JMIR Publications

ABSTRACT

Background:

Theory: Bullying against individuals with severe mental disorders (SMDs) is a critical public health issue, worsening symptoms, reducing treatment adherence, and increasing discrimination. Stigma and social misconceptions often contribute to their victimization. Hypotheses: This study hypothesizes that: (1) stigma is positively associated with bullying; (2) family function protects against bullying; (3) verbal bullying has a stronger impact on sleep quality than physical bullying; (4) caregiver bullying significantly affects sleep quality. Prior Work: Previous research highlights stigma's role in discrimination against SMD patients, but limited studies explore bullying's prevalence and risk factors, particularly in China. This study aims to fill that gap.

Objective:

This study aimed to examine bullying prevalence among SMD patients and explore the impacts of disease-specific factors, sleep quality, stigma, and family functioning on victimization, while controlling for sociodemographic variables. The findings can inform effective prevention and intervention strategies to improve their well-being and recovery.

Methods:

Recruitment: This study employed multi-stage stratified random sampling to recruit 486 SMD patients from Shandong Province, China. Participants were assessed for experiences of bullying, categorized as verbal or physical. Statistical Analysis: Self-stigma was measured using the 8-item Chronic Illness Stigma Scale (SSI-8). Sleep quality and family functioning were evaluated with the Pittsburgh Sleep Quality Index (PSQI) and the Family APGAR scale, respectively. Negative Binomial (NB) regression was conducted to examine the associations between bullying, stigma, sleep quality, and family function.

Results:

User Statistics: Among the 486 SMD patients surveyed, 42.4% reported experiencing bullying. Demographic factors such as age, educational level, only-child status, and disease type were found to influence bullying experiences. Evaluation Outcomes: Stigma was a significant risk factor for bullying (OR = 1.041, p < 0.001), whereas family function served as a protective factor (OR = 0.913, p < 0.05). Verbal abuse was associated with decreased sleep quality (OR = 1.056, p < 0.05) and was a strong predictor of caregiver bullying (OR = 1.068, p < 0.01).

Conclusions:

Principal

Results:

This study highlights stigma as a key factor contributing to bullying among individuals with SMDs, while family function serves as a protective factor. Verbal abuse was found to significantly reduce sleep quality, whereas no such correlation was observed with physical abuse. Caregiver bullying had a particularly strong negative impact on sleep quality. Limitations: This study is limited by its cross-sectional design, preventing causal inferences. Additionally, self-reported data may introduce recall bias. Future longitudinal studies are needed to validate these findings. Comparison with Prior Work: Previous research has linked stigma to discrimination against SMD patients, but few studies have examined its role in bullying. This study expands on prior findings by differentiating between verbal and physical bullying and assessing their distinct impacts.

Conclusions:

Reducing stigma and strengthening family support may help mitigate bullying among SMD patients. Targeted interventions addressing verbal abuse could improve sleep quality and overall well-being.