Association of Insight, Age, and Education Level with Relapse Rates in Schizophrenia Patients

Authors

  • Rahmad Dhani Rujito Universitas Muhammadiyah Surakarta
  • Erna Herawati Universitas Muhammadiyah Surakarta
  • Sahilah Ermawati Universitas Muhammadiyah Surakarta
  • Siti Soekiswati Universitas Muhammadiyah Surakarta

DOI:

https://doi.org/10.22225/wmj.11.1.14516.22-29

Keywords:

Insight, Age, Education Level, Relapse, Schizophrenia

Abstract

Abstract

Schizophrenia is a chronic mental disorder with a high tendency for relapse, which worsens the patient's prognosis and increases the burden of care. Clinical factors such as insight, as well as demographic factors including age and education level, are thought to play a crucial role in influencing treatment adherence and relapse risk. This study aims to analyze the association between insight, age, and education level with relapse rates in schizophrenia patients at RSJD dr. Arif Zainudin Surakarta. This was an analytic observational study with a cross-sectional design. Subjects were selected using purposive sampling, totaling 96 patients. Data were analyzed using Chi-Square test, Fisher’s Exact test, and Logistic Regression. The results showed a significant association between insight (p=0.045) and education level (p=0.046) with relapse rates. Meanwhile, age (p=0.588) was found to have no significant association with relapse incidence. It is concluded that insight and education level are associated with relapse rates, although no single factor emerged as a dominant independent predictor in the multivariate model. Improving patient insight through psychoeducation is recommended to prevent relapse.

References

1. Renwick L, Susanti H, Brooks H, Keliat B, Bradshaw T, Bee P, et al. Culturally adapted family intervention for people with schizophrenia in Indonesia (FUSION): a development and feasibility study protocol. Pilot Feasibility Stud 2023; 9: 53.

2. Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry 2020; 177: 868-72.

3. Moncrieff J, Pillai E, Marston L, Lewis G, Barnes TRE, Johnson S, et al. The association between relapse and the outcome of schizophrenia and recurrent psychotic disorders. Br J Psychiatry 2025; 227: 673-79.

4. World Health Organization. Schizophrenia [Internet]. Geneva: World Health Organization; 2025 [cited 2025 Oct 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/schizophrenia.

5. Glennasius T, Ernawati E. Program intervensi dalam upaya peningkatan pengetahuan dan keteraturan berobat pasien skizofrenia di wilayah kerja Puskesmas Sindang Jaya. Malahayati Nurs J 2023; 5: 4239-49.

6. Dewi IP, Utomo SFP, Aisyah PS, Haroen H, Agustina RH, Pahria T, et al. Mindfulness-Based Asmaul Husna and changes in general adaptive function response among schizophrenia: a quasi-experimental study. J Keperawatan Padjadjaran 2024; 12: 172-81.

7. Iswanti DI, Lestari P, Agusman F, Mendrofa M. The ability of family caregivers to prevent relapse of schizophrenia. J Keperawatan Jiwa 2024; 12: 125-34.

8. Rizkifani S, Susanti R, Febiani T. Kajian interaksi obat antidepresan dan antipsikotik pada pasien skizofrenia di rumah sakit jiwa daerah sungai bangkong pontianak. Med Sains 2023; 8: 163-72.

9. Hareru HE, Gezae KE, W/tsadik DS, Gebregergs GB. Time to Relapse and Relapse Predictors in Patients with Schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Mental Illness 2023.

10. Mulyani S. The impact of socio-demographic factors on the recovery potential of schizophrenia patients post hospitalization. J Epidemiol Public Health 2024; 9: 318-26.

11. Yu H, Sun YJ, Qin MN, Ren JX, Yu K, Song J, et al. Perception of risk of relapse among patients with first episode and recurrent schizophrenia: a descriptive phenomenological study. BMC Psychiatry 2023; 23: 582.

12. Hazan H, Ferrara M, Gibbs-Dean T, Tayfur SN, Corbera S, Karmani S, et al. Insight and its trajectory: predicting the risk of psychiatric hospitalizations among first-episode psychosis during the first year of coordinated specialty care. Schizophr Bull 2025; sbaf019.

13. Oneib B, Mansour A, Bouazzaoui MA. The effect of psychoeducation on clinical symptoms, adherence, insight and autonomy in patients with schizophrenia. Discov Ment Health 2025; 5: 26.

