Abstract
Objective: This study proposes a schizophrenia disability model to describe the associations between negative symptoms and disability to test the possible mediating roles of positive coping and resilience and to compare the relative weights of the indirect effects of these two mediators in an integrated whole. Methods: A total of 407 hospitalized Han Chinese patients diagnosed with stable schizophrenia or schizoaffective disorder were included. Patients were evaluated using the following scales: the Simplified Coping Style Questionnaire (SCQ) for positive coping, the Connor-Davidson Resilience Scale (CD-RISC) for resilience, the Positive and Negative Syndrome Scale (PANSS) for negative symptoms, and the World Health Organization Disability Assessment Schedule, Version II (WHO-DAS II) for the severity of disability. The schizophrenia disability distal mediation model was constructed using the structural modeling (SEM) approach. Bootstrapping procedures and the PRODCLIN program were used to examine the mediating roles of positive coping and resilience. Results: The schizophrenia disability model was well-fitted to the observed data. Positive coping and resilience together with negative symptoms explained 66% of the variance in disability. Positive coping and resilience partly mediated the negative symptoms–disability relationship. The bootstrapped unstandardized indirect effect was 0.319, and the direct effect was 0.224. Positive coping also has a significant positive effect on resilience. In addition, the ratio of the specific indirect effect of positive coping to the total indirect effect (48%) is higher than that of resilience (30%). Conclusion: Positive coping and resilience are two key causal mediators of the negative symptoms–disability relationship. Positive coping and resilience are important personal resources for patients with schizophrenia. We found that the indirect effect of positive coping was relatively more important than that of resilience. This result suggests that personalized treatments aimed at resilience and positive coping can effectively buffer the impact of negative symptoms for patients with schizophrenia and promote rehabilitation.
Highlights
Schizophrenia is among the most disabling disorders worldwide
Identifying the role of personal resources in the disability process of patients with schizophrenia may be an important step in developing effective targeted interventions that may offer new ways to reduce the impact of negative symptoms on disability and promote rehabilitation
Given the theoretical and empirical evidence, we propose a schizophrenia disability model (Figure 1) to describe the associations among negative symptoms, positive coping, resilience, and disability to test the possible mediating role of positive coping and resilience and to compare the relative weights of the indirect effects of these two mediators as an integral whole
Summary
Patients with schizophrenia have a wide range of deficits in their everyday functioning [1]. Negative symptoms have been identified as the main drivers of disability in patients with schizophrenia and are significantly better predictors than all other symptom domains, such as psychotic symptoms [3, 4]. Some studies have suggested that patients with a similar severity of psychopathology may have different functional outcomes because of differences in personal resources [6, 7]. Identifying the role of personal resources in the disability process of patients with schizophrenia may be an important step in developing effective targeted interventions that may offer new ways to reduce the impact of negative symptoms on disability and promote rehabilitation
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