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Published in: BMC Psychiatry 1/2023

Open Access 01-12-2023 | Schizophrenia | Research

Depression severity mediates stigma and quality of life in clinically stable people with schizophrenia in rural China

Authors: Siyuan Zheng, Ruoqi Wang, Shaofei Zhang, Yangxu Ou, Xuanlian Sheng, Meng Yang, Menglin Ge, Lei Xia, Jun Li, Xiaoqin Zhou

Published in: BMC Psychiatry | Issue 1/2023

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Abstract

Background

Depressive symptoms associated with schizophrenia are closely related to stigma and quality of life(QOL). There is, however, no thorough research on the connection between the three. This study sought to investigate the possible factors influencing depressive symptoms in people with schizophrenia (PWS) in rural Chaohu, China, and to further explore the role of depression severity in stigma and lifestyle quality.

Methods

Eight hundred twenty-one schizophrenia patients accomplished the entire scale, including the 9-item Patient Health Questionnaire (PHQ-9), the Social Impact Scale (SIS), and the World Health Organization on Quality of Life Brief Scale(WHOQOL—BREF). A straightforward mediation model was employed to determine if the intensity of the depression could act as a mediator between stigma and QOL.

Results

Two hundred seventy-nine schizophrenia patients (34%) had depressive symptoms (PHQ ≥ 10), and 542 patients (66%) did not (PHQ < 10). Logistic regression showed that marital status, job status, physical exercise, standard of living, and stigma contributed to the depressed symptoms of schizophrenia. Depression severity partially mediated the effect between stigma and QOL, with a mediating effect of 48.3%.

Conclusions

This study discovered a significant incidence of depressed symptoms associated with schizophrenia, with depression severity serving as a mediator variable connecting stigma and QOL and partially moderating the association.
Literature
1.
go back to reference Harvey PD, Strassnig MT, Silberstein J. Prediction of disability in schizophrenia: Symptoms, cognition, and self-assessment. J Exp Psychopathol. 2019;10:204380871986569.CrossRef Harvey PD, Strassnig MT, Silberstein J. Prediction of disability in schizophrenia: Symptoms, cognition, and self-assessment. J Exp Psychopathol. 2019;10:204380871986569.CrossRef
2.
go back to reference He X-Y, Migliorini C, Huang Z-H, Wang F, Zhou R, Chen Z-L, et al. Quality of life in patients with schizophrenia: a 2-year cohort study in primary mental health care in rural China. Front Public Health. 2022;10:983733.PubMedPubMedCentralCrossRef He X-Y, Migliorini C, Huang Z-H, Wang F, Zhou R, Chen Z-L, et al. Quality of life in patients with schizophrenia: a 2-year cohort study in primary mental health care in rural China. Front Public Health. 2022;10:983733.PubMedPubMedCentralCrossRef
3.
go back to reference Chen J, Song H, Li S, Teng Z, Su Y, Chen J, et al. Social support and quality of life among chronically homeless patients with schizophrenia. Front Psychiatry. 2022;13:928960.PubMedPubMedCentralCrossRef Chen J, Song H, Li S, Teng Z, Su Y, Chen J, et al. Social support and quality of life among chronically homeless patients with schizophrenia. Front Psychiatry. 2022;13:928960.PubMedPubMedCentralCrossRef
4.
go back to reference Rhee TG, Rosenheck RA. Does improvement in symptoms and quality of life in chronic schizophrenia reduce family caregiver burden? Psychiatry Res. 2019;271:402–4.PubMedCrossRef Rhee TG, Rosenheck RA. Does improvement in symptoms and quality of life in chronic schizophrenia reduce family caregiver burden? Psychiatry Res. 2019;271:402–4.PubMedCrossRef
5.
go back to reference Ehrminger M, Roux P, Urbach M, André M, Aouizerate B, Berna F, et al. The puzzle of quality of life in schizophrenia: putting the pieces together with the FACE-SZ cohort. Psychol Med. 2022;52:1501–8.PubMedCrossRef Ehrminger M, Roux P, Urbach M, André M, Aouizerate B, Berna F, et al. The puzzle of quality of life in schizophrenia: putting the pieces together with the FACE-SZ cohort. Psychol Med. 2022;52:1501–8.PubMedCrossRef
6.
go back to reference Ertekin Pinar S, Tel H. The Effect of Music on Auditory Hallucination and Quality of Life in Schizophrenic Patients: a randomised controlled trial. Issues Ment Health Nurs. 2019;40:50–7.PubMedCrossRef Ertekin Pinar S, Tel H. The Effect of Music on Auditory Hallucination and Quality of Life in Schizophrenic Patients: a randomised controlled trial. Issues Ment Health Nurs. 2019;40:50–7.PubMedCrossRef
7.
go back to reference Awad AG, Voruganti LNP. Measuring quality of life in patients with schizophrenia: an update. Pharmacoeconomics. 2012;30:183–95.PubMedCrossRef Awad AG, Voruganti LNP. Measuring quality of life in patients with schizophrenia: an update. Pharmacoeconomics. 2012;30:183–95.PubMedCrossRef
8.
