Simanullang, R. H., Belitung Nursing Journal.

2018 December;4(6):566-571
Received: 22 February 2018 | Revised: 13 May 2018 | Accepted: 3 July 2018
https://belitungraya.org/BRP/index.php/bnj/index

© 2018 The Author(s)

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ORIGINAL RESEARCH ISSN: 2477-4073

THE CORRELATION BETWEEN FAMILY SUPPORT AND RELAPSE

IN SCHIZOPHRENIA AT THE PSYCHIATRIC HOSPITAL
Rostime Hermayerni Simanullang*

STIKes Murni Teguh, Indonesia

*Corresponding author:
Rostime Hermayerni Simanullang
STIKes Murni Teguh
Jl. Jawa No.2, Gg. Buntu, Medan Tim., Kota Medan, Sumatera Utara 20236, Indonesia
Email: hermayerni@gmail.com

Abstract
Background: Schizophrenia is a severe mental illness with the majority of patients’ experiences relapses. Family support is
not a new topic, but still considered as an important factor to prevent the relapse. However, little is known about the
correlation between family support and relapse in schizophrenia patients in North Sumatra, Indonesia.
Objective: This study aims to examine the relationship between family support and relapse in schizophrenia.
Methods: This was a correlational cross-sectional study conducted from January to May 2015 at the psychiatric hospital in
Medan North Sumatra Indonesia. There were 90 samples selected using purposive sampling. Chi-square test was used to
analyze the data.
Results: Findings of this study reveals that there was statistically significant relationship between family informational
support (p=0.00), appraisal support (p=0.00), instrumental support (p=0.00), and emotional support (p=0.00) with relapse in
schizophrenia.
Conclusion: There is a significant correlation between family support (informational support, appraisal, instrumental and
emotional support) and relapse in schizophrenia. Therefore, it is recommended that health care professional should
continuously promote the important of family support and increase their knowledge regarding the type of supports needed
for patients with schizophrenia.

Keywords: schizophrenia; family support; relapse

INTRODUCTION

Schizophrenia is a severe mental disorder, mised compliance has extensive clinical and
which has long-term effect on mental health of economic consequences (Skarsholm,
an individual. People with schizophrenia often Stoevring, & Nielsen, 2014). In the past two
difficult in processing information, having decades, a growing body of research has called
interpersonal relationships, and having attention to the association between childhood
additional mental health problems such as adversity and psychotic disorders, particularly
anxiety disorders, major depressive illness, or schizophrenia, and patients with psychotic
substance-use disorders (Stuart & Sundeen, disorders that have high rates of self-reported
2007). The compliance to the schizo- childhood abuse and neglect, ranging from
phrenia medications is poor, as only 30% to over 75% (Rajkumar, 2015). Mortality
approximately 50% of the prescribed in schizophrenia is high, especially due to
medication is consumed although a compro- suicides. Several early predictors of outcomes

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have also been found. Individuals with patients having schizophrenia relapse, which is
schizophrenia have alterations in brain one of the challenges that has been facing by
morphometric and neurocognition, and our late health care professionals in Indonesia.(A. I.
studies have found that the use of high life Setiadi, 2006) such as mental disorder rate
time doses of anti-psychotics associated with occurrence in Central Java in 2008 reached
these changes (Jääskeläinen et al., 2015). 3768 patients, and increased to 3914 in 2010
(Setiadi, 2008).
Over the past 50 years, as evidenced by the
closure of mental hospitals and advent of Relapse in schizophrenia is broadly recognized
community-based care, there has been as the reemergence or the worsening of
transition of care for schizophrenia patients psychotic symptoms. More specifically,
from formal hospital-based healthcare systems certain criteria are used to define relapse; they
to outpatient and community services. The include aggravation of positive or negative
financial burden (in terms of direct and symptoms, hospital admission in the past 6
indirect costs) of community-dwelling patients months, and more intensive case management
with schizophrenia is high with estimated and/or a change in medication. According to
annual costs in the US of $23 billion (Gater et Kazadi study finding that Co-morbid
al., 2014). If ten percent of the population depressed mood, poor adherence owing to lack
experiences mental health problems, then we of insight, medication side-effects and lack of
must pay attention. It is estimated that there family support were the factors most likely to
are about 450 million people worldwide increase the risk of relapse in patients with
experience mental health disorders. The schizophrenia. Risk of relapse may be reduced
prevalence of patients with schizophrenia is when the treating psychiatrist identifies and
about 0.2% to 2%, while the incidences or new addresses these factors (Kazadi, Moosa, &
cases that appear every year are about 0.01%. Jeenah, 2008).
There are more than 80% of patients with
schizophrenia in Indonesia is not handled However, as lack of the studies focusing on
optimally by either the family or the medical schizophrenia relapse in North Sumatra
team (Yosep & Sutini, 2014). Indonesia, therefore this study aims to identify
the correlation between family support and
Based on the data in the United States, each schizophrenia relapse. Despite so many factors
year there is about 300,000 schizophrenia affect to healing schizophrenia, this study only
experiencing episodes of acute. The emphasize on family support as family is the
prevalence of schizophrenia is higher than key factor in healing patients with
Alzheimer’s disease, multiple sclerosis, the schizophrenia.
client with diabetes taking insulin, and muscle
disease (muscular dystrophy), and 20% - 50%
of schizophrenia patients attempted suicide, METHODS
and 10 % of them death to suicide, and death
rate of the schizophrenia is 8 times higher than Study design
the death rate of the population in general This was a correlational cross-sectional study
(Yosep & Sutini, 2014). According to the that was conducted from January to May 2015
results of the household health survey in at the Psychiatric Hospital of Prof. Dr.
Indonesia, it is estimated as many as 264 of the Muhammad Ildrem in Medan North Sumatra
1,000 members of the households suffering Indonesia.
from mental health disorders. And the
incidence of Schizophrenia in Indonesia Sample
reached 0.46%, and those who are There were 90 samples selected using
experiencing psychotic severe disorders are purposive sampling. The inclusion criteria
about 2% in Jakarta, 1.9% in Aceh, and 1.6% were all family members who have a family
in West Sumatra. It is about 50% - 53% of member with schizophrenia in both inpatient

