Community Participation and Unmet Needs among People with Severe Mental Illness in Guangzhou, China

Abstract Purpose Community participation is a key component of recovery and social inclusion among people with severe mental illness (SMI), yet it is often assessed using limited objective indicators. This study aimed to describe multidimensional community participation, including both objective participation and subjective needs in valued domains, and to examine their associated sociodemographic and psychosocial factors. Methods Baseline data from a community-based peer support intervention among people with SMI in Guangzhou, China were used. Community participation was assessed using the Temple University Community Participation (TUCP) measure adapted to the urban Chinese context. Three indicators were examined: participation days, number of activity domains, and participation insufficiency in important activity areas. Descriptive analyses and multivariable regression models were conducted. Results A total of 351 participants (mean [SD] age 41.5[11.5], 55.8% female) were included in the analysis. Participants reported low participation days (42.0 [19.0, 71.0]) and limited activity diversity (8.9 [5.6]) across 28 activity areas in the past 30 days, alongside substantial unmet participation needs. Activities with high importance and high insufficiency were related to social roles and social interaction. Employment and social support were associated with higher objective participation, while self-stigma and limited access to community-based services were associated with greater participation insufficiency. Conclusion Community participation among people with SMI is characterized not only by low levels of engagement but also by a mismatch between valued and actual participation. Interventions may need to address both structural and psychosocial barriers, including enhancing social support, reducing stigma, and improving opportunities for engagement in valued activities, to promote more meaningful and inclusive participation.