Negative Impacts of Self-Stigma on the Quality of Life of Patients in Methadone Maintenance Treatment: The Mediated Roles of Psychological Distress and Social Functioning
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Measures
2.2.1. Self-Stigma Scale-Short
2.2.2. Opiate Treatment Index for Psychological Distress and Social Functioning
2.2.3. The World Health Organization Quality of Life-Brief Version
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Model # | χ2 (df) | p-Value | χ2/df | CFI | RMSEA | SRMR |
---|---|---|---|---|---|---|
Physical | ||||||
Model a | 135.402 (68) | <0.001 | 1.991 | 0.946 | 0.063 | 0.061 |
Model b | 562.358 (284) | <0.001 | 1.980 | 0.897 | 0.063 | 0.066 |
Model c | 141.007 (80) | <0.001 | 1.763 | 0.952 | 0.055 | 0.059 |
Model d | 582.013 (307) | <0.001 | 1.896 | 0.899 | 0.060 | 0.065 |
Model e | 549.917 (306) | <0.001 | 1.797 | 0.911 | 0.057 | 0.065 |
Psychological | ||||||
Model a | 135.413 (68) | <0.001 | 1.991 | 0.946 | 0.063 | 0.062 |
Model b | 553.593 (284) | <0.001 | 1.949 | 0.899 | 0.062 | 0.067 |
Model c | 142.267 (80) | <0.001 | 1.778 | 0.951 | 0.056 | 0.060 |
Model d | 577.475 (307) | <0.001 | 1.881 | 0.900 | 0.059 | 0.066 |
Model e | 552.040 (306) | <0.001 | 1.804 | 0.909 | 0.057 | 0.065 |
Social | ||||||
Model a | 143.848 (68) | <0.001 | 2.115 | 0.939 | 0.067 | 0.062 |
Model b | 551.124 (284) | <0.001 | 1.941 | 0.898 | 0.061 | 0.066 |
Model c | 150.978 (80) | <0.001 | 1.887 | 0.944 | 0.060 | 0.060 |
Model d | 574.387 (307) | <0.001 | 1.871 | 0.899 | 0.059 | 0.065 |
Model e | 541.471 (306) | <0.001 | 1.770 | 0.911 | 0.056 | 0.064 |
Environment | ||||||
Model a | 144.120 (68) | <0.001 | 2.119 | 0.939 | 0.067 | 0.064 |
Model b | 561.155 (284) | <0.001 | 1.976 | 0.895 | 0.063 | 0.067 |
Model c | 149.879 (80) | <0.001 | 1.873 | 0.945 | 0.059 | 0.061 |
Model d | 582.081 (307) | <0.001 | 1.896 | 0.897 | 0.060 | 0.066 |
Model e | 551.384 (306) | <0.001 | 1.802 | 0.908 | 0.057 | 0.065 |
Model # | Coefficient (SE)/ p-Value (Lower Limit, Upper Limit) | % of Indirect Effects | |||
---|---|---|---|---|---|
Self-Stigma | Psychological Distress | Social Function | Psychological Distress and Social Function | ||
Direct effect | |||||
Model a | −2.013 (0.559)/ 0.002 (−3.21, −1.04) | -- | -- | -- | -- |
Model b | −0.349 (0.383)/ 0.38 (−1.07, 0.44) | −3.427 (0.351)/ 0.002 (−4.18, −2.83) | -- | -- | -- |
Model c | −1.909 (0.490)/ 0.002 (−3.00, −1.09) | -- | −0.163 (0.024)/ 0.002 (−0.21, −0.12) | -- | -- |
Model d | −0.445 (0.364)/ 0.26 (−1.08, 0.34) | −3.163 (0.352)/ 0.001 (−3.92, −2.58) | −0.054 (0.022)/ 0.01 (−0.10, −0.008) | -- | -- |
Model e | −0.468 (0.360)/ 0.25 (−1.08, 0.33) | −3.350 (0.353)/ 0.001 (−4.14, −2.75) | −0.056 (0.023)/ 0.01 (−0.10, −0.01) | -- | -- |
Indirect effect | |||||
Model a | -- | −1.678 (0.459)/ 0.001 (−2.89, −0.98) | -- | -- | 82.8% |
