Longitudinal predictors of stigma in first-episode psychosis: Mediating effects of depression

Lindsay A Bornheimer, Nicholas Tarrier, Aaron P Brinen, Juliann Li, Meredith Dwyer, Joseph A Himle, Lindsay A Bornheimer, Nicholas Tarrier, Aaron P Brinen, Juliann Li, Meredith Dwyer, Joseph A Himle

Abstract

Aim: Stigma is commonly experienced among individuals with schizophrenia spectrum disorders and has been shown to be a barrier to help-seeking and behavioural service utilization. Given the established relationships between stigma, barriers to treatment, and poorer psychiatric outcomes including depression and psychotic symptoms, we examined the relationships between symptoms of depression, positive and negative symptoms, and the emergence of stigma longitudinally among a sample of first-episode of psychosis (FEP) participants in the United States.

Methods: Data were obtained from the Recovery After an Initial Schizophrenia Episode project of National Institute of Mental Health's Early Treatment Program. Participants (n = 404) included adults between ages 15 and 40 with schizophrenia or other psychotic disorders based on the DSM-IV. Data were analysed using structural equation modelling (SEM).

Results: Findings indicated that increased positive and negative symptoms independently related to greater symptoms of depression at baseline. Furthermore, increased positive symptoms and symptoms of depression at baseline independently related to the emergence of greater stigma being experienced over time.

Conclusions: Considering the role that symptoms of depression played as a factor explaining the relationships between positive and negative symptoms and emergence of stigma over time among individuals in FEP, and symptoms of depression is important predictor of stigma and may furthermore present as a viable and less stigmatizing initial treatment target in the early course of a psychotic disorder.

Trial registration: ClinicalTrials.gov NCT01321177.

Keywords: depression; early intervention; first episode psychosis; negative symptoms; positive symptoms; stigma; structural equation modelling.

© 2020 John Wiley & Sons Australia, Ltd.

