OBJECTIVE: The aim of this study was to investigate the degree of self-stigma in schizophrenia and its association with clinical and demographic factors. PATIENTS AND METHODS: A total of 197 outpatients (54.3% females) diagnosed with schizophrenia spectrum disorders (schizophrenia, schizoaffective disorder, delusional disorder) according to International Classification of Diseases - tenth edition participated in the study. The mean age of the patients was 40.10±11.49 years. All individuals completed the Internalized Stigma of Mental Illness (ISMI) scale and a demographic questionnaire. The disorder severity was assessed by both a psychiatrist (the objective version of Clinical Global Impression - severity scale [objCGI-S]) and the patients (the subjective version of Clinical Global Impression - severity scale [subjCGI-S]). Treatment with antipsychotics stabilized the patients. RESULTS: The overall level of self-stigma measured by the total score of the ISMI was 63.32±13.59. The total score of the ISMI positively correlated with the severity of the disorder measured by the objCGI-S and subjCGI-S. In addition, self-stigma positively correlated with the treatment duration and the number of psychiatric hospitalizations. The backward stepwise regression was applied to identify the most significant factors connected to self-stigma. The regression analysis identified the following regressors as the most relevant to self-stigma: the number of previous psychiatric hospitalizations, the severity of the disorder rated by a psychiatrist, and the difference between the objective rating and the subjective rating of the severity of the disorder. CONCLUSION: Outpatients with schizophrenia spectrum disorders, who have undergone a higher number of psychiatric hospitalizations, who dispose of a higher severity of the disorder and show a higher discrepancy between their rating of the severity and the psychiatric rating, showed a greater degree of self-stigma. The management of self-stigma in patients with schizophrenia should be implemented in the routine care.

Department of Psychiatry Faculty of Medicine and Dentistry Palacky University in Olomouc University Hospital Olomouc Olomouc

Department of Psychiatry Faculty of Medicine and Dentistry Palacky University in Olomouc University Hospital Olomouc Olomouc; Department of Psychiatry Hospital Liberec Liberec Czech Republic

Department of Psychology Sciences Faculty of Social Science and Health Care Constantine the Philosopher University Nitra Slovak Republic

See more in PubMed

Dickerson FB, Sommerville J, Origoni AE, Ringel NB, Parente F. Experiences of stigma among outpatients with schizophrenia. Schizophr Bull. 2002;28(1):143–155. PubMed

Lee S, Chiu MY, Tsang A, Chui H, Kleinman A. Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong. Soc Sci Med. 2006;62(7):1685–1696. PubMed

Gray AJ. Stigma in psychiatry. J R Soc Med. 2002;95(2):72–76. PubMed PMC

Schulze B, Angermeyer MC. Subjective experiences of stigma: a focus group study of schizophrenic patients, their relatives, and mental health professionals. Soc Sci Med. 2003;56(2):299–312. PubMed

Dinos S, Stevens S, Serfaty M, Weich S, King M. Stigma: the feelings and experiences of 46 people with mental illness. Qualitative study. Br J Psychiatry. 2004;184:176–181. PubMed

Buizza C, Schulze B, Bertocchi E, Rossi G, Ghilardi A, Pioli R. The stigma of schizophrenia from patients’ and relatives’ view: a pilot study in an Italian rehabilitation residential care unit. Clin Pract Epidemol Ment Health. 2007;3:23. PubMed PMC

Gonzalez-Torres MA, Oraa R, Aristegui M, Fernandez-Rivas A, Guimon J. Stigma and discrimination towards people with schizophrenia and their family members. A qualitative study with focus groups. Soc Psychiatry Psychiatr Epidemiol. 2007;42(1):14–23. PubMed

Corrigan PW, Wassel A. Understanding and influencing the stigma of mental illness. J Psychosoc Nurs Ment Health Serv. 2008;46(1):42–48. PubMed

Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med. 2010;71(12):2150–2161. PubMed

Corrigan PA, Watson AC, Barr L. The self-stigma of mental illness: implications for self-esteem and self-efficacy. J Soc Clin Psychol. 2006;25:875–884.

