Psychosocial Factors Affecting Community Integration in Schizophrenia Patients: The Moderating Role of Perceived...

Schizophrenia patients in Istanbul, Türkiye, confront psychosocial and structural barriers to community integration, including pervasive stigma, self-imposed social withdrawal, and limited trust in a fragmented mental health policy landscape. In this context, community integration refers to the acceptance of an individual as part of society, regardless of any illness or difference they may have, and their ability to participate equally in social, cultural, and economic life. The current structure and social context of mental health policies in Türkiye, in particular, are factors that significantly shape the motivation of individuals diagnosed with schizophrenia to participate in the process of integration into society. The purpose of this study is to investigate the impact of perceived discrimination, social withdrawal, and mental health self-efficacy on integration into the community and to determine whether individuals' perceptions of policy effectiveness moderate these relationships.

In this cross-sectional study, data were collected using a questionnaire from 427 schizophrenia patients receiving outpatient treatment at two public hospitals and seven community mental health centers in Istanbul, Türkiye. The questionnaire included socio-demographic questions along with four scales: the Internalized Stigma of Mental Illness Scale, the General Mental Health Self-Efficacy Scale, the Perceived Policy Effectiveness Scale, and the Community Integration Scale. The data obtained were analyzed using SPSS and SmartPLS software packages. Structural equation modelling-based moderation analyses tested the direct effects of perceived stigma, social withdrawal, and self-efficacy on community integration, as well as interaction terms involving policy perception.

Higher perceived discrimination (β = -0.42, p < 0.001) and greater social withdrawal (β = -0.37, p < 0.001) each significantly predicted lower community integration, while self-efficacy emerged as a smaller positive effect (β = 0.36, p < 0.001). Moderation analyses revealed that positive policy perception had a limited buffering effect, reflecting patients' persistent skepticism toward policy implementation. Specifically, even among those who viewed services as accessible, stigma and withdrawal undermined social participation.

Findings underscore that, within Türkiye's current mental health system, strengthening individual agency through self-efficacy alone is insufficient to overcome entrenched discrimination and isolation. Sustainable community integration requires structural change: policy reforms must extend beyond paper commitments to include adequately resourced services and long-term anti-stigma initiatives. Only by aligning legislative intent with real-world service quality can policy perception become a genuine catalyst for integration.

During data collection, participants provided firsthand accounts of their experiences with stigma and service shortcomings. Their reflections on policy gaps and barriers to care informed the interpretation of findings and highlighted priorities for more responsive, patient-centered mental health policy.