Clinical, Demographic, Personal, and Social Predictors of Symptomatic Remission in a Community Sample of Persons with Schizophrenia
Schizophrenia is a severe disorder characterized by an episodic course. The reoccurrence of each symptomatic episode can have negative effects on treatment response and other psychosocial outcomes, whereas sustained symptom remission has been associated with better treatment outcomes. We applied the Remission in Schizophrenia Working Group’s consensus-criteria to examine the rate of symptomatic remission in an ethnically diverse community sample to determine the clinical, demographic, social, and personal predictors of remission. Prior research has largely examined clinical correlates.
The sample included 185 persons with schizophrenia from a NIMH-funded research project. Participants completed assessments every six months for the study duration. Based on the consensus-criteria, participants with ratings of mild or less (≤3) on the core psychopathologies of the Brief Psychiatric Rating Scale were classified in remission. Statistical analyses were conducted using baseline and 6-months data. Hierarchical binary logistic regression was used to determine whether baseline demographic, clinical, social, and personal factors predicted remission at 6-months. Variables from four domains were entered as follows: demographic (age, gender, ethnicity, education), clinical (length of illness, role functioning, marijuana use, negative symptom severity), social (social support, number of friends), and personal (intrinsic motivation, social competence). To build a parsimonious model, a series of bivariate analyses first identified baseline variables that were significantly related to remission at 6-months. Binary logistic regression was used to identify correlates of remission from the final multivariate model. Guided by previous research, a'priorione-tailed directional tests were set at a significance level of p < 0.05.
Over half of the sample was male (66.3%). The mean age was 37.8 years (SD = 9.56) and the average length of illness was 13.25 years (SD = 10.13). The sample included African-Americans (41.1%), Euro-Americans (36.2%), Latinos (13%), and Asians and other ethnicities (8.6%). A majority (63.2%) met the remission criteria at 6-months. Among these, 19.5% did not meet remission criteria at baseline but achieved remission at 6-months, and 43.8% met the criteria at baseline and remained in remission at 6-months. Analyses indicated that demographic, clinical, social, and personal factors provide an overall good model fit (X2 = 23.45, df = 13, p < 0.05). Our final model—length of illness, negative symptoms, number of friends, intrinsic motivation, and social competence—produced a good model fit (X2=18.55, df=5, p<0.01). Remission was related to shorter length of illness (OR=0.952, p<0.05), higher levels of intrinsic motivation (OR=1.13, p<0.05), and higher levels of social competence (OR=1.29, p<0.05).
This work extends prior research by more fully examining a range of predictors associated with remission in a diverse community-based context. Our main findings indicate that nearly two-thirds of participants achieved remission at 6-months. The correlates of remission were shorter length of illness, higher level of intrinsic motivation and social competence. These findings underscore the critical importance of targeting psychosocial interventions early in the illness course; practitioners could focus on approaches that foster motivation and increase social skills. It seems promising that such strategies aimed at modifiable personal factors can help achieve and sustain remission.