Original Research ARTICLE
Positive Coping and Resilience as Mediators Between Negative Symptoms and Disability Among Patients With Schizophrenia
- 1Second Affiliated Hospital, School of Medicine, Zhejiang University, China
- 2Harbin Medical University, China
- 3Beijing College of Social Administration, China
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.
Keywords: Coping skill, personal resources, psychosis, Schizophrenia, Disability, resilience (personality)
Received: 29 Apr 2019;
Accepted: 08 Aug 2019.
Copyright: © 2019 Tian, Feng, Yue, Li, Jing and Qiu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Mx. Zhou Y. Qiu, Harbin Medical University, Harbin, 130012, Heilongjiang, China, firstname.lastname@example.org