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.

Changes in brain-derived neurotrophic factors in schizophrenic patients with spiritual psychoreligious therapy

“…Risk factors associated with relapse have been identified as medication adherence, occupational status, ability of daily living and payment method of medical costs, with medication adherence being the most powerful predictor of relapse. 20 SQEFT psychospiritual therapy had an impact on decreasing BPRS value in the current study. A decrease in clinical symptoms of sentiments, like anxiety, guilt, despair and somatics, is indicated by a lower BPRS value.…”

Changes in brain-derived neurotrophic factors in schizophrenic patients with spiritual psychoreligious therapy

“…Risk factors associated with relapse have been identified as medication adherence, occupational status, ability of daily living and payment method of medical costs, with medication adherence being the most powerful predictor of relapse. 20 SQEFT psychospiritual therapy had an impact on decreasing BPRS value in the current study. A decrease in clinical symptoms of sentiments, like anxiety, guilt, despair and somatics, is indicated by a lower BPRS value.…”

Exploring Predictors of Self‐Management Abilities for Early Relapse Signs in Individuals With Schizophrenia and Their Caregivers

“…Individuals with a history of more hospitalizations may have a lower likelihood of independently identifying early warning signs and responding to them, which may lead to inadequacy in relapse prevention (Mi et al. 2020).…”

The impact of the COVID-19 pandemic and earthquake on mental health of persons with severe mental illness: A survey study among people receiving community mental health care versus treatment as usual in Croatia

“…This was also evident in the second wave of the pandemic, where the patients in the CMHT group were more likely to visit GPs as well as psychiatrists, possibly indicating higher adherence to treatment. As low adherence to treatment is a strong risk factor of relapse (Haywood et al, 1995; Mi et al, 2020), it is possible that this intervention is a protective factor against relapses in the near future (Wang et al, 2014). When looking at the whole sample, as many as 58.9% participants in our research sought psychiatric help during the first wave of the pandemic and Zagreb earthquake, and 15.9% were hospitalized in the same period due to worsening of psychiatric symptoms.…”

Changes in brain-derived neurotrophic factors in schizophrenic patients with spiritual psychoreligious therapy

“…Risk factors associated with relapse have been identified as medication adherence, occupational status, ability of daily living and payment method of medical costs, with medication adherence being the most powerful predictor of relapse. 20 SQEFT psychospiritual therapy had an impact on decreasing BPRS value in the current study. A decrease in clinical symptoms of sentiments, like anxiety, guilt, despair and somatics, is indicated by a lower BPRS value.…”

Exploring Predictors of Self‐Management Abilities for Early Relapse Signs in Individuals With Schizophrenia and Their Caregivers

“…Individuals with a history of more hospitalizations may have a lower likelihood of independently identifying early warning signs and responding to them, which may lead to inadequacy in relapse prevention (Mi et al. 2020).…”

The impact of the COVID-19 pandemic and earthquake on mental health of persons with severe mental illness: A survey study among people receiving community mental health care versus treatment as usual in Croatia

“…This was also evident in the second wave of the pandemic, where the patients in the CMHT group were more likely to visit GPs as well as psychiatrists, possibly indicating higher adherence to treatment. As low adherence to treatment is a strong risk factor of relapse (Haywood et al, 1995; Mi et al, 2020), it is possible that this intervention is a protective factor against relapses in the near future (Wang et al, 2014). When looking at the whole sample, as many as 58.9% participants in our research sought psychiatric help during the first wave of the pandemic and Zagreb earthquake, and 15.9% were hospitalized in the same period due to worsening of psychiatric symptoms.…”

Changes in brain-derived neurotrophic factors in schizophrenic patients with spiritual psychoreligious therapy

“…Risk factors associated with relapse have been identified as medication adherence, occupational status, ability of daily living and payment method of medical costs, with medication adherence being the most powerful predictor of relapse. 20 SQEFT psychospiritual therapy had an impact on decreasing BPRS value in the current study. A decrease in clinical symptoms of sentiments, like anxiety, guilt, despair and somatics, is indicated by a lower BPRS value.…”

Exploring Predictors of Self‐Management Abilities for Early Relapse Signs in Individuals With Schizophrenia and Their Caregivers

“…Individuals with a history of more hospitalizations may have a lower likelihood of independently identifying early warning signs and responding to them, which may lead to inadequacy in relapse prevention (Mi et al. 2020).…”

The impact of the COVID-19 pandemic and earthquake on mental health of persons with severe mental illness: A survey study among people receiving community mental health care versus treatment as usual in Croatia

“…This was also evident in the second wave of the pandemic, where the patients in the CMHT group were more likely to visit GPs as well as psychiatrists, possibly indicating higher adherence to treatment. As low adherence to treatment is a strong risk factor of relapse (Haywood et al, 1995; Mi et al, 2020), it is possible that this intervention is a protective factor against relapses in the near future (Wang et al, 2014). When looking at the whole sample, as many as 58.9% participants in our research sought psychiatric help during the first wave of the pandemic and Zagreb earthquake, and 15.9% were hospitalized in the same period due to worsening of psychiatric symptoms.…”