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

Ellen M A Horsselenberg, Jooske T van Busschbach, Andre Aleman, Gerdine H M Pijnenborg, Ellen M A Horsselenberg, Jooske T van Busschbach, Andre Aleman, Gerdine H M Pijnenborg

Abstract

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. First model: Direct effects symptoms…
Fig 1. First model: Direct effects symptoms and victimization on stigma and effect of self- stigma on self-esteem.
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

Fig 2. Second model: victimization mediating effects…

Fig 2. Second model: victimization mediating effects of symptoms on self-stigma and effect self- stigma…

Fig 2. Second model: victimization mediating effects of symptoms on self-stigma and effect self- stigma on self-esteem.
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

Fig 3. Third model: victimization mediating effects…

Fig 3. Third model: victimization mediating effects positive symptoms on self-stigma, direct effect negative symptoms…

Fig 3. Third model: victimization mediating effects positive symptoms on self-stigma, direct effect negative symptoms on self-stigma.
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
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References
    1. Schulze B, Angermeyer MC: Subjective experiences of stigma. A focus group studyof schizophrenic patients, their relatives and mental health professionals. Social Science & Medicine 56: 299–312, 2003. - PubMed
    1. Corrigan PW, Watson AC, Barr L. The self-stigma of mental illness: implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology 25: 875–884, 2006.
    1. Brohan E, Rodney E, Sartorius N, Thornicroft G. And for the GAMIAN-Europe Study Group. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: The GAMIAN-Europe study. Schizophrenia Research 122: 2332–238, 2010. - PubMed
    1. Corrigan PW, Larson JE, Rüsch N. Self-stigma and the “why try” effect: impact on life goals and evidence based practices. World Psychiatry 8: 75–81, 2009. - PMC - PubMed
    1. Rüsch N, Heekeren K, Theodoridou A, Müller M, Corrigan PW, Mayer B, et al. Stigma as a stressor and transition to schizophrenia after one year among young people at risk for psychosis. Schizophrenia Research 166: 43–48, 2015. 10.1016/j.schres.2015.05.027 - DOI - PubMed
Show all 57 references
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EH recieved funding for this study provided by the Research Fund of the PPO Opleidingsinstituut by grant number: 2008.305; 20-06-2012.
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Fig 2. Second model: victimization mediating effects…
Fig 2. Second model: victimization mediating effects of symptoms on self-stigma and effect self- stigma on self-esteem.
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

Fig 3. Third model: victimization mediating effects…

Fig 3. Third model: victimization mediating effects positive symptoms on self-stigma, direct effect negative symptoms…

Fig 3. Third model: victimization mediating effects positive symptoms on self-stigma, direct effect negative symptoms on self-stigma.
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
Similar articles
Cited by
References
    1. Schulze B, Angermeyer MC: Subjective experiences of stigma. A focus group studyof schizophrenic patients, their relatives and mental health professionals. Social Science & Medicine 56: 299–312, 2003. - PubMed
    1. Corrigan PW, Watson AC, Barr L. The self-stigma of mental illness: implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology 25: 875–884, 2006.
    1. Brohan E, Rodney E, Sartorius N, Thornicroft G. And for the GAMIAN-Europe Study Group. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: The GAMIAN-Europe study. Schizophrenia Research 122: 2332–238, 2010. - PubMed
    1. Corrigan PW, Larson JE, Rüsch N. Self-stigma and the “why try” effect: impact on life goals and evidence based practices. World Psychiatry 8: 75–81, 2009. - PMC - PubMed
    1. Rüsch N, Heekeren K, Theodoridou A, Müller M, Corrigan PW, Mayer B, et al. Stigma as a stressor and transition to schizophrenia after one year among young people at risk for psychosis. Schizophrenia Research 166: 43–48, 2015. 10.1016/j.schres.2015.05.027 - DOI - PubMed
Show all 57 references
MeSH terms
Related information
Grants and funding
EH recieved funding for this study provided by the Research Fund of the PPO Opleidingsinstituut by grant number: 2008.305; 20-06-2012.
[x]
Cite
Copy Download .nbib .nbib
Format: AMA APA MLA NLM
Fig 3. Third model: victimization mediating effects…
Fig 3. Third model: victimization mediating effects positive symptoms on self-stigma, direct effect negative symptoms on self-stigma.
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