go back to reference Hofer A, Mizuno Y, Wartelsteiner F, Wolfgang Fleischhacker W, Frajo-Apor B, Kemmler G, et al. Quality of life in schizophrenia and bipolar disorder: The impact of symptomatic remission and resilience. Eur Psychiatry. 2017;46:42–7.PubMedCrossRef Hofer A, Mizuno Y, Wartelsteiner F, Wolfgang Fleischhacker W, Frajo-Apor B, Kemmler G, et al. Quality of life in schizophrenia and bipolar disorder: The impact of symptomatic remission and resilience. Eur Psychiatry. 2017;46:42–7.PubMedCrossRef
9.
go back to reference Lu L, Zeng L-N, Zong Q-Q, Rao W-W, Ng CH, Ungvari GS, et al. Quality of life in Chinese patients with schizophrenia: a meta-analysis. Psychiatry Res. 2018;268:392–9.PubMedCrossRef Lu L, Zeng L-N, Zong Q-Q, Rao W-W, Ng CH, Ungvari GS, et al. Quality of life in Chinese patients with schizophrenia: a meta-analysis. Psychiatry Res. 2018;268:392–9.PubMedCrossRef
10.
11.
12.
go back to reference Fleury M-J, Grenier G, Bamvita J-M, Tremblay J, Schmitz N, Caron J. Predictors of quality of life in a longitudinal study of users with severe mental disorders. Health Qual Life Outcomes. 2013;11:92.PubMedPubMedCentralCrossRef Fleury M-J, Grenier G, Bamvita J-M, Tremblay J, Schmitz N, Caron J. Predictors of quality of life in a longitudinal study of users with severe mental disorders. Health Qual Life Outcomes. 2013;11:92.PubMedPubMedCentralCrossRef
13.
go back to reference Ruggeri M, Nosè M, Bonetto C, Cristofalo D, Lasalvia A, Salvi G, et al. Changes and predictors of change in objective and subjective quality of life: multiwave follow-up study in community psychiatric practice. Br J Psychiatry. 2005;187:121–30.PubMedCrossRef Ruggeri M, Nosè M, Bonetto C, Cristofalo D, Lasalvia A, Salvi G, et al. Changes and predictors of change in objective and subjective quality of life: multiwave follow-up study in community psychiatric practice. Br J Psychiatry. 2005;187:121–30.PubMedCrossRef
14.
go back to reference Evans S, Huxley P, Priebe S. A comparison of the quality of life of severely mentally ill people in UK & German samples. Int J Soc Psychiatry. 2000;46:47–55.PubMedCrossRef Evans S, Huxley P, Priebe S. A comparison of the quality of life of severely mentally ill people in UK & German samples. Int J Soc Psychiatry. 2000;46:47–55.PubMedCrossRef
15.
go back to reference Ruggeri M, Gater R, Bisoffi G, Barbui C, Tansella M. Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona Outcome Project 5. Acta Psychiatr Scand. 2002;105:131–40.PubMedCrossRef Ruggeri M, Gater R, Bisoffi G, Barbui C, Tansella M. Determinants of subjective quality of life in patients attending community-based mental health services. The South-Verona Outcome Project 5. Acta Psychiatr Scand. 2002;105:131–40.PubMedCrossRef
16.
17.
go back to reference Li W, Yang Y, An F-R, Zhang L, Ungvari GS, Jackson T, et al. Prevalence of comorbid depression in schizophrenia: a meta-analysis of observational studies. J Affect Disord. 2020;273:524–31.PubMedCrossRef Li W, Yang Y, An F-R, Zhang L, Ungvari GS, Jackson T, et al. Prevalence of comorbid depression in schizophrenia: a meta-analysis of observational studies. J Affect Disord. 2020;273:524–31.PubMedCrossRef
18.
go back to reference Hoertel N, Jaffré C, Pascal de Raykeer R, McMahon K, Barrière S, Blumenstock Y, et al. Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study. J Affect Disord. 2019;251:60–70.PubMedCrossRef Hoertel N, Jaffré C, Pascal de Raykeer R, McMahon K, Barrière S, Blumenstock Y, et al. Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study. J Affect Disord. 2019;251:60–70.PubMedCrossRef
19.
go back to reference van Rooijen G, van Rooijen M, Maat A, Vermeulen JM, Meijer CJ, Ruhé HG, et al. Longitudinal evidence for a relation between depressive symptoms and quality of life in schizophrenia using structural equation modeling. Schizophr Res. 2019;208:82–9.PubMedCrossRef van Rooijen G, van Rooijen M, Maat A, Vermeulen JM, Meijer CJ, Ruhé HG, et al. Longitudinal evidence for a relation between depressive symptoms and quality of life in schizophrenia using structural equation modeling. Schizophr Res. 2019;208:82–9.PubMedCrossRef
20.
go back to reference Akinsulore A, Aloba OO, Mapayi BM, Oloniniyi IO, Fatoye FO, Makanjuola ROA. Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2014;49:1191–8.PubMedCrossRef Akinsulore A, Aloba OO, Mapayi BM, Oloniniyi IO, Fatoye FO, Makanjuola ROA. Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2014;49:1191–8.PubMedCrossRef
21.
