Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders
Self-stigma and its relationship with insight, demoralization, and clinical outcome among people with schizophrenia spectrum disorders
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DOI：
10.1016/j.comppsych.2011.08.001
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发表时间：
2012-07-01
影响因子：
7.3
通讯作者：
Vauth, Roland
中科院分区：
文献类型：
--
作者：
Cavelti, Marialuisa;Kvrgic, Sara;Vauth, Roland
背景：矛盾的是，洞察力与积极的结果（例如更好的治疗依从性和恢复）以及负面结果，例如抑郁，绝望，自尊心低和生活质量等负面结果。自我污名作为调节变量，无论更多的洞察力导致更好还是更糟的结果，都可以决定性。另一方面，自我污名可以充当洞察力和结果之间的调解人。因此，我们检查了自我污名作为主持人和调解人。方法：在145名使用问卷和结构化访谈的精神分裂症谱系障碍的门诊病人中，评估了145名患有精神分裂症谱系障碍的门诊病人之间的洞察力，自我污名，沮丧，症状和功能。结构方程模型用于分析横截面数据。结果：结果确认为主持人的自我污名：随着自我污名的增加，洞察力和沮丧的关联更加强大。自我污名还部分介导了洞察力与沮丧之间的积极关系。此外，沮丧的化完全介导了自我污名与精神病症状和全球功能的不利联系。讨论：鉴于自我污名对洞察力的有害后果的决定性作用，干预措施应解决自我污名，特别是如果精神教育或其他干预措施有任何干预措施洞察力增加。讨论了在叙事身份级别恢复背景下与疾病和自我相关的功能失调信念的变化的治疗意义。 （c）2012 Elsevier Inc.保留所有权利。
Background: Paradoxically, insight is associated with positive outcomes, such as better treatment adherence and recovery, and negative outcomes, such as depression, hopelessness, low self-esteem, and quality of life. Self-stigma as a moderating variable can be decisive whether more insight leads to better or worse outcome. On the other hand, self-stigma can act as a mediator between insight and outcomes. We therefore examined self-stigma both as a moderator and a mediator.Methods: Insight, self-stigma, demoralization, symptoms, and functioning were assessed among 145 outpatients with schizophrenia spectrum disorders using questionnaires and structured interviews. Structural equation modeling was used to analyze the cross-sectional data.Results: Results confirmed self-stigma as a moderator: The association of insight and demoralization was stronger as self-stigma increased. Self-stigma also partially mediated the positive relationship between insight and demoralization. Moreover, demoralization fully mediated the adverse associations of self-stigma with psychotic symptoms and global functioning.Discussion: Given the decisive role of self-stigma regarding the detrimental consequences of insight, interventions should address self-stigma, particularly if psychoeducational or other interventions have increased insight. Therapeutic implications for changes of dysfunctional beliefs related to illness and self and change of self-concept in the context of recovery at the level of narrative identity are discussed. (C) 2012 Elsevier Inc. All rights reserved.