Automatic Thoughts, Self-Stigma, and Resilience Among Schizophrenia Patients with Metabolic Syndrome: A Cross-Sectional Study

Figures & data

Figure 1 Flow chart.

Table 1 General Demographic Background, Blood Routine, and Biochemical Indicators Among the Three Groups

Factors	Control Group	Non-MetS Group	MetS Group	χ^2/F/t	P
	(n=48)	(n=48)	(n=47)
Sex (male)	25 (52.1%)	21 (43.8%)	26 (55.3%)	1.358	0.507
Sex (female)	23 (47.9%)	27 (56.2%)	21 (43.7%)
Age (year)	33.5±10.37	35.6±11.28	38.70±10.52	2.289	0.105
Years of Education
≤9 years	13 (27.1%)	19 (39.6%)	24 (51.1%)	5.737	0.057
>9 years	35 (72.9%)	29 (60.4%)	23 (48.9%)
Marital status
No	21 (43.8%)	27 (56.2%)	22 (46.8%)	1.629	0.443
Yes	27 (56.2%)	21 (43.8%)	25 (53.2%)
Employment status
No	17 (35.4%)	29 (60.4%)	21 (44.7%)	6.157	0.046
Yes	31 (64.6%)	19 (39.6%)	26 (55.3%)
Course of disease
<1 year		12 (25%)	8 (17%)	0.098	0.345
≥1 years		36 (75%)	39 (83%)
DBP (mmHg)	71.58±6.00	75.13±6.06	77.94±8.34	2.049	0.133
SBP (mmHg)	117.51±11.54	115.00±10.81	119.48±13.95	10.191	<0.001
Waist^a (cm)	81.10±9.94	85.08±10.88	98.58±9.07	39.818	<0.001
FGB (mmol/l)	5.21±0.52	5.21±0.58	5.96±1.05	15.892	<0.001
CHOL	4.53±1.01	4.01±0.81	4.40±0.70	4.867	0.009
TG (mmol/l)	1.40±0.99	1.34±0.61	2.89±1.71	25.895	<0.001
HDL-C (mmol/l)	1.42±0.29	1.13±0.22	0.93±0.15	53.553	<0.001
Apo-A (g/l)	1.56±0.21	1.20±0.24	1.08±0.24	53.139	<0.001
Apo-B (g/l)	0.76±0.27	0.78±0.20	0.88±0.24	3.604	0.303
Cr (umol/l)	67.4±11.28	60.13±13.28	61.30±11.36	5.061	0.008
WBC (*10^9/L)	67.40±11.28	60.13±13.28	61.30±11.36	2.270	0.107
NEU (*10^9/L)	6.17±1.43	6.43±1.67	6.83±1.50	0.446	0.641
RED (*10^9/L)	5.41±5.54	4.21±0.44	4.45±0.41	1.824	0.165
CPZ/mg equivalents		410.08±224.75	446.81±264.91	−0.729	0.468
HAMA-14		4.56±4.43	3.96±3.46	0.741	0.131
HAMD-24		6.08±6.84	5.43±4.51	0.552	0.136
PANSS total score		60.48±12.42	60.11±12.16	0.148	0.350

Note: ^aWaist circumstance.

Abbreviations: DBP, diastolic pressure; SBP, systolic pressure; BMI, body mass index; WBC, white blood cell; NEU, neutrophile granulocyte; FGB, fasting blood glucose; CHOL, cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein; Apo-A, apolipoprotein-A; Apo-B, apolipoprotein-B; AST, aspartate aminotransferase; ALT, glutamic-pyruvic transaminase; BUN, urea nitrogen; Cr, creatinine; CPZ, chlorpromazine; PANSS, presented positive and negative symptoms; HAMA-14, Hamilton Anxiety Rating Scale-14; HAMD-24, Hamilton Depression Rating Scale-24.

