Journals / Journal of Health Sciences and Medicine / 2025 / Volume: 8 Issue: 6

The impact of perceived social support, internalized stigma, and childhood trauma on quality of life in schizophrenia spectrum disorders: a mediation and moderation approach

Algılanan sosyal destek, içselleştirilmiş damgalanma ve çocukluk çağı travmasının şizofreni spektrum bozukluklarında yaşam kalitesi üzerindeki etkisi: aracılık ve düzenleyicilik yaklaşımı

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Publication Date
2025-10-25
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Interventions that strengthen social support, reduce internalized stigma and address childhood traumatic experiences may be crucial for improving QoL in the SSD population.

📌 3 Key Takeaways

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Objective & Hypothesis:Aims: This study aimed to determine whether perceived social support and internalized stigma mediate the association between symptom severity and quality of life (QoL) in individuals with schizophrenia spectrum disorders (SSDs) and whether childhood trauma moderate this relationship.
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Key Findings & Data:Methods: A cross-sectional design was used with 258 patients diagnosed with schizophrenia, schizoaffective disorder, or unspecified psychosis at a community mental health center.
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Conclusion & Impact:Interventions that strengthen social support, reduce internalized stigma and address childhood traumatic experiences may be crucial for improving QoL in the SSD population.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Schizophrenia spectrum disorders · quality of life · perceived social support

Abstract

Aims: This study aimed to determine whether perceived social support and internalized stigma mediate the association between symptom severity and quality of life (QoL) in individuals with schizophrenia spectrum disorders (SSDs) and whether childhood trauma moderate this relationship. Methods: A cross-sectional design was used with 258 patients diagnosed with schizophrenia, schizoaffective disorder, or unspecified psychosis at a community mental health center. Standardized scales were administered to assess QoL, perceived social support, internalized stigma, history of childhood trauma, and symptom severity. Mediation analyses were conducted to test the indirect effects of symptom severity on QoL through social support and internalized stigma. Moderation analyses examined the effect of childhood traumas on the relationship between symptom severity and QoL. Results: Higher symptom severity was associated with lower perceived social support and greater internalized stigma, which in turn predicted worse QoL. Perceived social support and internalized stigma significantly mediated the negative effect of symptom severity on QoL. Childhood trauma had a significant moderating effect: the negative association between symptom severity and QoL was stronger among patients with a history of childhood trauma. These effects remained significant even after controlling for other variables. Conclusion: Psychosocial factors significantly influence QoL in patients with SSDs. Perceived social support and self-stigma emerged as key mediators linking symptom severity to QoL, and a history of childhood trauma exacerbated the impact of symptoms on QoL. Interventions that strengthen social support, reduce internalized stigma and address childhood traumatic experiences may be crucial for improving QoL in the SSD population.

Özet

Amaçlar: Bu çalışma, şizofreni spektrum bozuklukları (ŞSB) olan bireylerde semptom şiddeti ile yaşam kalitesi arasındaki ilişkide algılanan sosyal destek ve içselleştirilmiş damgalanmanın aracılık edip etmediğini ve çocukluk çağı travmasının bu ilişkiyi düzenleyip düzenlemediğini belirlemeyi amaçlamaktadır. Yöntem: Bu kesitsel çalışmada, bir toplum ruh sağlığı merkezine başvuran ve şizofreni, şizoaffektif bozukluk veya tanımlanmamış psikotik bozukluk tanısı almış 258 hasta yer aldı. Yaşam kalitesi, algılanan sosyal destek, içselleştirilmiş damgalanma, çocukluk çağı travma öyküsü ve semptom şiddetini değerlendirmek için standart ölçekler kullanıldı. Semptom şiddetinin yaşam kalitesi üzerindeki dolaylı etkilerini algılanan sosyal destek ve içselleştirilmiş damgalanma aracılığıyla test etmek amacıyla aracılık analizleri yapıldı. Düzenleyicilik analizleri ise çocukluk çağı travmalarının semptom şiddeti ile yaşam kalitesi arasındaki ilişki üzerindeki etkisini inceledi. Bulgular: Daha yüksek semptom şiddeti, daha düşük algılanan sosyal destek ve daha yüksek içselleştirilmiş damgalanma ile ilişkiliydi. Bu değişkenler ise daha düşük yaşam kalitesini yordadı. Algılanan sosyal destek ve içselleştirilmiş damgalanma, semptom şiddetinin yaşam kalitesi üzerindeki olumsuz etkisinde anlamlı bir aracılık rolü oynadı. Çocukluk çağı travması ise anlamlı bir düzenleyici etki gösterdi. Çocukluk çağı travması öyküsü olan hastalarda semptom şiddeti ile yaşam kalitesi arasındaki olumsuz ilişki daha güçlüydü. Bu etkiler, diğer değişkenler kontrol edildikten sonra da anlamlılığını korudu. Sonuç: Psikososyal etkenler, ŞSB olan hastalarda yaşam kalitesini önemli ölçüde etkilemektedir. Algılanan sosyal destek ve içselleştirilmiş damgalanma, semptom şiddeti ile yaşam kalitesi arasındaki ilişkiyi aracılık eden temel faktörler olarak öne çıkmıştır. Ayrıca, çocukluk çağı travması öyküsü, semptomların yaşam kalitesi üzerindeki olumsuz etkisini artırmaktadır. Sosyal desteği güçlendiren, içselleştirilmiş damgalanmayı azaltan ve çocukluk travmalarını ele alan müdahaleler, ŞSB grubunda yaşam kalitesini artırmak için kritik öneme sahip olabilir.

