Stress and schizophrenia: A review of research models and findings

Current thinking on schizophrenia suggests that patients are particularly vulnerable to stress, which may contribute significantly to triggering acute episodes of the illness. Previous investigation of the relationship of stress to schizophrenia has emphasized two themes. There is weak evidence that significantly stressful events may precipitate relapse. There are stronger indications that family communication styles characterized by criticism and hostility directed towards the patient may contribute to relapse. Working along both lines has provoked discussion and criticism on both conceptual and methodological grounds. The literature on stress models exhibits a diversity of approaches on several issues critical to the development of an effective stress‐schizophrenia model: the locus of stress in the person‐environment system; the elements to be included; the nature and direction of causal effect; and the methodology to be applied in the investigation of stress. Previous investigations have attempted but failed satisfactorily to isolate the person from the environment to obtain a clear measure of relationship between stress and schizophrenic episodes. The nature of the illness and of the identified psychosocial stress domain suggests that a more effective model would incorporate a systems‐theoretical approach, focusing on coping processes used in achieving various forms of equilibrium with the environment.