Self-stigma and treatment effectiveness in patients with anxiety disorders – a mediation analysis

Figures & data

Table 1 Descriptive and clinical characteristics of the sample and changes during the treatment

Factor	Number or mean
Number of the patients	209
Age, years	39.2±12.4
Gender: male/female	71 (34%)/138 (66%)
Education: primary/vocational training/secondary/tertiary	22 (10.5%)/61 (29.2%)/93 (44.5%)/33 (15.8%)
Employed: Yes/No	129 (61.7%)/80 (38.3%)
Pension: Yes/No	29 (13.9%)/180 (86.1%)
Marital status: single/married/divorced/widowed	88 (42.1%)/76 (36.4%)/39 (18.7%)/6 (2.9%)
Partner: Yes/No	122 (58.4%)/87 (41.6%)
Disorder: AP/SP/PD/GAD/MADD	13 (6.2%)/43 (20.6%)/64 (30.6%)/55 (26.3%)/34 (11.7%)
Comorbid personality disorder: Yes/No	33 (15.8%)/176 (84.2%)
Comorbid depression: Yes/No	16 (7.7%)/193 (92.3%)
Comorbid anxiety disorder: Yes/No	52 (24.9%)/157 (75.1%)
Onset of the disorder in years	29.5±13.8
Number of psychiatric hospitalizations	1.8±2.0
Length of the treatment in years	9.7±9.7
Positive familial anamnesis: Yes/No	115 (55.0%)/94 (45.0%)
Psychotherapy: CBT/short psychodynamic therapy	89 (42.6%)/120 (57.4%)
objCGI: At the start of the treatment	4.4±1.0
At the end of the treatment	2.7±1.1
Paired t-test	t=21.767; df=204; P<0.001
subjCGI: At the start of the treatment	4.4±1.3
At the end of the treatment	3.3±1.3
Paired t-test	t=9.089; df=185; P<0.001
BAI: At the start of the treatment	25.0±11.7
At the end of the treatment	22.2±14.0
Paired t-test	t=3.248; df=202; P<0.001
BDI-II: At the start of the treatment	26.0±10.4
At the end of the treatment	21.1±12.8
Paired t-test	t=6.054; df=201; P<0.001
ISMI: At the start of the treatment	66.6±12.4
At the end of the treatment	63.1±13.8
Paired t-test	t=−2.310; df=100; P<0.05
DES	15.4±13.7
SDS – Work	5.2±3.5
SDS – Social Life	6.1±2.6
SDS – Family Life/Home Responsibilities	5.8±2.7

Notes: Data are shown as mean ± SD unless otherwise specified. P<0.05 was considered significant.

Abbreviations: AP, agoraphobia; SP, social phobia; PD, panic disorder; GAD, generalized anxiety disorder; MADD, mixed anxiety-depressive disorder; CBT, cognitive behavioral therapy; objCGI, objective Clinical Global Impression; subjCGI, subjective Clinical Global Impression; BDI-II, Beck Depression Inventory, the second edition; BAI, Beck Anxiety Inventory; DES, Dissociative Experience Scale; ISMI, The Internalized Stigma of Mental Illness Scale; SDS, Sheehan Disability Scale.

Table 2 Spearman’s correlation coefficients between chosen predictive factors and indicators of the therapeutic change

Factors	Relative objCGI	Relative BAI	Relative BDI-II
Age, years	−0.03, ns	−0.06, ns	−0.09, ns
Onset of the disorder	−0.13, ns	0.00, ns	−0.05, ns
Number of hospitalizations	0.11, ns	−0.04, ns	0.03, ns
Length of the treatment	0.10, ns	−0.10, ns	−0.8, ns
objCGI	−0.06, ns	0.02, ns	0.11, ns
subjCGI	0.11, ns	−0.10, ns	0.06, ns
BDI-II	0.14*	0.02, ns	−0.05, ns
BAI	0.18*	−0.20**	0.10, ns
DES	0.17*	0.11, ns	0.21**
ISMI – Total score	0.28***	0.09, ns	0.11, ns
SDS – Work	−0.06, ns	−0.03, ns	−0.01, ns
SDS – Social Life	0.14, P=0.051	0.03, ns	0.02, ns
SDS – Family Life/Home Responsibilities	0.03, ns	0.02, ns	0.01, ns
Antidepressant index	0.04, ns	−0.05, ns	−0.01, ns
Anxiolytic index	−0.06, ns	0.02, ns	0.02, ns
Antipsychotic index	0.17, ns	−0.07, ns	0.03, ns

Notes:

* P<0.05;

** P<0.01;

*** P<0.001.

Abbreviations: objCGI, objective Clinical Global Impression; subjCGI, subjective Clinical Global Impression; BDI-II, Beck Depression Inventory, the second edition; BAI, Beck Anxiety Inventory; DES, Dissociative Experience Scale; ISMI, The Internalized Stigma of Mental Illness Scale; SDS, Sheehan Disability Scale; ns, non-significant.