14. Rivelli A, Fitzpatrick V, Nelson M, Laubmeier K, Zeni C, Mylavarapu S. Real-world predictors of relapse in patients with schizophrenia and schizoaffective disorder in a large health system. Schizophrenia (Heidelb) 2024; 10: 17.

15. Xu LH, Zhang M, Wang SQ, Wei YY, Cui HR, Qian ZY, et al. Relationship between cognitive and clinical insight at different durations of untreated attentional psychotic symptoms in high-risk individuals. Front Psychiatry 2021; 12: 656360.

16. Zhu X, Wen M, He Y, Feng J, Xu X, Liu J. The relationship between level of education, cognitive function and medication adherence in patients with schizophrenia. Neuropsychiatr Dis Treat 2023; 19: 2439-50.

17. Wulandari R, Herawati VD. Hubungan dukungan keluarga dan kepatuhan minum obat dengan tingkat kekambuhan pada orang dengan skizofrenia (ODS) di RSJD Surakarta. Senriabdi 2023; 3: 247-66.

18. Ichsan B. Pengantar metodologi penelitian kedokteran dan kesehatan masyarakat. Surakarta: Muhammadiyah University Press; 2022.

19. Lindenmayer JP, Khan A, Harvey P, Keefe R, Liharska L, Yavorsky C, et al. Impaired clinical insight as a predictor of relapse in schizophrenia. Schizophr Bull 2020; 46: S180.

20. Laabidi S, Abidi O, Aissa A, Hosni R, Ouali U, Jomli R. Treatment adherence and insight in schizophrenia spectrum disorders. Eur Psychiatry 2024; 67: S725.

21. Bitter I, Fehér L, Tényi T, Czobor P. Treatment adherence and insight in schizophrenia. Psychiatr Hung 2015; 30: 18-26.

22. Vlachos II, Selakovic M, Ralli I, Hatzimanolis A, Xenaki LA, Dimitrakopoulos S, et al. Role of clinical insight at first month in predicting relapse at the year in first episode of psychosis (FEP) patients. J Clin Med 2023; 12: 4261.

23. Alharthi MA, Al-Raddadi RM, Alfakeh SA. Predictors for readmission risk in schizophrenia: insights from a Saudi Arabian cohort. Front Psychiatry 2025; 16: 1593653.

24. Belihu GD, Moges WK, Yimer AK. Analysis of time to relapse among schizophrenia patients in St. Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. J Health Sci Med Res 2024; 42: 20241049.

25. Amalia I. Hubungan edukasi kesehatan keluarga terhadap tingkat kekambuhan di Rumah Sakit Jiwa Daerah Sungai Bangkong Pontianak. J Cerebellum 2022; 8: 1-6.

26. Bioque M, Mezquida G, Amoretti S, García-Rizo C, López-Ilundain JM, Diaz-Caneja CM, et al. Clinical and treatment predictors of relapse during a three-year follow-up of a cohort of first episodes of schizophrenia. Schizophr Res 2022; 243: 32-42.

27. Kelebie M, Kibralew G, Fentahun S, Rtbey G, Aderaw M, Endeshaw W, et al. Clinical outcomes in first-episode schizophrenia: identifying predictors of relapse. Soc Psychiatry Psychiatr Epidemiol 2025: 1-4.

28. Fan Y, Zhou L, Chen X, Su J, Zhong S. Determinants and outcomes of health-promoting lifestyle among people with schizophrenia. BMC Psychiatry 2024; 24: 210.

29. Prabhawidyaswari NMC, Darmawan IPE, Yanti NPE, Saraswati NWS, Puspitasari NPR, Suari DAWM, et al. Hubungan karakteristik keluarga terhadap frekuensi kekambuhan pada pasien dengan skizofrenia. J Ber Ilmu Keperawatan 2022; 15: 15-26.

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Published

2026-05-31

How to Cite

Rahmad Dhani Rujito, Erna Herawati, Sahilah Ermawati, & Siti Soekiswati. (2026). Association of Insight, Age, and Education Level with Relapse Rates in Schizophrenia Patients. WMJ (Warmadewa Medical Journal), 11(1), 22–29. https://doi.org/10.22225/wmj.11.1.14516.22-29

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Articles