Sense of Coherence in patients with stable schizophrenia: multidimensional determinants from a cross-sectional study of 438 inpatients in Guangzhou, China.

INTRODUCTION: Schizophrenia, a chronic psychiatric disorder, profoundly affects social functioning and quality of life. The Sense of Coherence (SOC), a core construct in salutogenic theory, plays a pivotal role in stress coping and recovery outcomes. While SOC has been studied in general populations, its determinants in stabilized schizophrenia inpatients remain underexplored. This study comprehensively investigated the Sense of Coherence (SOC) profile among stabilized schizophrenia inpatients by assessing its current status, exploring the interrelationships between SOC and demographic factors/Big Five personality traits (CBF-PI)/social support (SSRS), and identifying factors associated with SOC to inform potential personalized resilience-enhancing interventions. Findings may guide clinical strategies to enhance resilience and mental health recovery and potentially facilitate functional recovery in this population.

PATIENTS AND METHODS: A cross-sectional study was conducted at a Guangzhou tertiary psychiatric hospital with 438 stabilized schizophrenia inpatients from November 2024 to February 2025. Data collection included demographic/clinical variables, Chinese Big Five Personality Inventory (CBF-PI), 13-item Sense of Coherence Scale (SOC-13), and the Social Support Rating Scale (SSRS). Statistical analyses were performed using SPSS version 27.0. Descriptive statistics were used to summarize the data and independent-samples t-tests and one-way analysis of variance (ANOVA) were employed to compare SOC scores across demographic and clinical groups. Pearson correlation analysis was conducted to examine the relationships between personality traits, social support, and sense of coherence and multiple linear regression analysis was utilized to identify independent factors influencing sense of coherence (P < 0.05).

RESULT: The mean SOC score among the 438 stabilized schizophrenia inpatients was 53.35 ± 11.81. SOC correlated positively with all five dimensions of CBF-PI-B (P < 0.05), as well as subjective social support (P < 0.01), while showing inverse correlations with objective support (p < 0.01) and support utilization subscales (P < 0.01), Multiple regression identified personal income(yes), frequency of physical activity (≥3 times/week), and primary caregiver (Children) as significant SOC predictors.

CONCLUSION: This study demonstrates that stabilized schizophrenia inpatients in a tertiary psychiatric setting exhibit generally lower Sense of Coherence (SOC) levels compared with healthy normative values and moderately lower than several outpatient schizophrenia samples. Higher SOC was significantly associated with having a personal income, frequent physical activity (≥3 times/week), having children as primary caregivers, and Chinese Big Five Personality traits. Notably, while subjective support was positively correlated with SOC, objective support and support utilization showed negative associations. Given the moderate internal consistency of the SSRS (Cronbach's α = 0.626), the differential associations with social support dimensions should be interpreted cautiously. Concurrently, personality traits are relatively stable, their associations with SOC may inform indirect supportive strategies leveraging existing strengths rather than direct modification. These findings underscore the potential value of tailored interventions that enhance subjective support, promote structured recreational activities, and foster patients' perceived coping resources. Further cross-sectional and longitudinal outpatient studies are warranted to validate these results and elucidate the mechanisms underlying the support paradox.