| 艾桂局,金铭,邵全明,刘燕妮,王仙珍,罗红.精神分裂症患者内在病耻感与生活质量的关系：自尊及阴性症状严重程度的链式作用路径[J].四川精神卫生杂志,2025,(2):172-177.Ai Guiju,Jin Ming,Shao Quanming,Liu Yanni,Wang Xianzhen,Luo Hong,Relationship between internalized stigma and quality of life in patients with schizophrenia：：the chain mediating role of self-esteem and severity of negative symptoms[J].SICHUAN MENTAL HEALTH,2025,(2):172-177 |
| 精神分裂症患者内在病耻感与生活质量的关系：自尊及阴性症状严重程度的链式作用路径 |
| Relationship between internalized stigma and quality of life in patients with schizophrenia：：the chain mediating role of self-esteem and severity of negative symptoms |
| 投稿时间：2024-07-29 |
| DOI：10.11886/scjsws20240729002 |
| 中文关键词: 精神分裂症 生活质量 病耻感 自尊 阴性症状 |
| 英文关键词:Schizophrenia Quality of life Stigma Self-esteem Negative symptoms |
| 基金项目:湖北省大学生创新创业项目（项目名称：精神分裂症患者症状体验的同期症状网络研究，项目编号：S202410519027） |
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| 中文摘要: |
| 背景 精神分裂症患者的生活质量普遍较低，内在病耻感是生活质量的重要影响因素，但自尊、阴性症状严重程度在精神分裂症患者内在病耻感与生活质量之间的作用路径尚不明确。目的 探索自尊及阴性症状严重程度在内在病耻感与生活质量之间的作用路径，以期为提高精神分裂症患者的生活质量提供参考。方法 纳入2023年4月—9月于襄阳市、四平市、长春市6所医院住院治疗的、符合《国际疾病分类（第10版）》（ICD-10）精神分裂症诊断标准的342例患者。采用心理疾病内化污名量表（ISMI）、精神分裂症患者生活质量量表（SQLS）、自尊量表（SES）以及阳性和阴性症状量表（PANSS）的阴性症状分量表进行评定。采用Spearman相关分析考查各量表评分之间的相关性。利用Amos 28.0构建中介模型，采用Bootstrap法检验自尊和阴性症状严重程度在内在病耻感与生活质量之间的中介效应。结果 共309例（90.35%）患者完成本研究。精神分裂症患者ISMI评分与SQLS评分和PANSS阴性症状分量表评分均呈正相关（r=0.612、0.492，P均<0.01），与SES评分呈负相关（r=-0.513，P<0.01）；SQLS评分与SES评分呈负相关（r=-0.555，P<0.01），与PANSS阴性症状分量表评分呈正相关（r=0.672，P<0.01）；SES评分与PANSS阴性症状分量表评分呈负相关（r=-0.433，P<0.01）。内在病耻感对生活质量影响的总效应值为0.746（95% CI：0.680~0.806），自尊和阴性症状严重程度是内在病耻感与生活质量之间的作用路径，效应值分别为0.151（95% CI：0.062~0.254）、0.126（95% CI：0.047~0.205），分别占总效应的20.24%、16.89%。自尊和阴性症状严重程度是内在病耻感与生活质量之间的链式作用路径，间接效应值为0.102（95% CI：0.049~0.165）占总效应的13.67%。结论 精神分裂症患者的内在病耻感既可以直接影响生活质量，也可以通过自尊与阴性症状严重程度的独立作用路径及链式作用路径间接影响生活质量。 |
| 英文摘要: |
| Background Patients with schizophrenia experience low quality of life， and internalized stigma is considered an important indicator for quality of life， while the mediating role of self-esteem and severity of negative symptoms in the relationship between internalized stigma and quality of life remains underexplored.Objective To examine the mediating role of self-esteem and severity of negative symptoms in the relationship between internalized stigma and quality of life， so as to provide references for improving their quality of life.Methods A total of 342 patients with schizophrenia who were hospitalized in 6 hospitals in Xiangyang City， Siping City and Changchun City from April to September 2023 were included， and all of whom met the diagnostic criteria for schizophrenia according to the International Classification of Diseases， tenth edition （ICD-10）. Internalized Stigma of Mental Illness Scale （ISMI）， Schizophrenia Quality of Life Scale （SQLS）， Self-Esteem Scale （SES） and negative symptom subscale of Positive and Negative Symptom Scale （PANSS） were administered to all patients. Spearman correlation analysis was adopted to determine correlations between the different scales. A structural equation modeling was constructed using Amos 28.0， and Bootstrap method was employed to verify the mediating effect of self-esteem and negative symptom severity in the association between internalized stigma and quality of life.Results A total of 309 patients （90.35%） completed questionnaires in this study. The ISMI score of schizophrenia patients was positively correlated with both SQLS score and the PANSS negative symptom subscale score （r=0.612， 0.492， P<0.01）， while was negatively correlated with SES score （r=-0.513， P<0.01）. The SQLS score was negatively associated with the SES score （r=-0.555， P<0.01） and positively associated with PANSS negative symptom subscale score （r=0.672， P<0.01）. The SES score was negatively correlated with PANSS negative symptom subscale score （r=-0.433， P<0.01）.The total effect value of internalized stigma on quality of life was 0.746 （95% CI： 0.680~0.806）. Self-esteem and severity of negative symptoms independently mediated the relationship between internalized stigma and quality of life， and the indirect effect values were 0.151 （95% CI： 0.062~0.254） and 0.126 （95% CI： 0.047~0.205）， accounting for 20.24% and 16.89% of the total effect， respectively. In addition， a chained mediation effect of self-esteem and quality of life was also demonstrated， the indirect effect value was 0.102 （95% CI： 0.049~0.165）， accounting for 13.67% of the total effect）.Conclusion Internalized stigma in patients with schizophrenia patients can not only directly affect the quality of life， but also indirectly affect the quality of life of patients through either separate or chained mediation of self-esteem and the severity of negative symptoms. ［Funded by Hubei Provincial Undergraduate Innovation and Entrepreneurship Project （number， S202410519027）］ |
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