Effectiveness of community-based care pathways and relapse prevention strategies in schizophrenia: a systematic review and bibliometric analysis

Schizophrenia remains a global health challenge with high clinical, social, and economic burdens, and relapse persists as a major cause of long-term disability, repeated hospitalizations, and escalating service costs. This systematic literature review and network analysis examined the effectiveness of community-based care pathways and relapse prevention strategies in schizophrenia. The review synthesizes evidence on the comparative effectiveness of community-based interventions versus conventional care, key determinants of success, and the network of health service factors (accessibility, intervention quality, stigma, and financial sustainability) that shape relapse prevention outcomes. Bibliometric analysis maps research trends, influential authors, and articles, and predicts future developments. Key findings indicate that integrated, assertive, and recovery-oriented community care models consistently outperform usual care in reducing relapse/readmission rates, as well as improving psychosocial functioning. Determinants of effectiveness center on service organization (multidisciplinary teams, assertive outreach, and continuity of care) reinforced by community and family support. The determinant network revealed accessibility as a foundational factor that enables quality, with quality driving engagement, which in turn bridges the impact on relapse prevention. The stigma and financing act as network modifiers. Future research should prioritize hybrid implementation designs, standardized reporting of fidelity and process indicators, and leveraging digital technologies for monitoring and support to sustain relapse reduction at scale.