The mediation effect of social support between stigma and social alienation in patients with stroke

Analysis of the Current Status and Influencing Factors of Social Alienation in Adolescent Scoliosis Patients

OBJECTIVE

Adolescent scoliosis patients frequently experience social alienation, yet comprehensive studies addressing its determinants in China remain scarce. This study aims to understand the current status of social alienation in adolescent scoliosis patients and analyze its influencing factors to inform targeted interventions.

METHODS

A cross-sectional study was conducted from January 2022 to December 2023. A total of 252 adolescent scoliosis patients were investigated using the General Information Questionnaire, Social Alienation Scale, Family Care Scale, and Anxiety Self-Rating Scale. Multivariate linear regression analysis was employed to identify independent factors influencing social alienation.

RESULTS

Adolescent patients with scoliosis experience significant social isolation (37.21 ± 0.78), lower levels of family care (6.33 ± 0.70), and higher anxiety self-assessment scores (53.11 ± 0.88), and the results showed that education level, per capita monthly family income, time of disease onset, type of scoliosis, Cobb's angle, ability to take care of oneself, appearance deformation, family care, and anxiety were found to independently influence the social alienation score (all p < 0.05).

CONCLUSION

Adolescent patients with scoliosis exhibit a heightened degree of social isolation due to a variety of factors. Healthcare professionals should focus on providing individualized interventions, particularly for those with lower levels of education and family support, to alleviate their social isolation.

Empowering post-stroke older adults through wheelchair development: a conceptual synthesis for stigma reduction and well-being enhancement

Purpose: After a stroke, older adults may encounter social stigma due to their disability and age. This can cause emotions of shame, low self-esteem, and social isolation. The use of assistive devices can make the stigmatizing conditions even more difficult. This study attempts to establish a conceptual framework for designing wheelchairs that can help reduce stigma and improve the well-being of older people with lived experience of stroke.Method: The study utilized the research question construct classification to identify three primary research questions. To address these questions, a bibliographic search was performed using Scopus, Web of Science databases, and PubMed. Articles were selected based on their relevance to the development of wheelchairs and their focus on reducing stigma or enhancing well-being for post-stroke older adults.Results: Seventy articles were chosen to be meticulously reviewed and categorized into sub-themes. This categorization led to the creation of a comprehensive synthesis summary to address each question. The results are further synthesized to formulate a potential theoretical proposition for future investigation. The results suggest enhancing wheelchair design focusing on visibility, symbolism, usefulness, aesthetics, and adaptability through user empowerment and cultural interventions that can effectively reduce stigma, thereby improving the well-being, self-competence, and life quality of post-stroke older adults.Conclusion: The findings offer a design framework for wheelchair innovation specifically aimed at reducing the stigmatizing conditions to improve the well-being of post-stroke older adults through an interdisciplinary perspective. This study suggests further research to explore specific design strategies for wheelchair innovation across various contexts and cultures.

Mediation Analysis of the Social Isolation Between Stigma and Return-To-Work Readiness Among Young and Middle-Aged Patients With Stroke in China

AIM

This study aimed to (1) investigate the current status of social isolation, stigma, and return-to-work readiness among young and middle-aged patients with stroke and (2) explore the relationship among the three variables and construct a mediation model to test the mediating role of social isolation in the relationship between stigma and return-to-work readiness.

DESIGN

A cross-sectional descriptive study.

METHODS

Data collection was conducted among patients 18-60 years of age (N = 154) who visited for the management of stroke. Participants completed a questionnaire measuring social isolation, stigma, and return-to-work readiness. The analysis of data and effect of mediation was tested by the PROCESS for SPSS 25.0. This study was reported following the STROBE guidelines.

RESULTS

Stroke stigma was a significant predictor of social isolation (B = 0.0.68, SE = 0.02, t = 27.89, p < 0.000), with a confidence interval (LLCI = 0.63, ULCI = 0.73) excluding zero. Stigma was a significant predictor (c' = -0.140, SE = 0.066, p = 0.035 < 0.05, 95% CI [-0.270, -0.010]) of return-to-work readiness. Social isolation partially mediated the relationship between stigma and return-to-work readiness, with a mediation effect of -0.207, accounting for 59.67% of the total effect.

