title: Self-Stigma and Its Relationship with Victimization, Psychotic Symptoms and Self-Esteem among People with Schizophrenia Spectrum Disorders.
abstract: OBJECTIVE
  Self-stigma is highly prevalent in schizophrenia and can be seen as an important factor leading to low self-esteem. It is however unclear how psychological factors and actual adverse events contribute to self-stigma. This study empirically examines how symptom severity and the experience of being victimized affect both self-stigma and self-esteem.
  
  
  METHODS
  Persons with a schizophrenia spectrum disorder (N = 102) were assessed with a battery of self-rating questionnaires and interviews. Structural equation modelling (SEM) was subsequently applied to test the fit of three models: a model with symptoms and victimization as direct predictors of self-stigma and negative self-esteem, a model with an indirect effect for symptoms mediated by victimization and a third model with a direct effect for negative symptoms and an indirect effect for positive symptoms mediated by victimization.
  
  
  RESULTS
  Results showed good model fit for the direct effects of both symptoms and victimization: both lead to an increase of self-stigma and subsequent negative self-esteem. Negative symptoms had a direct association with self-stigma, while the relationship between positive symptoms and self-stigma was mediated by victimization.
  
  
  CONCLUSIONS
  Our findings suggest that symptoms and victimization may contribute to self-stigma, leading to negative self-esteem in individuals with a schizophrenia spectrum disorder. Especially for patients with positive symptoms victimization seems to be an important factor in developing self-stigma. Given the burden of self-stigma on patients and the constraining effects on societal participation and service use, interventions targeting victimization as well as self-stigma are needed.
authors: Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands.
authors: Ellen M A
authors: EM
authors: Horsselenberg
authors: University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen The Netherlands.|Windesheim University of Applied Sciences, Zwolle, The Netherlands.
authors: Jooske T
authors: JT
authors: van Busschbach
authors: Department of Neurosciences, University Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Andre
authors: A
authors: Aleman
authors: Department of Psychotic Disorders, GGZ Drenthe, Assen, The Netherlands.|Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University Groningen, Groningen, The Netherlands.
authors: Gerdine H M
authors: GH
authors: Pijnenborg
mesh_terms: D000328:Adult; D019548:Crime Victims; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000175:diagnosis* / Q000473:pathology; D012565:Schizophrenic Psychology; D012649:Self Concept; D057566:Self Report; D057545:Social Stigma; D011795:Surveys and Questionnaires