go back to reference Lin D, Joshi K, Keenan A, Shepherd J, Bailey H, Berry M, et al. Associations Between Relapses and Psychosocial Outcomes in Patients With Schizophrenia in Real-World Settings in the United States. Front Psychiatry. 2021;12:695672.PubMedPubMedCentralCrossRef Lin D, Joshi K, Keenan A, Shepherd J, Bailey H, Berry M, et al. Associations Between Relapses and Psychosocial Outcomes in Patients With Schizophrenia in Real-World Settings in the United States. Front Psychiatry. 2021;12:695672.PubMedPubMedCentralCrossRef
22.
go back to reference Hennings JM, Ising M, Uhr M, Holsboer F, Lucae S. Effects of weariness of life, suicide ideations and suicide attempt on HPA axis regulation in depression. Psychoneuroendocrinology. 2021;131:105286.PubMedCrossRef Hennings JM, Ising M, Uhr M, Holsboer F, Lucae S. Effects of weariness of life, suicide ideations and suicide attempt on HPA axis regulation in depression. Psychoneuroendocrinology. 2021;131:105286.PubMedCrossRef
23.
go back to reference Jeong H, Cho S-J, Jeon S, Lee J, Lee YJ, Kim SJ. Association between snoring and depressive symptoms in adolescents. J Psychiatr Res. 2021;140:165–71.PubMedCrossRef Jeong H, Cho S-J, Jeon S, Lee J, Lee YJ, Kim SJ. Association between snoring and depressive symptoms in adolescents. J Psychiatr Res. 2021;140:165–71.PubMedCrossRef
24.
go back to reference van Rooijen G, Vermeulen JM, Ruhé HG, de Haan L. Treating depressive episodes or symptoms in patients with schizophrenia. CNS Spectr. 2019;24:239–48.PubMedCrossRef van Rooijen G, Vermeulen JM, Ruhé HG, de Haan L. Treating depressive episodes or symptoms in patients with schizophrenia. CNS Spectr. 2019;24:239–48.PubMedCrossRef
25.
go back to reference Lien Y-J, Chang H-A, Kao Y-C, Tzeng N-S, Lu C-W, Loh C-H. Insight, self-stigma and psychosocial outcomes in Schizophrenia: a structural equation modelling approach. Epidemiol Psychiatr Sci. 2018;27:176–85.PubMedCrossRef Lien Y-J, Chang H-A, Kao Y-C, Tzeng N-S, Lu C-W, Loh C-H. Insight, self-stigma and psychosocial outcomes in Schizophrenia: a structural equation modelling approach. Epidemiol Psychiatr Sci. 2018;27:176–85.PubMedCrossRef
27.
28.
go back to reference Werner P, Segel-Karpas D. Depression-related stigma: comparing laypersons’ stigmatic attributions towards younger and older persons. Aging Ment Health. 2020;24:1149–52.PubMedCrossRef Werner P, Segel-Karpas D. Depression-related stigma: comparing laypersons’ stigmatic attributions towards younger and older persons. Aging Ment Health. 2020;24:1149–52.PubMedCrossRef
29.
go back to reference Asrat B, Ayenalem AE, Yimer T. Internalized stigma among patients with mental illness attending psychiatric follow-up at Dilla University Referral Hospital, Southern Ethiopia. Psychiatry Journal. 2018;2018:1–7.CrossRef Asrat B, Ayenalem AE, Yimer T. Internalized stigma among patients with mental illness attending psychiatric follow-up at Dilla University Referral Hospital, Southern Ethiopia. Psychiatry Journal. 2018;2018:1–7.CrossRef
30.
go back to reference Kato Y, Chiba R, Yamaguchi S, Goto K, Umeda M, Miyamoto Y. Association between Work Environments and Stigma towards People with Schizophrenia among Mental Health Professionals in Japan. Healthcare (Basel). 2021;9:107.PubMedCrossRef Kato Y, Chiba R, Yamaguchi S, Goto K, Umeda M, Miyamoto Y. Association between Work Environments and Stigma towards People with Schizophrenia among Mental Health Professionals in Japan. Healthcare (Basel). 2021;9:107.PubMedCrossRef
31.
go back to reference Oexle N, Waldmann T, Staiger T, Xu Z, Rüsch N. Mental illness stigma and suicidality: the role of public and individual stigma. Epidemiol Psychiatr Sci. 2018;27:169–75.PubMedCrossRef Oexle N, Waldmann T, Staiger T, Xu Z, Rüsch N. Mental illness stigma and suicidality: the role of public and individual stigma. Epidemiol Psychiatr Sci. 2018;27:169–75.PubMedCrossRef
32.
go back to reference Karakaş SA, Okanlı A, Yılmaz E. The Effect of Internalized Stigma on the Self Esteem in Patients with Schizophrenia. Arch Psychiatr Nurs. 2016;30:648–52.PubMedCrossRef Karakaş SA, Okanlı A, Yılmaz E. The Effect of Internalized Stigma on the Self Esteem in Patients with Schizophrenia. Arch Psychiatr Nurs. 2016;30:648–52.PubMedCrossRef
33.
go back to reference Corrigan PW, Rao D. On the self-stigma of mental illness: stages, disclosure, and strategies for change. Can J Psychiatry. 2012;57:464–9.PubMedCrossRef Corrigan PW, Rao D. On the self-stigma of mental illness: stages, disclosure, and strategies for change. Can J Psychiatry. 2012;57:464–9.PubMedCrossRef
34.