PATIENT OR PUBLIC CONTRIBUTION

This study was informed by young and middle-aged stroke survivors who contributed critical data through their participation. While patients were not directly involved in study design or analysis, their lived experiences with stigma and social isolation during post-stroke rehabilitation provided essential context for interpreting the mediation mechanisms. The findings illuminate actionable pathways to enhance return-to-work readiness, offering healthcare providers strategies to address psychosocial barriers in vocational rehabilitation programmes.

Clinical characteristics of schizophrenia, depression, and Alzheimer's diseases among older adults: a retrospective study of 271 consecutive admissions

Objective

This study aims to identify the clinical characteristics of schizophrenia, depression, and AD among older adults.

Methods

General information of patients was collected, including diagnosis, age, gender, level of education, marital status, drinking behavior, smoking behavior, course of mental disorder, type of admission, history of modified electroconvulsive therapy (MECT) and hospitalization period. The Brief Psychiatric Rating Scale (BPRS), Geriatric Depression Scale (GDS), Generalized Anxiety Disorder 7-Item Scale (GAD-7), Insight and Treatment Attitudes Questionnaire (ITAQ), and Mini-Mental State Examination (MMSE) were employed to evaluate the participants' mental status. The Functional Activities Questionnaire (FAQ), Social Support Rating Scale (SSRS), Barthel ADL Index, Standardized Swallowing Assessment (SSA), and Mini-Nutritional Assessment (MNA) were applied to measure social and daily living function. The Nurses' Global Assessment of Suicide Risk (NGASR) and The Brøset Violence Checklist (BVC) were used to assess the patients' risk of suicide.

Results

Totally 271 participants were recruited, the numbers of participants with schizophrenia, depression, and Alzheimer's diseases (AD), were 81 (29.9%), 85 (31.4%), and 105 (38.7%), respectively. One-way ANOVA was used to compare the variance of the crude score results among three groups of subjects. The results showed that patients with depression had the highest GDS total score, followed by patients with AD, and patients with schizophrenia had the lowest score (P < 0.001). The total scores of GAD-7 and ITAQ in patients with depression were higher than those in patients with AD and schizophrenia (P < 0.001). The total score of MMSE in patients with schizophrenia and depression was higher than that in patients with AD (P < 0.001). The incidence of circulatory system diseases in patients with depression and AD was higher than that in patients with schizophrenia (P < 0.05). The incidence of respiratory system diseases in patients with AD was highest, followed by patients with schizophrenia, and patients with depression had the lowest incidence (P < 0.05). The incidence of nervous system diseases in patients with AD was highest, followed by patients with depression, and patients with schizophrenia had the lowest incidence (P < 0.05). The total scores of FAQ and SSA in patients with AD were higher than those in patients with schizophrenia and depression (P < 0.001), while patients with depression had statistically lower SSRS scores than patients with schizophrenia and patients with AD (P < 0.05). Furthermore, patients with AD had lower Barthel ADL Index scores and water-swallowing test (P < 0.001). MNA scores of patients with schizophrenia were higher than those of patients with depression and AD, with statistical significance (P < 0.05). The NGASR scores of patients with depression were higher than those of patients with schizophrenia and AD, which was statistically significant (P < 0.001). Patients with AD had the highest BVC total score, followed by that of patients with schizophrenia and patients with depression had lowest score, and the difference was statistically significant (P < 0.05).

Conclusions

Patients with geriatric psychosis may experience abnormalities in various aspects that influenced daily living, including disorders of thinking, cognition, emotion, and behavior. Patients with schizophrenia have cognitive impairment. Cognitive training and medication are important. Patients with depression were considered to be at a greater risk for suicide compared to those with schizophrenia and AD. Active clinical measures must be adopted to improve patients' depressive symptoms, change their suicidal attitudes, and enhance their self-confidence. Patients with AD were prone to respiratory and neurological diseases. Treatment of respiratory infections and hypoxia and other respiratory diseases would be necessary, and cognitive function training should be conducted. In addition, regarding to high risk of swallowing disorders and malnutrition, swallowing function training should be carried out to ensure food intake and prevent malnutrition. Driven by psychiatric symptoms, violent behavior was prevalent, thus effective communication and de-escalation techniques are needed. Although the symptoms of these three diseases are different, timely professional intervention and support from family members are urgently needed.

