{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:11:10Z","timestamp":1791951070138,"version":"4.3.4"},"reference-count":63,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2019,4,11]],"date-time":"2019-04-11T00:00:00Z","timestamp":1554940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health and Welfare, Executive Yuen, Taiwan","award":["MOHW-10646, MOHW-10444 and MOHW-10445"],"award-info":[{"award-number":["MOHW-10646, MOHW-10444 and MOHW-10445"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>A sample of heroin users (n = 250) in methadone maintenance treatment (MMT) was used in this cross-sectional study to clarify the mechanisms of the effects of stigma on quality of life (QoL) through psychological distress and social functioning. All the participants had their self-stigma, psychological distress, social functioning, and QoL measured. Psychological distress and social functioning were proposed to be mediators between self-stigma and QoL. Several linear models using structural equation modeling were conducted to examine the mediated effects. The negative effects of self-stigma on QoL were significantly mediated by psychological distress, as self-stigma directly and significantly influenced psychological distress, but not social functioning. This study demonstrated a linear model describing the effects of self-stigma on QoL for opioid-dependent individuals; psychological distress was also an important mediator between self-stigma and their QoL. Clinicians were able to notice the importance of reducing self-stigma for opioid-dependent individuals according to the following results: higher levels of self-stigma were associated with high psychological distress, decreased social functioning, and impaired QoL. Our mediation findings suggest that treating psychological distress is better than treating social functioning if we want to eliminate the effects of self-stigma on QoL for heroin users.<\/jats:p>","DOI":"10.3390\/ijerph16071299","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T03:46:37Z","timestamp":1555040797000},"page":"1299","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":62,"title":["Negative Impacts of Self-Stigma on the Quality of Life of Patients in Methadone Maintenance Treatment: The Mediated Roles of Psychological Distress and Social Functioning"],"prefix":"10.3390","volume":"16","author":[{"given":"Ching-Ming","family":"Cheng","sequence":"first","affiliation":[{"name":"Jianan Psychiatric Center, Ministry of Health and Welfare, No. 80, Ln. 870, Zhongshan Rd., Rende Dist., Tainan 71742, Taiwan"},{"name":"Department of Natural Biotechnology, College of Science and Technology, Nanhua University, Chiayi 62249, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Cheng","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Chi Mei Medical Center, Tainan 70246, Taiwan"},{"name":"Department of Health Psychology, Chang Jung Christian University, Tainan 71101, Taiwan"},{"name":"Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King\u2019s College London, London SE5 8AF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Der","family":"Wang","sequence":"additional","affiliation":[{"name":"Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan"},{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun-Chia","family":"Chang","sequence":"additional","affiliation":[{"name":"Jianan Psychiatric Center, Ministry of Health and Welfare, No. 80, Ln. 870, Zhongshan Rd., Rende Dist., Tainan 71742, Taiwan"},{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo-Yen","family":"Ting","sequence":"additional","affiliation":[{"name":"Chang-Hua Hospital, Ministry of Health and Welfare, Puxin Township, Changhua County, Puhsin 51341, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2129-4242","authenticated-orcid":false,"given":"Chung-Ying","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,11]]},"reference":[{"key":"ref_1","unstructured":"Goffman, E. 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