Social isolation and its influencing factors among family caregivers of individuals with schizophrenia: A social-ecological systems theory perspective

Abstract

Background

Social isolation adversely affects both physical and mental health. However, limited research has examined this issue among family caregivers of individuals with schizophrenia, particularly within a structured theoretical framework.

Objective

This study aimed to investigate the prevalence of social isolation and explore its associated multilevel factors among family caregivers of individuals with schizophrenia, guided by the Social-Ecological Systems Theory.

Methods

A cross-sectional study was conducted following STROBE guidelines. A total of 267 schizophrenia patients and their primary family caregivers were recruited from a tertiary psychiatric hospital in China using consecutive sampling. Data were collected via self-reported questionnaires, including demographic and clinical information, the World Health Organization Quality of Life-BREF (WHOQOL-BREF), the Perceived Devaluation-Discrimination Scale (PDD), and the Lubben Social Network Scale-6 (LSNS-6). Descriptive statistics, Pearson correlation, univariate analysis, and multivariate linear regression were used to identify factors associated with social isolation.

Results

The mean LSNS-6 score was 12.56 (SD = 5.49), and 44.9 % of caregivers were classified as socially isolated. At the microsystem (individual) level, being employed (β = 0.181, p = 0.002) and having a better understanding of the disease (β = 0.107, p = 0.043) were significantly associated with lower levels of isolation. At the mesosystem (interpersonal) level, participation in social activities (β = 0.12, p = 0.046) and higher scores on the WHOQOL-BREF social relationships domain (β = 0.249, p = 0.004) were also associated with lower levels of isolation. At the macrosystem (policy and cultural) level, greater availability of residential mental health resources (β = 0.142, p = 0.018) and lower perceived stigma (PDD score, β = −0.124, p = 0.024) were associated with reduced isolation. These factors collectively accounted for 36 % of the variance in social isolation (adjusted R² = 0.32).

Conclusion

Social isolation is prevalent among schizophrenia caregivers and is associated with multilevel factors. Interventions targeting caregiver psychoeducation and employment (microsystem), promoting social participation (mesosystem), and advancing anti-stigma efforts and residential mental health service accessibility (macrosystem) are critical to reducing isolation and improving caregiver well-being.