Restricted accessResearch articleFirst published online 2026-2
The effect of self-management and subjective recovery on social functioning in people with schizophrenia: A cross-sectional study based on a community mental health centre
Schizophrenia is a mental illness that can affect an individual’s social functioning in various ways.
Aims:
This study aimed to determine the self-management and subjective recovery levels of individuals with schizophrenia and to examine the effects of these variables on their level of social functioning.
Methods:
The study was conducted on individuals with schizophrenia who were followed up at a community mental health centre. Data were collected using the ‘Chronic Illness Self-Management Scale’, ‘Social Functionality Assessment Scale’ and ‘Subjective Recovery Assessment Scale’. Descriptive statistics, Pearson’s correlation analysis, and a stepwise multiple regression model were used.
Results:
The subjective recovery of the participants was 52.56 (SD 19.95), social functioning 39.18 (SD 7.76), self-stigmatisation 2.49 (SD 0.93), coping with stigmatisation 2.95 (SD 0.70), health care effectiveness 3.22 (SD 0.93), and adherence to treatment 3.90 (SD 0.93). According to the Pearson correlation test, a statistically significant moderate positive correlation was found between self-management, subjective recovery and social functioning (r = .595 and .525, p ⩽ .001). Subjective recovery, self-stigmatisation, and healthcare effectiveness levels explained 44.7% of the total variance in social functioning.
Conclusion:
In this study, the most important predictors of social functioning were subjective recovery, self-stigmatisation, and health care effectiveness self-management. To improve social functioning in schizophrenia, the development of self-management strategies that increase subjective recovery and promote social integration is recommended.
AdilM.AtiqI.EllahiA. (2022). Stigmatization of schizophrenic individuals and its correlation to the fear of violent offence. Should we be concerned?Annals of Medicine and Surgery, 82, 2. https://doi.org/10.1016/j.amsu.2022.104666
2.
AkbayirN.OzH. S. (2025). Childhood experiences of individuals whose parents are schizophrenia patients: A phenomenological study. International Journal of Systemic Therapy. 1–29. https://doi.org/10.1080/2692398x.2025.2462355
3.
AmalinaD. B.EffendyE.CamelliaV. (2014). Social and personal functioning in schizophrenia: Relationship to sociodemographic and clinical factors. Journal of Biology, Agriculture and Healthcare, 4(24), 136–140. www.iiste.org
4.
Atef MokhtarA.Mahmoud ZakiM.Mohamed Abdel-AzizM.Mona. (2021). Relation between resilience and life satisfaction among schizophrenic patients. Journal of Nursing Science Benha University, 2(2), 225–240.
5.
Attepe ÖzdenS.TekindalM.TekindalM. A. (2023). Quality of life of people with schizophrenia: A meta-analysis. International Journal of Social Psychiatry, 69(6), 1444–1452. https://doi.org/10.1177/00207640231164019
6.
Attepe ÖzdenS.TuncayT. (2018). The experiences of Turkish families caring for individuals with schizophrenia: A qualitative inquiry. International Journal of Social Psychiatry, 64(5), 497–505.
7.
BenC. L.ChioF. H.MakW. W.CorriganP. W.ChanK. K. (2021). Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clinical Psychology Review, 87, 102029. https://doi.org/10.1016/j.cpr.2021.102029
8.
CronbachL. J. (1951). Coefficient alpha and the internal structure of tests. Psykometrika, 16, 297–334.
9.
DellN. A.LongC.ManciniM. A. (2021). Models of mental health recovery: An overview of systematic reviews and qualitative meta-syntheses. Psychiatric Rehabilitation Journal, 44(3), 238–253. https://doi.org/10.1037/prj0000444
10.
DrakeR. E.WhitleyR. (2014). Recovery and severe mental illness: Description and analysis. Canadian Journal of Psychiatry, 59(5), 236–242. https://doi.org/10.1177/070674371405900502
11.
