Stressful life events may hit schizophrenics harder
16 May 2007
Psychiatry Res 2007; 151: 77?86

Patients with schizophrenia may find it harder to handle stressful life events than those with other mental health problems and the general population, US research suggests.

To date, research suggesting that schizophrenic patients may find it hard to cope with stress has been criticized as "idiosyncratic" and for perhaps failing to account for differences in the stressful event experienced.

To overcome this problem, William Horan (University of California, Los Angeles) and co-workers assessed the effects of the same stressful event, namely the 1994 Northridge Earthquake, on 96 patients with schizophrenia, 18 patients with bipolar disorder, and 18 people with no mental illness.

The Northridge Earthquake measured 6.9 on the Richter scale and left 9000 people injured and 61 people dead.

The team used a variety of assessment scales to look at how this earthquake affected the participants within 1 and 5 weeks after the event. These included the Impact of Events Scale (IES), the Coping Responses Inventory (CRI), the Rosenberg Self-Esteem Scale (RSES), and the Provision of Social Relations Scale (PSRS).

They also developed a new self-report instrument specifically for the study, the Earthquake Exposure Questionnaire. This contains 21 "yes" or "no" questions and provided an objective measure of exposure to the earthquake and its consequences.

"Both patient groups reported higher IES avoidance symptoms than controls immediately after the earthquake," Horan and team write in the journal Psychiatry Research.

They add that, compared with controls, patients with schizophrenia reported lower CRI "Approach Coping", with scores of 61.1 and 48.6, respectively. The score for bipolar patients was intermediate, at 54.2.

RSES scores were also lower in schizophrenic patients than in bipolar patients or controls (29.1 vs 31.0 vs 35.1), indicating lower levels of self-esteem.

Furthermore, PSRS scores were lowest in schizophrenic patients than in bipolar patients or controls (53.6 vs 59.4 vs 63.4), suggesting they received less social support.

"Within the schizophrenia group, lower self-esteem and higher levels of both avoidance and approach coping were significantly correlated with higher stress-related symptoms at follow-up assessment," Horan et al report.

They conclude that their findings "encourage further efforts to identify personal characteristics that render some patients more vulnerable to stressors than others, and suggest that patients who tend to engage in avoidance coping strategies may be at heightened risk for persistent stress-related symptoms."

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