Model b | -- | -- | −0.133 (0.169)/ 0.41 (−0.50, 0.20) | -- | 6.5% |
Model c | -- | −1.550 (0.247)/ <0.001 (−2.03, −1.07) | −0.044 (0.532)/ 0.93 (−1.09, 1.00) | -- | 78.2% |
Model d | -- | −1.524 (0.244)/ <0.001 (−2.00, −1.05) | −0.079 (0.524)/ 0.88 (−1.11, 0.95) | −0.120 (0.307)/ 0.70 (−0.72, 0.48) | 77.0% |
Model # | Coefficient (SE)/ p-Value (Lower Limit, Upper Limit) | % of Indirect Effects | |||
---|---|---|---|---|---|
Self-Stigma | Psychological Distress | Social Function | Psychological Distress and Social Function | ||
Direct effect | |||||
Model a | −2.326 (0.683)/ 0.003 (−3.69, −1.01) | -- | -- | -- | -- |
Model b | −0.647 (0.494)/ 0.23 (−1.61, 0.35) | −3.341 (0.372)/ 0.002 (−4.11, −2.69) | -- | -- | -- |
Model c | −2.232 (0.647)/ 0.003 (−3.58, −1.04) | -- | −0.148 (0.026)/ 0.002 (−0.20, −0.10) | -- | -- |
Model d | −0.725 (0.341)/ 0.15 (−1.71, 0.23) | −3.147 (0.318)/ 0.002 (−3.92, −2.49) | −0.039 (0.019)/ 0.09 (−0.09, 0.007) | -- | -- |
Model e | −0.784 (0.343)/ 0.13 (−1.79, 0.21) | −3.239 (0.322)/ 0.002 (−4.05, −2.56) | −0.044 (0.020)/ 0.06 (−0.10, 0.003) | -- | -- |
Indirect effect | |||||
Model a | -- | −1.689 (0.448)/ 0.001 (−2.92, −1.04) | -- | -- | 72.3% |
Model b | -- | -- | −0.121 (0.156)/ 0.41 (−0.48, 0.17) | -- | 5.1% |
Model c | -- | −1.589 (0.259)/ <0.001 (−2.10, −1.08) | −0.032 (0.533)/ 0.95 (−1.08, 1.01) | -- | 69.1% |
Model d | -- | −1.526 (0.319)/ <0.001 (−2.15, −0.90) | −0.063 (0.527)/ 0.90 (−1.10, 0.97) | −0.085 (0.305)/ 0.78 (−0.68, 0.51) | 66.6% |
Model # | Coefficient (SE)/ p-Value (Lower Limit, Upper Limit) | % of Indirect Effects | |||
---|---|---|---|---|---|
Self-Stigma | Psychological Distress | Social Function | Psychological Distress and Social Function | ||
Direct effect | |||||
Model a | −2.139 (0.579)/ 0.002 (−3.53, −1.18) | -- | -- | -- | -- |
Model b | −0.831 (0.448)/ 0.050 (−1.83, 0.000) | −2.716 (0.366)/ 0.002 (−3.48, −2.02) | -- | -- | -- |
Model c | −2.048 (0.530)/ 0.001 (−3.37, −1.22) | -- | −0.142 (0.027)/ 0.001 (−0.20, −0.09) | -- | -- |
Model d | −0.937 (0.341)/ 0.02 (−1.85, −0.14) | −2.417 (0.318)/ 0.002 (−3.20, −1.76) | −0.060 (0.019)/ 0.02 (−0.11, −0.008) | -- | -- |
Model e | −0.959 (0.433)/ 0.02 (−1.90, −0.21) | −2.580 (0.380)/ 0.002 (−3.36, −1.87) | −0.062 (0.027)/ 0.02 (−0.11, −0.10) | -- | -- |
Indirect effect | |||||
Model a | -- | −1.317 (0.364)/ 0.001 (−2.23, −0.77) | -- | -- | 61.3% |
Model b | -- | -- | −0.116 (0.150)/ 0.40 (−0.45, 0.17) | -- | 5.4% |
Model c | -- | −1.175 (0.252)/ <0.001 (−1.67, −0.68) | −0.049 (0.532)/ 0.93 (−1.09, 0.99) | -- | 56.6% |
Model d | -- | -1.151 (0.256)/ <0.001 (−1.65, −0.65) | −0.087 (0.407)/ 0.83 (−0.88, 0.71) | −0.133 (0.315)/ 0.67 (−0.75, 0.48) | 55.5% |
Model # | Coefficient (SE)/ p-Value (Lower Limit, Upper Limit) | % of Indirect Effects | |||
---|---|---|---|---|---|