DziwotaE.StepulakM. Z.Włoszczak-SzubzdaA.OlajossyM. (2018). Social functioning and the quality of life of patients diagnosed with schizophrenia. Annals of Agricultural and Environmental Medicine, 25(1), 50–55. https://doi.org/10.5604/12321966.1233566
12.
FanH.GaoX.YaoX.LiZ.ZouH.Campbell-GrossmanC.LiuS.ZhangF.ZhangC. (2022). Identification of four patterns for self-management behaviors in clients with schizophrenia: A cross-sectional study. Archives of Psychiatric Nursing, 37, 10–17. https://doi.org/10.1016/j.apnu.2021.12.006
13.
GagiuC.DionisieV.ManeaM. C.MaziluD. C.ManeaM. (2024). Internalised stigma, self-esteem and perceived social support as psychosocial predictors of quality of life in adult patients with schizophrenia. Journal of Clinical Medicine, 13, 6959. https://doi.org/10.3390/jcm13226959
14.
GuedesdePinhoL. M.PereiraA. M. D. S.ChavesC. M. C. B. (2018). Quality of life in schizophrenic patients: The influence of sociodemographic and clinical characteristics and satisfaction with social support. Trends in Psychiatry and Psychotherapy, 40(3), 202–209. https://doi.org/10.1590/2237-6089-2017-0002
15.
Gutiérrez-RojasL.González-DomenechP. J.JunqueraG.HalversonT. F.LaheraG. (2021). Functioning and happiness in people with schizophrenia: Analyzing the role of cognitive impairment. International Journal of Environmental Research and Public Health, 18, 7706. https://doi.org/10.3390/ijerph18147706
16.
HuangL. T.LiuY. L.PaoC. H.ChangY. H.ChuR. Y.HsuH. M.WeiD. R.YangC. Y. (2024). The association of social support and hope with self-stigma and perceived recovery among people with schizophrenia: The serial mediation effect. Journal of Advanced Nursing, 80(6), 2340–2350. https://doi.org/10.1111/jan.15980
İpçiK.YildizM.İncedereA.KirasF.EsenD.GürcanM. B. (2020). Subjective recovery in patients with schizophrenia and related factors. Community Mental Health Journal, 56(6), 1180–1187. https://doi.org/10.1007/s10597-020-00616-5
19.
JohnsonS.LambD.MarstonL.OsbornD.MasonO.HendersonC.AmblerG.MiltonA.DavidsonM.ChristoforouM.SullivanS.HunterR.HindleD.PatersonB.LevertonM.PiotrowskiJ.ForsythR.MosseL.GoaterN. . . .Lloyd-EvansB. (2018). Peer-supported self-management for people discharged from a mental health crisis team: A randomised controlled trial. Lancet, 392(10145), 409–418. https://doi.org/10.1016/s0140-6736(18)31470-3
20.
KuklaM.LysakerP. H.RoeD. (2014). Strong subjective recovery as a protective factor against the effects of positive symptoms on quality of life outcomes in schizophrenia. Comprehensive Psychiatry, 55(6), 1363–1368. https://doi.org/10.1016/j.comppsych.2014.04.022
21.
LeanM.Fornells-AmbrojoM.MiltonA.Lloyd-EvansB.Harrison-StewartB.Yesufu-UdechukuA.KendallT.JohnsonS. (2019). Self-management interventions for people with severe mental illness: Systematic review and meta-analysis. British Journal of Psychiatry, 214(5), 260–268. https://doi.org/10.1192/bjp.2019.54
22.
LiaoS. J.WangL. J. (2024). Correlation of health literacy, health management self-efficacy, and attitude in elderly patients with schizophrenia: A cross-sectional study. Nursing Open, 11(1), e2065. https://doi.org/10.1002/nop2.2065
23.
LiuF.DengH.HuN.HuangW.WangH.LiuL.ChaiJ.LiY. (2024). The relationship between self-stigma and quality of life in long-term hospitalized patients with schizophrenia: A cross-sectional study. Frontiers in Psychiatry, 15, 1366030. https://doi.org/10.3389/fpsyt.2024.1366030
24.
