| Introduction:Schizophrenia is a kind of serious mental disorder,which often manifests as various symptoms.It refers multiple disorders such as perception,thought,affection and behavior,as well as discordance of mental activities,which will seriously affect patients'lives.So far,how to improve the recovery of patients with schizophrenia is still a challenging subject.Previous research has found that patients'illness perception and psychological feelings can affect health-seeking behaviors and treatment adherence,and finally affect rehabilitation.However,there is no tool can assess the illness perception of schizophrenia in China.The research on psychological feelings of schizophrenia lacks a longitudinal investigation,and the relationship between different psychological feelings is still not clear.Therefore,the purpose of this study is the following two points:First,to translate and modify the Revised Illness Perception Questionnaire(IPQ-R),to explore its applicability in patients with schizophrenia,and to evaluate the reliability and validity,providing valid assessment tool for future research in the fields of treatment,prognosis,and rehabilitation of schizophrenia.The second is using grounded theory to explore the psychological feelings of patients with schizophrenia,extract the themes and try to construct a theoretical model,propose psychological intervention methods to help patients with schizophrenia obtain stable and positive psychological feelings,and provide the basis for future researches.Methods:After the authorization of the author,IPQ-R was translated and back-translated and culturally debugged.Delphi experts'consultation was used to modify the questionnaire,so that it could be suitable for patients with schizophrenia.Pretest was done to check if the expression of questionnaire was clarified.Finally the Chinese version of IPQ-R for patients with schizophrenia was formed.A total of 223 outpatients who were diagnosed as schizophrenia were selected.All participants completed General Information Questionnaire,Chinese version of IPQ-R,Positive and Negative Symptom Scale(PANSS),Hospital Anxiety and Depression Scale(HADS),Insight and Treatment Attitude Questionnaire(ITAQ),and Morisky Medication Adherence Scale(MMAS-8).35 patients were scheduled for retesting after 2 weeks.Epi Data 3.1 software was used to enter data,and SPSS 21.0 software and AMOS22.0 software were used to analyze data.Count data was described by frequency and percentage,and measurement data was described by mean and standard deviation.Effective questionnaire recovery rate was used to evaluate the enthusiasm of experts.Mean of item importance score,coefficient of variation,and consent rate were calculated to evaluate the concentration of experts'advice.Kendall's W coefficient was calculated to evaluate the coordination of experts'advice.Cronbach's?coefficient was used to evaluate the internal consistency of IPQ-R.Pearson correlation analysis was used to calculate the correlation coefficients of each dimension of IPQ-R and retest reliability.Spearman correlation analysis was used to calculate the construct validity,convergence validity and predict validity.Exploratory factor analysis and confirmatory factor analysis were used to evaluate the construct validity.P<0.05 meant the difference was statistically significant.In qualitative research,the participants were outpatients with schizophrenia.After screening through the inclusion and exclusion criteria,the patients were interviewed in-depth to collect their psychological feelings after illness.When the data showed saturation,a total of 16interviewees'data were collected,and 129,746 words of text were collated.Nvivo 11software was used to analyze the data,to extract the themes of psychological feelings of patients with schizophrenia,and establish a theoretical model.Results:All the participants were diagnosed with schizophrenia.The course of schizophrenia ranged from 4 to 163 months,with a median of 22 months.223questionnaires were distributed and 216 valid questionnaires were collected in the study,with an effective rate of 96.9%.32 patients participated in the retest and 32 valid questionnaires were collected,with an effective rate of 100%.The positive coefficients of experts in two rounds of Delphi consultations were 100%,the authority coefficients of expert were 0.93 and 0.96,and the Kendall's coordination coefficients were 0.387 and0.484,with P<0.001.After two rounds of experts'consultations,the Chinese version of IPQ-R was formed with 89 items totally.The Cronbach's?coefficient of each dimension was between 0.69 and 0.86 in Chinese version of IPQ-R,and the retest reliability was between 0.68 and 0.90(P<0.001).Correlation analysis between different dimensions of the Chinese version of IPQ-R shows there was a positive correlation between timeline acute/chronic and timeline cyclical,consequences and identify,treatment control and personal control,emotional representation and identify,timeline acute/chronic,timeline cyclical,consequences and illness coherence,with correlation coefficient between 0.25and 0.63(P<0.01).There was a negative correlation between personal control and illness coherence,emotional representation and treatment control,with correlation coefficients of 0.30 and 0.20 respectively(P<0.01).The significant correlation coefficients between the Chinese version of IPQ-R and PANSS,HADS,ITAQ and MASS-8 were between-0.28 and 0.64(P<0.01).The exploratory factor analysis extracted 7 factors,and the cumulative variance contribution rate was 61.37%.In confirmatory factor analysis,X~2/df=2.714,RMSEA=0.072,RMR=0.038,GFI=0.915,AGFI=0.901,CFI=0.884,TLI=0.854.Three most common symptoms of patients were anxiety(176 people,81%),memory loss(172 people,80%),and lack of motivation(167 people,77%).Patients attributed most of the symptoms to current mental health problems(69%),and a few attributed them to adverse reactions(21%)and other factors(10%).The most recognized causes of current mental health problems for patients were"Stress or worry","Receive stimulation in life","Family problems or worries caused my illness",and"My mental attitude".Patients generally thought that their current mental health problems were chronic and cyclical with bad consequences.They thought they could control over the illness and had positive expectations for treatment.They had a coherent view of the illness,but had more negative emotional responses to current mental health problems.In the qualitative research,four themes of psychological feelings of schizophrenic patients were extracted from 16 patients.They were feelings related to identity(negative self-awareness,differential treatment,dignity),feelings related to belonging(being outsiders,loneliness,together with others and connection with others),feelings related to trust(conflict and confrontation,trust);feelings related to hope(negative thought and hopelessness,hope).The patient's feelings on identify,belonging,trust,and hope were volatile,and would change continuously with the progress of the illness,treatment and life experience.Serious or repeated experiences would make the patient's feelings become continuous.The four themes were influenced by each other and the influence was isotropic.Conclusions:The Chinese version of IPQ-R has good reliability and validity in patients with schizophrenia.It can meet the requirements of psychometrics and can be applied to patients with schizophrenia.It is a reliable and valid assessment tool.The psychological feelings of patients with schizophrenia include four themes:feelings related to identity,feelings related to belonging,feelings related to trust,and feelings related to hope.They are influenced by each other,and the influence is isotropic.The rehabilitation of patients with schizophrenia requires the integration of multiple forms of intervention and the establishment of alarming system.In addition to drug treatment,integration of group psychotherapy,family psychotherapy,social skill training,and supportive interventions will help patients obtain more stable and positive psychological feelings,to promote rehabilitation. |
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