The Moderating Role of Social Functioning in the Relationship Between Stigma and Quality of Life in Rural Chinese Patients with Schizophrenia: A Cross-Sectional Study

Purpose: Individuals with schizophrenia often face significant stigma, social functioning impairments, and poor quality of life. However, the interrelationship among these factors remains insufficiently explored. This study investigates whether social functioning moderates the relationship between stigma and quality of life among rural Chinese individuals with schizophrenia. Patients and Methods: A cross-sectional study was conducted with 815 rural schizophrenia patients from Chaohu, China. Participants completed the Social Functioning Deficit Screening Scale (SDSS, higher scores indicate poorer social functioning/greater social disability), Social Impact Scale (SIS), the two global items of the WHOQOL-BREF to index overall QOL (higher scores indicate better QOL), Patient Health Questionnaire-9 (PHQ-9), and Insomnia Severity Index (ISI). Moderation analysis was performed using SPSS version 25.0 with the PROCESS macro (version 4.1, Model 1), with PHQ-9 and ISI entered as covariates, examining the stigma × SDSS interaction. Results: Stigma (β = − 0.132, p < 0.001) and social functional impairment (β = − 0.166, p < 0.001) were both significant independent negative predictors of quality of life. The moderating effect of social functional impairment was significant (β for interaction = 0.094, p = 0.003), explaining an additional 0.85% of the variance (ΔR 2 = 0.0085, p = 0.003). Simple slope analysis indicated that stigma had a significantly stronger negative impact on quality of life among individuals with mild social functional impairment (β = − 0.028, p < 0.001), while no significant effect was observed in those with severe impairment (β = − 0.006, p = 0.332). Johnson-Neumann analysis revealed a significant negative impact of stigma in individuals with lower levels of social disability (63.1%). Conclusion: Social functioning plays a significant moderating role in the relationship between stigma and quality of life in patients with schizophrenia(PWS). Stigma primarily impairs quality of life among patients with better social functioning. These findings suggest the need for a functionally stratified intervention model, prioritizing stigma reduction for patients with higher social functioning while focusing on symptom management and functional recovery for those with greater impairment. Keywords: schizophrenia, stigma, social functioning, quality of life