LloydC.KingR.MooreL. (2010). Subjective and objective indicators of recovery in severe mental illness: A cross-sectional study. International Journal of Social Psychiatry, 56(3), 220–229. https://doi.org/10.1177/0020764009105703
25.
MaramisM. M.Sofyan AlmahdyM.AtikaA.Bagus Jaya LesmanaC.Gerick PantouwJ. (2022). The biopsychosocial-spiritual factors influencing relapse of patients with schizophrenia. International Journal of Social Psychiatry, 68(8), 1824–1833. https://doi.org/10.1177/00207640211065678
26.
McCutcheonR. A.KeefeR. S. E.McGuireP. K. (2023). Cognitive impairment in schizophrenia: Aetiology, pathophysiology, and treatment. Molecular Psychiatry, 28(5), 1902–1918. https://doi.org/10.1038/s41380-023-01949-9
MutluE. (2024). Opportunities and challenges of community mental health centers in Türkiye. European Psychiatry, 67(S1), S7–S7. https://doi.org/10.1192/j.eurpsy.2024.43
29.
MyersN. L. (2010). Culture, stress and recovery from schizophrenia: Lessons from the field for global mental health. Culture Medicine and Psychiatry, 34, 500–528.
30.
NgaiS. S. Y.CheungC. K.NgY. H.TangH. Y.NgaiH. L.WongK. H. C. (2020). Development and validation of the chronic illness self-management (CISM) scale: Data from a young patient sample in Hong Kong. Children and Youth Services Review, 114, 105077. https://doi.org/10.1016/j.childyouth.2020.105077
31.
NunnallyJ. C.BernsteinI. H. (Eds.). (1994). Psychometric theory (3rd ed.). McGraw-Hill.
32.
OnitsukaT.HiranoY.NakazawaT.IchihashiK.MiuraK.InadaK.MitomaR.Yasui-FurukoriN.HashimotoR. (2022). Toward recovery in schizophrenia: Current concepts, findings, and future research directions. Psychiatry and Clinical Neurosciences, 76(7), 282–291. https://doi.org/10.1111/pcn.13342
33.
ÖztürkY. E.YeşildalM.Arık, FidanY. (2021). Turkish validity and reliability of the chronic disease self-management scale. Journal of Academic Value Studies, 7(3), 375–381. https://doi.org/10.29228/javs.52376
34.
O’DonnellB. F.Schnakenberg MartinA. M. (2016). Emerging behavioral and psychotherapeutic interventions for schizophrenia. Dusunen Adam The Journal of Psychiatry and Neurological Sciences, 29(3), 189–201. https://doi.org/10.5350/dajpn20162903001
35.
PallantJ. (Ed.). (2020). SPSS survival manual: A step by step guide to data analysis using IBM SPSS (7th ed.). Routledge.
36.
PenasP.UriarteJ. J.GorbeñaS.SladeM.Moreno-CalveteM. C.IraurgiI. (2021). Discrepancy between experience and importance of recovery components in the symptomatic and recovery perceptions of people with severe mental disorders. BMC Psychiatry, 21(1), 277–311. https://doi.org/10.1186/s12888-021-03287-y
37.
RoeD.Mashiach-EizenbergM.LysakerP. H. (2011). The relation between objective and subjective domains of recovery among persons with schizophrenia-related disorders. Schizophrenia Research, 131(1-3), 133–138. https://doi.org/10.1016/j.schres.2011.05.023
38.
SarrafL.LepageM.SauvéG. (2022). The clinical and psychosocial correlates of self-stigma among people with schizophrenia spectrum disorders across cultures: A systematic review and meta-analysis. Schizophrenia Research, 248, 64–78. https://doi.org/10.1016/j.schres.2022.08.001
39.
ShiodaA.TadakaE.OkochiA. (2016). Loneliness and related factors among people with schizophrenia in Japan: A cross-sectional study. Journal of Psychiatric and Mental Health Nursing, 23(6-7), 399–408. https://doi.org/10.1111/jpm.12318
40.
