Factors contributing to family resilience in the context of schizophrenia: a descriptive qualitative study

Schizophrenia poses a significant global public health challenge, imposing substantial economic and caregiving burdens on families. While previous studies examined family resilience from caregiver perspectives only, patients' voices remain absent, limiting comprehensive understanding of resilience dynamics. Walsh's Family Resilience Framework offers a robust theoretical foundation for understanding these dynamics.

We undertook a study employing descriptive qualitative research methods. Data were gathered from a psychiatric hospital in Northeast China, where we recruited 18 schizophrenia patients and 15 caregivers using purposeful sampling. We conducted face-to-face semi-structured in-depth interviews, the recordings of which were transcribed by the research team. Two independent coders performed a thematic analysis of these transcriptions. Data saturation was achieved and confirmed through systematic assessment.

The influencing factors of family resilience of patients with schizophrenia include 3 themes and 11 sub-themes: (1) Family organization and resources: Family Structure, Awareness and Knowledge of Illness, Financial Considerations, Support Network, Health Status; (2) Family Belief: Hope, Faith and Values, Adherence, Past Experience; (3) Family Communication: Communication Willingness, Family Conflict. Key findings revealed patient-caregiver divergences: patients emphasized experiential knowledge ("I know when I'm getting worse") while caregivers focused on clinical symptoms.

Family resilience plays a pivotal role in the lives of patients with schizophrenia. Our dual-perspective approach uncovered dynamic interactions between resources, beliefs, and communication creating four patterns: positive spirals, negative cascades, compensatory mechanisms, and transformation events. In clinical practice, clinicians should: (1) assess patient-caregiver belief divergences; (2) time interventions to support families through predictable hope fluctuations; (3) recognize culturally appropriate communication styles; (4) address financial barriers systematically. Interventions targeting dynamic theme interactions rather than single factors may prove most effective.