Table 2 Comparison of Resilience, Automatic Thoughts and Stigma Among Three Groups

Factors	Contro group	Non-MetS group	MetS group	χ^2/F/t	P	AvsB	AvsC	BvsC
	(n=48)	(n=48)	(n=47)
ATQ total score	45.69±15.41	57.00±19.09	69.85±29.01	14.50	<0.001	0.002	<0.001	0.012
CD-RISC total score	65.69±16.27	59.17±15.46	52.34±15.48	8.54	<0.001	0.047	<0.001	0.034
Tenacity	32.77±9.08	30.46±8.92	26.62±8.68	5.79	0.004	0.211	<0.001	0.036
Strength	23.21±4.81	20.52±5.27	18.23±5.50	10.90	<0.001	0.011	<0.001	0.041
Optimism	9.71±3.13	8.19±2.92	7.49±2.91	6.85	0.001	0.016	<0.001	0.246
Stigma total score		1.94±0.46	2.08±0.52	0.300	0.157	/	/	/
No internalized stigma		1.72 (41.67%)	1.80 (34.04%)	0.587	0.527
Internalized stigma		2.34 (58.33%)	2.42 (65.96%)

Notes: A vs B, Control vs non-Mets; A vs C, Control vs Mets; B vs C, non-Mets vs Mets.

Abbreviations: CD-RISC, Connor-Davidson Resilience Scale; ATQ, Automatic Thoughts Questionnaire. A, healthy control group; B, non metabolic syndrome group; C, metabolic syndrome group.

Table 3 Correlation Analysis Among Clinical Symptoms and Resilience, Stigma and Automatic Thinking

	Tenacity		Strength		Optimism		CD-RISC		Stigma		ATQ
	r	p	r	p	r	p	r	p	r	p	r	p
ATQ	−0.181	0.078	−0.218*	0.034	−0.049	0.634	−0.175	0.089	0.244*	0.017	\	\
PANSS	−0.064	0.540	−0.045	0.667	0.025	0.807	−0.041	0.694	−0.062	0.548	0.214*	0.038
PANSS^a	−0.03	0.974	−0.002	0.985	0.101	0.331	0.021	0.840	0.009	0.930	−0.061	0.554
PANSS^b	−0.114	0.270	−0.167	0.106	−0.081	0.436	−0.130	0.209	0.076	0.466	0.253*	0.013
PANSS^c	0.067	0.521	0.174	0.091	0.068	0.511	0.121	0.242	−0.111	0.284	−0.039	0.711
PANSS^d	−0.111	0.285	−0.166	0.109	−0.043	0.682	−0.130	0.208	−0.046	0.657	0.242*	0.018
PANSS^e	−0.120	0.246	−0.014	0.892	−0.045	0.667	−0.081	0.437	−0.074	0.479	0.133	0.199
HAMD	−0.055	0.598	−0.107	0.300	−0.008	0.940	−0.071	0.493	0.059	0.573	0.301**	0.003
HAMA	−0.121	0.242	−0.076	0.464	−0.053	0.610	−0.107	0.301	0.014	0.890	0.202*	0.049
CD-RISC	\	\	\	\	\	\	\	\	−0.035	0.737	−0.175	0.089
Stigma	0.008	0.936	−0.161	0.118	0.050	0.629	−0.035	0.737	\	\	0.244*	0.017

Notes: ^aPositive, ^bNegative, ^cExcitement, ^dDepression, ^eCognitive; *p<0.05, **p<0.01.

Abbreviations: CD-RISC, Connor-Davidson Resilience Scale; ATQ, Automatic Thoughts Questionnaire; HAMA-14, Hamilton Anxiety Rating Scale-14; HAMD-24, Hamilton Depression Rating Scale-24; PANSS, presented positive and negative symptoms; Stigma, The Internalized Stigma of Mental Illness scale.