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and outpatient, able to communicate well, University with approval number:

conscious and willing to be respondents. 1292/IV/SP/2015. Each participant signed
Instrument informed consent prior to data collection.
The instruments to measure family support and
schizophrenia relapse were adopted from the Data analysis
previous research (Nursia, 2011). Schi- Chi-square test was used for data analysis.
zophrenia relapse was measured by observing
how many times of relapse during the last two
years. While family support questionnaire RESULTS
consists of twenty statements using Likert
scale: always, often, rarely and never, with Characteristics of respondents in the Table 1
total scores of 80. The dimension of the showed that the majority of respondents aged
instrument includes informational support, 40-49 years (47.8%), followed by the age
appraisal, instrumental and emotional support. group of 30-39 years (37.8%), which was
The score from respondents is converted into considered as young and productive group.
two-interval scale, namely good and less Most of respondents were having senior high
support. Good support if the score is >50 and school background (46.7%) and bachelor level
less support if the score is <50. background (36.7%). And majority of them
were self-employed. There was a slightly
Ethical consideration difference between male (53.3%) and female
Ethical approval of this research was obtained (46.7%) participants who experienced relapse
from The Commission of Conduct Health in schizophrenia in this study.
Study, Faculty of Nursing, North Sumatra

Table 1 Characteristic of respondents (N=90)

Characteristic Frequency Percentage (%)
Age
30 – 39 34 37.8
40 – 49 43 47.8
50 – 59 11 12.2
60 – 69 2 2.2
Gender
Male 48 53.3
Female 42 46.7
Education
Elementary 1 1.1
Junior high school 14 15.6
Senior high school 42 46.7
Bachelor 33 36.7
Occupation
Housewife 24 26.7
Self-employee 34 37.8
Private-employee 28 31.1
Civil servant 4 4.4

Table 2 shows that more than 50% of family have less supports from family members tends
members have good family support, which to have more relapses then those who have
consist of informational support (60%), good family supports. There were 31% of
appraisal support (58%), instrumental support patients relapse with less informational
(58%), and emotional support (66%). It also support, 27% of patients with less appraisal
shows that the schizophrenia patients who support, 12% of patients with less instrumental

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support, and 26% of patients relapse with less emotional support.

Table 2 Frequency distribution of family support and relapse in schizophrenia (N=90)

Relapse
Family Support Category Relapse No Relapse Total
F % F % F %
Good 8 9 46 51 54 60
Informational support Less 28 31 8 9 36 40
Total 36 40 54 60 90 100
Good 12 13 40 44 52 58
Appraisal support Less 24 27 14 16 38 42
Total 36 40 54 60 90 100
Good 43 48 9 10 52 58
Instrumental support Less 11 12 27 30 38 42
Total 54 60 36 40 90 100
Good 13 14 46 51 59 66
Emotional support Less 23 26 8 9 31 34
Total 36 40 54 60 90 100

Table 3 shows that there was a statistically Muhammad Ildrem in Medan North Sumatra
significant relationship between informational Indonesia. This result showed the strong
support (p=0.00), appraisal support (p=0.00), evidence that family support is very important
instrumental support (p=0.00), and emotional for those who are experiencing schizophrenia
support (p=0.00) with relapse in schizophrenia to prevent relapse.
in the Psychiatric Hospital of Prof. Dr.

