Recovery in Schizophrenia and Its Determinants: A Malaysian Hospital-Based Study

Abstract Background Recovery in schizophrenia has transitioned from a narrow clinical focus on symptom remission to a holistic framework incorporating functional and social reintegration. However, evidence regarding recovery rates and their determinants within Southeast Asia, particularly Malaysia, remains scarce. This study aimed to determine the prevalence of recovery among individuals with schizophrenia in Malaysia and to identify key sociodemographic, clinical, and psychosocial determinants. Methods A cross-sectional study was conducted among 152 adult outpatients with schizophrenia or schizoaffective disorder recruited via systematic random sampling from two urban psychiatric hospitals in Kuala Lumpur. Recovery was operationalized using Liberman and Kopelowicz criteria, requiring both symptomatic remission (Brief Psychiatric Rating Scale [BPRS] score ≤ 4 on all positive and negative symptom items) and functional recovery (Global Assessment of Functioning [GAF] score ≥ 65) sustained for at least 2 consecutive years. Data were collected using structured interviews and validated instruments, including the Childhood Trauma Questionnaire (CTQ-SF). Bivariate analyses were performed, followed by multivariable binary logistic regression. Results Overall, 50.7% of participants (n = 77) met the composite criteria for sustained recovery. In the final multivariable logistic regression model, five factors were independently associated with recovery. Being married (AOR = 15.39, 95% CI: 3.63–65.22, p < 0.01), having a college/university education (AOR = 7.05, 95% CI: 2.34–21.25, p < 0.01), and good medication adherence (AOR = 4.19, 95% CI: 1.28–13.67, p = 0.02) were strong positive predictors. Conversely, treatment with clozapine (AOR = 0.22, 95% CI: 0.06–0.78, p = 0.02) and higher childhood trauma exposure (AOR = 0.92 per unit increase in CTQ score, 95% CI: 0.89–0.97, p < 0.01) were significant negative predictors of recovery. The final model demonstrated excellent fit (Hosmer–Lemeshow p = 0.49), strong explanatory power (Nagelkerke R² = 0.74), and outstanding discrimination (ROC AUC = 0.95). Conclusions Schizophrenia recovery is an attainable goal within the Malaysian context, with approximately one in two patients achieving functional and clinical stability. The findings highlight the critical role of social support, cognitive/educational resources, and medication adherence. The strong negative impact of childhood trauma underscores the urgent need to integrate trauma-informed and family-centered approaches within national mental health services. Clozapine use serves as an indicator of illness severity, emphasizing the value of early treatment optimization and timely intervention pathways.