Octavia CĂPĂȚÎNĂ1, Ioana MICLUȚIA2
1 Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania;
2 Department of Neurosciences, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania;
Background: Quality of life (QoL) in patients with schizophrenia has been a subject of growing interest in the last few years. Understanding the link between QoL and internalized stigma is important in enhancing the prospect of patient recovery. The present study aimed to investigate internalized stigma as a possible determinant of poor QoL. Materials and methods: In the present cross-sectional study 106 patients diagnosed with schizophrenia completed a comprehensive battery of instruments assessing: internalized stigma, clinical symptoms, QoL, sociodemographic and clinical variables. Hierarchical regression analyses were performed to test the significance of internalized stigma as a predictor variable for subjective and objective QoL. Results: Blockwise multiple regression analyses revealed that internalized stigma and excitement were significant predictors for the variability of subjective QoL and internalized stigma and experiential deficit were significant predictors of the variability objective QoL. Conclusions: Overall, these data reveal high levels of internalized stigma among patients with schizophrenia and suggest the incremental validity of internalized stigma as a predictor of QoL, indicating a possible point of intervention. The roles of experiential deficit and excitement in relation with QoL are also discussed.
Keywords: schizophrenia, internalized stigma, hierarchical regression analysis, subjective and objective quality of life
Published online: 2018/09/01
Published print: 2018/09/01
Adelufosi, A., Ogunwale, A., Abayomi, O., & Mosanya, J. (2013). Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia. Psychiatry Research, 209(3), 320-325.
Addington, D., Addington, J., & Schissel, B. (1990). A depression rating scale for schizophrenics. Schizophrenia Research, 3(4), 247-251.
Aleman, A., Lincoln, T., Bruggeman, R., Melle, I., Arends, J., Arango, C., & Knegtering, H. (2017). Treatment of negative symptoms: Where do we stand, and where do we go?. Schizophrenia Research, 186, 55-62.
Awad, A., & Voruganti, L. (2012). Measuring Quality of Life in Patients with Schizophrenia. Pharmacoeconomics, 30(3), 183-195.
Axelrod, B., Goldman, R., & Alphs, L. (1993). Validation of the 16-item negative symptom assessment. Journal Of Psychiatric Research, 27(3), 253-258.
Beck, A. (2004). A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophrenia Research, 68(2-3), 319-329.
Boyd Ritsher, J., Otilingam, P., & Grajales, M. (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research, 121(1), 31-49.
Boyd, J., Adler, E., Otilingam, P., & Peters, T. (2014). Internalized Stigma of Mental Illness (ISMI) Scale: A multinational review. Comprehensive Psychiatry, 55(1), 221-231.
Boyer, L., Baumstarck, K., Boucekine, M., Blanc, J., Lançon, C., & Auquier, P. (2013). Measuring quality of life in patients with schizophrenia:an overview. Expert Review Of Pharmacoeconomics & Outcomes Research, 13(3), 343-349.
Briggs, A., Wild, D., Lees, M., Reaney, M., Dursun, S., Parry, D., & Mukherjee, J. (2008). Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation. Health And Quality Of Life Outcomes, 6(1), 105.
Capatina, O., & Miclutia, I. (2016). Internalized stigma, negative symptoms and global functioning in schizophrenia. European Psychiatry, 33, S574-S575.
Cavelti, M., Rüsch, N., & Vauth, R. (2014). Is Living With Psychosis Demoralizing?. The Journal Of Nervous And Mental Disease, 202(7), 521-529.
Constitution of the World Health Organization, Signed on July 22, 1946, in New York City1. (1947). International Organization, 1(01), 1-29.
Daniel, D., Alphs, L., Cazorla, P., Bartko, J., & Panagides, J. (2011). Training for Assessment of Negative Symptoms of Schizophrenia across Languages and Cultures: Comparison of the NSA-16 with the PANSS Negative Subscale and Negative Symptom Factor. Clinical Schizophrenia & Related Psychoses, 5(2), 87-94.
Díaz-Caneja, C., Pina-Camacho, L., Rodríguez-Quiroga, A., Fraguas, D., Parellada, M., & Arango, C. (2015). Predictors of outcome in early-onset psychosis: a systematic review. Npj Schizophrenia, 1(1).
