King's College London

Stress and coping may play an important role in the development, maintenance and recovery of psychosis. However, relatively little is known about whether coping styles are associated with longer-term outcomes following a first episode of psychosis.

The study, published in Schizophrenia Bulletin, followed 269 people experiencing FEP across the UK at baseline, 4, 8 and 12 months. The researchers examined whether adaptive and maladaptive coping styles at baseline were associated with subsequent relapse, hallucinations, delusions and functioning. Machine learning techniques were also used to examine whether coping styles could help predict relapse at an individual level.

Over the 12-month follow-up period, 20% of participants experienced a relapse. The study found that:

• Greater use of maladaptive coping was associated with higher odds of relapse within 12 months.
• Maladaptive coping was also associated with greater likelihood of experiencing hallucinations and delusions during follow-up.
• Greater use of maladaptive coping was associated with poorer symptom functioning across the follow-up period and poorer disability functioning at 8 months.
• Adaptive coping was associated with lower odds of hallucinations at 4 and 8 months and lower odds of delusions at 4 months.
• Adaptive coping was also associated with better functioning at 4 months, although these associations were not sustained across the full 12-month follow-up.
• Machine learning models showed that coping styles could significantly predict relapse at the individual level, with maladaptive coping showing stronger predictive accuracy than adaptive coping.
• Among maladaptive coping strategies, self-distraction and substance use were the most important contributors to relapse prediction.
• Among adaptive coping strategies, spiritual/religious coping and active problem-solving were the most important contributors to prediction.

Overall, the findings suggest that the ways people cope with stress may be an important factor associated with clinical and functional outcomes following a first episode of psychosis. In particular, maladaptive coping may be associated with greater relapse risk and more persistent psychosis symptoms, highlighting coping as a potentially important target for early intervention.

The findings also suggest that interventions could focus on reducing maladaptive coping behaviours while supporting adaptive strategies such as active problem-solving and spiritual or religious coping where these are consistent with an individual's personal values. The researchers emphasise that further research is needed to determine whether changing coping strategies over time can improve outcomes.

 "Coping Style as a Predictor of Relapse and Functioning in First Episode Psychosis" by Georgiades et al, was published in Schizophrenia Bulletin. https://doi.org/10.1093/schbul/sbag079