Objective: This study was conducted to investigate the impact of perceived stigma on the mental health among patients with schizophrenia and to test the mediating effects of self-compassion and self-stigma.
Methods: A total of 102 clinically stable patients with schizophrenia were recruited and they completed the Perceived Devaluation Discrimination Scale (PDD), the Internalized Stigma of Mental Illness (ISMI), the Self-Compassion Scale (SCS), the Self-Esteem Scale (SES), the Patient Health Questionnaire-9 (PHQ-9), and the Social Avoidance and Distress Scale (SAD). Pearson correlation analyses were conducted among the six variables: perceived stigma, self-compassion, self-stigma, self-esteem, depression, and social avoidance and distress. Furthermore, with perceived stigma as the independent variable, self-compassion and self-stigma as mediating variables, and self-esteem, depression, and social avoidance and distress as dependent variables, the significance of three chain mediation models was examined separately.
Results: Data analysis results showed that perceived stigma of patients with schizophrenia significantly predicted self-esteem (total effect=-0.306), depression (total effect=0.213), and social avoidance and distress (total effect=0.220). Mediation analyses indicated that self-compassion played a mediating role between perceived stigma and self-esteem, depression, social avoidance and distress; self-compassion and self-stigma jointly functioned as a chain mediation between perceived stigma and self-esteem, depression, social avoidance and distress.
Conclusion: Perceived stigma among patients with schizophrenia has a negative impact on mental health through decreasing self-compassion, and can also exerts its influence through decreasing self-compassion and increasing self-stigma.
[1] 卞崔冬, 何筱衍, 钱洁, 吴文源, 李春波. (2009). 患者健康问卷抑郁症状群量表在综合性医院中的应用研究.同济大学学报(医学版), 30(5), 136-140.
[2] 何孔亮, 耿峰, 郜见亮, 郝蕊, 靳胜春, 王璐, 汪凯. (2018). 精神分裂症患者自我怜悯水平与病耻感之间的相关性分析.安徽医科大学学报, 53(3), 445-448. doi: 10.19405/j.cnki.issn1000-1492.2018.03.025
[3] 汪向东, 王希林, 马弘. (1999). 心理卫生评定量表手册(增订版, pp.215-216, 282-283). 北京: 中国心理卫生杂志社.
[4] 王宇, 李英丽, 周郁秋. (2021). 稳定期精神分裂症患者社区融合体验的质性研究.解放军护理杂志, 38(4), 25-28.
[5] 徐晖. (2008). 精神分裂症患者病耻感及其与服药依从性关系的研究(硕士学位论文). 中国协和医科大学, 北京.
[6] 张经纬, 郝志红. (2019). 公众污名对大学生心理求助态度的影响:自我怜悯和自我污名的链式中介作用.中国临床心理学杂志, 27(6), 1227-1231. doi: 10.16128/j.cnki.1005-3611.2019.06.030
[7] Ali M. P., Tiles-Sar N., Simons C. J., Osicka D. A., Habtewold T. D., van der Meer L.,.. Alizadeh B. Z. (2024). Does stigma leave its mark? The interplay between negative effects of perceived stigma with positive effect of self-esteem on long-term social functioning in schizophrenia.Schizophr Res, 274, 417-426. doi: 10.1016/j.schres.2024.10.011
[8] Bommarito S., Stevenson A., & Warren R. (2025). Self-compassion across anxiety and mood disorders: Implications for treatment.Curr Psychiatry Rep, 27(2), 134-139. doi: 10.1007/s11920-024-01582-5
[9] Chan, K. K., & Tsui, J. K. (2023). Longitudinal impact of experienced discrimination on mental health among people with mental disorders.Psychiat Res, 322, 115099. doi: 10.1016/j.psychres.2023.115099
[10] Chan K. K., Tsui J. K., & Tang A. T. (2023). Longitudinal impact of self-compassion and psychological flexibility on mental illness recovery: The mediating roles of self-stigma and mental health service engagement.Mindfulness, 14(5), 1125-1134. doi: 10.1007/s12671-023-02127-2
[11] Dubreucq J., Plasse J., & Franck N. (2021). Self-stigma in serious mental illness: A systematic review of frequency, correlates, and consequences.Schizophrenia Bull, 47(5), 1261-1287. doi: 10.1093/schbul/sbaa181
[12] Eccles F. J., Sowter N., Spokes T., Zarotti N., & Simpson J. (2023). Stigma, self-compassion, and psychological distress among people with Parkinson’s.Disabil Rehabil, 45(3), 425-433. doi: 10.1080/09638288.2022.2037743
[13] Ewert C., Vater A., & Schroder-Abe M. (2021). Self-compassion and coping: A meta-analysis.Mindfulness, 12(5), 1063-1077. doi: 10.1007/s12671-020-01563-8
[14] Fond G., Vidal M., Joseph M., Etchecopar-Etchart D., Solmi M., Yon D. K.,.. Boyer L. (2023). Self-stigma in schizophrenia: A systematic review and meta-analysis of 37 studies from 25 high-and low-to-middle income countries.Molecular Psychiatry, 28(5), 1920-1931. doi: 10.1038/s41380-023-02003-4
[15] Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall Inc.