go back to reference Kamaradova D, Latalova K, Prasko J, Kubinek R, Vrbova K, Krnacova B, et al. Connection between self-stigma, adherence to treatment, and discontinuation of medication. PPA. 2016;10:1289–98.PubMedPubMedCentralCrossRef Kamaradova D, Latalova K, Prasko J, Kubinek R, Vrbova K, Krnacova B, et al. Connection between self-stigma, adherence to treatment, and discontinuation of medication. PPA. 2016;10:1289–98.PubMedPubMedCentralCrossRef
35.
go back to reference Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. Eur psychiatr. 2005;20:529–39.CrossRef Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. Eur psychiatr. 2005;20:529–39.CrossRef
36.
go back to reference Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 2010;71:2150–61.PubMedCrossRef Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 2010;71:2150–61.PubMedCrossRef
37.
go back to reference Riebel M, Rohmer O, Charles E, Lefebvre F, Weibel S, Weiner L. Compassion-focused therapy (CFT) for the reduction of the self-stigma of mental disorders: the COMpassion for Psychiatric disorders, Autism and Self-Stigma (COMPASS) study protocol for a randomized controlled study. Trials. 2023;24:393.PubMedPubMedCentralCrossRef Riebel M, Rohmer O, Charles E, Lefebvre F, Weibel S, Weiner L. Compassion-focused therapy (CFT) for the reduction of the self-stigma of mental disorders: the COMpassion for Psychiatric disorders, Autism and Self-Stigma (COMPASS) study protocol for a randomized controlled study. Trials. 2023;24:393.PubMedPubMedCentralCrossRef
38.
go back to reference Ogundare T, Onifade PO, Ogundapo ’Deji, Ghebrehiwet S, Borba CPC, Henderson DC. Relationship between quality of life and social integration among patients with schizophrenia attending a Nigerian tertiary hospital. Qual Life Res. 2021;30:1665–74. Ogundare T, Onifade PO, Ogundapo ’Deji, Ghebrehiwet S, Borba CPC, Henderson DC. Relationship between quality of life and social integration among patients with schizophrenia attending a Nigerian tertiary hospital. Qual Life Res. 2021;30:1665–74.
39.
go back to reference Pellet J, Golay P, Nguyen A, Suter C, Ismailaj A, Bonsack C, et al. The relationship between self-stigma and depression among people with schizophrenia-spectrum disorders: a longitudinal study. Psychiatry Res. 2019;275:115–9.PubMedCrossRef Pellet J, Golay P, Nguyen A, Suter C, Ismailaj A, Bonsack C, et al. The relationship between self-stigma and depression among people with schizophrenia-spectrum disorders: a longitudinal study. Psychiatry Res. 2019;275:115–9.PubMedCrossRef
40.
go back to reference Aukst-Margetić B, Jakšić N, Boričević Maršanić V, Jakovljević M. Harm avoidance moderates the relationship between internalized stigma and depressive symptoms in patients with schizophrenia. Psychiatry Res. 2014;219:92–4.PubMedCrossRef Aukst-Margetić B, Jakšić N, Boričević Maršanić V, Jakovljević M. Harm avoidance moderates the relationship between internalized stigma and depressive symptoms in patients with schizophrenia. Psychiatry Res. 2014;219:92–4.PubMedCrossRef
41.
go back to reference Tang AL, Thomas SJ. Relationships between depressive symptoms, other psychological symptoms, and quality of life. Psychiatry Res. 2020;289:113049.PubMedCrossRef Tang AL, Thomas SJ. Relationships between depressive symptoms, other psychological symptoms, and quality of life. Psychiatry Res. 2020;289:113049.PubMedCrossRef
42.
go back to reference Ishii Y, Tomotake M, Chiba S, Tsutsumi R, Aono M, Taguchi K. Relationship between quality of life and clinical factors in inpatients with schizophrenia. J Med Investig. 2022;69(1.2):80–5.CrossRef Ishii Y, Tomotake M, Chiba S, Tsutsumi R, Aono M, Taguchi K. Relationship between quality of life and clinical factors in inpatients with schizophrenia. J Med Investig. 2022;69(1.2):80–5.CrossRef
44.
go back to reference Fitzgerald PB, Williams CL, Corteling N, Filia SL, Brewer K, Adams A, et al. Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand. 2001;103:387–92.PubMedCrossRef Fitzgerald PB, Williams CL, Corteling N, Filia SL, Brewer K, Adams A, et al. Subject and observer-rated quality of life in schizophrenia. Acta Psychiatr Scand. 2001;103:387–92.PubMedCrossRef
45.
46.
go back to reference Li Y-C, Bai W, Cai H, Wu Y, Zhang L, Ding Y-H, et al. Suicidality in clinically stable bipolar disorder and schizophrenia patients during the COVID-19 pandemic. Transl Psychiatry. 2022;12:303.PubMedPubMedCentralCrossRef Li Y-C, Bai W, Cai H, Wu Y, Zhang L, Ding Y-H, et al. Suicidality in clinically stable bipolar disorder and schizophrenia patients during the COVID-19 pandemic. Transl Psychiatry. 2022;12:303.PubMedPubMedCentralCrossRef
47.
go back to reference Ma Y-F, Li W, Deng H-B, Wang L, Wang Y, Wang P-H, et al. Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. J Affect Disord. 2020;275:145–8.PubMedPubMedCentralCrossRef Ma Y-F, Li W, Deng H-B, Wang L, Wang Y, Wang P-H, et al. Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. J Affect Disord. 2020;275:145–8.PubMedPubMedCentralCrossRef
49.