Lebel T. Perceptions of and responses to stigma. Soc Comp. 2008;2:409–432.

Werner P, Aviv A, Barak Y. Self-stigma, self-esteem, and age in persons with schizophrenia. Int Psychogeriatr. 2008;20(1):174–187. PubMed

Yanos PT, Roe D, Markus K, Lysaker PH. Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatr Serv. 2008;59(12):1437–1442. PubMed PMC

Segalovich J, Doron A, Behrbalk P, Kurs R, Romem P. Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia. Arch Psychiatr Nurs. 2013;27(5):231–234. PubMed

Collett N, Pugh K, Waite F, Freeman D. Negative cognitions about the self in patients with persecutory delusions: an empirical study of self-compassion, self-stigma, schematic beliefs, self-esteem, fear of madness, and suicidal ideation. Psychiatry Res. 2016;239:79–84. PubMed

Vidović D, Brecić P, Vilibić M, Jukić V. Insight and self-stigma in patients with schizophrenia. Acta Clin Croat. 2016;55(1):23–28. PubMed

Ritsher JB, Phelan JC. Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res. 2004;129(3):257–265. PubMed

Mashiach-Eizenberg M, Hasson-Ohayon I, Yanos PT, Lysaker PH, Roe D. Internalized stigma and quality of life among persons with severe mental illness: the mediating roles of self-esteem and hope. Psychiatry Res. 2013;208(1):15–20. PubMed PMC

Trosbach J, Angermeyer MC, Stengler-Wenzke K. Zwischen einbezogensein und widerstand: angehorige im umgang mit zwangserkrankten. Psychiatr Prax. 2003;30:8–13. PubMed

Gerlinger G, Hauser M, De Hert M, Lacluyse K, Wampers M, Correll CU. Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact, and interventions. World Psychiatry. 2013;12(2):155–164. PubMed PMC

Birchwood M, Trower P, Brunet K, Gilbert P, Iqbal Z, Jackson C. Social anxiety and the shame of psychosis: a study in first episode psychosis. Behav Res Ther. 2007;45(5):1025–1037. PubMed

Tarrier N, Khan S, Cater J, Picken A. The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour. Soc Psychiatry Psychiatr Epidemiol. 2007;42(1):29–35. PubMed

Maxdorf Praha . Mezinárodní klasifikace nemocí – 10 revize, MKN-10 [International Classification of Diseases – 10th revision] (1 vydání) Praha: Maxdorf; 1996.

Ritsher JB, Otilingam PO, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res. 2003;121:31–49. PubMed

Boyd JE, Adler EP, Otilingam PG, Peters T. Internalized Stigma of Mental Illness (ISMI) Scale: a multinational review. Compr Psychiatry. 2014;55(1):221–231. PubMed

Ocisková M, Praško J, Kamarádová D, et al. Self-stigma in psychiatric patients – standardization of the ISMI scale. Neuro Endocrinol Lett. 2014;35(7):624–632. PubMed

Guy W, editor. ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: DHEW; 1976.

European Medicines Agency Guideline for good clinical practice. Jul, 2002. [Accessed May 19, 2016]. Available from: http://www.edctp.org/fileadmin/documents/EMEA_ICH-GCP_Guidelines_July_2002.pdf.

Ceskova E, Prikryl R, Pec O. Schizofrenie u dospělých. In: Raboch J, Uhlikova P, Hellerova P, Anders M, Susta M, editors. Psychiatrie. Doporučené postupy psychiatrické péče IV [Psychiatry. Recommended practices in psychiatric care IV] Psychiatrická společnost ČSL JEP; 2014. pp. 44–51.

Ocisková M, Praško J, Látalová K, et al. Internalizované stigma a efektivita farmakoterapie a psychoterapie u úzkostných poruch a poruch neurotického spektra [Internalized stigma and efficacy of pharmacotherapy and psychotherapy in anxiety and neurotic spectrum disorders] Čes a Slov Psychiat. 2014;110(3):233–243. Czech.

