title: How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences.
abstract: This study aimed to examine how stigma impacts on symptomatic and subjective recovery from psychosis, both concurrently and longitudinally. We also aimed to investigate whether self-esteem and hopelessness mediated the observed associations between stigma and outcomes. 80 service-users with psychosis completed symptom (Positive and Negative Syndrome Scale) and subjective recovery measures (Process of Recovery Questionnaire) at baseline and 6-months later, and also completed the King Stigma Scale, the Self-Esteem Rating Scale and the Beck Hopelessness Scale at baseline. In cross sectional regression and multiple mediation analyses of the baseline data, we found that stigma predicted both symptomatic and subjective recovery, and the effects of stigma on these outcomes were mediated by hopelessness and self-esteem. When the follow-up data were examined, stigma at baseline continued to predict recovery judgements and symptoms. However, self-esteem only mediated the effect of stigma on PANSS passive social withdrawal. Self-esteem and hopelessness should be considered in interventions to reduce the effects of stigma. Interventions that address the current and long-term effects of stigma may positively affect outcome for people being treated for psychosis.
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom. Electronic address: vvass@liverpool.ac.uk.
authors.forename: Victoria
authors.initials: V
authors.lastname: Vass
authors.affiliation: Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Morrison
authors.affiliation: Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom.
authors.forename: Heather
authors.initials: H
authors.lastname: Law
authors.affiliation: Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Dudley
authors.affiliation: Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom.
authors.forename: Pamela
authors.initials: P
authors.lastname: Taylor
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Bennett
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Bentall
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D065026:Hope; D006801:Humans; D007389:Internal-External Control; D007600:Judgment; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology* / Q000628:therapy; D012559:Schizophrenia / Q000175:diagnosis* / Q000628:therapy; D012565:Schizophrenic Psychology; D012649:Self Concept; D012803:Sick Role; D057545:Social Stigma; D013240:Stereotyping; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Indirect effects; Mental disorders; Psychosis; Social discrimination; Social stigmas; Stereotyping/stigmatisation