References

    1. Schulze B, Angermeyer MC: Subjective experiences of stigma. A focus group studyof schizophrenic patients, their relatives and mental health professionals. Social Science & Medicine 56: 299–312, 2003.
    1. Corrigan PW, Watson AC, Barr L. The self-stigma of mental illness: implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology 25: 875–884, 2006.
    1. Brohan E, Rodney E, Sartorius N, Thornicroft G. And for the GAMIAN-Europe Study Group. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: The GAMIAN-Europe study. Schizophrenia Research 122: 2332–238, 2010.
    1. Corrigan PW, Larson JE, Rüsch N. Self-stigma and the “why try” effect: impact on life goals and evidence based practices. World Psychiatry 8: 75–81, 2009.
    1. Rüsch N, Heekeren K, Theodoridou A, Müller M, Corrigan PW, Mayer B, et al. Stigma as a stressor and transition to schizophrenia after one year among young people at risk for psychosis. Schizophrenia Research 166: 43–48, 2015. 10.1016/j.schres.2015.05.027
    1. Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & medicine 71: 2150–2161, 2010.
    1. Lysaker PH, Davis LW, Warman DM, Strasburger A, Beattie N.. Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: Associations across 6 months. Psychiatry research 149: 89–95, 2007. 10.1016/j.psychres.2006.03.007
    1. Penn DL, Kohlmaier JR, Corrigan PH. Interpersonal factors contributing to the stigma of schizophrenia: social skills perceived attractiveness and symptoms. Schizophrenia Research 45: 37–45, 2000.
    1. Hill K, Startup M. The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: The mediating role of self-efficacy. Psychiatry research 206: 151–157, 2013. 10.1016/j.psychres.2012.09.056
    1. Cavelti M, Kvrgic S, Beck EM, Rüsch N, Vauth R. Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders. Comprehensive Psychiatry 53: 468–479, 2012. 10.1016/j.comppsych.2011.08.001
    1. Yanos PT, Roe D, Markus K, Lysaker PH. Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatric Services 59: 1437–1442, 2008. 10.1176/appi.ps.59.12.1437
    1. Ben-Zeev D, Frounfelker R, Morris BM, Corrigan PW. Predictors of Self-Stigma in Schizophrenia: New Insights Using Mobile Technologies. Journal of dual diagnosis 8(4): 305–314, 2012. 10.1080/15504263.2012.723311
    1. Teplin LA, McClelland GM, Abram KM, Dulcan MK, Mericle AA. Crime victimization in adults with severe mental illness: comparison with the national crime victimization survey. Archives of General Psychiatry 62: 911–921, 2005. 10.1001/archpsyc.62.8.911
    1. Choe JY, Teplin LA, Abram KM. Perpetration of violence, violent victimization and severe mental illness: Balancing public health concerns. Psychiatric Services 59: 153–164, 2008. 10.1176/appi.ps.59.2.153
    1. Mueser KT, Goodman LB, Trumbetta Sl, Rosenberg SD, Osher FC, Vidaver R, et al. Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology 66: 493–499, 1998.
    1. Hiday VA, Swartz M, Swanson JW, Borum R, Wagner HR. Criminal victimization of persons with severe mental illness. Psychiatric Services 50: 62–68, 1999. 10.1176/ps.50.1.62
    1. Maniglio R. Severe mental illness and criminal victimization: systematic review. Acta Psychiatrica Scandinavica 119: 180–191, 2009. 10.1111/j.1600-0447.2008.01300.x
    1. Walsh E, Moran P, Scott C, Burns T, Creed F, Tyrer P, et al. Prevalence of violent victimisation in severe mental illness. British Journal of Psychiatry 183: 233–238, 2003.
