Association Between Family Support and Relapse among Patients with Schizophrenia

Family Support and Schizophrenia Relapse

Abstract

Background: Relapse in schizophrenia contributes to rehospitalization, functional deterioration, and caregiver burden. Although families are central to community care, evidence from Maluku on family support and relapse is limited. Objective: To examine the association between family support reported by family respondents and relapse among patients with schizophrenia at the Regional Specialized Hospital (RSKD) of Maluku Province, Indonesia. Methods: This cross-sectional study was conducted in October 2024. Forty adult family respondents were recruited purposively during the predefined study period (planned sample, 72). Family support was assessed with a 24-item questionnaire covering emotional, informational, instrumental, and appraisal support. Patient relapse was reported by the family respondent for the preceding 12 months and defined as symptom recurrence requiring hospital treatment; more than two episodes was classified as high relapse. Fisher's exact test was used for the 2 x 2 analysis. Results: Thirty-four respondents (85.0%) were classified as providing good family support and six (15.0%) as providing poor support. Twenty-six patients (65.0%) had high relapse and 14 (35.0%) had low relapse. Counterintuitively, high relapse occurred in 25 of 34 patients in the good-support group and 1 of 6 in the poor-support group (two-sided Fisher's exact test, p = 0.014; OR = 13.89, 95% CI: 1.42-135.55). Conclusion: Family-support category was associated with the patient's retrospectively reported relapse classification, but the unexpected direction, small sample, wide confidence interval, and cross-sectional design preclude a causal interpretation. Greater support may be a response to more severe or recurrent illness.