra-marital relation-
ships, household relationships, and the factor 'occu-
pational problems' could not be examined due to
insufficient cases. Significance levels are given for
one-tailed tests as it was predicted that the personal-
ity disordered group would obtain higher scores than
the non-personality disordered group who would in
turn score higher than the normal group (higher
scores indicate greater problems in social func-
tioning).
The predictions were partially corroborated. The
personality disordered group showed more severe
problems on all but three comparisons with both the
non-personality disordered and normal groups. Only
the section on social contacts revealed a significant
difference in the problems of non-personality disor-
dered and normal groups.
Discussion
The SFS is a brief, reliable and valid measure of
reported problems within twelve areas of function-
ing. To our knowledge it is the only interview method
of rating social functioning in non-psychotic patients
which does not base ratings on arbitrary criteria of
'adequate' performance.
The version of the schedule for informants shows
reasonable agreement with that for patients, indicat-
ing that an informant's account is on the whole fairly
representative of that elicited from the patient.
Understandably a somewhat different picture
emerges from informants, in particular on 'stress'
sections where measures are taken of patient com-
plaint as reported by the informant. The results with
informants are consistent with previous work in
which data from relatives has been found to be both
reliable and valid (Ellsworth et al., 1968; Katz and
Lyerly, 1963).
The schedule is valid in that it significantly dis-
criminates between groups of patients with poor
social functioning (personality disorders) and those
with less or no social function problems. Only one
section, that representing social contacts outside the
family, separated the last two groups. This result may
156
p a r t l y b e d u e to a ' f l o o r ' effect as t h e m e m b e r s o f t h e
n o n - p e r s o n a l i t y d i s o r d e r e d g r o u p w e r e all u n d e r g o -
ing m a i n t e n a n c e t r e a t m e n t a f t e r t h e a c u t e p h a s e s of
illness h a d p a s s e d , a n d this r e f l e c t e d in r e l a t i v e l y l o w
s c o r e s o n m o s t sections. T h e n o r m a l g r o u p , as
e x p e c t e d , a c h i e v e d low scores w i t h o n e n o t a b l e
e x c e p t i o n , t h e s e c t i o n o n m a r i t a l r e l a t i o n s h i p s . This
r e s u l t is n o t s u r p r i s i n g g i v e n t h a t e l e v e n of t h e f o u r -
t e e n ' n o r m a l ' g r o u p w e r e t h e s p o u s e s of p s y c h i a t r i c
p a t i e n t s w h o , in turn, also p r o d u c e d e l e v a t e d s c o r e s
on marital problems.
T h e i n s t r u m e n t h a s also b e e n a p p l i e d to t h e c o m -
p a r a t i v e e v a l u a t i o n of d a y - a n d o u t - p a t i e n t c a r e f o r
n e u r o t i c s ( T y r e r a n d R e m i n g t o n , 1979). P a t i e n t s
were assessed before treatment and 4 and 8 months
a f t e r t h e b e g i n n i n g of t r e a t m e n t . P r e l i m i n a r y a n a -
lyses i n d i c a t e t h a t t h e scales of t h e S F S a r e sensitive
to c h a n g e s o v e r t i m e in this p o p u l a t i o n a n d s h o w
s o m e p a r a l l e l s w i t h clinical i m p r o v e m e n t .
T h e f a c t o r analysis g a v e rise to f o u r f a c t o r s w h i c h
w e r e r e l a t i v e l y e a s y to i n t e r p r e t b y e x a m i n a t i o n of
h i g h l o a d i n g sections. T h e y offer an a l t e r n a t i v e , b r i e f
m e t h o d of s c o r i n g w h i c h is r e p r e s e n t a t i v e o f t h e
m a j o r p a r t of t h e v a r i a n c e in s e c t i o n s c o r e s if h i g h
l o a d i n g v a r i a b l e s a r e a p p l i e d in t h e e s t i m a t i o n of fac-
tors. T h i s m e t h o d o f o r g a n i s i n g d a t a f r o m t h e
s c h e d u l e is also v i n d i c a t e d b y t h e fact t h a t t h e f a c t o r s
discriminated between the validation groups,
r e p l i c a t i n g t h e p a t t e r n o f d i f f e r e n c e s f o u n d w i t h sec-
t i o n scores.
Acknowledgements. We thank Sheila Hewett for her valuable help
in the development of the schedule, and John Alexander for help
with the statistical analysis.
Appendix
Part of Social Functioning Schedule (SFS) illustrating
main features
2. Household Chores
Now I would like to discuss household chores - cooking,
shopping, the washing, cleaning, gardening, decorating,
household repairs and so on.
What household jobs do you usually do?
Give details:
Where necessary: Does this mean you do something in the
house every week? YES / NO
If NO (i. e., no regular contribution each week), cut off here
and go to section 3.
2(a) Have you had any difficulties in managing the chores over
this last month? Have you found that you cannot do as much
as usual, or that others have had to take over? Have you
found it difficult to get things done? Have you been slow at
doing things? Have you felt that you have done jobs well on
the whole?
M. Remington and P. Tyrer: Social Functioning Schedule
2(a) Rate problems with chores: Behaviour
severe
none
difficulties
2(b) How do you feel about the chores? Have you found managing
the chores a strain? Do chores get you down? Do the chores
bore you, or irritate you?
2(b) Rate problems with chores: Stress
severe
none
difficulties
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Note added in proof. In the full analysis of the data from the study evaluating day- and out-patient care (Tyrer and Remington, 1979) no
significant differences were found in outcome measured by SFS ratings between the two types of service. However, there was a highly
significant improvement in mean SFS scores 4 and 8 months after treatment (p < 0.001) and there were differences in improvement over
time between individual sections of the SFS. Scores for social contacts, spare-time behaviour and stress showed highly significant improve-
ment in all groups of patient (p < 0.001), items concerned with work, household chores, child care and extramarital relationship showed
lesser improvement (p < 0.05), and improvement on the sections concerned with marital relationships, financial problems and parental
relationships was not significant.

Responsiblefor the text: Dr. N. Kreitman,Edinburgh,Scotland,U. K. Responsiblefor advertisements:L. Siegel,G. Martin, Kurfiirstendamm237, D-1000 Berlin15,
Springer-Verlag,Berlin,Heidelberg,NewYork. Printedin Germanyby aprinta, Wemding/gchwaben.
9 by Springer-Verlag,Berlin,Heidelberg1979
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