go back to reference Levis B, Benedetti A, Thombs BD, DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.PubMedPubMedCentralCrossRef Levis B, Benedetti A, Thombs BD, DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019;365:l1476.PubMedPubMedCentralCrossRef
50.
go back to reference Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–44.PubMedCrossRef Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–44.PubMedCrossRef
51.
go back to reference Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–58.PubMedCrossRef
52.
go back to reference 卞崔冬, 何筱衍, 钱洁, 吴文源, 李春波. 患者健康问卷抑郁症状群量表在综合性医院中的应用研究. 同济大学学报(医学版). 2009;30:136–40. 卞崔冬, 何筱衍, 钱洁, 吴文源, 李春波. 患者健康问卷抑郁症状群量表在综合性医院中的应用研究. 同济大学学报(医学版). 2009;30:136–40.
53.
go back to reference Fife BL, Wright ER. The Dimensionality of Stigma: A Comparison of Its Impact on the Self of Persons with HIV/AIDS and Cancer. J Health Soc Behav. 2000;41:50.PubMedCrossRef Fife BL, Wright ER. The Dimensionality of Stigma: A Comparison of Its Impact on the Self of Persons with HIV/AIDS and Cancer. J Health Soc Behav. 2000;41:50.PubMedCrossRef
54.
go back to reference Pan A-W, Chung L, Fife BL, Hsiung P-C. Evaluation of the psychometrics of the Social Impact Scale: a measure of stigmatization. Int J Rehabil Res. 2007;30:235–8.PubMedCrossRef Pan A-W, Chung L, Fife BL, Hsiung P-C. Evaluation of the psychometrics of the Social Impact Scale: a measure of stigmatization. Int J Rehabil Res. 2007;30:235–8.PubMedCrossRef
55.
go back to reference The Whoqol Group. Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychol Med. 1998;28:551–8.CrossRef The Whoqol Group. Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychol Med. 1998;28:551–8.CrossRef
56.
go back to reference Kruithof N, Haagsma JA, Karabatzakis M, Cnossen MC, de Munter L, van de Ree CLP, et al. Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population. Injury. 2018;49:1796–804.PubMedCrossRef Kruithof N, Haagsma JA, Karabatzakis M, Cnossen MC, de Munter L, van de Ree CLP, et al. Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population. Injury. 2018;49:1796–804.PubMedCrossRef
57.
go back to reference Li W, Zhao N, Yan X, Zou S, Wang H, Li Y, et al. The prevalence of depressive and anxiety symptoms and their associations with quality of life among clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Transl Psychiatry. 2021;11:75.PubMedPubMedCentralCrossRef Li W, Zhao N, Yan X, Zou S, Wang H, Li Y, et al. The prevalence of depressive and anxiety symptoms and their associations with quality of life among clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Transl Psychiatry. 2021;11:75.PubMedPubMedCentralCrossRef
58.
go back to reference Li M, Xia L, Yang Y, Zhang L, Zhang S, Liu T, et al. Depression, Anxiety, Stress, and Their Associations With Quality of Life in a Nationwide Sample of Psychiatrists in China During the COVID-19 Pandemic. Front Psychol. 2022;13:881408.PubMedPubMedCentralCrossRef Li M, Xia L, Yang Y, Zhang L, Zhang S, Liu T, et al. Depression, Anxiety, Stress, and Their Associations With Quality of Life in a Nationwide Sample of Psychiatrists in China During the COVID-19 Pandemic. Front Psychol. 2022;13:881408.PubMedPubMedCentralCrossRef
59.
go back to reference Haag DG, Peres KG, Brennan DS. Tooth loss and general quality of life in dentate adults from Southern Brazil. Qual Life Res. 2017;26:2647–57.PubMedCrossRef Haag DG, Peres KG, Brennan DS. Tooth loss and general quality of life in dentate adults from Southern Brazil. Qual Life Res. 2017;26:2647–57.PubMedCrossRef
60.
go back to reference Jeyagurunathan A, Vaingankar JA, Abdin E, Sambasivam R, Seow E, Pang S, et al. Gender differences in positive mental health among individuals with schizophrenia. Compr Psychiatry. 2017;74:88–95.PubMedCrossRef Jeyagurunathan A, Vaingankar JA, Abdin E, Sambasivam R, Seow E, Pang S, et al. Gender differences in positive mental health among individuals with schizophrenia. Compr Psychiatry. 2017;74:88–95.PubMedCrossRef
61.
go back to reference Zheng G, Lyu X, Pan L, Chen A. The role conflict-burnout-depression link among Chinese female health care and social service providers: the moderating effect of marriage and motherhood. BMC Public Health. 2022;22:230.PubMedPubMedCentralCrossRef Zheng G, Lyu X, Pan L, Chen A. The role conflict-burnout-depression link among Chinese female health care and social service providers: the moderating effect of marriage and motherhood. BMC Public Health. 2022;22:230.PubMedPubMedCentralCrossRef
63.
