Identifying Modifiable Risk Factors for Relapse in Patients With Schizophrenia in China

Abstract

Background Preventing relapse of schizophrenic patients is really a challenge. The present study sought to provide more explicit evidence and factors of different grades and weights by a series of step-by-step analysis through χ 2 test, logistic regression analysis and decision-tree model. The results of this study may contribute to controlling relapse of schizophrenic patients. Methods A total of 1,487 schizophrenia patients were included who were 18–65 years of age and discharged from 10 hospitals in China from January 2009 to August 2009 and from September 2011 to February 2012 with improvements or recovery of treatment effect. We used a questionnaire to collect information about relapse and correlative factors during one year after discharge by medical record collection and telephone interview. The χ 2 test and logistic regression analysis were used to identify risk factors and high-risk factors firstly, and then a decision-tree model was used to find predictive factors. Results The χ 2 test found nine risk factors which were associated with relapse. Logistic regression analysis also showed four high-risk factors further (medication adherence, occupational status, ability of daily living, payment method of medical costs). At last, a decision-tree model revealed four predictors of relapse; it showed that medication adherence was the first grade and the most powerful predictor of relapse (relapse rate for adherence vs. nonadherence: 22.9 vs. 55.7%, χ 2 = 116.36, p < 0.001). The second grade factor was occupational status (employment vs. unemployment: 19.7 vs. 42.7%, χ 2 = 17.72, p < 0.001); the third grade factors were ability of daily living (normal vs. difficult: 28.4 vs. 54.3%, χ 2 = 8.61, p = 0.010) and household income (household income ≥ 3000 RMB vs. <3000 RMB: 28.6 vs. 42.4%, χ 2 = 6.30, p = 0.036). The overall positive predictive value (PPV) of the logistic regression was 0.740, and the decision-tree model was 0.726. Both models were reliable. Conclusions For schizophrenic patients discharged from hospital, who had good medication adherence, more higher household income, be employed and normal ability of daily living, would be less likely to relapse. Decision tree provides a new path for doctors to find the schizophrenic inpatient’s relapse risk and give them reasonable treatment suggestions after discharge.

Uncertainty in illness among individuals with schizophrenia: a phenomenology study in Indonesia

“…Meanwhile, non-adherence to treatment, history of frequent hospitalizations, unemployment, difficulties in daily living, health insurance medical costs, low income, low family support, longer duration of illness, consumption of cocaine and marijuana and occasional use of different antipsychotic drugs are all factors that lead to relapse in people with schizophrenia (San et al , 2013; Mi et al , 2020). The vast majority were also unemployed, which means they do not have a regular income, a situation that could deteriorate their mental well-being.…”

Risk Factors for Relapse in People with Severe Mental Disorders during the COVID-19 Pandemic: A Multicenter Retrospective Study

“…The economic impact of the pandemic is increasingly evident, with unemployment rates, which constitute an established risk factor for mental disorders across a person’s lifespan [ 30 ], rising dramatically. Regarding how these factors influence people with SMDs, unemployment appears to increase the likelihood of developing psychosis by 53% [ 26 ] and is also a risk factor for relapse in patients with schizophrenia [ 34 , 35 , 37 ]. Job loss, as a primary loss, also entails losses in areas like economic security, independence, health care, and sense of future [ 39 ].…”

“…Other psychosocial circumstances, such as unemployment and economic problems, which have increased significantly during the COVID-19 pandemic, have been shown to be risk factors for mental health [ 30 , 31 , 32 , 33 ] and, more specifically, for the development of SMDs and future relapse [ 34 , 35 , 36 , 37 ].…”

Faktor-faktor yang Berhubungan dengan Kekambuhan Orang dengan Skizofrenia yang Berobat di Poli-Klinik Rumah Sakit Jiwa Prof. Dr. Muhammad Ildrem Medan Tahun 2021

“…Barnett et al (2018) menyebutkan bahwa kekambuhan Orang dengan Skizofrenia juga dipengaruhi oleh perilaku pasien, sehingga perilaku tersebut harus diawasi oleh lingkungannya, seperti keluarga, masyarakat dan tenaga kesehatan (Barnett et al, 2018). Penelitian Mi et al (2020) bahwa kekambuhan Orang dengan Skizofrenia di China utamanya dipengaruhi oleh faktor pengobatan, selanjutnya faktor pekerjaan dan pendapatan yang dapat memicu terjadinya kekambuhan ( (Mi et al, 2020). Takeuchi (2018) juga mengatakan bahwa pengobatan merupakan pemicu kekambuhan Orang dengan Skizofrenia (Takeuchi et al, 2018).…”

“…Penelitian Kokurcan (2020) juga menyebutkan kepatuhan pengobatan dapat menyebabkan keparahan pada penderita skizofrenia, selian itu lama atau onset juga dapat memeprparah keadaan pasien (Kokurcan, Karadag, Dogu, Erdi, & Orsel, 2020) rendah dapat memperparah dan meningkatkan kekambuhan pasien dengan skizofrenia (Sajatovic et al, 2021). Penelitian Mi et al (2020) bahwa kekambuhan Orang dengan Skizofrenia di China utamanya dipengaruhi oleh faktor pengobatan, selanjutnya faktor pekerjaan dan pendapatan yang dapat memicu terjadinya kekambuhan ( (Mi et al, 2020). Takeuchi (2018) juga mengatakan bahwa pengobatan merupakan pemicu kekambuhan Orang dengan Skizofrenia (Takeuchi et al, 2018).…”