Self-Stigma and Its Relationship with Victimization, Psychotic Symptoms and Self-Esteem among People with Schizophrenia Spectrum Disorders

Objective Self-stigma is highly prevalent in schizophrenia and can be seen as an important factor leading to low self-esteem. It is however unclear how psychological factors and actual adverse events contribute to self-stigma. This study empirically examines how symptom severity and the experience of being victimized affect both self-stigma and self-esteem. Methods Persons with a schizophrenia spectrum disorder (N = 102) were assessed with a battery of self-rating questionnaires and interviews. Structural equation modelling (SEM) was subsequently applied to test the fit of three models: a model with symptoms and victimization as direct predictors of self-stigma and negative self-esteem, a model with an indirect effect for symptoms mediated by victimization and a third model with a direct effect for negative symptoms and an indirect effect for positive symptoms mediated by victimization. Results Results showed good model fit for the direct effects of both symptoms and victimization: both lead to an increase of self-stigma and subsequent negative self-esteem. Negative symptoms had a direct association with self-stigma, while the relationship between positive symptoms and self-stigma was mediated by victimization. Conclusions Our findings suggest that symptoms and victimization may contribute to self-stigma, leading to negative self- esteem in individuals with a schizophrenia spectrum disorder. Especially for patients with positive symptoms victimization seems to be an important factor in developing self- stigma. Given the burden of self- stigma on patients and the constraining effects on societal participation and service use, interventions targeting victimization as well as self- stigma are needed

Correlation coefficients and descriptive statistics of variables included in the SEM (n = 102).

<p>Correlation coefficients and descriptive statistics of variables included in the SEM (n = 102).</p

First model: Direct effects symptoms and victimization on stigma and effect of self- stigma on self-esteem.

<p>Structural equation modeling. Numbers by single-headed arrows reflect standardized regression weights. Fit indices: χ2 = 3.953; df = 6; p = .6830, RMSEA (90%CI) = .000 (0-.1), SRMR = .036, CFI = 1.000, TLI = 1.041, Akaike (AIC) 3602.784. * p<0.05, ** p<0.01. PANSS_pos: level of positive symptoms on PANSS, PANSS_neg: level of negative symptoms. ISMIS: total score on four subscales of the Internalized Stigma of Mental Illness Scale (alienation, stereotype endorsement, perceived discrimination, social withdrawal) indicating level of self-stigma. SERS_pos: score on subscale positive self-esteem of the Self-Esteem Rating Scale-Short Form and SERS-neg: subscale negative self-esteem.</p

Second model: victimization mediating effects of symptoms on self-stigma and effect self- stigma on self-esteem.

<p>Structural equation modeling. Numbers by single-headed arrows reflect standardized regression weights. Fit indices: χ2 = 12.272; df = 8; p = .1395, RMSEA (90%CI) = .072 (0-.128), SRMR = .0086, CFI = .961, TLI = .932, Akaike (AIC) 3615.103. * p<0.05, ** p<0.01. PANSS_pos: level of positive symptoms on PANSS, PANSS_neg: level of negative symptoms. ISMIS: total score on four subscales of the Internalized Stigma of Mental Illness Scale (alienation, stereotype endorsement, perceived discrimination, social withdrawal) indicating level of self-stigma. SERS_pos:score on subscale positive self-esteem of the Self-Esteem Rating Scale-Short Form and SERS-neg: score on the subscale negative self-esteem.</p

Third model: victimization mediating effects positive symptoms on self-stigma, direct effect negative symptoms on self-stigma.

<p>Structural equation modeling. Numbers by single-headed arrows reflect standardized regression weights. Fit indices: χ2 = 7.674; df = 8; p = .4659, RMSEA (90%CI) = .000 (0-.113), SRMR = .0059, CFI = 1.000, TLI = 1.005, Akaike (AIC) 3610.505. * p<0.05, ** p<0.01. PANSS_pos:level of positive symptoms on PANSS, PANSS_neg: evel of negative symptoms. ISMIS: total score on four subscales of the Internalized Stigma of Mental Illness Scale (alienation, stereotype endorsement, perceived discrimination, social withdrawal) indicating level of self-stigma. SERS_pos:score on subscale positive self-esteem of the Self-Esteem Rating Scale-Short Form and SERS-neg:score on the subscale negative self-esteem.</p

(Standardized) effects in in the original hypothesized model (Model 1) and in the new model (Model 3).

<p>(Standardized) effects in in the original hypothesized model (Model 1) and in the new model (Model 3).</p