Dickerson, F., Sommerville, J., Origoni, A., Ringel, N., & Parente, F. (2002). Experiences of Stigma Among Outpatients With Schizophrenia. Schizophrenia Bulletin, 28(1), 143-155.
Domenech, C., Altamura, C., Bernasconi, C., Corral, R., Elkis, H., & Evans, J. et al. (2018). Health-related quality of life in outpatients with schizophrenia: factors that determine changes over time. Social Psychiatry And Psychiatric Epidemiology, 53(3), 239-248. Firmin, R., Lysaker, P., Luther, L., Yanos, P., Leonhardt, B., Breier, A., & Vohs, J. (2018). Internalized stigma in adults with early phase versus prolonged psychosis. Early Intervention In Psychiatry. doi: 10.1111/eip.12553
Foussias, G., & Remington, G. (2008). Negative Symptoms in Schizophrenia: Avolition and Occam’s Razor. Schizophrenia Bulletin, 36(2), 359-369.
Grover, S., Sahoo, S., Chakrabarti, S., & Avasthi, A. (2017). Association of internalized stigma and insight in patients with schizophrenia. International Journal Of Culture And Mental Health, 11(3), 338-350.
Harvey, P., Vanover, K., Davis, R., Penn, D., & Pinkham, A. (2018). F250. Depression in schizophrenia: correlations with objective and subjective quality of life outcomes. Schizophrenia Bulletin, 44(suppl_1), S320-S320.
Hsiao, C., Hsieh, M., Tseng, C., Chien, S., & Chang, C. (2012). Quality of life of individuals with schizophrenia living in the community: relationship to socio-demographic, clinical and psychosocial characteristics. Journal Of Clinical Nursing, 21(15-16), 2367-2376.
Hill, K., & Startup, M. (2013). The relationship between internalized stigma, negative symptoms and social functioning in schizophrenia: The mediating role of selfefficacy. Psychiatry Research, 206(2-3), 151-157.
Kay, S., Fiszbein, A., & Opler, L. (1987). The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophrenia Bulletin, 13(2), 261-276.
Katschnig, H. (2000). Schizophrenia and quality of life. Acta Psychiatrica Scandinavica, 102(s407), 33-37.
Kim, J., Lee, S., Han, A., Kim, K., & Lee, J. (2015). Relationship between cognitive insight and subjective quality of life in outpatients with schizophrenia. Neuropsychiatric Disease And Treatment, 2041.
Kuruvilla, A., & Jacob, J. (2018). Quality of life and explanatory models of illness in patients with schizophrenia. Indian Journal Of Psychological Medicine, 40(4), 328.
Lally, J., & MacCabe, J. (2015). Antipsychotic medication in schizophrenia: a
review. British Medical Bulletin, 114(1), 169-179.
Lehman, A. (1988). A quality of life interview for the chronically mentally ill. Evaluation And Program Planning, 11(1), 51-62.
Lien, Y., Chang, H., Kao, Y., Tzeng, N., Lu, C., & Loh, C. (2017). The impact of cognitive insight, self-stigma, and medication compliance on the quality of life in patients with schizophrenia. European Archives Of Psychiatry And Clinical Neuroscience, 268(1), 27-38.
Liberman, R., Kopelowicz, A., Ventura, J., & Gutkind, D. (2002). Operational criteria and factors related to recovery from schizophrenia. International Review Of Psychiatry, 14(4), 256-272.
Lysaker, P., Vohs, J., & Tsai, J. (2009). Negative symptoms and concordant impairments in attention in schizophrenia: Associations with social functioning, hope, self-esteem and internalized stigma. Schizophrenia Research, 110(1-3), 165-172.
Naber, D. (2008). Subjective vs objective quality of life, clinical implications. Schizophrenia Research, 102(1-3), 27.
Narvaez, J., Twamley, E., McKibbin, C., Heaton, R., & Patterson, T. (2008). Subjective and objective quality of life in schizophrenia. Schizophrenia Research, 98(1-3), 201-208.
Park, S., Bennett, M., Couture, S., & Blanchard, J. (2013). Internalized stigma in schizophrenia: Relations with dysfunctional attitudes, symptoms, and quality of life. Psychiatry Research, 205(1-2), 43-47. Picco, L., Pang, S., Lau, Y., Jeyagurunathan, A., Satghare, P., & Abdin, E. et al. (2016). Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem. Psychiatry Research, 246, 500-506.
