Internalized Stigma Predicts Life Engagement in People With Schizophrenia: A Cross-Sectional Observational Study in a Real-World Setting

Abstract

Background:

People living with schizophrenia often experience high levels of stigma and are consistently at risk of internalizing it. Internalized stigma has a negative impact on several clinical and recovery outcomes in people with schizophrenia, but the effect of internalized stigma on important patient reported outcomes that are gaining increasing scientific and clinical relevance, such as life engagement, has not yet been extensively investigated.

Aims:

This study aims to investigate the relationship between several different socio-demographic, clinical, functional and medication-related variables and life engagement, with the hypothesis that internalized stigma, alongside other factors, could represent an individual predictor of reduced life engagement.

Methods:

Ninety-four participants diagnosed with schizophrenia were included in this cross-sectional study and were investigated with validated instruments assessing life engagement, schizophrenia symptoms severity, global clinical severity, internalized stigma, psychosocial functioning, antipsychotic-related side effects, attitude toward medications, and subjective well-being. Predictors of life engagement were assessed using a stepwise multivariate linear regression analysis.

Results:

Greater global clinical severity (β = .685, p < .001), fewer years of education (β = −.240, p < .001), and greater stigma endorsement (β = .180, p = .005) emerged as individual predictors of reduced patient life engagement, explaining a large proportion of the observed variance (Adjusted R² = .649, p = .001).

Conclusions:

Internalized stigma, among other well-recognized variables, appears to represent an individual predictor of worse patient life engagement in people living with schizophrenia. This finding should strengthen the notion that stigma, and internalized stigma in particular, represent important dimensions and treatment targets in the clinical management of schizophrenia, also in the perspective of improving patient-reported outcomes.