Internalized stigma in schizophrenia: a cross-sectional study of prevalence and predictors

Self-stigma is a major problem in schizophrenia, with far reaching consequences on treatment and overall outcome, but scarcely examined. In this study we investigated the prevalence and predictors of internalized stigma in schizophrenia in an outpatient population. We recruited 370 adult outpatients with DSM-IV diagnosis of schizophrenia. All participants were interviewed with a sociodemographic and clinical questionnaire, the 18-item Brief Psychiatric Rating Scale (BPRS-18) and the 29-item Internalized Stigma of Mental Illness (ISMI) scale. The mean age of participants was 37.87 (± 11.24) years, and included 189 (51.1%) females. The prevalence of high self-stigma was 16.5%. As per ISMI subscales, high experience of discrimination was reported more by participants (24.1%) compared to high alienation (22.4%), high stereotype endorsement(8.6%), and high social withdrawal (20.3%). Only 28.1% of participants scored high on stigma resistance. Following regression analysis, the experience of high self-stigma was independently related to lack of formal education (OR = 3.908), absence of good social support (OR = 0.387), high psychopathology based on the BPRS-18 (OR = 1.156) and less than US$25 average income per month (OR = 0.4990). Self-stigma is a major challenge among patients with schizophrenia beyond acute in-patient treatment. Routine information elicited during clinic visits may help index those with high stigma risk to warrant further exploration and targeted anti-stigma intervention if needed.