Self-Stigma, Positive and Negative Symptoms of Psychosis, and Depression in First-Episode Psychosis

Background and Purpose: Self-stigma, the experience of internalizing negative stereotypes of an illness, is common among individuals with psychotic disorders and is shown to be a barrier in help-seeking and service utilization.  Among individuals experiencing a first episode of psychosis, self-stigma may further delay help-seeking and has the potential to be detrimental to recovery. While the relationship between symptoms of depression and stigma is consistently reported, there is a lack of literature to date on the relationships between positive and negative symptoms of psychosis and stigma, in particular among individuals in a first episode of psychosis. This study aimed to examine 1) the direct relationships between positive and negative symptoms of psychosis, symptoms of depression, and stigma; and, 2) the indirect relationships between symptoms of psychosis and stigma through symptoms of depression among a sample of participants in a first-episode of psychosis.

Methods: Data were obtained from National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) project (n=404) that tested and compared two Early Treatment Programs (ETP) among adolescents and adults who were experiencing a first episode of psychosis. The outcome of stigma was measured at baseline by 7 items of the Stigma Scale, symptoms of depression by the Calgary Depression Rating Scale (CDRS), and symptoms of psychosis by the Positive and Negative Syndrome Scale (PANSS) with covariates including antipsychotic medication at baseline and randomized treatment condition.  Data were analyzed using Structural Equation Modeling (SEM) in Mplus 7. 

Results: Participants were on average 23.6 years of age (SD=5.06) and identified as male (73%), White (54%), and non-Hispanic/Latino (82%). The majority endorsed having a diagnosis of schizophrenia (53%) and reported the experience of untreated psychosis for on average 6 months (SD=.72).  SEM findings indicated that: 1) increased positive symptoms of psychosis (b= .04, SE= .01, p < .001) and symptoms of depression (b= .06, SE= .01, p < .001) independently related to increased stigma; and, 2) increased positive (b= .17, SE= .04, p < .001) and negative symptoms of psychosis (b= .12, SE= .04, p < .01) independently related to increased symptoms of depression.  Thus, positive symptoms of psychosis related to stigma both directly and indirectly through symptoms of depression (partial mediator) based upon the joint significance test.    

Conclusions and Implications: These results emphasize relationships between symptoms of depression, positive symptoms of psychosis, and stigma among individuals in a first episode of psychosis. Findings point towards the implication that social workers must attend to the way in which stigma has the potential to negatively impact clients.  Future research is needed to further examine the role of self-stigma in first episode psychosis.