Schizophrenia stigma and mental disability：moderated mediation analysis

doi:10.12114/j.issn.1007-9572.2019.00.749

Abstract

Abstract: Background　Stigma is one of the important factors that cause mental disability in patients with schizophrenia.Previous studies have shown that stigma and hope are significantly correlated with mental disability of resilience，but the interaction mechanism between these factors is not yet clear.Objective　To explore the relationships among appearance comparison on stigma，mental disability，hope and resilience in schizophrenia.Methods　In Harbin BaiYuPao Psychiatric Hospital and the Third Hospital of Daqing，patients with schizophrenia were selected from September to December 2018 by convenient sampling method.WHO-DASⅡ，Internalized Stigma of Mental Illness Scale，Schizophrenia Hope Scale，Connor-Davidson Resilience Scale were used in this survey.Results　A total of 310 questionnaires were sent out and 304 valid questionnaires were returned，with valid response rate of 98.06%.Moderated mediation effect analysis suggested that，stigma positively predicted mental disability（P<0.01）.Both stigma and hope significant predicted mental disability（P<0.01）；and stigma significant predicted hope（P<0.01），hope affect partially mediated the relationship between stigma and mental disability.The product term of hope and resilience significant predicted mental disability（P<0.01），the mediating effect of hope was moderated by resilience.Conclusion　The stigma of schizophrenia not only has a mediated effect through hope but also a moderated effect through resilience on mental disability.

Key words: Schizophrenia, Mentally handicapped, Hope, Resilience, Stigma, Mediating effect, Predictive function

摘要： 背景　病耻感是造成精神分裂症患者精神残疾的重要影响因素之一，既往研究表明病耻感和希望、心理韧性、精神残疾呈显著相关关系，但各因素间相互作用机制尚未明确。目的　探讨病耻感与精神残疾的关系，以及希望与心理韧性的内在作用机制。方法　采用方便取样法，选取2018年9—12月哈尔滨市精神专科白渔泡医院和大庆市第三医院住院的精神分裂症患者。采用世界卫生组织残疾评定量表、精神疾病内在化病耻感量表、心理韧性量表、精神分裂症患者希望量表对患者进行调查。结果　共发放问卷310份，回收有效问卷304份，有效回收率为98.06%。有调节的中介效应分析表明，病耻感可显著正向预测精神残疾（P<0.01）；病耻感和希望对精神残疾的预测作用均显著（P<0.01），病耻感对希望的预测作用亦显著（P<0.01），希望在病耻感对精神残疾的影响中发挥部分中介作用；希望与心理韧性的乘积项对精神残疾的预测作用显著（P<0.01），心理韧性可在希望对精神残疾的预测作用中产生调节效应。结论　精神分裂症患者病耻感通过希望的中介作用和心理韧性的调节作用对精神残疾产生影响。

关键词: 精神分裂症, 精神残疾, 希望, 心理韧性, 病耻感, 中介效应, 预测作用

MAO Yingying,WANG Weiliang,LI Ci, et al. Schizophrenia stigma and mental disability：moderated mediation analysis[J]. Chinese General Practice, 2020, 23(20): 2509-2513. DOI: 10.12114/j.issn.1007-9572.2019.00.749.
毛英莹,王伟梁,李辞等. 精神分裂症患者病耻感与精神残疾的关系：有调节的中介效应分析[J]. 中国全科医学, 2020, 23(20): 2509-2513. DOI: 10.12114/j.issn.1007-9572.2019.00.749.

