https://orcid.org/0000-0003-2468-1595
Abstract
Purpose
This study aims to explore the serial mediating effect of stigma and depression on the association between social support and medication adherence.
Patients and Methods
A cross-sectional survey was undertaken in the Changning District of Shanghai using a five-part questionnaire from August to December 2023. A convenient sampling method was employed, and 35 patients with schizophrenia were invited from each of the 9 streets in Changning District to participate in the survey, resulting in a total of 305 valid questionnaires collected. The questionnaire measured social support, stigma, depression, medication adherence, and demographic characteristics. Data analysis involved descriptive statistics, independent samples t-tests, ANOVA, Pearson correlation analysis, and the bootstrap method.
Results
There was a direct and significantly positive association between social support and medication adherence (β = 0.69, p < 0.001). Moreover, increased levels of stigma (β = - 0.45, p = 0.013) and depression (β = - 0.09, p = 0.017) were both associated with a decline in medication adherence. Bootstrapping analysis revealed that the association between social support and medication adherence operated indirectly through stigma (β = 0.11, 95% CI: 0.03, 0.18). Additionally, social support was indirectly associated with medication adherence through depression (β = 0.15, 95% CI: 0.04, 0.30). Further analysis indicated that social support had an indirect association with medication adherence through both stigma and depression (β = 0.04, 95% CI: 0.01, 0.07).
Conclusion
Stigma and depression serially mediate the association between social support and medication adherence among patients with schizophrenia. This serial multiple mediation model underscores the importance of integrating social support interventions with psychological interventions aimed at reducing stigma and depression, thereby effectively enhancing medication adherence in patients with schizophrenia.
Data Sharing Statement
The datasets used to support the findings of this study are available from the corresponding author on reasonable request.
Ethics Approval and Informed Consent
This study was approved by the Medical Research Ethics Committee of the School of Public Health, Fudan University (The international registry no. IRB00002408 & FWA00002399).
Acknowledgments
We are grateful to all the works, experts, and participants who contributed to this study.
Disclosure
The authors report no conflicts of interest in this work.