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Cite This Article

Korkmaz, U., Çelik, F. G. H. (2025). The impact of perceived social support, internalized stigma, and childhood trauma on quality of life in schizophrenia spectrum disorders: a mediation and moderation approach. Journal of Health Sciences and Medicine, Volume: 8 Issue: 6. https://doi.org/10.32322/jhsm.1750254

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References (49)

  1. Boylu AA, Paçaçıoğlu B. Quality of life and indicators. J Acad Res Stud. 2016;8(15):137-150. doi:10.20990/kilisiibfakademik.266011
  2. World Health Organization. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version. December 1996. 1996;
  3. Pergolotti M, Deal AM, Williams GR, et al. Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. J Geriatr Oncol. 2017;8(4):249-254. doi:10.1016/j.jgo.2017.02.009
  4. Defar S, Abraham Y, Reta Y, et al. Health related quality of life among people with mental illness: The role of socio-clinical characteristics and level of functional disability. Front Public Health. 2023;11:1134032. doi:10.3389/fpubh.2023.1134032
  5. Boyer L, Millier A, Perthame E, Aballea S, Auquier P, Toumi M. Quality of life is predictive of relapse in schizophrenia. BMC Psychiatry. 2013;13:1-8. doi:10.1186/1471-244X-13-15
  6. Collaborators GMD. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Psychiatry. 2022;9(2):137-150. doi:10.1016/S2215-0366(21)00395-3
  7. Patmisari E, Huang Y, Orr M, Govindasamy S, Hielscher E, McLaren H. Supported employment interventions with people who have severe mental illness: systematic mixed-methods umbrella review. PLoS One. 2024;19(6):e0304527. doi:10.1371/journal.pone.0304527
  8. Wang J, Mann F, Lloyd-Evans B, Ma R, Johnson S. Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry. 2018;18:1-16. doi:10.1186/s12888-018-1736-5
  9. Harandi TF, Taghinasab MM, Nayeri TD. The correlation of social support with mental health: a meta-analysis. Electronic Physician. 2017;9(9):5212. doi:10.19082/5212
  10. Feeney BC, Collins NL. A new look at social support: a theoretical perspective on thriving through relationships. Person Soc Psychol Rev. 2015;19(2):113-147. doi:10.1177/1088868314544222
  11. 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(12):2150-2161. doi:10.1016/j.socscimed.2010.09.030
  12. Thornicroft G, Mehta N, Clement S, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet. 2016;387(10023):1123-1132. doi:10.1016/S0140-6736(15)00298-6
  13. Eglit GM, Palmer BW, Martin AvS, Tu X, Jeste DV. Loneliness in schizophrenia: Construct clarification, measurement, and clinical relevance. PLoS One. 2018;13(3):e0194021. doi:10.1371/journal.pone. 0194021
  14. Lambert M, Naber D. Current issues in schizophrenia: overview of patient acceptability, functioning capacity and quality of life. CNS drugs. 2004;18(Suppl 2):5-17. doi:10.2165/00023210-200418002-00002
  15. Gagiu C, Dionisie V, Manea MC, Mazilu DC, Manea M. Internalised stigma, self-esteem and perceived social support as psychosocial predictors of quality of life in adult patients with schizophrenia. J Clin Med. 2024;13(22):6959. doi:10.3390/jcm13226959
  16. Corrigan PW, Rafacz J, Rüsch N. Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatr Res. 2011;189(3):339-343. doi:10.1016/j.psychres.2011.05.024
  17. Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatr. 2005;20(8):529-539. doi:10.1016/j.eurpsy.2005.04.004
