Self-stigma in patients with schizophrenia, especially those afraid to disclose their disease, increases depressive symptoms, according to study data published in Psychiatry Research.

Investigators abstracted data from a randomized controlled clinical trial testing the effectiveness of the Positive Emotion Program for Schizophrenia (PEPS) on apathy and anhedonia. Individuals with schizophrenia were randomly assigned to receive either the PEPS intervention or a control condition in this primary study. Participants were interviewed at baseline and then at 2 and 6 months posttreatment to assess treatment effect on mood. For the present analyses, investigators extracted participant scores on the Stigma Scale and the Calgary Depression Scale for Schizophrenia, in which a score ≥6 indicates a major depressive disorder. Multivariate linear regression was performed to determine the reciprocal effect of self-stigma on depression. All patients were recruited from French-speaking Switzerland, and analyses were conducted in Switzerland. The final cohort comprised 80 interview participants of mean age 39.9 (standard deviation, 10.9) years, of whom 49 (61.3%) were men. The average disease duration for schizophrenia was 16.1 years.

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At baseline, the mean Stigma Scale score was 20.82 (standard deviation, 4.93) against a maximum value of 36. The mean scores for the “disclosure” and “discrimination” Stigma Scale subdimensions were 7.88 and 6.90, respectively, and the mean score for difficulty in considering positive aspects of the disease was 6.04. No associations were found between Self Stigma total score and age, illness duration, sex, education level, being single, or working in sheltered employment. However, individuals who lived in a sheltered home reported lower levels of self-stigmatization at baseline than those who lived in an apartment (P =.01). In addition, greater age (P =.04) and illness duration (P =.03) were positively correlated with discrimination subscale scores. At posttreatment, men had significantly more difficulty identifying positive aspects of the disease (P =.01), whereas women had worse discrimination subscale scores (P =.02).

Self-stigma and depression were correlated over time (P =.001). Per regression analyses, self-stigma predicted higher depressive symptoms (P =.001), although total self-stigma did not predict the evolution of depression between points when controlling for baseline depression and participation in PEPS. Instead, higher depression at any given time was mainly predicted by higher discrimination subscale scores and increased difficulty in considering positive aspects of the disease. Depression at baseline was the strongest predictor of depression at posttreatment and follow-up.

These data indicate that self-stigma has a substantial effect on depressive symptoms in individuals with schizophrenia. Addressing self-stigma may improve mood symptoms for this patient demographic, although further research on the subject is needed.

“The collaboration of people with schizophrenia is essential to develop interventions that are relevant and appropriate for user needs,” the investigators suggested.

Reference

Pellet J, Golay P, Nguyen A, et al. The relationship between self-stigma and depression among people with schizophrenia-spectrum disorders: a longitudinal study. Psychiatry Res. 2019;275:115-119.