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Insight, positive and negative symptoms, hope, depression and self-stigma: a comprehensive model of mutual influences in schizophrenia spectrum disorders

Published online by Cambridge University Press:  24 July 2013

B. Schrank ,
M. Amering ,
A. Grant Hay ,
M. Weber  and
I. Sibitz
B. Schrank*
Affiliation:
King's College London, Institute of Psychiatry, London, UK Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
M. Amering
Affiliation:
Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
A. Grant Hay
Affiliation:
Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
M. Weber
Affiliation:
Department of Radiology, Medical University Vienna, Vienna, Austria
I. Sibitz
Affiliation:
Department of Psychiatry and Psychotherapy, Medical University Vienna, Vienna, Austria
*
*Address for correspondence: Dr B. Schrank, Department of Psychiatry and Psychotherapy, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. (Email: [email protected])
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Abstract

Aims.

Insight, positive and negative symptoms, hope, depression and self-stigma are relevant variables in schizophrenia spectrum disorders. So far, research on their mutual influences has been patchy. This study simultaneously tests the associations between these variables.

Methods.

A total of 284 people with schizophrenia spectrum disorders were assessed using the Schedule for the Assessment of Insight, Positive and Negative Syndrome Scale, Integrative Hope Scale, Centre for Epidemiological Studies Depression Scale and Internalized Stigma of Mental Illness scale. Path analysis was applied to test the hypothesized relationships between the variables.

Results.

Model support was excellent. Strong and mutual causal influences were confirmed between hope, depression and self-stigma. The model supported the assumption that insight diminishes hope and increases depression and self-stigma. While negative symptoms directly affected these three variables, reducing hope and increasing depression and self-stigma, positive symptoms did not. However, positive symptoms diminished self-stigma on a pathway via insight.

Conclusions.

This study provides a comprehensive synopsis of the relationships between six variables relevant for schizophrenia spectrum disorders. Research implications include the need to investigate determinants of consequences of insight, and the sequence of influences exerted by positive and negative symptoms. Clinical implications include the importance of interventions against self-stigma and of taking a contextualized approach to insight.

Keywords

Insightpath modellingschizophrenia spectrum disordersself-stigma
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 23 , Issue 3 , September 2014 , pp. 271 - 279
Copyright
Copyright © Cambridge University Press 2013 