References

REFERENCES

    1. Addington, D., Addington, J., & Maticka-Tyndale, E. (1993). Assessing depression in schizophrenia: The Calgary depression scale. The British Journal of Psychiatry, 163(22), 39-44.
    1. Addington, D., Addington, J., & Schissel, B. (1990). A depression rating scale for schizophrenics. Schizophrenia Research, 3(4), 247-251.
    1. American Psychiatric Association. (2013). DSM-5 task force. Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, D.C.: American Psychiatric Association.
    1. Birchwood, M., & Jackson, C. (2011). Schizophrenia. Philadelphia, PA: Psychology Press.
    1. Bornheimer, L. A. (2016). Moderating effects of positive symptoms of psychosis in suicidal ideation among adults diagnosed with schizophrenia. Schizophrenia Research, 176(2-3), 364-370.
    1. Bornheimer, L. A., & Jaccard, J. (2017). Symptoms of depression, positive symptoms of psychosis, and suicidal ideation among adults diagnosed with schizophrenia within the clinical antipsychotic trials of intervention effectiveness. Archives of Suicide Research, 21(4), 633-645.
    1. Corcoran, C., Gerson, R., Sills-Shahar, R., Nickou, C., McGlashan, T., Malaspina, D., & Davidson, L. (2007). Trajectory to a first episode of psychosis: A qualitative research study with families. Early Intervention in Psychiatry, 1(4), 308-315.
    1. Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16-20.
    1. Davidson, L., O'Connell, M. J., Tondora, J., Staeheli, M., & Evans, A. C. (2005). Recovery in serious mental illness: A new wine or just a new bottle? Professional Psychology Research and Practice, 36(5), 480-487.
    1. Davidson, M., Galderisi, S., Weiser, M., Werbeloff, N., Fleischhacker, W. W., Keefe, R. S., … Libiger, J. (2009). Cognitive effects of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: a randomized, open-label clinical trial (EUFEST). American Journal of Psychiatry, 166(6), 675-682.
    1. Dickerson, F. B., Sommerville, J., Origoni, A. E., Ringel, N. B., & Parente, F. (2002). Experiences of stigma among outpatients with schizophrenia. Schizophrenia Bulletin, 28(1), 143-155.
    1. Ertugrul, A., & Ulug, B. (2004). Perception of stigma among patients with schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 39(1), 73-77.
    1. Franz, L., Carter, T., Leiner, A. S., Bergner, E., Thompson, N. J., & Compton, M. T. (2010). Stigma and treatment delay in first-episode psychosis: A grounded theory study. Early Intervention in Psychiatry, 4(1), 47-56.
    1. Fung, K. M., Tsang, T., Hector, W. H., & Corrigan, P. W. (2008). Stigma of people with schizophrenia as predictor of their adherence to psychosocial treatment. Psychiatric Rehabilitation Journal, 32(2), 95-104.
    1. Goffman, E. (1963). Stigma: Notes on a spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
    1. González-Torres, M. A., Oraa, R., Arístegui, M., Fernández-Rivas, A., & Guimon, J. (2007). Stigma and discrimination towards people with schizophrenia and their family members: a qualitative study with focus groups. Social Psychiatry and Psychiatric Epidemiology, 42(1), 14-23.
    1. Grant, N., Lawrence, M., Preti, A., Wykes, T., & Cella, M. (2017). Social cognition interventions for people with schizophrenia: A systematic review focusing on methodological quality and intervention modality. Clinical Psychology Review, 56, 55-64.
    1. Grant, P. M., & Beck, A. T. (2008). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin, 34(4), 798-806.
    1. Griffiths, K. M., Bradley, C., Parsons, A., & Reid, R. (2014). Effectiveness of programs for reducing the stigma associated with mental disorders: A meta-analysis of randomized control trials. World Psychiatry, 13(2), 161-175.
    1. Harrigan, S. M., McGorry, P. D., & Krstev, H. (2003). Does treatment delay in first-episode psychosis really matter? Psychological Medicine, 33(1), 97-110.
    1. Ho, R. W. H., Chang, W. C., Kwong, V. W. Y., Lau, E. S. K., Chan, G. H. K., Jim, O. T. T., … Chen, E. Y. H. (2018). Prediction of stigma in early psychosis: 3-year follow-up of the randomized-controlled trial on extended early intervention. Schizophrenia Research, 195, 463-468.
    1. Kane, J. M., Robinson, D. G., Schooler, N. R., Mueser, K. T., Penn, D. L., Rosenheck, R. A., … Heinssen, R. K. (2016). Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE early treatment program. The American Journal of Psychiatry, 173(4), 362-372.
    1. Kane, J. M., Schooler, N. R., Marcy, P., Correll, C. U., Brunette, M. F., Mueser, K. T., … Robinson, D. G. (2015). The RAISE early treatment program for first episode psychosis: Background, rationale, and study design. The Journal of Clinical Psychiatry, 76(3), 240-246.