Self-Stigma | Psychological Distress | Social Function | Psychological Distress and Social Function | ||
Direct effect | |||||
Model a | −1.523 (0.546)/ 0.002 (−2.74, −0.64) | -- | -- | -- | -- |
Model b | −0.168 (0.401)/ 0.71 (−0.94, 0.69) | −2.792 (0.326)/ 0.002 (−3.48, −2.17) | -- | -- | -- |
Model c | −1.444 (0.507)/ 0.002 (−2.59, −0.59) | -- | −0.125 (0.025)/ 0.002 (−0.17, −0.07) | -- | -- |
Model d | −0.232 (0.341)/ 0.59 (−0.99, 0.60) | −2.613 (0.318)/ 0.001 (−3.36, −1.97) | −0.035 (0.019)/ 0.16 (−0.08, 0.01) | -- | -- |
Model e | −0.273 (0.343)/ 0.55 (−1.02, 0.58) | −2.748 (0.322)/ 0.002 (−3.51, −2.07) | −0.038 (0.020)/ 0.14 (−0.09, 0.01) | -- | -- |
Indirect effect | |||||
Model a | -- | −1.362 (0.399)/ 0.002 (−2.37, −0.78) | -- | -- | 89.0% |
Model b | -- | -- | −0.103 (0.135)/ 0.37 (−0.42, 0.14) | -- | 6.7% |
Model c | -- | −1.278 (0.243)/ <0.001 (−1.75, −0.80) | −0.028 (0.534)/ 0.96 (−1.07, 1.02) | -- | 84.9% |
Model d | -- | −1.234 (0.247)/ <0.001 (−1.72, −0.75) | −0.053 (0.525)/ 0.92 (−1.08, 0.98) | −0.082 (0.312)/ 0.79 (−0.69, 0.53) | 82.2% |
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n (%) | Mean (SD) | |
Demographics | ||
Age in year | 45.12 (7.49) | |
30 or below | 2 (0.8%) | |
31–40 | 61 (24.4%) | |
41–50 | 120 (48.0%) | |
51–60 | 59 (23.6%) | |
61 or above | 8 (3.2%) | |
Missing | 0 (0.0%) | |
Gender | ||
Male | 224 (89.6%) | |
Female | 26 (10.4%) | |
Missing | 0 (0.0%) | |
Educational level | ||
Junior high or below | 159 (63.6%) | |
Senior high or above | 91 (36.4%) | |
Missing | 0 (0.0%) | |
Marital status | ||
Currently married | 58 (23.2%) | |
Others | 192 (76.8%) | |
Missing | 0 (0.0%) | |
Full-time employment | ||
Yes | 126 (50.4%) | |
No | 124 (49.6%) | |
Missing | 0 (0.0%) | |
Monthly income | ||
Less than minimum monthly wages in Taiwan | 96 (38.4%) | |
Greater than minimum monthly wages in Taiwan | 154 (61.6%) | |
Missing | 0 (0.0%) | |
Clinical characteristics | ||
Onset age in year | 25.92 (6.97) | |
20 or below | 65 (26.0%) | |
21–30 | 135 (54.0%) | |
31–40 | 38 (15.2%) | |
41–50 | 11 (4.4%) | |
Missing | 1 (0.4%) | |
Human immunodeficiency virus (HIV) | ||
Yes | 36 (14.4%) | |
No | 214 (85.6%) | |
Missing | 0 (0.0%) | |
Hepatitis B virus (HBV) | ||
Yes | 45 (18.0%) | |
No | 205 (82.0%) | |
Missing | 0 (0.0%) | |
Hepatitis C virus (HCV) | ||
Yes | 178 (71.2%) | |
No | 72 (28.8%) | |
Missing | 0 (0.0%) | |
Diabetes mellitus (DM) | ||
Yes | 5 (2.0%) | |
No | 245 (98.0%) | |
Missing | 0 (0.0%) | |
Hypertension (HTN) | ||
Yes | 9 (3.6%) | |
No | 241 (96.4%) | |
Missing | 0 (0.0%) | |
Previous episodes of MMT | ||
0 | 71 (28.4%) | |
1 | 119 (47.6%) | |
2 and above | 60 (24.0%) | |
Missing | 0 (0.0%) | |
Self-stigma | 2.90 (0.59) | |
QoL | ||
Physical domain | 13.26 (2.81) | |
Psychological domain | 11.70 (2.97) | |
Social domain | 12.47 (2.78) | |
Environment domain | 13.19 (2.73) | |