References

［1］FLEISCHHACKER W W，ARANGO C，ARTEEL P，et al．Schizophrenia——time to commit to policy change［J］．Schizophr Bull，2014，40（Suppl 3）：S165-194．DOI：10.1093/schbul/sbu006. ［2］WIERSMA D，WANDERLING J，DRAGOMIRECKA E，et al．Social disability in schizophrenia：its development and prediction over 15 years in incidence cohorts in six European centres［J］．Psychol Med，2000，30（5）：1155-1167．DOI： 10.1017/s0033291799002627. ［3］第二次全国残疾人抽样调查办公室.第二次全国残疾人抽样调查主要数据手册［M］．北京：华夏出版社，2007. ［4］RITSHER J B，PHELAN J C.Internalized stigma predicts erosion of morale among psychiatric outpatients［J］．Psychiatry Res，2004，129（3）：257-265．DOI：10.1016/j.psychres.2004.08.003. ［5］LIVINGSTON J D，BOYD J E.Correlates and consequences of internalized stigma for people living with mental illness：a systematic review and metaanalysis［J］．Soc Sci Med，2010，71（12）：2150-2161．DOI： 10.1016/j.socscimed.2010.09.030. ［6］CAVELTI M，RüSCH N，VAUTH R.Is living with psychosis demoralizing? Insight，self-stigma，and clinical outcome among people with schizophrenia across 1 year［J］．J Nerv Ment Dis，2014，202（7）：521-529．DOI： 10.1097/NMD.0000000000000160. ［7］LYSAKER P H，ROE D，YANOS P T.Toward understanding the insight paradox：internalized stigma moderates the association between insight and social functioning，hope，and self-esteem among people with schizophrenia spectrum disorders［ J］．Schizophr Bull，2007，33（1）：192-199．DOI：10.1093/schbul/sbl016. ［8］MCCAY E A，SEEMAN M V.A scale to measure the impact of a schizophrenic illness on an individual's self-concept［J］．Arch Psychiatr Nurs，1998，12（1）：41-49. ［9］COSKUN E，SAHIN ALTUN ?.The relationship between the hope levels of patients with schizophrenia and functional recovery［J］．Arch Psychiatr Nurs，2018，32（1）：98-102．DOI：10.1016/j.apnu.2017.10.006. ［10］LYSAKER P H，CLEMENTS C A，WRIGHT D E，et al．Neurocognitive correlates of helplessness，hopelessness，and well-being in schizophrenia［J］．J Nerv Ment Dis，2001，189（7）：457-462．DOI：10.1097/00005053-200107000-00007. ［11］MASTEN A S.Resilience in children threatened by extreme adversity：frameworks for research，practice，and translational synergy［J］．Dev Psychopathol，2011，23（2）：493-506．DOI：10.1017/S0954579411000198. ［12］MIHALI A，SUBRAMANI S，KAUNITZ G，et al．Modeling resilience to schizophrenia in genetically modified mice：a novel approach to drug discovery［J］．Expert Rev Neurother，2012，12（7）：785-799．DOI：10.1586/ern.12.60. ［13］TORGALSB?EN A K.Sustaining full recovery in schizophrenia after 15 years：does resilience matter?［J］．Clin Schizophr Relat Psychoses，2012，5（4）：193-200．DOI：10.3371/CSRP.5.4.3. ［14］JAKOBSEN K D，FREDERIKSEN J N，HANSEN T，et al．Reliability of clinical ICD-10 schizophrenia diagnoses［J］．Nord J Psychiatry，2005，59（3）：209-212．［15］何燕玲，张明园.阳性和阴性综合征量表（PANSS）及其应用［J］．临床精神医学杂志，1997，7（6）：353-355.http：//www.cnki.com.cn/Article/CJFDTotal-LCJS706.020.htm. ［16］王莲娥，周洁，金欢.世界卫生组织残疾评定量表第2版中文版在精神残疾评定中的信效度检验［J］．中国心理卫生杂志，2013，27（2）：121-125．DOI：10.3969/j.issn.1000-6729.2013.02.008. WANG L E，ZHOU J，JIN H.Reliability and validity of the Chinese version of WHO Disability Assessment Schedule 2.0 in mental disability assessment［J］．Chinese Mental Health Journal，2013，27（2）：121-125．DOI：10.3969/j.issn.1000- 6729.2013.02.008. ［17］RITSHER J B，OTILINGAM P G，GRAJALES M.Internalized stigma of mental illness：psychometric properties of a new measure［J］．Psychiatry Res，2003，121（1）：31-49．