The biopsychosocial-spiritual factors influencing relapse of patients with schizophrenia.

OBJECTIVE: High relapse rate of patients with schizophrenia has a large impact on patients and their families that can be reviewed from biopsychosocial and spiritual factors. Determining all the potential risk factors of relapse in schizophrenia can help increase awareness of physicians, patients, and families. Physicians are the ones who examine patients and have responsibility to manage and educate them and expect to prevent relaps. This study analyze various biopsychosocial and spiritual factors affecting relapse occurrence in patients with schizophrenia.

METHODS: Cross sectional observational analytic study on 226 subjects with schizophrenia in three places in East Java, Indonesia, namely Soetomo Academic Hospital Surabaya (33.2%), Menur Hospital Surabaya (32.7%), and Radjiman Wediodiningrat Mental Hospital Lawang (34.1%) that met the inclusion and exclusion criteria. Data collection including 33 biopsychosocial and spiritual factors and were analyzed using bivariate and multivariate logistic regression.

RESULTS: Relapse rate within 1 year was 59.73%. There were 12 factors significantly affected the relapse of schizophrenia, namely history of physical disease of mothers during pregnancy ( p  < .001; B  = 27.31; 95% CI 3.96-188.52), presence of trigger ( p  < .000; B  = 6.25; 95% CI 2.61-14.96), negative beliefs ( p  < .000; B  = 4.94; 95% CI 2.10-11.61), hereditary factors ( p  < .001; B  = 4.84; 95% CI 1.93-12.10), insight ( p  < .003; B  = 4.27; 95% CI 1.62-11.27), 1-year GAF Scale ( p  < .015; B  = 3.79; 95% CI 1.30-11.09), response to treatment ( p  < .006; B  = 3.68; 95% CI 1.45-9.36), family knowledge ( p  < .011; B  = 3.23; 95% CI 1.31-7.93), history of head trauma ( p  < .029; B  = 3.13; 95% CI 1.13-8.69), medication side effects ( p  < .028; B  = 2.92; 95% CI 1.12-7.61), substance use history ( p  < .031; B  = 2.86; 95% CI 1.10-7.45), and occupation ( p  < .040; B  = 2.40; 95% CI 1.04-5.52).

CONCLUSIONS: The 12 factors of biopsychosocial-spiritual are determinant to predict the risk of relapse in patients with schizophrenia. These factors should be emphasized in psychoeducation for patients and their families to enable intervention and relapse prevention.