Table 4 Correlation Analysis Among Biochemical Parameters with Stigma, Resilience and Automatic Thoughts

	Tenacity		Strength		Optimism		CD-RISC		Stigma		ATQ
	r	p	r	p	r	r	p	p	r	p	r	p
Waist^a (cm)	−0.215*	0.036	−0.174*	0.092	−0.206*	0.270**	0.001	0.045	−0.226**	0.007	0.112	0.280
FGB (mmol/l)	−0.225*	0.028	−0.275**	0.007	−0.137	0.198*	0.018	0.186	−0.220**	0.008	0.150	0.146
CHOL	−0.051	0.624	−0.076	0.464	−0.099	−0.018	0.834	0.339	0.025	0.769	0.134	0.196
TG (mmol/l)	−0.21*	0.041	−0.176	0.088	−0.079	0.265**	0.001	0.446	−0.133	0.115	0.123	0.236
HDL-C (mmol/l)	0.011	0.919	0.037	0.721	0.06	−0.291**	<0.001	0.566	0.150	0.073	−0.152	0.142
Apo-A (g/l)	−0.016	0.878	−0.066	0.526	−0.176	−0.338**	<0.001	0.088	0.124	0.141	−0.118	0.254
Apo-B (g/l)	−0.142	0.171	−0.096	0.355	−0.245*	0.082	0.327	0.017	−0.095	0.260	0.072	0.487
Cr (umol/l)	0.053	0.611	0.078	0.453	0.11	−0.121	0.151	0.29	0.221**	0.008	0.099	0.340
WBC (*10^9/L)	−0.037	0.721	−0.047	0.648	0.016	0.247**	0.003	0.876	−0.019	0.825	−0.005	0.960
NEU (*10^9/L)	−0.148	0.152	−0.187	0.07	−0.071	0.242**	0.004	0.494	−0.109	0.193	−0.066	0.525
RBC (*10^9/L)	−0.037	0.72	0.042	0.683	0.04	−0.105	0.213	0.704	0.166*	0.047	−0.008	0.939

Notes: ^aWaist circumstance. *p < 0.05, **p < 0.01.

Abbreviations: FGB, fasting blood glucose; CHOL, cholesterol; TG, triglyceride; HDL-C, high-density lipoprotein; Apo-A, apolipoprotein-A; Apo-B, apolipoprotein-B; Cr, creatinine; WBC, white blood cell; NEU, neutrophile granulocyte; RBC, red blood cell; stigma, The Internalized Stigma of Mental Illness scale; CD-RISC, Connor-Davidson Resilience Scale; ATQ, Automatic Thoughts Questionnaire.

Table 5 Stepwise Linear Regression Analysis of Stigma, CD-RISC and Automatic Thinking

Dependent Variables	Independent Variables	B	SD	Beta (β)	t	Sig.
Stigma	ATQ	0.133	0.053	0.251	2.504	0.014
	Years of education	−5.742	2.695	−0.216	−2.130	0.036
	Course of Disease	0.026	0.011	0.228	2.255	0.026
ATQ	Years of education	−14.444	3.919	−0.296	−3.685	<0.001
	Employment status	−9.055	3.941	−0.190	−2.297	0.023
	Waist^a	0.520	0.156	0.271	3.340	0.001
	TG	4.894	1.395	0.283	3.509	0.001
	HDL-C	−21.734	6.324	−0.278	−3.437	0.001
	WBC	3.551	1.262	0.231	2.815	0.006
	CD-RISC	−0.342	0.118	−0.238	−2.904	0.004
	Stigma	0.476	0.190	0.251	2.504	0.014
CD-RISC	Waist^a	−0.304	0.109	−0.229	−2.787	0.006
	Cr	0.288	0.110	0.215	2.612	0.010

Note: ^aWaist circumstance.

Abbreviations: TG, triglyceride; HDL-C, high-density lipoprotein; WBC, white blood cell; Cr, creatinine; Stigma, The Internalized Stigma of Mental Illness scale; ATQ, Automatic; Thoughts Questionnaire; CD-RISC, Connor-Davidson Resilience Scale.

Figure 2 ROC curve analysis was used to predict the psychological structure impairment of MetS groups by using dysbiosis of MetS parameters and demographic and clinical characteristics. (A) Independent risk factors used to predict stigma; (B) Independent risk factors used to predict ATQ; (C) lndependent risk factors used to predict CD-RISC.

Note: ATQ, Automatic Thoughts Questionnaire; TG, triglyceride; HDL-C, high-density lipoprotein; CD-RISC, Connor-Davidson Resilience Scale; WBC, white blood cell; Cr, creatinine.