Influence of symptom burden on social alienation in lung cancer patients receiving chemotherapy: the chain mediating effect of perceived social support and positive psychological capital

BACKGROUND

Social alienation is prevalent among lung cancer (LC) patients undergoing chemotherapy. Although previous research has established an association between social alienation and symptom burden, the mechanisms underlying this relationship remain not fully understood.

METHODS

This cross-sectional study used convenience sampling to select 378 LC patients undergoing chemotherapy from September 2022 to December 2023 at a tertiary care hospital in Guangzhou, China. Data collection was conducted using a proprietary Sociodemographic Information Questionnaire, MD Anderson Symptom Inventory (MDASI), Social Alienation Questionnaire, Perceptions of Social Support (PSS) Questionnaire, and Positive Psychological Capital (PPC) Questionnaire. To analyze chain-mediated effects, the PROCESS v3.3 Model 6 SPSS macro software was employed.

RESULTS

The analysis revealed that the burden of symptoms significantly exacerbates social alienation, as evidenced in the mediation effects model (Bootstrap 95% CI: 0.031, 0.092). Furthermore, the burden of symptoms indirectly diminishes PSS (Bootstrap 95% CI: 0.019, 0.057) and PPC (Bootstrap 95% CI: 0.002, 0.020). It is crucial to note that both PSS and PPC significantly mediate the relationship between symptom burden and social alienation, as evidenced (Bootstrap 95% CI: 0.001, 0.011).

CONCLUSIONS

The impact of symptom burden on social alienation is moderated through PSS and PPC, manifesting both directly and indirectly. Moreover, the influence of PPC tends to mitigate the mediating role of PSS. Clinical interventions aimed at bolstering PSS and augmenting PPC may potentially alleviate social alienation and enhance the quality of life for patients undergoing chemotherapy for LC.

Exploration of Body Image in Postoperative Patients With Oral Cancer: An Exploratory Sequential Mixed Methods Study

BACKGROUND

Postoperative patients with oral cancer are deeply distressed about their body image. However, their true inner feelings and the factors influencing body image remain unclear.

AIMS

This study aims to investigate the experience of body image disturbance in patients 3 months after oral cancer surgery and analyze the influencing factors.

METHODS

This study process was divided into three steps: (1) semi-structured interviews, based on the Society Ecosystems Theory, of patients with body image disorders 3 months after oral cancer surgery, followed by theme summaries; (2) appropriate selection of scales according to the qualitative results; and (3) a cross-sectional survey to explore the factors and pathways affecting the body image of the patients.

RESULTS

Qualitative research summarized nine themes from the individual, family/employment, and societal/institutional levels, with the individual level being most commonly mentioned. Further investigation into the individual factors influencing the body image of the patients revealed that self-esteem and social alienation have a chain mediating effect on the relationship between speech handicap and body image.

CONCLUSIONS

The body image of postoperative patients with oral cancer is influenced by personal, family, and societal aspects. These study results lay the groundwork for formulating interventions to alleviate body image concerns.

Development of the Japanese version of the stroke stigma scale: a validity and reliability assessment

BACKGROUND

The stigma perceived by many post-stroke persons hinders their social lives. A scale to measure stigma is needed to identify social problems related to stigma, and to evaluate effectiveness of interventions.

OBJECTIVES

This study aimed to develop a Japanese version of the Stroke Stigma Scale (SSS-J), and confirm its utility by examining reliability and validity.

METHODS

Eighty community-dwelling post-stroke individuals were enrolled at six sites. After translating the scale into Japanese using back translation methods, psychometric properties of the rating scale, internal scale validity, and reliability were examined to fit the Rasch model. Criterion-related validity, construct validity, and test-retest reliability were examined using total scores transformed to logit. For test-retest reliability, 30 participants completed the SSS-J twice, one week apart.

