A cross-sectional study on social functioning and its associated factors among patients with severe mental illness in Minhang District, Shanghai

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Objective To examine the current status of social functioning and its associated factors among patients with severe mental illness (SMI) in Minhang District, Shanghai, and to provide evidence for community-based rehabilitation interventions. Methods A district-wide population-based cross-sectional survey was conducted in 2022 among all registered patients with SMI in Minhang District, Shanghai. Social functioning, perceived social support, anxiety symptoms, and depressive symptoms were assessed using the Social Disability Screening Schedule (SDSS), the Perceived Social Support Scale (PSSS), the Generalized Anxiety Disorder 7-item scale (GAD-7), and the Patient Health Questionnaire 9-item scale (PHQ-9), respectively. Univariate comparisons were performed using t-tests and ANOVA, with Bonferroni correction for post-hoc comparisons. Multiple linear regression, adjusted for age and gender, was used to examine factors independently associated with social functioning; multicollinearity was assessed using variance inflation factors (VIF). Results A total of 3510 eligible patients were included. The prevalence of social dysfunction was 36.6%, with social interaction as the most severely affected domain. Depressive symptoms were more prevalent than anxiety symptoms, and 11.3% of patients had comorbid anxiety and depressive symptoms. After adjusting for age and gender, more severe depressive symptoms were independently and positively associated with social dysfunction ( P < 0.001), whereas higher perceived social support was independently and negatively associated with social dysfunction ( P < 0.001). Clinical significance More severe depressive symptoms were associated with greater social dysfunction among patients with SMI, while higher social support was associated with better social functioning. Routine screening and timely intervention for depressive symptoms may be considered in community mental health management. Methodological innovation This district-wide census using standardized clinical assessments provides a replicable model for regional mental health surveys in other large cities in China. Public health value Integrating depressive symptom screening into routine follow-up may help improve the efficiency of regional mental health services and promote social functioning recovery among patients with SMI.

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