  18. Brohan E, Elgie R, Sartorius N, Thornicroft G, Group G-ES. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res. 2010;122(1-3):232-238. doi:10.1016/j.schres.2010.02.1065
  19. Bernstein DP, Fink L, Handelsman L, Foote J. Childhood trauma questionnaire. Assessment of family violence: a handbook for researchers and practitioners. 1998.
  20. Varese F, Smeets F, Drukker M, et al. Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective-and cross-sectional cohort studies. Schizophr Bullet. 2012;38(4):661-671. doi:10.1093/schbul/sbs050
  21. Bailey T, Alvarez-Jimenez M, Garcia-Sanchez AM, Hulbert C, Barlow E, Bendall S. Childhood trauma is associated with severity of hallucinations and delusions in psychotic disorders: a systematic review and meta-analysis. Schizophr Bullet. 2018;44(5):1111-1122. doi:10.1093/schbul/sbx161
  22. Wells R, Jacomb I, Swaminathan V, et al. The impact of childhood adversity on cognitive development in schizophrenia. Schizophr Bullet. 2020;46(1):140-153. doi:10.1093/schbul/sbz033
  23. Andrianarisoa M, Boyer L, Godin O, et al. Childhood trauma, depression and negative symptoms are independently associated with impaired quality of life in schizophrenia. Results from the national FACE-SZ cohort. Schizophr Res. 2017;185:173-181. doi:10.1016/j.schres. 2016.12.021
  24. Eser E, Fidaner H, Fidaner C, Eser SY, Elbi H, Göker E. Psychometric properties of tlte WHOQOL-100 and WHOOOL-BREF. Psikiyatr Psikol Psikofarmakol (3P) Derg. 1999;7(Suppl 2):23-40.
  25. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Person Assessment. 1988;52(1):30-41. doi:10.1207/s15327752jpa5201_2
  26. Eker D, Arkar H. Perceived social support: psychometric properties of the MSPSS in normal and pathological groups in a developing country. Soc Psychiatr Psychiatr Epidemiol. 1995;30:121-126. doi:10.1007/BF00 802040
  27. Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatr Res. 2003; 121(1):31-49. doi:10.1016/j.psychres.2003.08.008
  28. Ersoy MA, Varan A. Reliability and validity of the Turkish version of the internalized stigma of Mental Illness Scale. Turk J Psychiatr. 2007;18(2):163-171.
  29. Şar V, Öztürk E, İkikardeş E. Validity and reliability of the Turkish version of childhood trauma questionnaire. Turk Clin J Med Sci. 2012;32(4):1054-1063. doi:10.5336/medsci.2011-26947
  30. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bullet. 1987;13(2):261-276. doi:10.1093/schbul/13.2.261
  31. Kostakoğlu A, Batur S, Tiryaki A, Göğüş A. Reliability and validity of the Turkish version of the Positive and Negative Syndrome Scale. Turk J Psychol. 1999;14(44):23-34.
  32. Galuppi A, Turola MC, Nanni MG, Mazzoni P, Grassi L. Schizophrenia and quality of life: how important are symptoms and functioning? Int J Mental Health Syst. 2010;4:1-8. doi:10.1186/1752-4458-4-31
  33. İzci F, Fidan Y, Çallı S, Aslan M. Stigma, perception of social support, and functionality levels of schizophrenia patients with and without legal guardianship. Psychiatr Clin Psychopharmacol. 2024;34(1):74. doi:10.5152/pcp.2024.22602
  34. Fan C-H, Hsu S-C, Hsiao F-H, et al. The association of social support and symptomatic remission among community-dwelling schizophrenia patients: a cross-sectional study. Int J Environment Res Public Health. 2021;18(8):3977. doi:10.3390/ijerph18083977
