title: Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis.
abstract: According to stress-vulnerability models, social stressors contribute to the onset of schizophrenia. Stigma and discrimination associated with mental illness may be a stressor for young people at risk of psychosis even prior to illness onset, but quantitative longitudinal data on this issue are lacking. We examined the cognitive appraisal of stigma-related stress as predictor of transition to schizophrenia among young people at risk of psychosis. In Zürich, Switzerland, 172 participants between 13 and 35years old and with either high or ultra-high risk of psychosis or risk of bipolar disorder were included. With 71 dropouts, transition was assessed during 12months among 101 participants of whom 13 converted to schizophrenia. At baseline, the cognitive appraisal of stigma as a stressor was measured by self-report, based on the primary appraisal of stigma as harmful and the secondary appraisal of resources to cope with stigma. Positive and negative symptoms were examined using the Positive and Negative Syndrome Scale. Compared with participants who did not convert to schizophrenia, converters had significantly more positive (p<.001) and negative (p<.001) symptoms and reported higher levels of stigma-related harm (p=.003) and stress (p=.009) at baseline. More perceived harm due to stigma at baseline predicted transition to schizophrenia (odds ratio 2.34, 95%-CI 1.19-4.60) after adjusting for age, gender, symptoms and functioning. Stigma stress may increase the risk of transition to schizophrenia. Research is needed on interventions that reduce public negative attitudes towards young people at risk and that support individuals at risk to cope with stigma-related stress.
authors.affiliation: Department of Psychiatry II, University of Ulm and BKH Günzburg, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland. Electronic address: nicolas.ruesch@uni-ulm.de.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rüsch
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: Karsten
authors.initials: K
authors.lastname: Heekeren
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Theodoridou
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: Mario
authors.initials: M
authors.lastname: Müller
authors.affiliation: Illinois Institute of Technology, Chicago, USA.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Corrigan
authors.affiliation: Institute of Epidemiology and Medical Biometry, University of Ulm, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mayer
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Metzler
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland.
authors.forename: Diane
authors.initials: D
authors.lastname: Dvorsky
authors.affiliation: Hospital of Child and Adolescent Psychiatry, University of Zürich, Switzerland.
authors.forename: Susanne
authors.initials: S
authors.lastname: Walitza
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience, LIM27, University of Sao Paulo, Brazil.
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology*; D012306:Risk; D012559:Schizophrenia; D012565:Schizophrenic Psychology; D057566:Self Report; D012737:Sex Factors; D057545:Social Stigma; D013315:Stress, Psychological; D055815:Young Adult
keywords: Risk of psychosis; Social stress; Stigma; Transition to schizophrenia