title: Resilience, internalized stigma, self-esteem, and hopelessness among people with schizophrenia: Cultural comparison in Austria and Japan.
abstract: Resilience is becoming an important topic in people with schizophrenia since there is evidence that it increases the probability for long-term recovery. The current study investigated transcultural differences in resilience across schizophrenia patients from two different geographical regions, Austria and Japan. Another objective was to examine transcultural differences in internalized stigma, self-esteem, and hopelessness, which can be expected to be relevant in this context, as well as the interrelations between these subjective elements of recovery and symptom severity. To this end, patients from outpatient mental health services in Innsbruck, Austria (N=52) and Tokyo, Japan (N=60) as well as 137 healthy comparison subjects from both countries were included into this cross-sectional study. Notably, we detected a significant country effect with markedly lower resilience (F=74.4, p<0.001) and self-esteem scores (F=226.0, p<0.001) as well as higher hopelessness scores (F=37.4, p<0.001) among Japanese subjects in general. In addition, both Austrian and Japanese patients indicated significantly lower degrees of resilience (F=57.5, p<0.001), self-esteem (F=51.8, p<0.001), and hope (F=29.5, p<0.001) compared to healthy control subjects. The inter-correlations between subjective elements of recovery were comparable in size in the two patient samples, but the inter-correlations between these issues and residual symptoms of schizophrenia as objective domains of recovery were markedly higher in Austrian subjects. This suggests that schizophrenia patients from Western European and Japanese cultures may have different needs to achieve recovery. In conclusion, it will be critical to develop culture-specific psychosocial programs and to examine their feasibility and effectiveness among these patients.
authors.affiliation: Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria. Electronic address: a.hofer@i-med.ac.at.
authors.forename: Alex
authors.initials: A
authors.lastname: Hofer
authors.affiliation: Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Mizuno
authors.affiliation: Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Frajo-Apor
authors.affiliation: Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Kemmler
authors.affiliation: Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pardeller
authors.affiliation: Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria.
authors.forename: Anna-Sophia
authors.initials: AS
authors.lastname: Welte
authors.affiliation: Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sondermann
authors.affiliation: Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
authors.affiliation: Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Wartelsteiner
authors.affiliation: Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria.
authors.forename: W Wolfgang
authors.initials: WW
authors.lastname: Fleischhacker
authors.affiliation: Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uchida
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001317:Austria; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007389:Internal-External Control; D007564:Japan; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D055500:Resilience, Psychological; D012559:Schizophrenia / Q000503:physiopathology; D012565:Schizophrenic Psychology; D012649:Self Concept; D057566:Self Report; D057545:Social Stigma; D011795:Surveys and Questionnaires
keywords: Hopelessness; Resilience; Schizophrenia; Self-esteem; Stigma; Transcultural