Xin Liu ¹ Chao Li ^2* Xushu Chen ^1* Fengxiang Tian ^1* Juan Liu ^3* Yuanyuan Liu ^4,5* Xiang Liu ^4,5* Xiaolan Yin ^6* Xiangrui Wu ^4* Chuanlong Zuo ^6* Changjiu He ^2*

• ¹ School of Nursing, Chengdu Medical College, Chengdu, Sichuan Province, China
• ² Chengdu Fourth People's Hospital, Chengdu, Sichuan Province, China
• ³ Western Theater General Hospital, Chengdu, Sichuan Province, China
• ⁴ West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
• ⁵ West China Fourth Hospital of Sichuan University, Chengdu, Sichuan Province, China
• ⁶ Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China

Introduction: Research has demonstrated that higher social support is associated with better psychological health, quality of life, cognition, activities of daily living, and social participation, but the relationship between social support and sleep quality remains unknown. This study aims to investigate the mediating effects of anxiety and depression in the relationship between social support and sleep among community-dwelling patients with schizophrenia.Method: Purposive sampling was used to collect face-to-face data from 1107 community-dwelling patients with schizophrenia in Chengdu, Sichuan Province, China, between April and July 2023. The Athens Insomnia Scale (AIS) was used to assess sleep quality; the Generalized Anxiety Disorder 7-item scale (GAD-7) was utilized to evaluate anxiety symptoms; and the Patient Health Questionnaire-9 (PHQ-9) was employed to assess depressive symptoms. The mediating effect of anxiety and depression symptoms was assessed using the bootstrap method via Model 6 (Serial multiple mediator model) of the SPSS PROCESS macro.Results: Among the 1107 participants, the proportions of people with schizophrenia experiencing anxiety, depressive symptoms, and poor sleep quality were 22.8%, 37.7%, and 42.1%, respectively. Mediation analyses indicated that although social support had no direct effect on sleep quality, anxiety and depressive symptoms fully mediated the relationship between social support and sleep quality.Patients with schizophrenia experience low levels of social support and poor sleep quality. To enhance the sleep quality of individuals with schizophrenia, all levels of society (government, medical institutions, and communities) must pay more attention to mental health. Implementing diverse intervention measures to strengthen social support and improve symptoms of anxiety and depression should be considered. This approach may potentially lead to an improvement in sleep quality among individuals with schizophrenia.