go back to reference Kwok JYY, Kwan JCY, Auyeung M, Mok VCT, Lau CKY, Choi KC, et al. Effects of mindfulness yoga vs stretching and resistance training exercises on anxiety and depression for people with Parkinson disease: a randomized clinical trial. JAMA Neurol. 2019;76:755.PubMedPubMedCentralCrossRef Kwok JYY, Kwan JCY, Auyeung M, Mok VCT, Lau CKY, Choi KC, et al. Effects of mindfulness yoga vs stretching and resistance training exercises on anxiety and depression for people with Parkinson disease: a randomized clinical trial. JAMA Neurol. 2019;76:755.PubMedPubMedCentralCrossRef
64.
go back to reference Imboden C, Gerber M, Beck J, Holsboer-Trachsler E, Pühse U, Hatzinger M. Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone. J Affect Disord. 2020;276:866–76.PubMedCrossRef Imboden C, Gerber M, Beck J, Holsboer-Trachsler E, Pühse U, Hatzinger M. Aerobic exercise or stretching as add-on to inpatient treatment of depression: Similar antidepressant effects on depressive symptoms and larger effects on working memory for aerobic exercise alone. J Affect Disord. 2020;276:866–76.PubMedCrossRef
65.
go back to reference Philippot A, Dubois V, Lambrechts K, Grogna D, Robert A, Jonckheer U, et al. Impact of physical exercise on depression and anxiety in adolescent inpatients: a randomized controlled trial. J Affect Disord. 2022;301:145–53.PubMedCrossRef Philippot A, Dubois V, Lambrechts K, Grogna D, Robert A, Jonckheer U, et al. Impact of physical exercise on depression and anxiety in adolescent inpatients: a randomized controlled trial. J Affect Disord. 2022;301:145–53.PubMedCrossRef
66.
go back to reference Petersson E-L, Wikberg C, Westman J, Ariai N, Nejati S, Björkelund C. Effects on work ability, job strain and quality of life of monitoring depression using a self-assessment instrument in recurrent general practitioner consultations: a randomized controlled study. WOR. 2018;60:63–73.CrossRef Petersson E-L, Wikberg C, Westman J, Ariai N, Nejati S, Björkelund C. Effects on work ability, job strain and quality of life of monitoring depression using a self-assessment instrument in recurrent general practitioner consultations: a randomized controlled study. WOR. 2018;60:63–73.CrossRef
67.
go back to reference Chafi YK, Amare T, Haile K, Damene W, Tesfaye G, Minichil W. Prevalence and correlates of job loss among schizophrenia outpatients at St. AmanuelMental Specialized Hospital, Addis Ababa, Ethiopia; cross sectional study. PLoS One. 2020;15:e0242352.PubMedPubMedCentralCrossRef Chafi YK, Amare T, Haile K, Damene W, Tesfaye G, Minichil W. Prevalence and correlates of job loss among schizophrenia outpatients at St. AmanuelMental Specialized Hospital, Addis Ababa, Ethiopia; cross sectional study. PLoS One. 2020;15:e0242352.PubMedPubMedCentralCrossRef
68.
go back to reference Kraines MA, White EJ, Grant DM, Wells TT. Social anxiety as a precursor for depression: Influence of interpersonal rejection and attention to emotional stimuli. Psychiatry Res. 2019;275:296–303.PubMedCrossRef Kraines MA, White EJ, Grant DM, Wells TT. Social anxiety as a precursor for depression: Influence of interpersonal rejection and attention to emotional stimuli. Psychiatry Res. 2019;275:296–303.PubMedCrossRef
69.
go back to reference Soltani S, Newman K, Quigley L, Fernandez A, Dobson K, Sears C. Temporal changes in attention to sad and happy faces distinguish currently and remitted depressed individuals from never depressed individuals. Psychiatry Res. 2015;230:454–63.PubMedCrossRef Soltani S, Newman K, Quigley L, Fernandez A, Dobson K, Sears C. Temporal changes in attention to sad and happy faces distinguish currently and remitted depressed individuals from never depressed individuals. Psychiatry Res. 2015;230:454–63.PubMedCrossRef
70.
go back to reference Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102:1009–16.PubMedCrossRef Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102:1009–16.PubMedCrossRef
71.
go back to reference Valtorta NK, Kanaan M, Gilbody S, Hanratty B. Loneliness, social isolation and risk of cardiovascular disease in the English Longitudinal Study of Ageing. Eur J Prev Cardiolog. 2018;25:1387–96.CrossRef Valtorta NK, Kanaan M, Gilbody S, Hanratty B. Loneliness, social isolation and risk of cardiovascular disease in the English Longitudinal Study of Ageing. Eur J Prev Cardiolog. 2018;25:1387–96.CrossRef
72.
go back to reference Jorm AF. Effect of contact-based interventions on stigma and discrimination: a critical examination of the evidence. PS. 2020;71:735–7.CrossRef Jorm AF. Effect of contact-based interventions on stigma and discrimination: a critical examination of the evidence. PS. 2020;71:735–7.CrossRef
73.
go back to reference Calear AL, Griffiths KM, Christensen H. Personal and perceived depression stigma in Australian adolescents: magnitude and predictors. J Affect Disord. 2011;129:104–8.PubMedCrossRef Calear AL, Griffiths KM, Christensen H. Personal and perceived depression stigma in Australian adolescents: magnitude and predictors. J Affect Disord. 2011;129:104–8.PubMedCrossRef
74.
