The impact of internalized stigma on the well-being of people with Schizophrenia

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Previous research has shown that the internalization of schizophrenia-related stigma is associated with a worse prognosis and more suicidal tendencies. Empirical literature suggests that affective well-being -composed of positive affect (e.g. pride, enthusiasm, vitality, inspiration) and negative affect (e.g. shame, guilt, annoyance, worry)- seems to be the key component which, when being negatively affected by internalized stigma and the subsequent deterioration of self-concept, would lead to more severe symptomatology, lower recovery, and higher risk of suicide. Thus, our aim was to delve into the process by which affective well-being is impacted by the two main dimensions of internalized stigma (stereotype endorsement and alienation), with self-esteem and self-efficacy as mediators. The model was tested by path analysis -maximum likelihood procedure- in a sample of 216 patients. Our results indicate that alienation would entail more damage than stereotype endorsement both on affective well-being and on self-concept. Findings suggest that self-esteem mediates the impact of both internalized stigma dimensions on both types of affect, and that self-efficacy mediates the impact of alienation on positive affect. It is concluded that, in clinical practice, an important effort should be made to prevent internalized stigma (especially, alienation) and to promote positive self-concept of patients (especially, self-esteem).