    1. Fitzgerald PB, de Castella AR, Filia KM, Filia SL, Benitez J, Kulkarni Jl. Victimization of patients with schizophrenia and related disorders. Australian and New Zealand Journal of psychiatry 39: 169–174, 2005. 10.1111/j.1440-1614.2005.01539.x
    1. Brekke JS, Prindle C, Bae SW, Long JD.Risks for individuals with schizophrenia who are living in the community. Psychiatric Services 52: 1358–1366, 2001. 10.1176/appi.ps.52.10.1358
    1. Hiday VA, Swartz M, Swanson JW, Borum R, Wagner HR. Impact of outpatient commitment on victimization of people with severe mental illness. American journal of Psychiatry 159: 1403–1411, 2002. 10.1176/appi.ajp.159.8.1403
    1. Bebbington P, Bhugra T, Singleton N, Singleton N, Farrell M, Jenkins R, et al. Psychosis, victimization and childhood disadvantage: evidence from the second British national survey of psychiatric morbidity. British Journal of Psychiatry 185: 220–226, 2004. 10.1192/bjp.185.3.220
    1. Butler R, Mueser K, Sprock J, Braff DL. Positive symptoms of psychosis in posttraumatic stress disorder. Biological Psychology 39: 839–844, 1996.
    1. Neria Y, Bromet E, Sievers S, Lavelle J, Fochtmann LJ. Trauma exposure and PTSD in psychosis. Journal of consulting and Clinical Psychology 70: 246–251, 2002.
    1. Shevlin M, Dorahy MJ, Adamson G. Trauma and psychosis: An analysis of the National Comorbidity Survey. American Journal of Psychiatry 164: 166–169, 2007. 10.1176/ajp.2007.164.1.166
    1. Fortugno F, Katsakou C, Bremner S, Kiejna A, Kjellin L, Nawka P, et al. Symptoms associated with victimization in patients with schizophrenia and related disorders. PLoS ONE 8(3): e58142 10.1371/journal.pone.0058142, 2013.
    1. Krupnick J, Horowitz M. Victims of violence: Psychological responses, treatment implications. Evaluation and change [Special issue: Services for survivors] 42–46, 1980.
    1. Coates D, Winston T. Counteracting the deviance of depression: Peer support groups for victims. Journal of Social Issues 39: 169–194, 1983.
    1. Hodges E, Malone MJ, Perry DG. Individual risk and social risk as interacting determinants of victimization in the peer group. Developmental Psychology, 33: 1032–1039, 1997.
    1. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (S20): 22–33, 1998.
    1. Pijnenborg GM, Van der Gaag M, Bockting CL, Van der Meer L, Aleman A. REFLEX, a social-cognitive treatment to improve insight in schizophrenia: study protocol of a multi-center RCT. BMC psychiatry 11: 161–169, 2011. 10.1186/1471-244X-11-161
    1. Van der Meer L, De Vos AE, Stiekema APM, Pijnenborg GHM, Van Tol M, Nolen WA, et al. Insight in Schizophrenia: Involvement of Self-Reflection Networks? Schizophr Bull, 39(6), 1352–1362. 10.1093/schbul/sbs122
    1. Birchwood M, Smith JD, Drury V, Healy J, Macmillan F, Slade M. A self-report insight scale for psychosis: reliability, validity and sensitivity to change. Acta Psychiatrica Scandinavica 89: 62–67, 1994.
    1. Sibitz I, Unger A, Woopmann A, Zidek T, Amering M. Stigma resistance in patients with schizophrenia. Schizophrenia Bulletin 37: 316–323, 2011. 10.1093/schbul/sbp048
    1. Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research 121: 31–49, 2003.
    1. Kay SR, Fsizbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13: 261–276, 1987.
    1. CBS Integrale veiligheidsmonitor 2009. Landelijke rapportage [Safety monitor 2009. National report]. The Hague, Centraal Bureau voor de Statistiek, 2010.
    1. Bureau Veiligheidsmonitor, Integrale veiligheidsmonitor (IVM) [Safety monitor]. The Hague, Nicis Institute 2010.
