Influencing factors of multiple adverse outcomes among schizophrenia patients using count regression models: a cross-sectional study

Abstract

Background: Schizophrenia patients have increased risks of adverse outcomes, including violent crime, aggressiveness, and suicide. However, studies of different adverse outcomes in schizophrenia patients are limited and the influencing factors for these outcomes need clarification by appropriate models. This study aimed to identify influencing factors of these adverse outcomes by examining and comparing different count regression models.

Methods: This study included schizophrenia patients who had at least one follow-up record in the Guangdong Mental Health Center Network Medical System during 2020. Three types of adverse outcomes were included: a) aggressiveness with police dispatch or violent crime, b) aggressiveness without police dispatch, and c) self-harm or suicide attempts. The incidence density of these adverse outcomes was investigated using the Poisson, negative binomial (NB), zero-inflated Poisson (ZIP), and zero-inflated negative binomial (ZINB) models, accordingly. The best model was chosen based on goodness-of-fit tests. We further analyzed associations between the number of occurrences of adverse outcomes and sociodemographic, clinical factors with the best model.

Results: A total of 130,474 schizophrenia patients were enrolled. Adverse outcomes rates were reported to be less than 1% for schizophrenia patients in 2020, in Guangdong. The NB model performed the best in terms of goodness-of-fit and interpretation when fitting for the number of occurrences of aggressiveness without police dispatch, whereas the ZINB models performed better for the other two outcomes. Age, sex, and history of adverse outcomes were influencing factors shared across these adverse outcomes. Higher education and employment were protective factors for aggressive and violent behaviors. Disease onset aged ≥ 18 years served as a significant risk factor for aggressiveness without police dispatch, and self-harm or suicide attempts. Family history of mental diseases was a risk factor for self-harm or suicide attempts individually.

Conclusions: NB and ZINB models were selected for fitting the number of occurrences of adverse outcomes among schizophrenia patients in our studies. Influencing factors for the incidence density of adverse outcomes included both those shared across different types and those individual to specific types. Therefore, comprehensive and customized tools in risk assessment and intervention might be necessary.

Keywords: Aggressiveness; Count model; Influencing factor; Schizophrenia; Suicide attempt; Violent crime.

Fig. 1

Predicted minus observed probabilities for four intercept-only models. NB, negative binomial; ZIP, zero-inflated Poisson; ZINB, zero-inflated negative binomial

Fig. 2

Multivariate count regression models for the number of occurrences of adverse outcomes among schizophrenia patients. Zero-inflated Negative Binomial regression was used to model the number of occurrences of aggressiveness with police dispatch or violent crime, and to the number of occurrences of self-harm or suicide attempts, count model regression results were displayed. Negative Binomial regression was used to model the number of occurrences of aggressiveness without police dispatch. (D), Excluding from model