The relationship of self-stigma and insight to social functioning in people with first episode psychosis

Abstract

Background Many researches have studied stigma among people with mental illness, mainly focusing on its relationship with insight, psychological well-being and clinical outcomes. Psychotic disorder is described as a condition that influences one’s affect, thoughts and behaviors, with psychiatric symptoms including disorganized speech and bizarre behaviors, which frighten the general population. Common scales used in literatures to study stigma target the general population’s attitude towards mental illness instead of self-stigma, the internalized stereotypes of people suffering from psychotic disorders. Insight is likely to be different at different stages of schizophrenic spectrum disorder, but current evidence was mostly done in chronic schizophrenia patients.

Aim This study explored the correlational association between self-stigma, insight and social functioning among people with first episode psychotic disorder and if self-stigma and insight were predictors of social functioning.

Method Self-stigma, insight and social functioning were assessed among using structured interviews and questionnaires. Thirty-three out patients from the Early Intervention Team at Queen Mary Hospital in Hong Kong diagnosed with schizophrenic spectrum disorder participated in the study. The internalized stigma of mental illness scale was used to assess self-stigma; the unawareness of mental disorder scale was used to assess level of insight; and the social and occupational functioning assessment scale was used to assess level of social functioning.

Results The linear regression analysis showed that self-stigma and insight were not significant predictors of social functioning (r = 0.67, β= -0.289, p < 0.05; adjusted R² = 0.39). However the regression analysis showed the subscale stereotype endorsement was a significant predictor of social functioning (r = 0.690, β= -0.333, p < 0.05; adjusted R² = 0.420) and accounted for 47.6% of the variance in social functioning levels. Moreover, the bivariate correlational analysis showed significant negative correlational relationships between self-stigma and social functioning, and insight and social functioning. There was no correlational relationship between self-stigma and level of insight.

Conclusion Results showed that self-stigma and insight play different roles towards social and role functioning. Although analysis did not show a significant outcome indicating self-stigma and insight being the predictors of functioning, data showed that the values were close to being significant.