The Impact of Caregivers’ Distress Tolerance and Perfectionism on Treatment Adherence and Functioning in Patients with Schizophrenia: A Cross-Sectional Study

Background Schizophrenia is a severe and persistent mental disorder that disrupts emotional, cognitive, and behavioral functioning, often leading to significant impairments in daily life. Adherence to treatment plays a central role in determining long-term clinical outcomes. As community-based mental health care increasingly emphasizes family involvement, caregiver-related psychological characteristics may influence patients’ engagement with treatment and functional status. Aim This study aimed to examine the associations between caregivers’ distress tolerance and perfectionism and patients’ medication adherence and functional outcomes in schizophrenia. Methods This cross-sectional study included 80 clinically stable patients with schizophrenia and their 80 primary caregivers recruited from a psychiatry outpatient clinic between October 2024 and April 2025. Caregivers completed standardized measures assessing perfectionism and distress tolerance. Patients were evaluated using validated instruments measuring symptom severity, medication adherence, and psychosocial functioning. Correlation, logistic regression, and linear regression analyses were performed while controlling for relevant sociodemographic and clinical variables. Results Patients demonstrated moderate levels of functional impairment and medication adherence. Caregiver perfectionism was not significantly associated with patients’ medication adherence. In contrast, higher caregiver distress tolerance, particularly the tolerance dimension, was independently associated with greater motivational adherence to medication. Regarding functional outcomes, caregiver perfectionism showed selective associations with patients’ autonomy functioning, whereas caregiver distress tolerance was not significantly related to overall functioning. Conclusion Overall, the findings indicate that caregivers’ emotional and personality-related characteristics may differentially relate to treatment engagement and specific functional domains. These results suggest that caregiver-focused psychological processes could be considered in family-based interventions aimed at improving adherence and functional outcomes in schizophrenia.