Fear of relapse in schizophrenia: a mixed methods systematic review

Introduction: Fears of relapse in people diagnosed with schizophrenia have long been recognised as an impediment to recovery and wellbeing. However, the extent of the empirical basis for the fear of relapse concept is unclear. A systematic review is required to collate available evidence and define future research directions.Methods: A pre-registered systematic search (PROSPERO CRD42020196964) of four databases (PubMed, MEDLINE-Ovid, PsycINFO-Ovid, and Cochrane Central Register of Controlled Trials) was conducted from their inception to 05/04/2021. Results: We found 9 eligible studies. Of these, 4 were quantitative descriptive studies and 1 was a randomised controlled trial, and 4 were qualitative. The available quantitative evidence suggests fear of relapse may have concurrent positive relationships with depression. Qualitative synthesis suggests fear of relapse is a complex phenomenon with behavioural and emotional components which has both direct and indirect effects on wellbeing.Conclusions: Evidence in this area is limited and research is urgently needed to refine existing fear of relapse measurement tools and to examine relationships with wellbeing rather than just psychopathology. Nonetheless, clinicians should be aware that fear of relapse exists and comprises of fears of losing personal autonomy, losing social and occupational functioning and previous traumatic experiences and that fear of relapse appears to impact carers as well as those diagnosed with schizophrenia.