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References

Amering, M (2012). Recovery, science and human rights. Epidemiology and Psychiatric Sciences 21, 367–369.CrossRefGoogle ScholarPubMed
Arnau, RC, Rosen, DH, Finch, JF, Rhudy, JL, Fortunato, VJ (2007). Longitudinal effects of hope on depression and anxiety: a latent variable analysis. Journal of Personality 75, 43–64.CrossRefGoogle ScholarPubMed
Brissos, S, Dias, VV, Balanza-Martinez, V, Carita, AI, Figueira, ML (2011). Symptomatic remission in schizophrenia patients: relationship with social functioning, quality of life, and neurocognitive performance. Schizophrenia Research 129, 133–136.CrossRefGoogle ScholarPubMed
Brohan, E, Elgie, R, Sartorius, N, Thornicroft, G (2010). Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophrenia Research 122, 232–238.CrossRefGoogle ScholarPubMed
Chakraborty, K, Basu, B (2010). Insight in schizophrenia – a comprehensive update. German Journal of Psychiatry 13, 17–30.Google Scholar
Corrigan, PW, Rafacz, J, Rüsch, N (2011). Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Research 189, 339–343.CrossRefGoogle ScholarPubMed
Erickson, M, Jaafari, N, Lysaker, P (2011). Insight and negative symptoms as predictors of functioning in a work setting in patients with schizophrenia. Psychiatry Research 189, 161–165.CrossRefGoogle Scholar
Ghaemi, SN, Rosenquist, KJ (2004). Is insight in mania state-dependent? A meta-analysis. Journal of Nervous and Mental Disorder 192, 771–775.CrossRefGoogle ScholarPubMed
Grace, JB (2006). Structural Equation Modeling and Natural Systems. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Hasson-Ohayon, I, Kravetz, S, Meir, T, Rozencwaig, S (2009). Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders. Psychiatry Research 167, 231–238.CrossRefGoogle ScholarPubMed
Hautzinger, M, Bailer, M (1993). ADS. Allgemeine Depressions Skala. Beltz Test GmbH: Göttingen.Google Scholar
Hengartner, MP, Loch, AA, Lawson, FL, Guarniero, FB, Wang, Y-P, Rössler, W, Gattaz, WF (2012). Public stigmatization of different mental disorders: a comprehensive attitude survey. Epidemiology and Psychiatric Sciences 26 July, 1–6. [Epub ahead of print].Google ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.CrossRefGoogle ScholarPubMed
Kemp, R, David, A (1996). Insight and compliance. In Treatment Compliance and the Therapeutic Alliance (ed. Blackwell, B.), pp. 61–84. Gordon and Breach Publishing Group: Newark, NJ.Google Scholar
Lanfredi, M, Rossi, G, Rossi, R, Van Bortel, T, Thornicroft, G, Quinn, N, Zoppei, S, Lasalvia, A (2013). Depression prevention and mental health promotion interventions: is stigma taken into account? An overview of the Italian initiatives. Epidemiology and Psychiatric Sciences 28 February, 1–12. [Epub ahead of print].CrossRefGoogle ScholarPubMed
Lakeman, R, McGowan, P, MacGabhann, L, Parkinson, M, Redmond, M, Sibitz, I, Stevenson, C, Walsh, J (2012). A qualitative study exploring experiences of discrimination associated with mental health problems in Ireland. Epidemiology and Psychiatric Sciences 21, 271–279.CrossRefGoogle ScholarPubMed
Levine, SZ, Rabinowitz, J, Rizopoulos, D (2011). Recommendations to improve the positive and negative syndrome scale (PANSS) based on item response theory. Psychiatry Research 188, 446–452.CrossRefGoogle ScholarPubMed
Lincoln, TM, Lullmann, E, Rief, W (2007). Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review. Schizophrenia Bulletin 33, 1324–1342.CrossRefGoogle ScholarPubMed
Link, BG, Struening, EL, Neese-Todd, S, Asmussen, S, Phelan, JC (2001). Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services 52, 1621–1626.CrossRefGoogle ScholarPubMed
Lopez-Morinigo, JD, Ramos-Rios, R, David, AS, Dutta, R (2012). Insight in schizophrenia and risk of suicide: a systematic update. Comprehensive Psychiatry 53, 313–322.CrossRefGoogle ScholarPubMed
Lysaker, PH, Roe, D, Yanos, PT (2007). Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin 33, 192–199.CrossRefGoogle ScholarPubMed
Mittal, D, Sullivan, G, Chekuri, L, Allee, E, Corrigan, PW (2012). Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatric Services 63, 974–981.CrossRefGoogle ScholarPubMed
Moritz, S, Favrod, J, Andreou, C, Morrison, AP, Bohn, F, Veckenstedt, R, Tonn, P, Karow, A (2012). Beyond the usual suspects: positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis. Schizophrenia Bulletin [Epub ahead of print 15 February 2012]Google ScholarPubMed
Müller, MJ, Rossbach, W, Davids, E, Wetzel, H, Benkert, O (2000). Evaluation of standardized rater training for the positive and negative syndrome scale (PANSS). Der Nervenarzt 71, 195–204.Google ScholarPubMed
