Delusional themes and forensic status in schizophrenia spectrum disorders: a machine learning based discriminative study.

Colorectal cancer (CRC) is one of the most common malignancies worldwide and poses a serious threat to human health. According to the International Agency for Research on Cancer (IARC), CRC ranks third in incidence and second in mortality among all cancers globally. In 2020, approximately 1.93 million new cases and 0.9 million deaths were reported, with developed countries bearing the heaviest disease burden (). In China, statistics from 2022 revealed a substantial burden of CRC, with 517,000 new cases and 240,000 deaths (). These figures position CRC as the second most common cancer in terms of incidence and the fourth leading cause of cancer-related death in China (). Despite continuous advances in surgical techniques and treatment modalities, intestinal ostomy surgery remains a primary treatment for many patients with low rectal cancer (). It is estimated that the number of patients with an ostomy in China increases by more than 100,000 annually, and this trend is expected to continue growing (). Although ostomy surgery can save and prolong life, it alters the patient’s excretory pathway, leading to involuntary defecation. Patients 1 often experience anxiety and feelings of inferiority due to issues such as a full stoma bag, irregular defecation, and altered body image, which severely impact their quality of life (, ). Stigma, as a form of psychological stress response, often arises from patients’ perceived loss of identity and social status due to physical dysfunction. This sense of loss profoundly affects their daily life and psychological state and can trigger intense feelings of shame (). Changes in excretory patterns, potential noise or odor from the stoma bag, and altered body image frequently expose patients to perceived social prejudice and discrimination. This leads to shame, isolation, and self-deprecation. Interview-based studies have found that patients with high levels of stigma often show reduced social motivation, diminished self-worth, and heightened insecurity, which may further result in social withdrawal (, ). Survey-based studies with larger samples have also shown that stigma levels among rectal cancer patients with anostomy are moderately high (, ). These studies provide preliminary evidence for the relationship between stigma and psychosocial variables. However, a closer look at their analytical strategies reveals a commonly overlooked issue. Most previous studies have treated stigma as a homogeneous construct, using variable-centered approaches (such as correlation and regression analyses) to examine its relationships with other variables through total or domain scores (–). This analytical approach implicitly assumes that all patients share a uniform experience of stigma. For instance, Yuan et al. () and Xi et al. () analyzed the associations among stigma, stoma acceptance, and psychosocial adaptation based on total scale scores. Li et al. () tested the mediating role of stoma acceptance in the relationship between stigma and social isolation. However, none of these studies examined whether these relationships or mediating pathways differ across patient subgroups. Although variable-centered analyses are valuable, they may obscure clinically meaningful individual heterogeneity.