    1. Van Dijk JJM, van Kesteren J, Smit P. Criminal Victimisation in International Perspective, Key findings from the 2004–2005 ICVS and EU ICS. The Hague, Boom Juridische Uitgevers, 2008.
    1. Van Busschbach JT. Reports of incidents with violence in routine outcome assessments in mental health care: a prevalence study with a focus the validity of screening and clinical implications. Unpublished data, 2014.
    1. Lecomte T, Corbiere M, Laisne F. Investigating self-esteem in individuals with schizophrenia: relevance of the Self-Esteem Rating Scale-Short Form. Psychiatry research 143: 99–108, 2006. 10.1016/j.psychres.2005.08.019
    1. Ullman JB. Structural Equation Modeling In: Tabachnick BG. & Fidell LS (eds). Using multivariate statistics. Boston, MA: Allyn and Bacon; 653–771, 2001.
    1. Jöreskog KG. Testing structural equation models In: Bollen KA, Long JS (eds): Testing structural Equation models. In sage Publications, New Delhi, 294–316, 1993.
    1. Tucker LR, Lewis C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika 38: 1–10, 1973.
    1. Bentler PM. Comparative fit indexes in structural models. Psychological Bulletin 107: 238–246, 1990.
    1. Chapple B, Chant D, Nolan P, Cardy S, Whiteford H, McGrath J. Correlates of victimisation amongst people with psychosis. Soc Psychiatry Psychiatr Epidemiol 39: 836–840, 2004.
    1. Silver E.. Mental disorder and violent victimization: The mediating effect of involvement in conflicted social relationships. Criminology, 41, 191–212, 2002.
    1. Hiday VA, Swanson JW, Swartz MS, Borum R, Wagner HR. Victimization: A link between mental illness and violence? International Journal of Law and Psychiatry, 24, 559–572, 2001.
    1. Silver E, Piquero AR, Jennings WG, Piquero NL, Leiber M: Assessing the violent offending and violent victimization overlap among discharged psychiatric patients. Law Hum Behav 35:49–59, 2011. 10.1007/s10979-009-9206-8
    1. Ventura J, Subotnik KL, Ered A, Gretchen-Doorly D, Hellemann GS, Vaskinn A, et al.: The relationship of attitudinal beliefs to negative symptoms, neurocognition, and daily functioning in recent-onset schizophrenia. Schizophrenia Bulletin 40: 1308–18, 2014. 10.1093/schbul/sbu002
    1. Mittal D, Sullivan G, Chekuri L, Allee E, Corrigan PW. Empirical studies of self-stigma reduction strategies: A critical review of the literature. Psychiatric Services 63: 974–981, 2012. 10.1176/appi.ps.201100459
    1. Hiday VA, Swartz MS, Swanson JW, Borum RH. Wagner R. Impact of outpatient commitment on victimization of people with severe mental illness. American Journal of Psychiatry 159: 1403–1411, 2002. 10.1176/appi.ajp.159.8.1403
    1. Perese EF. Stigma, Poverty and Victimization: Roadblocks to recovery for individuals with Severe Mental Ilness. Journal of the American Psychiatric Nurses Association 13: 285–295, 2007.
    1. Jonikas JA, Cook JA. Safe, secure and street-smart: Empowering women with mental illness to achieve greater independence in the community. Tresholds National research and Training Center; Chicago, 1993.
    1. Corrigan PW, Holmes EP. Patient identification of “Street Skills” for a Psychosocial training Module. Hospital and Community psychiatry 45: 273–276, 1994.
    1. Holmes EP, Corrigan PW, Stephenson J, Nugent-Hirschbeck J. Learning “Street Skills” for an Urban Setting. Psychiatric Rehabilitation Journal 20: 64–66, 1997.
    1. Lam JA, Rosenheck R. The effect of victimization on clinical outcomes of homeless persons with serious mental illness. Psychiatric Services 49: 678–683, 1998. 10.1176/ps.49.5.678

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