Vrbová K, Kamarádová D, Látalová K, et al. Self-stigma and adherence to medication in patients with psychotic disorders – cross-sectional study. Neuro Endocrinol Lett. 2014;35(7):645–652. PubMed

Ociskova M, Prasko J, Kamaradova D, et al. Coping strategies, hope, and treatment efficacy in pharmacoresistant inpatients with neurotic spectrum disorders. Neuropsychiatr Dis Treat. 2015;11:1191–1201. PubMed PMC

Hajda M, Kamaradova D, Latalova K, et al. Self-stigma, treatment adherence, and medication discontinuation in patients with bipolar disorders in remission – a cross sectional study. Act Nerv Super Rediviva. 2015;5(1–2):6–11.

Kamaradova D, Latalova K, Prasko J, et al. Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient Prefer Adherence. 2016;10:1289–1298. PubMed PMC

Holubova M, Prasko J, Latalova K, et al. Are self-stigma, quality of life, and clinical data interrelated in schizophrenia spectrum patients? A cross-sectional outpatient study. Patient Prefer Adherence. 2016;10:265–274. PubMed PMC

Grambal A, Prasko J, Kamaradova D, Latalova K, Holubova M, Sedlackova Z. Self-stigma in borderline personality disorder in comparison with schizophrenia, major depressive disorder, and anxiety disorders – cross-sectional study. Patient Prefer Adherence. 2016;10:1421–1433. PubMed PMC

Buckland HT, Schepp KG, Crusoe K. Defining happiness for young adults with schizophrenia: a building block for recovery. Arch Psychiatr Nurs. 2013;27(5):235–240. PubMed PMC

Oliveira SE, Esteves F, Carvalho H. Clinical profiles of stigma experiences, self-esteem, and social relationships among people with schizophrenia, depressive, and bipolar disorders. Psychiatry Res. 2015;229(1–2):167–173. PubMed

Boyer L, Baumstarck K, Boucekine M, Blanc J, Lançon C, Auquier P. Measuring quality of life in patients with schizophrenia: an overview. Expert Rev Pharmacoecon Outcomes Res. 2013;13(3):343–349. PubMed

Lysaker PH, Vohs J, Hillis JD, et al. Poor insight into schizophrenia: contributing factors, consequences, and emerging treatment approaches. Expert Rev Neurother. 2013;13(7):785–793. PubMed

Lysaker PH, Buck KD, Salvatore G, Popolo R, Dimaggio G. Lack of awareness of illness in schizophrenia: conceptualizations, correlates, and treatment approaches. Expert Rev Neurother. 2009;9(7):1035–1043. PubMed

Lysaker PH, Vohs J, Hasson-Ohayon I, Kukla M, Wierwille J, Dimaggio G. Depression and insight in schizophrenia: comparisons of levels of deficits in social cognition and metacognition and internalized stigma across three profiles. Schizophr Res. 2013;148(1–3):18–23. PubMed

Lysaker PH, Roe D, Ringer J, Gilmore EM, Yanos PT. Change in self-stigma among persons with schizophrenia enrolled in rehabilitation: associations with self-esteem and positive and emotional discomfort symptoms. Psychol Serv. 2012;9(3):240–247. PubMed

Firmin RL, Luther L, Lysaker PH, Minor KS, Salyers MP. Stigma resistance is positively associated with psychiatric and psychosocial outcomes: a meta-analysis. Schizophr Res. 2016;175(1–3):118–128. PubMed

Nabors LM, Yanos PT, Roe D, et al. Stereotype endorsement, meta-cognitive capacity, and self-esteem as predictors of stigma resistance in persons with schizophrenia. Compr Psychiatry. 2014;55(4):792–798. PubMed

Yanos PT, Lucksted A, Drapalski AL, Roe D, Lysaker P. Interventions targeting mental health self-stigma: a review and comparison. Psychiatr Rehabil J. 2015;38(2):171–178. PubMed PMC

Suicidality, self-stigma, social anxiety and personality traits in stabilized schizophrenia patients - a cross-sectional study

Comorbidity of schizophrenia and social phobia - impact on quality of life, hope, and personality traits: a cross sectional study