title: Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis.
abstract: It is acknowledged that people with a schizophrenia-spectrum diagnosis experience higher levels of stigma compared to any other mental health diagnosis. As a consequence, their experience of internalised stigma is likely to be the most detrimental and pervasive. Internalised stigma interventions have shown some benefits in those who experience serious mental illness including those with a schizophrenia-spectrum diagnosis. A systematic narrative review and meta-analysis were conducted examining the efficacy of internalised stigma interventions for people with a schizophrenia-spectrum diagnosis. Randomised Controlled Trials, controlled trials, and cohort studies were included and assessed against quality criteria. The search identified 12 studies; 7 randomised controlled trials, 3 cohort studies and 2 controlled trials. A variety of psychosocial interventions were utilised with the majority employing Cognitive Behaviour Therapy (CBT), psychoeducation and social skills training. The core outcomes used to examine the efficacy of the intervention were internalised stigma, self-esteem, empowerment, and functioning. The meta-analysis revealed an improvement in internalised stigma favouring the internalised stigma intervention but was not significant (5 RCTs, n=200). Self-efficacy and insight were significantly improved favouring the internalised stigma intervention. Internalised stigma interventions show promise in those with schizophrenia-spectrum diagnoses. Existing interventions have demonstrated small effects and employed small samples. Large scale RCTs are required to further develop the evidence base of more targeted interventions.
authors.affiliation: North East London Foundation Trust, Goodmayes Hospital, Barley Lane, Ilford IG3 8XJ, United Kingdom; University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom. Electronic address: lisawood3@nhs.net.
authors.forename: Lisa
authors.initials: L
authors.lastname: Wood
authors.affiliation: Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Rico House, Prestwich, Manchester M25 9WL, United Kingdom.
authors.forename: Rory
authors.initials: R
authors.lastname: Byrne
authors.affiliation: University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom.
authors.forename: Filippo
authors.initials: F
authors.lastname: Varese
authors.affiliation: University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Rico House, Prestwich, Manchester M25 9WL, United Kingdom.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Morrison
mesh_terms: D006801:Humans; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D057545:Social Stigma
keywords: Internalised stigma interventions; Narrative synthesis; Psychosis; Schizophrenia; Stigma; Systematic review