DOI：10.1016/j.psychres.2003.08.008. ［18］李强，高文珺，白炳清，等．心理疾病内化污名量表初步应用［J］．中国临床心理学杂志，2009，17（2）：127-130．DOI：10.16128/j.cnki.1005-3611.2009.02.001. LI Q，GAO W J，BAI B Q，et al．Preliminary application of internalized stigma of mental illness scale［J］．Chinese Journal of Clinical Psychology，2009，17（2）：127-130．DOI：10.16128/j.cnki.1005-3611.2009.02.001. ［19］CONNOR K M，DAVIDSON J R.Development of a new resilience scale：the Connor-Davidson Resilience Scale（CD-RISC）［J］．Depress Anxiety，2003，18（2）：76-82．DOI：10.1002/da.10113. ［20］YU X，ZHANG J.Factor analysis and psychometric evaluation of the Connor- Davidson Resilience Scale（CD-RISC）with Chinese people［J］．Soc Behav Pers，2007，35（1）：19-30. ［21］CHOE K.Development and preliminary testing of the Schizophrenia Hope Scale，a brief scale to measure hope in people with schizophrenia［J］．Int J Nurs Stud，2014，51（6）：927-933．DOI：10.1016/j.ijnurstu.2013.10.018. ［22］王伟梁，周郁秋，柴囡楠，等．精神分裂症患者希望量表中文版的心理测量学评价［J］．中国心理卫生杂志，2018，32（12）：982-985．DOI：10.3969/j.issn.1000-6729.2018.12.002. WANG W L，ZHOU Y Q，CHAI N N，et al．Psychometric properties of the Chinese version of the Schizophrenia Hope Scale［J］．Chinese Mental Health Journal，2018，32（12）：982-985．DOI：10.3969/j.issn.1000-6729.2018.12.002. ［23］周浩，龙立荣.共同方法偏差的统计检验与控制方法［J］．心理科学进展，2004，12（6）：942-950．DOI：10.3969/j.issn.1671-3710.2004.06.018. ZHOU H，LONG L R.Statistical remedies for common method biases［J］．Advances in Psychological Science，2004，12（6）：942-950．DOI：10.3969/j.issn.1671-3710.2004.06.018. ［24］GALDERISI S，ROSSI A，ROCCA P，et al．The influence of illness-related variables，personal resources and context-related factors on real-life functioning of people with schizophrenia［J］．World Psychiatry，2014，13（3）：275-287． DOI：10.1002/wps.20167. ［25］耿峰，董毅.精神疾病患者病耻感研究进展［J］．精神医学杂志，2010，23（2）：151-154．DOI：10.3969/j.issn.1009-7201.2010.02.028.http：//www.cnki.com.cn/Article/CJFDTotal-SDJB201002031.htm. ［26］LIEN Y J，CHANG H A，KAO Y C，et al．Self-stigma mediates the impact of insight on current suicide ideation in suicide attempters with schizophrenia：results of a moderated mediation approach［J］．Suicide Life Threat Behav，2018， 48（6）：661-676．DOI：10.1111/sltb.12384. ［27］VRBOVA K，PRASKO J，OCISKOVA M，et al．Quality of life，self-stigma，and hope in schizophrenia spectrum disorders：a cross-sectional study［J］．Neuropsychiatr Dis Treat，2017，13：567-576．DOI：10.2147/NDT.S122483. ［28］LAGGER N，AMERING M，SIBITZ I，et al．Stability and mutual prospective relationships of stereotyped beliefs about mental illness，hope and depressive symptoms among people with schizophrenia spectrum disorders［J］．Psychiatry Res ，2018，268：484-489．DOI：10.1016/j.psychres.2018.08.010. ［29］YANOS P T，ROE D，MARKUS K，et al．Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders［J］．Psychiatr Serv，2008，59（12）：1437-1442．DOI：10.1176/ps.2008.59.12.1437. ［30］刘东玮，周郁秋，李国华.社会支持与精神分裂症残疾：自尊与心理韧性的链式中介作用［J］．中国临床心理学杂志，2019，27（1）：78-82．DOI：10.16128/j.cnki.1005-3611.2019.01.016. LIU D W，ZHOU Y Q，LI G H.Social support and schizophrenia disability：the chain mediating role of self esteem and resilience［J］．Chinese Journal of Clinical Psychology，2019，27（1）：78-82．DOI：10.16128/j.cnki.1005-3611.2019.01.016. ［31］刘洋，沙丽艳，郭中献，等．维持性血液透析患者希望水平和心理弹性的相关性研究［J］．中国实用护理杂志，2016，32（35）：2739-2741．DOI：10.3760/cma.j.issn.1672-7088.2016.35.005.http//www.wanfangdata.com.cn/details/detail.do? _type=perio&id=syhlzz201635006.

