Recovery in Individuals with Schizophrenia Engaged in Community-Based Psychosocial Rehabilitation: Prevalence and Predictors

Introduction: Recovery in schizophrenia is possible. Little is, however, known about recovery in psychosocial rehabilitation programs where social work practitioners are charged with planning for the provision of and delivering of psychosocial therapies. The following research questions guided the study: (1) what proportion of individuals with schizophrenia showed recovery during the first year of intensive community-based psychosocial rehabilitation; and (2) what are the associated predictors. Specifically, we investigated whether intrapersonal characteristics (intrinsic motivation and self-esteem) and social factors (family network relationships and social support) predict recovery during the yearlong follow-up over and above demographics (age, gender, and educational attainment) and clinical indicators (length of illness, substance use, and medication adherence) found to influence outcomes in schizophrenia.

Methods: Data came from two NIMH-funded longitudinal studies of individuals with schizophrenia (N = 149) conducted in Los Angeles, California. Participants completed a battery of research assessments at baseline and every six months thereafter over one year. Recovery was defined as simultaneously fulfilling extant research criteria for at least six months: be in symptomatic remission per the Remission in Schizophrenia Working Group definition, demonstrate adequate role and social functioning, and did not receive inpatient psychiatric treatment. Binary multivariate logistic regression analysis was performed to identify predictors of recovery outcome during follow-up. To arrive at a parsimonious model, the selection of explanatory variables for entry into the multivariate model was guided by the purposeful selection of covariates method.

Results: The ethnically diverse sample comprised a majority of male participants (67%). The average age of the sample was 38.05 (SD = 9.60) with a mean duration of illness of 14.28 years (SD = 10.24). Given that participants were recruited at admissions to psychosocial rehabilitation, the sample, in general, comprised individuals with marked functional deficits and impaired social function. Indeed, only 6.71% (n = 10) were in recovery at baseline. Nonetheless, the rate almost tripled over time: 18.12% (n = 27) of participants showed recovery during the yearlong follow-up. A multivariate logistic regression model was fitted to investigate the predictive relationships between intrinsic motivation and family network relationships with recovery during follow-up controlling for baseline recovery status. The predictors, as a set, reliably distinguished between participants’ recovery outcomes during follow up (X² = 15.02, df = 3, p < 0.01) and yielded a ROC curve of 0.74 for an acceptable discrimination of outcomes. For a given recovery status at baseline, recovery during follow-up was predicted by more positive family relationships (OR = 1.37, 95% CI = 1.05 – 1.78), but not by higher levels of intrinsic motivation (OR = 1.28, 95% CI = 0.91 – 1.81).

Conclusion: Individuals with schizophrenia engaged in intensive community-based psychosocial rehabilitation have about 20% chance of achieving recovery during the first year of treatment. Positive family relationships at the start of treatment was important in effecting recovery during follow-up. Psychosocial therapies targeting family systems are vital to promote recovery in individuals with schizophrenia.