    1. Kay, S. R., Fiszbein, A., & Opfer, L. A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.
    1. King, M., Dinos, S., Shaw, J., Watson, R., Stevens, S., Passetti, F., … Serfaty, M. (2007). The stigma scale: Development of a standardized measure of the stigma of mental illness. The British Journal of Psychiatry, 190(3), 248-254.
    1. Kleim, B., Vauth, R., Adam, G., Stieglitz, R. D., Hayward, P., & Corrigan, P. (2008). Perceived stigma predicts low self-efficacy and poor coping in schizophrenia. Journal of Mental Health, 17(5), 482-491.
    1. Krynicki, C. R., Upthegrove, R., Deakin, J. F. W., & Barnes, T. R. E. (2018). The relationship between negative symptoms and depression in schizophrenia: A systematic review. Acta Psychiatrica Scandinavica, 137(5), 380-390.
    1. Latalova, K., Kamaradova, D., & Prasko, J. (2014). Perspectives on perceived stigma and self stigma in adult male patients with depression. Neuropsychiatric Disease and Treatment, 10, 1399.
    1. Link, B. G. (1987). Understanding labeling effects in the area of mental disorders: An assessment of the effects of expectations of rejection. American Sociological Review, 52(1), 96-112.
    1. Lysaker, P. H., & Buck, K. D. (2008). Is recovery from schizophrenia possible? An overview of concepts, evidence, and clinical implications. Primary Psychiatry, 15(6), 60-65.
    1. Lysaker, P. H., Roe, D., & Yanos, P. T. (2007). Toward understanding the insight paradox: Internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin, 33(1), 192-199.
    1. MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7(1), 83-104.
    1. Marshall, M., Lewis, S., Lockwood, A., Drake, R., Jones, P., & Croudace, T. (2005). Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: A systematic review. Archives of General Psychiatry, 62(9), 975-983.
    1. Mueser, K. T., Penn, D. L., Addington, J., Brunette, M. F., Gingerich, S., Glynn, S. M., … Kane, J. M. (2015). The NAVIGATE program for first-episode psychosis: Rationale, overview, and description of psychosocial components. Psychiatric Services, 66(7), 680-690.
    1. Muthén, L. K., & Muthén, B. O. (1998-2012). Mplus user's guide: Statistical analysis variables (7th ed.). Los Angeles, CA: Muthén & Muthén.
    1. National Institutes of Mental Health Data Archive (NDA). n.d. Recovery After an Initial Schizophrenia Episode (RAISE): RAISE Early Treatment Program #2249. Retrieved from:
    1. Penn, D. L., & Wykes, T. (2003). Stigma, discrimination and mental illness. Journal of Mental Health, 12(3), 203-208.
    1. Perkins, D. O., Gu, H., Boteva, K., & Lieberman, J. A. (2005). Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: A critical review and meta-analysis. The American Journal of Psychiatry, 162(10), 1785-1804.
    1. Schrank, B., Amering, M., Hay, A. G., Weber, M., & Sibitz, I. (2014). Insight, positive and negative symptoms, hope, depression and stigma: A comprehensive model of mutual influences in schizophrenia spectrum disorders. Epidemiology and Psychiatric Sciences, 23(3), 271-279.
    1. Sirey, J. A., Bruce, M. L., Alexopoulos, G. S., Perlick, D. A., Friedman, S. J., & Meyers, B. S. (2001). Stigma as a barrier to recovery: Perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatric Services, 52(12), 1615-1620.
    1. Siris, S. G. (2001). Suicide and schizophrenia. Journal of Psychopharmacology, 15(2), 127-135.
    1. Staring, A. B. P., Van der Gaag, M., Van den Berge, M., Duivenvoorden, H. J., & Mulder, C. L. (2009). Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophrenia Research, 115(2-3), 363-369.
    1. Tarrier, N., Gooding, P., Pratt, D., Kelly, J., Awenat, Y., & Maxwell, J. (2013). Cognitive behavioural prevention of suicide in psychosis: A treatment manual. New York: Routledge.
    1. Upthegrove, R., Marwaha, S., & Birchwood, M. (2017). Depression and schizophrenia: Cause, consequence, or trans-diagnostic issue? Schizophrenia Bulletin, 43(2), 240-244.
    1. van Zelst, C. (2009). Stigmatization as an environmental risk in schizophrenia: A user perspective. Schizophrenia Bulletin, 35(2), 293-296.
    1. Yanos, P. T., Roe, D., Markus, K., & Lysaker, P. H. (2008). Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatric Services, 59(12), 1437-1442.
    1. Young, D. K., & Ng, P. Y. (2016). The prevalence and predictors of stigma of individuals with mental health illness in two Chinese cities. The International Journal of Social Psychiatry, 62(2), 176-185.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera