title: Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders.
abstract: BACKGROUND
  Paradoxically, insight is associated with positive outcomes, such as better treatment adherence and recovery, and negative outcomes, such as depression, hopelessness, low self-esteem, and quality of life. Self-stigma as a moderating variable can be decisive whether more insight leads to better or worse outcome. On the other hand, self-stigma can act as a mediator between insight and outcomes. We therefore examined self-stigma both as a moderator and a mediator.
  
  
  METHODS
  Insight, self-stigma, demoralization, symptoms, and functioning were assessed among 145 outpatients with schizophrenia spectrum disorders using questionnaires and structured interviews. Structural equation modeling was used to analyze the cross-sectional data.
  
  
  RESULTS
  Results confirmed self-stigma as a moderator: The association of insight and demoralization was stronger as self-stigma increased. Self-stigma also partially mediated the positive relationship between insight and demoralization. Moreover, demoralization fully mediated the adverse associations of self-stigma with psychotic symptoms and global functioning.
  
  
  CONCLUSIONS
  Given the decisive role of self-stigma regarding the detrimental consequences of insight, interventions should address self-stigma, particularly if psychoeducational or other interventions have increased insight. Therapeutic implications for changes of dysfunctional beliefs related to illness and self and change of self-concept in the context of recovery at the level of narrative identity are discussed.
authors.affiliation: Department of Psychiatric Outpatient Treatment, Psychiatric University Hospital Basel, Switzerland.
authors.forename: Marialuisa
authors.initials: M
authors.lastname: Cavelti
authors.forename: Sara
authors.initials: S
authors.lastname: Kvrgic
authors.forename: Eva-Marina
authors.initials: EM
authors.lastname: Beck
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rüsch
authors.forename: Roland
authors.initials: R
authors.lastname: Vauth
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001364:Awareness; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009013:Morale; D010349:Patient Compliance / Q000523:psychology*; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology* / Q000534:rehabilitation*; D011788:Quality of Life; D012565:Schizophrenic Psychology; D012649:Self Concept; D057545:Social Stigma; D013557:Switzerland; D016896:Treatment Outcome