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Hrefish Z A, Mohammed S H. Mental Health Literacy as a Mediator Between Stigma Among Caregivers and Medication Adherence of Psychotic Patients. Iranian Rehabilitation Journal 2025; 23 (4) :399-406
URL: http://irj.uswr.ac.ir/article-1-2602-en.html

Objectives: Treatment adherence in patients with psychosis is critical to treatment effectiveness, but stigma toward caregivers may negatively impact adherence. This study aimed to investigate the mediating role of mental health culture between caregiver stigma and treatment adherence in patients with psychosis.
Methods: A descriptive cross-sectional study was conducted at a psychiatric center in Baghdad City, Iraq, involving 150 primary caregivers of patients with psychotic disorders. Data were collected using validated Arabic versions of the mental health literacy scale (MHLS), medication adherence rating scale (MARS), and caregivers’ perceived stigma scale (CPMI). Statistical analyses included Pearson’s correlation, multiple regression, and mediation analyses.
Results: Significant negative correlations were found between stigma and both MHL (r=-0.48, P<0.01) and medication adherence (r=-0.52, P<0.01). MHL positively correlated with medication adherence (r=0.58, P<0.01). Regression analysis identified MHL as a strong positive predictor (β=0.46, P<0.001) and stigma as a negative predictor (β=-0.41, P<0.001) of adherence. Mediation analysis confirmed that MHL partially mediated the stigma-adherence relationship (indirect effect B=-0.2, P<0.001).
Discussion: Improving MHL among caregivers reduces the harmful effects of stigma on medication adherence. Targeted psychoeducational interventions are recommended to improve caregivers’ knowledge and support adherence to the treatment of patients with psychotic disorders.