Moderator Of The Relationship Between Life Events And Schizophrenia Relapse Under The Framework Of Stress Theory And The Construction Of Intervention

Objective We attempted to analyze the relationship between life events and relapse of schizophrenia,and to explore the moderating effect of coping style and social support on this relationship under the framework of stress theory.Based on the results of a cross-sectional survey and the Guidelines for the Prevention and Treatment of Schizophrenia(second edition),an intervention plan for the prevention of schizophrenia relapse was constructed through a literature review.Methods This research includes two parts: a cross-sectional study and the construction of intervention.Cross-sectional study: convenient sampling was used.Psychiatric outpatients were selected from October 2019 to October 2020 from three psychiatric hospitals in the central western region of China(The Second People’s Hospital of Hunan Province,Ningxia Ning-an Hospital,and Department of Health Hospital).Inclusion/exclusion criteria were applied,and 315 schizophrenia patients in good general physical condition were selected.Four questionnaires,the Social Rehabilitation Rating Scale(SRRS),Simplified Coping Style Questionnaire(SCSQ),Social Support Rating Scale(SSRS),and Brief Psychiatric Rating Scale(BPRS),were used to assess patients’ sociodemographic data,life events,coping styles,social support,and schizophrenia relapse,respectively.Spearman correlation analysis and binary logistic regression analysis were used for data analysis.Construction of intervention: Select 20 experts in psychiatry,psychology,nursing,etc.,adopt the Delphi method,and send two rounds of questionnaires face-to-face and email from November 2019 to March 2020 to form the prevention of schizophrenia interventions for relapse.Results1 Cross-sectional study1.1 Statistical description: The mean life event score was 205.22 ± 119.59.Among the coping styles,the mean score for positive coping was 1.69 ± 0.71 and that for negative coping was 1.29 ± 0.65.In social support,the following scores were obtained: subjective support score(19.50 ± 4.73),objective support score(10.50 ± 14.35),support utilization score(7.73 ± 2.24),and total social support score(37.05 ± 9.66).1.2 Correlation test: Overall,only residence was significantly associated with schizophrenia relapse(p = 0.009),while the remaining factors were not associated with schizophrenia(p < 0.05).There was a significant positive correlation between life events and schizophrenia relapse(p = 0.037).Positive coping was negatively associated with schizophrenia relapse(p < 0.001),while social support(p = 0.001)and its two dimensions [subjective support(p = 0.002)and support utilization(p = 0.008)] were significantly negatively correlated with schizophrenia relapse.1.3 Logistics regression analysis: Residence(p = 0.017)and medication status(p = 0.046)were significantly correlated with schizophrenia relapse.1.4 Moderating effect test: Both positive coping(p = 0.042)and negative coping(p = 0.036)had a moderating effect on the relationship between life events and schizophrenia relapse.Social support(p = 0.001)and its two dimensions [subjective support(p = 0.003)and support utilization(p = 0.004)] had a significant moderating effect on the relationship between life events and schizophrenia relapse.2.Construction of interventionConsultation results: Twenty experts were included.The recovery rates of the two rounds of questionnaires were 87.0% and 100%,respectively.The expert authority coefficient was 0.898,and the coefficient of variation was between 0.09 and 0.22.Finally,4 first-level indicators,13second-level indicators and 40 third-level indicators were established.We concluded:Conclusions1 Coping style and social support both have a moderating effect on the relationship between life events and schizophrenia relapse.Future measures to prevent relapse risk in patients with schizophrenia should emphasize accurate assessment of life events coping styles and social support.Schizophrenia patients should monitor their own coping style,and family and society should apply a variety of measures to provide adequate social support for schizophrenia patients.2 Based on the results of a cross-sectional survey and the Guidelines for Prevention and Treatment of Schizophrenia(second edition),this study used the Delphi expert consultation method to construct an intervention scheme for prevention of schizophrenia relapse,which we feel is worthy of being promoted and applied after clinical verification.