Assessing the stability of schizophrenia patients' explanatory models of illness over time

Abstract

Background: There is increasing interest in explanatory models of illness in mental health care and the possibility that they vary according to cultural background. However, little is known about their stability over time as a factor influencing long-term outcome.

Aims: To assess the stability over time of explanatory models of illness among people with schizophrenia.

Methods: A modified version of the Short Explanatory Model Interview was used to elicit explanatory models with 8 participants from four ethnic groups on two occasions. The interviews took place approximately 1 year apart.

Results: The concept and cause of illness along with treatment preferences tended to be inconsistent in all patients between the baseline and follow-up interview. On the other hand, perceived severity of illness and prognosis were more inclined to be consistent over time. The consistency in responses was partly a function of the question type. Open-ended questions were more likely to elicit less consistent responses than questions with implied choice responses.

Conclusions: The lack of stability of explanatory models may be a feature of explanatory models or it may be a weakness of the method used. This instability may limit their usefulness in predicting long-term outcome. Future research is warranted to investigate whether a more valid method could identify a stable component of explanatory models over time, whether this is then related to outcome and, if so, in what ways.

Declaration of interest: None

• Explanatory model
• schizophrenia
• stability
• test – retest reliability