  35. Munikanan T, Midin M, Daud TIM, et al. Association of social support and quality of life among people with schizophrenia receiving community psychiatric service: a cross-sectional study. Comprehen Psychiatr. 2017;75:94-102. doi:10.1016/j.comppsych.2017.02.009
  36. Chan KKS, Fung WTW, Leung DCK, Tsui JKC. The impact of perceived and internalised stigma on clinical and functional recovery among people with mental illness. Healt Social Care Commun. 2022;30(6):e6102-e6111. doi:10.1111/hsc.14047
  37. Yanos PT, Lysaker PH, Silverstein SM, et al. A randomized-controlled trial of treatment for self-stigma among persons diagnosed with schizophrenia-spectrum disorders. Soc Psychiatr Psychiatr Epidemiol. 2019;54:1363-1378. doi:10.1007/s00127-019-01702-0
  38. Sarraf L, Lepage M, Sauve G. The clinical and psychosocial correlates of self-stigma among people with schizophrenia spectrum disorders across cultures: a systematic review and meta-analysis. Schizophr Res. 2022;248:64-78. doi:10.1016/j.schres.2022.08.001
  39. Howell MK, Marggraf M, Taylor ML, et al. Social functioning mediates the relationship between psychiatric symptoms and recovery among veteran and community service users with serious mental illness. Psychiatr Rehabil J. 2023;46(2):156. doi:10.1037/prj0000559
  40. Starzer M, Hansen HG, Hjorthøj C, Albert N, Glenthøj LB, Nordentoft M. Long-term quality of life and social disconnection 20 years after a first episode psychosis, results from the 20-year follow-up of the OPUS trial. Schizophr Res. 2024;274:33-45. doi:10.1016/j.schres.2024.08.021
  41. Ercan Doğu S, Örsel S. The relationship between psychopathology, occupational balance, and quality of life among people with schizophrenia. Austral Occupat Ther J. 2023;70(3):314-326. doi:10.1111/ 1440-1630.12855
  42. Grover S, Sahoo S, Chakrabarti S, Avasthi A. Association of internalized stigma and insight in patients with schizophrenia. Int J Culture Mental Health. 2018;11(3):338-350. doi:10.1080/17542863.2017.1381750
  43. Tworek G, Thompson NR, Kane A, Sullivan AB. The impact of stigma on perceived quality of life and experience of anxiety and depression in individuals diagnosed with MS. Multip Scleros Relat Disord. 2023; 72:104591. doi:10.1016/j.msard.2023.104591
  44. Vass V, Morrison AP, Law H, et al. How stigma impacts on people with psychosis: the mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatr Res. 2015;230(2):487-495. doi:10.1016/j.psychres.2015.09.042
  45. Kilian S, Asmal L, Phahladira L, et al. The association between childhood trauma and treatment outcomes in schizophrenia spectrum disorders. Psychiatr Res. 2020;289:113004. doi:10.1016/j.psychres.2020.113004
  46. Inyang B, Gondal FJ, Abah GA, et al. The role of childhood trauma in psychosis and schizophrenia: a systematic review. Cureus. 2022;14(1): e21466. doi:10.7759/cureus.21466
  47. Alkema A, Marchi M, Van Der Zaag JA, et al. Childhood abuse v. neglect and risk for major psychiatric disorders. Psychol Med. 2024;54(8):1598-1609. doi:10.1017/S0033291723003471
  48. Teicher MH, Samson JA, Anderson CM, Ohashi K. The effects of childhood maltreatment on brain structure, function and connectivity. Natur Rev Neurosci. 2016;17(10):652-666. doi:10.1038/nrn.2016.111
  49. Burger SR, van der Linden T, Hardy A, et al. Trauma-focused therapies for post-traumatic stress in psychosis: study protocol for the RE. PROCESS randomized controlled trial. Trials. 2022;23(1):851. doi:10. 1186/s13063-022-06808-6