go back to reference Georg Hsu LK, Wan YM, Chang H, Summergrad P, Tsang BYP, Chen H. Stigma of depression is more severe in Chinese Americans than Caucasian Americans. Psychiatry. 2008;71:210–8.PubMedCrossRef Georg Hsu LK, Wan YM, Chang H, Summergrad P, Tsang BYP, Chen H. Stigma of depression is more severe in Chinese Americans than Caucasian Americans. Psychiatry. 2008;71:210–8.PubMedCrossRef
75.
go back to reference Yang LH. Application of mental illness stigma theory to Chinese societies: synthesis and new directions. Singapore Med J. 2007;48:977–85.PubMed Yang LH. Application of mental illness stigma theory to Chinese societies: synthesis and new directions. Singapore Med J. 2007;48:977–85.PubMed
76.
go back to reference Lee S, Lee MTY, Chiu MYL, Kleinman A. Experience of social stigma by people with schizophrenia in Hong Kong. Br J Psychiatry. 2005;186:153–7.PubMedCrossRef Lee S, Lee MTY, Chiu MYL, Kleinman A. Experience of social stigma by people with schizophrenia in Hong Kong. Br J Psychiatry. 2005;186:153–7.PubMedCrossRef
77.
go back to reference Miyashiro GM. The illness narratives: suffering, healing and the human condition. Cad Saúde Pública. 1991;7:430–5.PubMedCrossRef Miyashiro GM. The illness narratives: suffering, healing and the human condition. Cad Saúde Pública. 1991;7:430–5.PubMedCrossRef
78.
go back to reference Lee S, Chiu MYL, Tsang A, Chui H, Kleinman A. Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong. Soc Sci Med. 2006;62:1685–96.PubMedCrossRef Lee S, Chiu MYL, Tsang A, Chui H, Kleinman A. Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong. Soc Sci Med. 2006;62:1685–96.PubMedCrossRef
79.
go back to reference Li P-L, Logan S, Yee L, Ng S. Barriers to meeting the mental health needs of the Chinese community. J Public Health. 1999;21:74–80.CrossRef Li P-L, Logan S, Yee L, Ng S. Barriers to meeting the mental health needs of the Chinese community. J Public Health. 1999;21:74–80.CrossRef
80.
go back to reference Kolstad A, Gjesvik N. Collectivism, individualism, and pragmatism in China: implications for perceptions of mental health. Transcult Psychiatry. 2014;51:264–85.PubMedCrossRef Kolstad A, Gjesvik N. Collectivism, individualism, and pragmatism in China: implications for perceptions of mental health. Transcult Psychiatry. 2014;51:264–85.PubMedCrossRef
81.
go back to reference Li L, Wu S, Wu Z, Sun S, Cui H, Jia M. Understanding family support for people living with HIV/AIDS in Yunnan. China Aids Behav. 2006;10:509–17.PubMedCrossRef Li L, Wu S, Wu Z, Sun S, Cui H, Jia M. Understanding family support for people living with HIV/AIDS in Yunnan. China Aids Behav. 2006;10:509–17.PubMedCrossRef
82.
go back to reference Gerlinger G, Hauser M, De Hert M, Lacluyse K, Wampers M, Correll CU. Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry. 2013;12:155–64.PubMedPubMedCentralCrossRef Gerlinger G, Hauser M, De Hert M, Lacluyse K, Wampers M, Correll CU. Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry. 2013;12:155–64.PubMedPubMedCentralCrossRef
83.
go back to reference Lv Y, Wolf A, Wang X. Experienced stigma and self-stigma in Chinese patients with schizophrenia. Gen Hosp Psychiatry. 2013;35:83–8.PubMedCrossRef Lv Y, Wolf A, Wang X. Experienced stigma and self-stigma in Chinese patients with schizophrenia. Gen Hosp Psychiatry. 2013;35:83–8.PubMedCrossRef
84.
go back to reference Öztürk Z, Şahi̇n Altun Ö. The effect of nursing interventions to instill hope on the internalized stigma, hope, and quality of life levels in patients With schizophrenia. Perspect Psychiatric Care. 2022;58:364–73.CrossRef Öztürk Z, Şahi̇n Altun Ö. The effect of nursing interventions to instill hope on the internalized stigma, hope, and quality of life levels in patients With schizophrenia. Perspect Psychiatric Care. 2022;58:364–73.CrossRef
85.
go back to reference Wahyuhadi J, Efendi F, Al Farabi MJ, Harymawan I, Ariana AD, Arifin H, et al. Association of stigma with mental health and quality of life among Indonesian COVID-19 survivors. PLoS One. 2022;17:e0264218.PubMedPubMedCentralCrossRef Wahyuhadi J, Efendi F, Al Farabi MJ, Harymawan I, Ariana AD, Arifin H, et al. Association of stigma with mental health and quality of life among Indonesian COVID-19 survivors. PLoS One. 2022;17:e0264218.PubMedPubMedCentralCrossRef
86.
go back to reference Sewilam AM, Watson AM, Kassem AM, Clifton S, McDonald MC, Lipski R, et al. Suggested avenues to reduce the stigma of mental illness in the Middle East. Int J Soc Psychiatry. 2015;61:111–20.PubMedCrossRef Sewilam AM, Watson AM, Kassem AM, Clifton S, McDonald MC, Lipski R, et al. Suggested avenues to reduce the stigma of mental illness in the Middle East. Int J Soc Psychiatry. 2015;61:111–20.PubMedCrossRef
87.