TabachnickB. G.FidellL. S. (2019). Using multivariate statistics title: Using multivariate statistics (Vol. 8). Pearson. https://lccn.loc.gov/2017040173
41.
TaberK. S. (2018). The use of Cronbach’s alpha when developing and reporting research instruments in science education. Research in Science Education, 48, 1273–1296.
42.
TandonR.NasrallahH.AkbarianS.CarpenterW. T.DeLisiL. E.GaebelW.GreenM. F.GurR. E.HeckersS.KaneJ. M.MalaspinaD.Meyer-LindenbergA.MurrayR.OwenM.SmollerJ. W.YassineW.KeshavanM. (2024). The schizophrenia syndrome, circa 2024: What we know and how that informs its nature. Schizophrenia Research, 264, 1–28. https://doi.org/10.1016/j.schres.2023.11.015
43.
TaylorS. J.PinnockH.EpiphaniouE.PearceG.ParkeH. L.SchwappachA.PurushothamN.JacobS.GriffithsC. J.GreenhalghT.SheikhA. (2014). A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic review of self-management support for long-term conditions. Health and Social Care Delivery Research, 2(53), 1–580. https://doi.org/10.3310/hsdr02530
44.
TuC. Y.LiuW. S.HuangW. L. (2023). Associations of internalized stigma with psychosocial functioning and quality of life in people with schizophrenia. International Journal of Social Psychiatry, 69(6), 1409–1419. https://doi.org/10.1177/00207640231164013
45.
van SchieD.CasteleinS.van der BijlJ.MeijburgR.StringerB.van MeijelB. (2016). Systematic review of self-management in patients with schizophrenia: Psychometric assessment of tools, levels of self-management and associated factors. Journal of Advanced Nursing, 72(11), 2598–2611. https://doi.org/10.1111/jan.13023
46.
ViningD.RobinsonJ. C. (2016). Concept analysis of illness engulfment in schizophrenia. Archives of Psychiatric Nursing, 30(3), 370–374. https://doi.org/10.1016/j.apnu.2016.01.001
47.
WhiteR.HaddockG.HaarmansM.VareseF. (2023). Being more satisfied with romantic relationship status is associated with increased mental wellbeing in people with experience of psychosis. Frontiers in Psychiatry, 14, 1232973. https://doi.org/10.3389/fpsyt.2023.1232973
YildizM. (2021). Psychosocial rehabilitation interventions in the treatment of schizophrenia and bipolar disorder. Archives of Neuropsychiatry, 58(Suppl 1), S77–S82. https://doi.org/10.29399/npa.27430
50.
YildizM.ErimR.SoygurH.TuralU.KirasF.GulesE. (2018). Development and validation of the subjective recovery assessment scale for patients with schizophrenia. Psychiatry and Clinical Psychopharmacology, 28(2), 163–169. https://doi.org/10.1080/24750573.2017.1405579
51.
YıldızM.KirasF.İncedereA.EsenD.GürcanM.AbutB.İpçiK.TuralM. (2018). Development of social functioning assessment scale for people with schizophrenia: Validity and reliability study. Anatolian Journal of Psychiatry, 19(0), 29. https://doi.org/10.5455/apd.2374
52.
ZhouC.LiZ. (2020). Modelling of self-management in schizophrenia: The role of neurocognition, self-efficacy and motivation. Journal of Clinical Nursing, 29(21-22), 3966–3976. https://doi.org/10.1111/jocn.15407
53.
ZouH.LiZ.ArthurD.WangH. (2014). Self-management in Chinese people with schizophrenia and their caregivers: A qualitative study on facilitators and barriers. International Journal of Mental Health Nursing, 23(4), 355–363. https://doi.org/10.1111/inm.12055
54.
ZouH.LiZ.NolanM. T.ArthurD.WangH.HuL. (2013). Self-management education interventions for persons with schizophrenia: A meta-analysis. International Journal of Mental Health Nursing, 22(3), 256–271. https://doi.org/10.1111/j.1447-0349.2012.00863.x