Table 3 Relationship between selected demographic and clinical factors and therapeutic change

Factors	Relative objCGI	Relative BAI	Relative BDI-II
Gender
Male	−0.37±0.28	−0.14±0.51	−0.23±0.63
Female	−0.37±0.24	−0.08±1.53	−0.13±0.58
Mann–Whitney U	U =4,549, ns	U =3,912, ns	U =3,658*
Education
Primary	−0.33±0.30	−0.24±0.09	−0.07±0.65
Vocational training	−0.38±0.29	0.18±1.00	−0.12±0.56
Secondary	−0.36±0.23	−0.08±0.59	−0.17±0.58
Tertiary	−0.40±0.22	−0.53±2.70	−0.28±0.67
Kruskal–Wallis test	χ^2=1.508, ns	χ^2=4.219, ns	χ^2=1.187, ns
Heredity
Yes	−0.38±0.27	−0.01±0.74	−0.14±0.60
No	−0.36±0.24	−0.21±1.73	−0.19±0.59
Mann–Whitney U	U =4,927, ns	U =4,798, ns	U =5,021, ns
Occupation
Yes	−0.40±0.26	−0.13±1.55	−0.20±0.56
No	−0.33±0.24	−0.04±0.59	−0.11±0.64
Mann–Whitney U	U =3,987*	U =4,720, ns	U =4,578, ns
Pension
Yes	−0.37±0.25	−0.05±0.54	−0.15±0.46
No	−0.37±0.26	−0.10±1.36	−0.17±0.61
Mann–Whitney U	U =2,510, ns	U =2,407, ns	U =2,361, ns
Marital status
Single	−0.36±0.25	−0.06±0.60	−0.14±0.58
Married	−0.38±0.29	−0.06±0.74	−0.18±0.56
Divorced	−0.39±0.22	−0.41±2.51	−0.17±0.73
Widowed	−0.34±0.21	0.81±1.80	−0.20±0.12
Kruskal–Wallis test	χ^2=1.165, ns	χ^2=1.058, ns	χ^2=0.891, ns
Partner
Yes	−0.40±0.25	−0.19±1.53	−0.20±0.63
No	−0.33±0.26	0.04±0.76	−0.12±0.54
Mann–Whitney U	U =0.4250*	U=4673, ns	U=4505, ns
Psychotherapy
CBT	−0.39±0.24	−0.07±0.55	−0.19±0.63
Short psychodynamic therapy	−0.36±0.27	−0.11±1.63	−0.14±0.57
Mann–Whitney U	U =4,796, ns	U =4,861, ns	U =4,556, ns
Category of disorder
Panic disorder + agoraphobia	−0.35±0.23	0.16±1.10	−0.05±0.70
Social phobia	−0.41±0.20	−0.06±0.48	−0.20±0.55
GAD + MADD	−0.36±0.30	−0.29±1.70	−0.23±0.53
Kruskal–Wallis test	χ^2=2.210, ns	χ^2=0.644	χ^2=2.121, ns
Comorbidity with personality disorder
Yes	−0.29±0.28	−0.12±0.77	−0.07±0.61
No	−0.38±0.25	−0.13±1.35	−0.18±0.59
Mann–Whitney U	U =2,151, ns	U =2,320, ns	U =2,302, ns
Comorbidity with anxiety disorder
Yes	−0.33±0.25	−0.05±0.76	−0.09±0.60
No	−0.38±0.26	−0.11±1.41	−0.19±0.59
Mann–Whitney U	U =3,327, ns	U =3,747, ns	U =3,438, ns

Notes:

* P<0.05. Data are presented as mean ± SD.

Abbreviations: objCGI, objective Clinical Global Impression; BAI, Beck Anxiety Inventory; BDI-II, Beck Depression Inventory, the second edition; GAD, generalized anxiety disorder; MADD, mixed anxiety-depressive disorder; CBT, cognitive behavioral therapy; ns, non-significant.

Figure 1 Mediation model with self-stigma as a predictor and the relative change of the overall psychopathology as an outcome.

Note: Numbers indicate the strength of pathways.
Abbreviations: BDI, Beck Depression Inventory; BAI, Beck Anxiety Inventory; DES, Dissociative Experience Scale; ISMI, The Internalized Stigma of Mental Illness Scale; relobjCGI, relative change of the objective Clinical Global Impression.