Quality of life between schizophrenia patients and family caregivers in Northern China: an actor-partner interdependence mediation model of stigma and social support

BACKGROUND: Schizophrenia poses significant challenges to the lives of individuals and to society. However, limited research has explored the relationship between stigma and quality of life in both patients with schizophrenia and their family caregivers. Furthermore, the potential mediating role of social support in the association between stigma and quality of life remains underexplored in this dyadic context. Therefore, this study aimed to analyze the mediating effect of social support on the relationship between stigma and quality of life in patients with schizophrenia and their family caregivers, using the actor-partner interdependence mediation model (APIMeM). METHODS: A total of 284 pairs of patients with schizophrenia and their family caregivers were recruited for this study. The Internalized Stigma of Mental Illness (ISMI) scale and the Affiliate Stigma Scale (ASS) were used to measure stigma in patients and their caregivers, respectively. Social support and quality of life were assessed using the Social Support Rating Scale (SSRS) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale. An actor-partner interdependence mediation model (APIMeM) was constructed to examine the actor and partner effects of stigma on quality of life, as well as the mediating role of social support. RESULTS: In terms of actor effects, patients' (β=-0.385, p < 0.001)and family caregivers' (β=-0.471, p < 0.001) stigma significantly affected their own quality of life.For the partner effects, patient's stigma significantly affected family caregiver's quality of life (β=-0.124, p = 0.002) and family caregiver's stigma significantly affected patient's quality of life (β=-0.125, p = 0.004). In the mediation model: patients' stigma affected their own and family caregivers' quality of life through their own social support (β=-0.092, p = 0.026; β=-0.017, p = 0.026); family caregivers' stigma affected their own quality of life through their own and patients' social support (β=-0.250, p < 0.001; β=-0.044, p = 0.028); family caregiver's stigma affects patient's quality of life through self and patient's social support ( β=-0.056, p = 0.024; β=-0.234, p < 0.001). CONCLUSIONS: Stigma significantly affected the quality of life of patients with schizophrenia and their family caregivers, with significant actor-partner effects between patients and family caregivers. In mediation analyses, patients' stigma was indirectly associated with the QoL of both themselves and their caregivers through its association with their own social support, whereas caregivers' stigma was indirectly associated with the QoL of both parties through its association with their own and the patients' social support. Therefore, in future research on interventions to improve the quality of life of patients with schizophrenia and family caregivers, it is important to consider not only the role of one's own sense of stigma, but also the mediating role played by social support in the impact of stigma on quality of life.