[1]	ZHANG Siyu, ZHOU Yuqiu, DU Xiaohui, WANG Zhengjun. Advances in Duration of Untreated Psychosis and Its Early Intervention [J]. Chinese General Practice, 2023, 26(33): 4110-4117.
[2]	LI Qian, ZHANG Yunshu, YAN Baoping, WANG Jian, MA Yanjuan, WANG Yuan, QIN Yingjie, NA Long, REN Zhiyong, SUN Junwei, DENG Huaili, MA Hongjun, QU Xuehui, ZHOU Nan, SI Tianmei. Efficacy and Safety of Risperidone Microspheres for Injection (Ⅱ) in the Treatment of Patients with Acute Schizophrenia [J]. Chinese General Practice, 2023, 26(32): 4007-4012.
[3]	LUO Dan, XU Jingjing, WANG Yubing, LI Mingzi, FORBES Angus. Development and Preliminary Practice of Resilience-oriented Structured Treatment and Educational Program for Adolescents with Type 1 Diabetes [J]. Chinese General Practice, 2023, 26(27): 3423-3429.
[4]	SUN Yujing, ZHANG Jing, YU Hong, ZHOU Yuqiu, JIANG Wenlong, JIA Yannan. Effect of Childhood Trauma on Aggressive Behavior in Stable Schizophrenia Patients: the Chain Mediating Effect of Self-esteem and Resilience [J]. Chinese General Practice, 2023, 26(23): 2899-2906.
[5]	CAO Ziyao, QIAN Cheng, XIE Guohua, CHANG Qingsong, WU Donghui. Analysis on the Correlation of Passive Suicidal Ideation with Thyroid Stimulating Hormone and Prolactin among Elderly Schizophrenia Inpatients [J]. Chinese General Practice, 2023, 26(23): 2894-2898.
[6]	MA Rui, WANG Yu, LI Yuxin, WANG Zhengjun, ZHOU Yuqiu. Application of Cognitive Interviewing in the Development of a Help-seeking Motivation Scale for Patients with Schizophrenia [J]. Chinese General Practice, 2023, 26(23): 2907-2911.
[7]	GE Anxin, ZHANG Guiqing, JIANG Liang, XING Wenlong, HU Min, LI Haohao, MENG Yao. Epidemiological Survey of the Prevalence and Associated Factors of Mental Disorders in Xinjiang Uygur Autonomous Region [J]. Chinese General Practice, 2023, 26(19): 2395-2401.
[8]	LIU Rui, DENG Jing, CHEN Ailing, CHENG Peihua, LUO Xingneng, HU Yongjiao, ZHANG Munan. Influence of Policy Factors on Healthcare-seeking Behaviors in Patients with Schizophrenia [J]. Chinese General Practice, 2023, 26(19): 2385-2394.
[9]	CAO Xiaolang, WANG Weiliang, YU Hong, WANG Xue, ZHOU Yuqiu. Application of Disability Point Matching Intervention Programme Based on Intervention Mapping Theory in Patients with Schizophrenia Disability [J]. Chinese General Practice, 2023, 26(19): 2376-2384,2394.
[10]	CHEN Yilin, LIN Ping, HAN Yongkui, WANG Yini. Research on the Construction of Adherence and Its Influencing Factors of Patients with Percutaneous Coronary Intervention in Phase Ⅰ Cardiac Rehabilitation [J]. Chinese General Practice, 2023, 26(18): 2209-2216.
[11]	FU Shi, CHEN Chen, YU Mengzhu, JIN Changqin, HE Gan, CHU Qiao, HE Yaping. Potential Effect of Walking on Emotional Health among Breast Cancer Survivors: the Mediating Effects of Different Dimensions of Posttraumatic Growth [J]. Chinese General Practice, 2023, 26(17): 2089-2094.
[12]	SUN Liang, LIU Zhiwei, ZHANG Yulong, ZHANG Dapeng, LI Wenzheng, YAO Xianhu, LIU Huanzhong. Plasma Cytokine Level and Influencing Factors of Depression in Stable Schizophrenia Patients [J]. Chinese General Practice, 2023, 26(06): 687-691.
[13]	ZHANG Guanbai, ZHENG Ling, YANG Liping, ZHOU Qin, WANG Fei, HE Liangze, CHENG Xuan, CHA Li, LI Xinyue. Co-prevalence of Substance Use Disorders and Common AxisⅠDisorders in Yunnan's Drug Users [J]. Chinese General Practice, 2022, 25(36): 4554-4560.
[14]	GUO Jin, TANG Yuanru, YAN Wei, HUANG Min, ZHANG Yueqi, MA Yimin, TIAN Yuan. Practice and Reflection Regarding the Development of Featured Brand Community-based Specialty Care: a Case Study of Chu's Traumatology [J]. Chinese General Practice, 2022, 25(34): 4350-4354.
[15]	Zhenwei DAI, Mingyu SI, Yijin WU, Xu CHEN, Jiaqi FU, Yiman HUANG, Hao WANG, Weijun XIAO, Fei YU, Guodong MI, Xiaoyou SU. Influence of HIV-related Knowledge and Anticipated Stigma on Depression of Men Who Have Sex with Men: a Latent Class Analysis [J]. Chinese General Practice, 2022, 25(30): 3803-3809,F01.