RESULTS

Rasch analysis showed that the SSS-J had the best fit with 15 items on a 3-category rating scale. Item difficulty logits were -2.01 to 2.21, person ability logits were -4.69 to 0.62 (mean, -1.41), person reliability coefficient was 0.71 (separation index, 1.58), and item reliability coefficient was 0.96 (separation index, 5.04). For criterion validity, Spearman's rank correlation coefficient with the Center for Epidemiologic Studies Depression Scale was 0.51 (p < 0.001). For construct validity, Spearman's rank correlation coefficients with each subscale of the Stroke Impact Scale ranged from -0.36 to -0.16 (p = 0.002-0.126). For test-retest reliability, the intra-class correlation coefficient was 0.64 (p < 0.001).

CONCLUSIONS

The SSS-J adapted to the Rasch model was reliable and valid. This scale can be used to quantitatively measure stigma among community-dwelling post-stroke persons in Japan.

Felt stigma and associated factors in children and adolescents with epilepsy: a multicenter cross-sectional study in China

Objective

Epilepsy-related stigma is a global problem, yet there has been an inadequate focus on children and adolescents. The purpose of this study was to determine the status quo of stigma and its determinants among children and adolescents with epilepsy in China.

Methods

A multicenter cross-sectional study was conducted across nine hospitals in eight cities within six provinces in China from 10 October 2023 to 15 June 2024. Participants included patients aged 8 to 18 years with epilepsy and their caregivers. Felt stigma was assessed with the Kilifi Stigma Scale for Epilepsy (KSSE). Social support and self-efficacy were collected through the Social Support Rating Scale (SSRS) and the Generalized Self-Efficacy Scale (GSES). The data were analyzed using t-tests, analysis of variance (ANOVA), Spearman correlation analysis, and multiple linear regression analysis.

Results

The study enrolled 281 children and adolescents, with a mean age of 12.25 years (SD = 2.56), including 46.6% females. A total of 35.6% participants had self-reported felt stigma. The mean KSSE score is 9.58 (SD = 7.11). Meanwhile, stigma scores correlated strongly with reduced social support (r = -0.55, p < 0.01) and self-efficacy (r = -0.43, p < 0.01). Place of residence (rural vs. non-rural), academic performance (average and above vs. fair or poor), region (western region vs. non-western region), duration of epilepsy (≤5 years vs. >5 years), drug-resistant epilepsy (yes vs. no), comorbidities (yes vs. no), social support and self-efficacy are major influencing factors among the complex factors influencing the felt stigma among children and adolescents.

Conclusion

Medical staff should be more aware of stigma among children and adolescents with epilepsy, especially those who live in rural and western areas, have poor academic performance, have epilepsy duration of more than 5 years, have drug-resistant epilepsy, and have comorbidities, who are at higher risk of stigma. It is recommended that effective measures be taken to alleviate stigma by improving children and adolescents' self-efficacy and providing more social support for them and their families.

Social support and sleep quality in people with schizophrenia living in the community: the mediating roles of anxiety and depression symptoms

Introduction

Research has demonstrated that higher social support is associated with better psychological health, quality of life, cognition, activities of daily living, and social participation, but the relationship between social support and sleep quality remains unknown. This study aims to investigate the mediating effects of anxiety and depression in the relationship between social support and sleep among community-dwelling patients with schizophrenia.

Method

Purposive sampling was used to collect face-to-face data from 1,107 community-dwelling patients with schizophrenia in Chengdu, Sichuan Province, China, between April and July 2023. The Athens Insomnia Scale (AIS) was used to assess sleep quality; the Generalized Anxiety Disorder 7-item scale (GAD-7) was utilized to evaluate anxiety symptoms; and the Patient Health Questionnaire-9 (PHQ-9) was employed to assess depressive symptoms. The mediating effect of anxiety and depression symptoms was assessed using the bootstrap method via Model 6 (Serial multiple mediator model) of the SPSS PROCESS macro.

Results

Among the 1,107 participants, the proportions of people with schizophrenia experiencing anxiety, depressive symptoms, and poor sleep quality were 22.8, 37.7, and 42.1%, respectively. Mediation analyses indicated that although social support had no direct effect on sleep quality, anxiety and depressive symptoms fully mediated the relationship between social support and sleep quality.