Puia, I., Fadgyas Stanculete, M., Puia, A., Hopulele-Petri, A., & Muresan, D. (2017). Patients’ Perception of Weight-Related Stigma in a Romanian Sample. Journal Of Evidence-Based Psychotherapies, 17(2), 147-158.
Ritsher, J., & Phelan, J. (2004). Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Research, 129(3), 257-265.
Rofail, D., Regnault, A., le Scouiller, S., Berardo, C., Umbricht, D., & Fitzpatrick, R. (2015). Health-related quality of life in patients with prominent negative symptoms: results from a multicenter randomized Phase II trial on bitopertin. Quality Of Life Research, 25(1), 201-211.
Savill, M., Orfanos, S., Reininghaus, U., Wykes, T., Bentall, R., & Priebe, S. (2016). The relationship between experiential deficits of negative symptoms and subjective quality of life in schizophrenia. Schizophrenia Research, 176(2-3), 387-391.
Schrank, B., Amering, M., Hay, A., Weber, M., & Sibitz, I. (2013). Insight, positive and negative symptoms, hope, depression and self-stigma: a comprehensive model of mutual influences in schizophrenia spectrum disorders. Epidemiology And Psychiatric Sciences, 23(03), 271-279.
Shaheen, S., & Amin, R. (2016). Effects of internalized stigma on symptoms and quality of life in schizophrenic patients; mediated by dysfunctional attitude. International Journal Of Health, 4(2), 145.
Staring, A., Van der Gaag, M., Van den Berge, M., Duivenvoorden, H., & Mulder, C. (2009). Stigma moderates the associations of insight with depressed mood, low selfesteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophrenia Research, 115(2-3), 363-369.
Stiekema, A., Islam, M., Liemburg, E., Castelein, S., van den Heuvel, E., & van Weeghel, J. et al. (2018). Long-term course of negative symptom subdomains and relationship with outcome in patients with a psychotic disorder. Schizophrenia Research, 193, 173-181.
Theofilou, P. (2013). Quality of Life: Definition and Measurement. Europe’S Journal Of Psychology, 9(1), 150-162.
Tolman, A., & Kurtz, M. (2010). Neurocognitive Predictors of Objective and Subjective Quality of Life in Individuals With Schizophrenia: A Meta-Analytic Investigation. Schizophrenia Bulletin, 38(2), 304-315.
Tomotake, M. (2006). Subjective and objective measures of quality of life have different predictors for people with schizophrenia. Psychological Reports, 99(6), 477.
Tomotake, M. (2011). Quality of life and its predictors in people with schizophrenia. The Journal Of Medical Investigation, 58(3,4), 167-174.
Wallwork, R., Fortgang, R., Hashimoto, R., Weinberger, D., & Dickinson, D. (2012).
Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Research, 137(1-3), 246-250.
Wang, X., Petrini, M., & Morisky, D. (2016). Predictors of quality of life among Chinese people with schizophrenia. Nursing & Health Sciences, 19(2), 142-148.
Wilkinson, G., Hesdon, B., Wild, D., Cookson, R., Farina, C., & Sharma, V. et al. (2000). Self-report quality of life measure for people with schizophrenia: The SQLS. British Journal Of Psychiatry, 177(01), 42-46. Woods, S. (2003). Chlorpromazine Equivalent Doses for the Newer Atypical Antipsychotics. The Journal Of Clinical Psychiatry, 64(6), 663-667.
Yamauchi, K., Aki, H., Tomotake, M., Iga, J., Numata, S., & Motoki, I. et al. (2008). Predictors of subjective and objective quality of life in outpatients with schizophrenia. Psychiatry And Clinical Neurosciences, 62(4), 404-411.
Yanos, P., Roe, D., Markus, K., & Lysaker, P. (2008). Pathways Between Internalized Stigma and Outcomes Related to Recovery in Schizophrenia Spectrum Disorders. Psychiatric Services, 59(12), 1437-1442.
Yılmaz, E., & Okanlı, A. (2015). The Effect of Internalized Stigma on the Adherence to Treatment in Patients With Schizophrenia. Archives Of Psychiatric Nursing, 29(5), 297-301.
Zäske, H., & Gaebel, W. (2015). Stigma and Discrimination Experiences in Patients with First-episode Schizophrenia. European Psychiatry, 30, 1377.