Noordsy, D, Torrey, W, Mueser, K, Mead, S, O'Keefe, C, Fox, L (2002). Recovery from severe mental illness: an intrapersonal and functional outcome definition. International Review of Psychiatry 14, 318–326.CrossRefGoogle Scholar
Norman, RM, Windell, D, Lynch, J, Manchanda, R (2011). Parsing the relationship of stigma and insight to psychological well-being in psychotic disorders. Schizophrenia Research 133, 3–7.CrossRefGoogle ScholarPubMed
Park, SG, Bennett, ME, Couture, SM, Blanchard, JJ (2012). Internalized stigma in schizophrenia: relations with dysfunctional attitudes, symptoms, and quality of life. Psychiatry Research 205, 43–47.CrossRefGoogle ScholarPubMed
Pruß, L, Wiedl, KH, Waldorf, M (2012). Stigma as a predictor of insight in schizophrenia. Psychiatry Research 198, 187–193.CrossRefGoogle ScholarPubMed
Radloff, LS (1977). The CES-D scale: a self-report depression scale for research in the General Population. Applied Psychological Measurement 1, 385–401.CrossRefGoogle Scholar
Resnick, SG, Fontana, A, Lehman, AF, Rosenheck, RA (2005). An empirical conceptualization of the recovery orientation. Schizophrenia Research 75, 119–128.CrossRefGoogle ScholarPubMed
Ritsher, JB, Otilingam, PG, Grajales, M (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research 121, 31–49.CrossRefGoogle ScholarPubMed
Rose, D, Willis, R, Brohan, E, Sartorius, N, Villares, C, Wahlbeck, K, Thornicroft, G (2011). Reported stigma and discrimination by people with a diagnosis of schizophrenia. Epidemiology and Psychiatric Sciences 20, 193–204.CrossRefGoogle ScholarPubMed
Santor, DA, Ascher-Svanum, H, Lindenmayer, JP, Obenchain, RL (2007). Item response analysis of the positive and negative syndrome scale. BMC Psychiatry 7, 66.CrossRefGoogle ScholarPubMed
Schrank, B, Stanghellini, G, Slade, M (2008). Hope in psychiatry: a review of the literature. Acta Psychiatrica Scandinavica 118, 421–433.CrossRefGoogle ScholarPubMed
Schrank, B, Woppmann, A, Sibitz, I, Lauber, C (2011). Development and validation of an integrative scale to assess hope. Health Expectations 14, 417–428.CrossRefGoogle ScholarPubMed
Schrank, B, Woppmann, A, Grant Hay, A, Sibitz, I, Zehetmayer, S, Lauber, C (2012). Validation of the integrative hope scale in people with psychosis. Psychiatry Research 198, 395–399.CrossRefGoogle ScholarPubMed
Sibitz, I, Amering, M, Unger, A, Seyringer, ME, Bachmann, A, Schrank, B, Benesch, T, Schulze, B, Woppmann, A (2011 a). The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. European Psychiatry 26, 28–33.CrossRefGoogle ScholarPubMed
Sibitz, I, Unger, A, Woppmann, A, Zidek, T, Amering, M (2011 b). Stigma resistance in patients with schizophrenia. Schizophrenia Bulletin 37, 316–323.CrossRefGoogle ScholarPubMed
Sibitz, I, Friedrich, ME, Unger, A, Bachmann, A, Benesch, T, Amering, M (2013). Internalized stigma of schizophrenia: validation of the German version of the Internalized Stigma of Mental Illness-Scale (ISMI). Psychiatrische Praxis 40, 83–89.Google ScholarPubMed
Slade, M, Leamy, M, Bacon, F, Janosik, M, Le Boutillier, C, Williams, J, Bird, V (2012). International differences in understanding recovery: systematic review. Epidemiology and Psychiatric Sciences 21, 353–364.CrossRefGoogle ScholarPubMed
Staring, AB, Van der Gaag, M, Van den Berge, M, Duivenvoorden, HJ, Mulder, CL (2009). Stigma moderates the associations of insight with depressed mood, low self-esteem, and low quality of life in patients with schizophrenia spectrum disorders. Schizophrenia Research 115, 363–369.CrossRefGoogle ScholarPubMed
Vauth, R, Kleim, B, Wirtz, M, Corrigan, PW (2007). Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia. Psychiatry Research 150, 71–80.CrossRefGoogle ScholarPubMed
Warner, R, Mandiberg, JM (2013). Social networks, support and early psychosis: mutual support within service user communities. Epidemiology and Psychiatric Sciences 22, 151–154.CrossRefGoogle ScholarPubMed
Watson, AC, Corrigan, P, Larson, JE, Sells, M (2007). Self-stigma in people with mental illness. Schizophrenia Bulletin 33, 1312–1318.CrossRefGoogle ScholarPubMed
Yanos, PT, Roe, D, Lysaker, PH (2010). The impact of illness identity on recovery from severe mental illness. American Journal of Psychiatric Rehabilitation 13, 73–93.CrossRefGoogle ScholarPubMed
Yanos, PT, West, ML, Gonzales, L, Smith, SM, Roe, D, Lysaker, PH (2012 a). Change in internalized stigma and social functioning among persons diagnosed with severe mental illness. Psychiatry Research 200, 1032–1034.CrossRefGoogle ScholarPubMed
Yanos, PT, Roe, D, West, ML, Smith, SM, Lysaker, PH (2012 b). Group-based treatment for internalized stigma among persons with severe mental illness: findings from a randomized controlled trial. Psychological Services 9, 248–258.CrossRefGoogle ScholarPubMed