Psychological distress | 10.05 (6.41) | |
Social functioning | 15.52 (6.33) |
Model # | χ2 (df) | p-Value | χ2/df | CFI | RMSEA | SRMR |
---|---|---|---|---|---|---|
Model a | 194.540 (109) | <0.001 | 1.79 | 0.956 | 0.056 | 0.059 |
Model b | 699.606 (361) | <0.001 | 1.94 | 0.901 | 0.061 | 0.065 |
Model c | 207.475 (124) | <0.001 | 1.67 | 0.957 | 0.052 | 0.058 |
Model d | 725.721 (387) | <0.001 | 1.88 | 0.902 | 0.059 | 0.064 |
Model e | 697.854 (386) | <0.001 | 1.81 | 0.910 | 0.057 | 0.063 |
Model # | Coefficient (SE)/ p-Value (Lower Limit, Upper Limit) | % of Indirect Effects | |||
---|---|---|---|---|---|
Self-Stigma | Psychological Distress | Social Function | Psychological Distress and Social Function | ||
Direct effect | |||||
Model a | −1.967 (0.543)/ 0.002 (−3.11, −0.99) | -- | -- | -- | -- |
Model b | −0.477 (0.321)/ 0.14 (−1.11, 0.15) | −3.098 (0.316)/ 0.001 (−3.72, −2.48) | -- | -- | -- |
Model c | −1.889 (0.492)/ 0.002 (−2.98, −1.06) | -- | −0.143 (0.023)/ 0.002 (−0.19, −0.10) | -- | -- |
Model d | −0.561 (0.341)/ 0.097 (−1.25, 0.12) | −2.886 (0.318)/ 0.001 (−3.59, −2.33) | −0.046 (0.019)/ 0.02 (−0.08, −0.007) | -- | -- |
Model e | −0.594 (0.343)/ 0.07 (−1.26, 0.07) | −3.017 (0.322)/ 0.001 (−3.72, −2.47) | −0.049 (0.020)/ 0.01 (−0.09, −0.01) | -- | -- |
Indirect effect | |||||
Model b | -- | −1.546 (0.421)/ 0.001 (−2.60, −0.91) | -- | -- | 76.4% |
Model c | -- | -- | −0.117 (0.150)/ 0.40 (−0.45, 0.17) | -- | 5.8% |
Model d | -- | −1.440 (0.231)/ <0.001 (−1.89, −0.99) | −0.038 (0.531)/ 0.94 (−1.08, 1.00) | -- | 72.5% |
Model e | -- | −1.406 (0.229)/ <0.001 (−1.85, −0.96) | −0.070 (0.524)/ 0.89 (−1.10, 0.96) | −0.106 (0.302)/ 0.73 (−0.70, 0.49) | 70.9% |
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Cheng, C.-M.; Chang, C.-C.; Wang, J.-D.; Chang, K.-C.; Ting, S.-Y.; Lin, C.-Y. Negative Impacts of Self-Stigma on the Quality of Life of Patients in Methadone Maintenance Treatment: The Mediated Roles of Psychological Distress and Social Functioning. Int. J. Environ. Res. Public Health 2019, 16, 1299. https://doi.org/10.3390/ijerph16071299
Cheng C-M, Chang C-C, Wang J-D, Chang K-C, Ting S-Y, Lin C-Y. Negative Impacts of Self-Stigma on the Quality of Life of Patients in Methadone Maintenance Treatment: The Mediated Roles of Psychological Distress and Social Functioning. International Journal of Environmental Research and Public Health. 2019; 16(7):1299. https://doi.org/10.3390/ijerph16071299
Chicago/Turabian StyleCheng, Ching-Ming, Chih-Cheng Chang, Jung-Der Wang, Kun-Chia Chang, Shuo-Yen Ting, and Chung-Ying Lin. 2019. "Negative Impacts of Self-Stigma on the Quality of Life of Patients in Methadone Maintenance Treatment: The Mediated Roles of Psychological Distress and Social Functioning" International Journal of Environmental Research and Public Health 16, no. 7: 1299. https://doi.org/10.3390/ijerph16071299