[16] Li Q., Wu J., & Wu Q. (2022). Self-compassion buffers the psychological distress from perceived discrimination among socioeconomically disadvantaged emerging adults: A longitudinal study.Mindfulness, 13(2), 500-508. doi: 10.1007/s12671-021-01810-6
[17] Liao K. Y., Kashubeck-West S., Weng C. Y., & Deitz C. (2015). Testing a mediation framework for the link between perceived discrimination and psychological distress among sexual minority individuals.J Couns Psychol., 62(2), 226-241. doi: 10.1037/cou0000064
[18] Link B. G., Struening E., Cullen F. T., Shrout P. E., & Dohrenwend B. P. (1989). A modified labeling theory approach to mental disorders: An empirical assessment.Am Sociol Rev, 54(3), 400-423. doi: 10.2307/2095613
[19] Lu M., Yang Y., Wang G., Wang H., & Feng D. (2022). Effects of perceived stigma on depressive symptoms and demoralization in maintenance hemodialysis patients: Self-warmth and self-coldness as mediators.Mindfulness, 13(12), 3058-3069. doi: 10.1007/s12671-022-02011-5
[20] Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself.Self Identity, 2(2), 85-101. doi: 10.1080/15298860390129863
[21] Ociskova M., Prasko J., Holubova M., Latalova K., Sollar T., Zatkova M.,.. Bocek J. (2023). Self-stigma in patients with schizophrenia: Impact and management.Neuro Endocrinol Lett, 44(6), 368-383.
[22] Picco L., Lau Y. W., Pang S., Abdin E., Vaingankar J. A., Chong S. A., & Subramaniam M. (2017). Mediating effects of self-stigma on the relationship between perceived stigma and psychosocial outcomes among psychiatric outpatients: Findings from a cross-sectional survey in Singapore. BMJ Open, 7(8), Article e018228. doi: 10.1136/bmjopen-2017-018228
[23] Pullmer R., Kerrigan S. G., Grilo C. M., & Lydecker J. A. (2021). Factors linking perceived discrimination and weight bias internalization to body appreciation and eating pathology: A moderated mediation analysis of self-compassion and psychological distress.Stig Health, 6(4), 494-501. doi: 10.1037/sah0000334
[24] Riebel M., Rohmer O., Charles E., Lefebvre F., Weibel S., & Weiner L. (2023). Compassion-focused therapy (CFT) for the reduction of the self-stigma of mental disorders: The compassion for psychiatric disorders, autism and self-stigma (COMPASS) study protocol for a randomized controlled study.Trials, 24(1), 393. doi: 10.1186/s13063-023-07393-y
[25] Ritsher J. B., Otilingam P. G., Grajales M. (2003). Internalized stigma of mental illness: psychometric properties of a new measure.Psychiatry Res, 121(1), 31-49. doi: 10.1016/j.psychres.2003.08.008
[26] Tang Q., Yang S., Liu C., Li L., Chen X., Wu F., & Huang X. (2021). Effects of mindfulness-based cognitive therapy on stigma in female patients with schizophrenia.Front Psychiatry, 12. doi: 10.3389/fpsyt.2021.694575
[27] Williams S. L., Fekete E. M., & Skinta M. D. (2021). Self-compassion in PLWH: Less internalized shame and negative psychosocial outcomes.Behav Med, 47(1), 60-68. doi: 10.1080/08964289.2019.1659749
[28] Wong C. C., Knee C. R., Neighbors C., & Zvolensky M. J. (2019). Hacking stigma by loving yourself: A mediated-moderation model of self-compassion and stigma.Mindfulness, 10(3), 415-433. doi: 10.1007/s12671-018-0984-2
[29] Yip C. C., Fung W. T., Leung D. C., & Chan K. K. (2023). The impact of stigma on engaged living and life satisfaction among people with mental illness in Hong Kong.Qual Life Res, 32(1), 161-170. doi: 10.1007/s11136-022-03218-8
[30] Yuen, A. S., & Mak, W. W. (2021). The effects of immersive virtual reality in reducing public stigma of mental illness in the university population of Hong Kong: Randomized controlled trial. J Med Internet Res, 23(7). doi: 10.2196/23683
[31] Zheng S., Wang R., Zhang S., Ou Y., Sheng X., Yang M.,.. Zhou X. (2023). Depression severity mediates stigma and quality of life in clinically stable people with schizophrenia in rural China.BMC Psychiatry, 23(1), 826. doi: 10.1186/s12888-023-05355-x