Conclusion

Patients with schizophrenia experience low levels of social support and poor sleep quality. To enhance the sleep quality of individuals with schizophrenia, all levels of society (government, medical institutions, and communities) must pay more attention to mental health. Implementing diverse intervention measures to strengthen social support and improve symptoms of anxiety and depression should be considered. This approach may potentially lead to an improvement in sleep quality among individuals with schizophrenia.

Development and validation of a social alienation predictive model for older maintenance hemodialysis patients based on latent profile analysis-a cross-sectional study

BACKGROUND

Social alienation refers to the state of feeling isolated, helpless, and unsatisfied due to maintaining distance from others or avoiding social interaction and activities. This phenomenon is caused by a lack of social skills, social anxiety, physical health problems, and other reasons. Older maintenance hemodialysis patients are exposed to a higher risk of social alienation. However, previous studies have been performed using the total score of the scale, which does not allow the identification of the characteristics of various patient groups with different levels of social alienation. In contrast, latent profile analysis can classify individuals into different categories based on continuous observational indicators, which improves accuracy and provides a more objective assessment by accounting for the uncertainty of variables. Given the concealed nature of social alienation and the differences in characteristics and treatment measures between different profiles, developing a predictive model for social alienation in older maintenance hemodialysis patients holds significance.

OBJECTIVE

To explore the latent profile analysis of social alienation in older maintenance hemodialysis patients and to develop and validate a predictive model for social alienation in this population.

METHODS

A total of 350 older maintenance hemodialysis patients were selected as the study subjects using convenience sampling. A cross-sectional survey was conducted using a general information questionnaire, the Generalized Alienation Scale, and the Self-Perceived Burden Scale. Based on the results of the Generalized Alienation Scale, a latent profile analysis was performed, followed by univariate analysis and multinomial logistic regression to develop a predictive model. The effectiveness of the predictive model was evaluated in terms of its authenticity, reliability, and predictive ability.

RESULTS

Three hundred nineteen valid questionnaires were collected. The social alienation of older maintenance hemodialysis patients based on latent profile analysis were divided into three profiles, which were named the low/medium/high-symptom groups, comprising 21%, 38.9%, and 40.1% of participants, respectively. Based on male, monthly social activity hours, Age-Adjusted Charlson Comorbidity Index, dialysis age, and Self-Perceived Burden Scale, a predictive model of social alienation for older maintenance hemodialysis patients was developed, and the Hosmer-Lemeshow tests showed no statistical significance (P > 0.05). The model has high predictive efficiency in authenticity, reliability and predictability.

CONCLUSION

Older maintenance hemodialysis patients exhibited moderate to high levels of social alienation. The latent profile analysis based method was used to divide patients into low/medium/high-symptom profiles, and the predictive model demonstrates excellent authenticity, reliability, and predictability.

The effect of social activities on the alienation and family resilience of Chinese caregivers for children with autism: a latent class analysis

Introduction

Caregivers of children with autism spectrum disorder (ASD) in China often experience alienation due to societal stigma. While this alienation detrimentally impacts their mental well-being, family resilience serves as a protective factor. Previous research has predominantly examined the social support derived from social activities but has neglected to delve into the specific patterns of these activities. The primary objective of this study was twofold: firstly, to gain insights into the various social activities engaged in by caregivers of children with autism in China, and secondly, to ascertain the influence of these social activities on alienation and family resilience.

Methods

Between June and August 2023, a cross-sectional survey was carried out across multiple cities in Jilin Province, aiming to gather data from a total of 205 Chinese caregivers of children with autism. Data collection was conducted through the utilization of a structured questionnaire. The assessment of social activity involved the completion of 12 questionnaires, while alienation was evaluated using the Generalized Alienation Scale (GSAS), and family resilience was gauged through the Chinese version of the Family Resilience Scale (FaRE). The classification of social activities was conducted through latent class analysis (LCA), while the impact of these social activities on alienation and family resilience was examined using linear regression analysis.

Results

The findings revealed that social activities can be categorized into five types (Low, Self-Recreation, Communication, Web Surfing, High). Communication social activities were found to reduce family resilience(β=.332, p<0.01), while high social activities were associated with reduced alienation(β=-.349, p<0.05) and increased family resilience(β=.417, p<0.01).

Conclusion

Supporting these particular types of social activities has the potential to reduce alienation and bolster family resilience among caregivers for children with autism in China.