title: The role of shame in people with a diagnosis of schizophrenia.
abstract: OBJECTIVE
  To examine the role of shame and its relationship to depression in schizophrenia. It was predicted that individuals with a diagnosis of schizophrenia would exhibit higher levels of shame due to the stigma associated with their diagnosis, independently of depression levels, compared with psychiatric and medical control groups.
  
  
  METHODS
  Cross-sectional design with three groups: individuals with a diagnosis of (1) schizophrenia, (2) depression, and (3) rheumatoid arthritis.
  
  
  METHODS
  Sixty individuals participated in the study (20 per group). Groups were compared on questionnaires assessing external shame, trait shame and guilt, and depression.
  
  
  RESULTS
  The pattern of group differences depended on the type of shame measure used. Both the schizophrenia and depression groups exhibited higher levels of external shame, or seeing others as shaming, than the medical group. For individuals with schizophrenia, seeing others as shaming was associated with higher levels of depression, a relationship not found in either control group. They also showed lower levels of trait guilt and shame (at trend level), compared with both control groups. No difference was found between the groups on depression, suggesting that the observed differences were not attributable to differences in levels of depression.
  
  
  CONCLUSIONS
  The findings highlight the importance of shame in schizophrenia, especially the link between seeing other people as shaming and depression, which was unique to this group. These results suggest that stigma associated with a diagnosis of mental illness, and schizophrenia in particular, has negative emotional consequences that may impede recovery, and should be addressed by psychological and social interventions.
  
  
  CONCLUSIONS
  Clinical implications Individuals with a diagnosis of mental illness (schizophrenia or depression) are more likely to experience others as shaming than those diagnosed with a physical illness, irrespective of current levels of depression and proneness to shame. There is a specific association between external shame and depression in individuals diagnosed with schizophrenia, suggesting the need for interventions levelled both at the individual's illness appraisals, and at social stigma relating to schizophrenia. Limitations of the study The participant numbers were low in each group. The three groups could not be matched on all variables. No additional internalized-stigma measure was used.
authors.affiliation: Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London and Maudsley NHS Foundation Trust, UK.
authors.forename: Nadine
authors.initials: N
authors.lastname: Keen
authors.affiliation: Ganjuu Wellbeing Service, Okinawan Institute of Science & Technology (OIST), Japan.|Department of Clinical, Educational and Health Psychology, University College London, UK.
authors.forename: Darren
authors.initials: D
authors.lastname: George
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Scragg
authors.affiliation: Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London and Maudsley NHS Foundation Trust, UK.|Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.|National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, UK.
authors.forename: Emmanuelle
authors.identifier: http://orcid.org/0000-0003-3327-9223
authors.initials: E
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012559:Schizophrenia / Q000150:complications*; D012752:Shame; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: depression; schizophrenia; shame; social-rank; stigma