go back to reference Komatsu H, Ono T, Onoguchi G, Tomita H, Kakuto Y. Mediating effects of self-stigma and depression on the association between autistic symptoms and recovery in patients with schizophrenia-spectrum disorders: a cross-sectional study. BMC Psychiatry. 2021;21:464.PubMedPubMedCentralCrossRef Komatsu H, Ono T, Onoguchi G, Tomita H, Kakuto Y. Mediating effects of self-stigma and depression on the association between autistic symptoms and recovery in patients with schizophrenia-spectrum disorders: a cross-sectional study. BMC Psychiatry. 2021;21:464.PubMedPubMedCentralCrossRef
88.
go back to reference Sheehan DV, Nakagome K, Asami Y, Pappadopulos EA, Boucher M. Restoring function in major depressive disorder: A systematic review. J Affect Disord. 2017;215:299–313.PubMedCrossRef Sheehan DV, Nakagome K, Asami Y, Pappadopulos EA, Boucher M. Restoring function in major depressive disorder: A systematic review. J Affect Disord. 2017;215:299–313.PubMedCrossRef
89.
go back to reference Karanci NA, Aras A, Kumpasoğlu GB, Can D, Çakır E, Karaaslan C, et al. Living with schizophrenia: Perspectives of Turkish people with schizophrenia from two Patient Associations on how the illness affects their lives. Int J Soc Psychiatry. 2019;65:98–106.PubMedCrossRef Karanci NA, Aras A, Kumpasoğlu GB, Can D, Çakır E, Karaaslan C, et al. Living with schizophrenia: Perspectives of Turkish people with schizophrenia from two Patient Associations on how the illness affects their lives. Int J Soc Psychiatry. 2019;65:98–106.PubMedCrossRef
91.
go back to reference Sönmez N, Romm KL, Østefjells T, Grande M, Jensen LH, Hummelen B, et al. Cognitive behavior therapy in early psychosis with a focus on depression and low self-esteem: a randomized controlled trial. Compr Psychiatry. 2020;97:152157.PubMedCrossRef Sönmez N, Romm KL, Østefjells T, Grande M, Jensen LH, Hummelen B, et al. Cognitive behavior therapy in early psychosis with a focus on depression and low self-esteem: a randomized controlled trial. Compr Psychiatry. 2020;97:152157.PubMedCrossRef
92.
go back to reference Dubreucq J, Plasse J, Franck N. Self-stigma in Serious Mental Illness: a systematic review of frequency, correlates, and consequences. Schizophr Bull. 2021;47:1261–87.PubMedPubMedCentralCrossRef Dubreucq J, Plasse J, Franck N. Self-stigma in Serious Mental Illness: a systematic review of frequency, correlates, and consequences. Schizophr Bull. 2021;47:1261–87.PubMedPubMedCentralCrossRef
93.
go back to reference Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, et al. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatry. 2019;24:965–86.PubMedCrossRef Lassale C, Batty GD, Baghdadli A, Jacka F, Sánchez-Villegas A, Kivimäki M, et al. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol Psychiatry. 2019;24:965–86.PubMedCrossRef
94.
go back to reference Sarris J, Byrne GJ, Stough C, Bousman C, Mischoulon D, Murphy J, et al. Nutraceuticals for major depressive disorder- more is not merrier: An 8-week double-blind, randomised, controlled trial. J Affect Disord. 2019;245:1007–15.PubMedCrossRef Sarris J, Byrne GJ, Stough C, Bousman C, Mischoulon D, Murphy J, et al. Nutraceuticals for major depressive disorder- more is not merrier: An 8-week double-blind, randomised, controlled trial. J Affect Disord. 2019;245:1007–15.PubMedCrossRef
95.
go back to reference Fond G, Tinland A, Boucekine M, Girard V, Loubière S, Boyer L, et al. Improving the treatment and remission of major depression in homeless people with severe mental illness: The multicentric French Housing First (FHF) program. Prog Neuropsychopharmacol Biol Psychiatry. 2020;99:109877.PubMedCrossRef Fond G, Tinland A, Boucekine M, Girard V, Loubière S, Boyer L, et al. Improving the treatment and remission of major depression in homeless people with severe mental illness: The multicentric French Housing First (FHF) program. Prog Neuropsychopharmacol Biol Psychiatry. 2020;99:109877.PubMedCrossRef
96.
go back to reference Whitehead C, Moss S, Cardno A, Lewis G. Antidepressants for the treatment of depression in people with schizophrenia: a systematic review. Psychol Med. 2003;33:589–99.PubMedCrossRef Whitehead C, Moss S, Cardno A, Lewis G. Antidepressants for the treatment of depression in people with schizophrenia: a systematic review. Psychol Med. 2003;33:589–99.PubMedCrossRef
Metadata
Title
Depression severity mediates stigma and quality of life in clinically stable people with schizophrenia in rural China
Authors
Siyuan Zheng
Ruoqi Wang
Shaofei Zhang
Yangxu Ou
Xuanlian Sheng
Meng Yang
Menglin Ge
Lei Xia
Jun Li
Xiaoqin Zhou
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2023
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-023-05355-x

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