Table 3 The correlation between family support and relapse in schizophrenia using Chi-square (N=90)

Relapse
Family Support Relapse No relapse
P-value
F % F %
Informational support
Good - - 54 60 .00
Less 36 40 - -
Appraisal support
Good - - 52 58
Less .00
38 42 - -
Instrumental support
Good - - 52 58
Less .00
38 42 - -
Emotional support
Good - - 59 66
Less .00
31 34 - -

DISCUSSION and relapse in schizophrenia patients. In this

study, family support is divided into
Findings of this study revealed that there was a informational support, appraisal, instrumental
significant correlation between family support and emotional support. This finding is in line

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with previous studies showing that there were needs of the patients. As there is a significant
significant correlation between family support correlation between instrumental support and
(informational, appraisal, instrumental and relapse, thus this kind of support should be
emotional) and social functions of patients informed to the family member.
with schizophrenia (Hartanto, 2014; Sefrina,
2016); but this result is in contrast with The other important support in this study is
(Nursia, 2011) found that there is no emotional support, which has a significant
significant relations between family support relationship with relapse. Emotional support
with repeated treatments of patients with by family members may include expressions
mental disorders (p=0.217). of empathy, such as listening, being open, trust
towards what is complained of, understanding,
The result of this study is in contrast with expressing the affection and attention.
previous study (Nursia, 2011) stated that there Emotional support will make the patients feel
is no significant relationship between valuable, comfortable, safe, peaceful, secure
informational support with repeated treatments and loved (Friedman, 2008).
of patients with mental disorders. It is
probably due to this study is specifically This study provides the insight of knowledge
focusing on schizophrenia, instead of that family support is very important in the
measuring the whole patients with repeated healing of the patient. Current practice
treatments in the hospital. However, according guidelines for the treatment of patients with
to literature (Friedman, 2008), family should schizophrenia suggest a combination of
always provide information about the benefit antipsychotic medication plus individual and
of medicine and give advice to patients to take family interventions. Having a family
the medicine regularly. Informational support available and supportive (regardless of the
may include giving advice, instructions, and interpersonal issues between patient and
explanations of how a person behave and act family) improves outcome mediated by
when in the stress situation and solve the improving long-term adherence (Glick, Stekoll,
problems. & Hays, 2011). Thus, the need for family
support and responsiveness in maintaining
Appraisal support is also correlated with mental well-being should not be
relapse in schizophrenia patients in this study. underestimated. There is a constant and deep
Appraisal support means that the families longing for relatedness throughout life, which
involves the patients in day activities and involves continuous, mutual balancing
always give positive reward or feedback in between the tension of giving and receiving
every activity to increase a sense of confidence (Lyberg, Holm, Lassenius, Berggren, &
and feel valued by the family. In contrast, no Severinsson, 2013).
appraisal support will reduce patient’s
confidence, feel devalued and useless and the
risk of relapses increased (Friedman, 2008). CONCLUSION

Family support in relation to instrumental Based on the results of the study, it can be
support refers to the real direct support such as concluded that there is significant correlation
providing facilities, money, foods and daily between family support (informational support,
needs, which is not only about physical needs, appraisal, instrumental and emotional support)
but also about the time spending with them. and relapse in schizophrenia. Therefore, it is
Patients will be more motivated because the recommended that health care professional
family always provides assistance both should continuously promote the important of
morally and materially. The majority of the family support and increase their knowledge
families are just paying attention to the time regarding the type of supports needed for
for the next treatment of visit to the hospitals patients with schizophrenia.
as a routine, with less attention to the real

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ORCID Lyberg, A., Holm, A. L., Lassenius, E., Berggren, I., &
http://orcid.org/0000-0002-8373-9358 Severinsson, E. (2013). Older persons’
experiences of depressive ill-health and family
Declaration of Conflicting Interest support. Nursing Research and Practice, 2013.
None declared. Nursia, N. (2011). Hubungan antara dukungan keluarga
dengan perawatan berulang pasien gangguan
Funding jiwa di Rumah Sakit Khusus Daerah (RSKD)
This study is supported by STIKes Murni Teguh, Provinsi Sulawesi Selatan [Relationship
Indonesia. between family support and repeated treatment
of patients with mental disorder at Rumah
Author Contribution Sakit Khusus Daerah (RSKD)].
This is the original study of the corresponding author. Makassar:Universitas Islam Negeri Alauddin
Makassar.
Rajkumar, R. P. (2015). The impact of childhood
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Cite this article as: Simanullang, R. H. (2018). The correlation between family support and relapse in schizophrenia at the
psychiatric hospital. Belitung Nursing Journal,4(6), 566-571. https://doi.org/10.33546/bnj.389

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