Elucidating the relationship between internalized stigma, cognitive insight, illness severity, and functioning in patients with schizophrenia using a path analysis approach

Abstract

Background

There is a paucity of studies examining the interrelationship between internalized stigma, cognitive insight, illness severity, and functioning.

Aims

This study examined the dynamics of the relationship between these factors using a path modelling approach.

Methods

Two hundred and seven patients with schizophrenia spectrum disorders were recruited in this cross-sectional study. Patients were assessed on internalized stigma, cognitive insight (including its two domains, self-reflectiveness and self-certainty), illness severity and functioning. Path analysis was used to test the hypothesized model for the interrelationship between the variables.

Results

A direct positive association was observed between self-certainty and internalized stigma. This was also observed via the paths running through illness severity and functioning. Self-reflectiveness was only associated with self-certainty in the model. The residual variance of internalized stigma in the path model was relatively high.

Conclusion

Our findings highlight that self-certainty is associated with internalized stigma along with illness severity and functioning in individuals with schizophrenia. Therefore, interventions on reduction of internalized stigma may benefit from a multipronged approach targeting self-certainty, illness severity and functioning. The relatively high residual variance of internalized stigma in the model highlights the need for further research to provide better understanding on the mechanisms underlying internalized stigma.

Keywords:

• Internalized stigma
• cognitive insight
• schizophrenia
• path analysis

Acknowledgements

The authors thank Dr. CK Lee of Kowloon Hospital and Miss Sania Yau of the New Life Hong Kong for their support with patient recruitment.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributor

Miss Min Yi Sum and Dr. Sherry Kit Wa Chan conducted data analysis and prepared the manuscript. Dr. Sherry Kit Wa Chan carried out the study and ensured the quality of the data. Prof Samson Tse and Prof. John Bola provided support with interpretation of the data. Dr. Wing Chung Chang, Dr. Edwin Ho Ming Lee and Dr. Roger Ng were responsible for patient recruitment and interpretation of the results. Dr. Christy Lai Ming Hui was responsible for interpretation of the results. Prof Eric Chen was the principle investigator of the project and responsible for interpretation of the results. All authors have approved the final manuscript.

Additional information

Funding

This work was supported by the General Research Fund of the Research Grants Council of Hong Kong [11606615]. The funding source is only responsible for overseeing the completion of the study according to the proposal. The funding source had no role in the study design; collection, analysis and interpretation of the data; writing of report; and the decision to submit the paper for publication.