Predicting Physical Aggression among Schizophrenia Patients in Rural Communities of Southwestern China

Objective: Physical aggression in schizophrenia patients carries significant societal implications. Previous studies on aggression prediction have primarily focused on hospitalized patients, overlooking specific rural community contexts in China. This study investigated multidimensional predictive factors to develop and validate a predictive model for predicting physical aggression in schizophrenia patients in rural communities in southwestern China. Methods: We used convenience sampling to select 889 confirmed patients with schizophrenia from 22 rural townships recorded by the Pengzhou Mental Health Center from September to November, 2019 for baseline survey. Sixty-two candidate factors were investigated using the Morningness-Eveningness Questionnaire, Multidimensional Fatigue Inventory, and Medication Coherence Rating Scale, and aggression was evaluated using the Modified Overt Aggression Scale during a 3-month follow-up. Logistic regression was used to construct a risk prediction model and the model was validated using the receiver operating characteristic (ROC) curve. Results: Two variable selection methods, least absolute shrinkage and selection operator and multivariate logistic regression, yielded two models: Model 1 with 27 variables and Model 2 with six variables. Both models demonstrated perfect discrimination, good calibration, and clinical utility. Model 2, with three historical and three modifiable factors, demonstrated greater utility for communities, which included physical aggression against others prior to the first episode of schizophrenia, the Modified Overt Aggression Scale score at first episode onset, mental fatigue, body mass index, experiences of discrimination, and aggression against objects before the first episode. Most predictors were non-specific to schizophrenia. Conclusion: These findings may help to alleviate the social discrimination and constraints faced by individuals with schizophrenia in rural communities, facilitating the provision of proactive mental health services. Furthermore, our results highlight body mass index, discrimination experiences, and mental fatigue as critical areas for rural community mental health nursing professionals. Clinical Trial Registration: No: ChiCTR1800015219. https://www.chictr.org.cn/showproj.html?proj=25941.