Skip to main content
SpringerLink
Log in

The Mediating Effect of Depression and Disability in the Relationship Between Schizophreniaand Self-Esteem

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Depressive symptoms, in addition to positive and negative symptoms, are commonly observed in the course of schizophrenia. These symptoms may cause disability and reduced self-esteem. Disability and lower self-esteem may disrupt the quality of life and lead to social isolation. Demonstrating the relationships among these concepts and correcting possible disturbances may help to augment treatment compliance and improve the prognosis. In this study, the Calgary Depression Scale for Schizophrenia (CDSS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and the Rosenberg Self Esteem Scale (RSES) were applied along with a sociodemographic data form to 146 patients with schizophrenia. Path analyses were used to demonstrate the direct effect of schizophrenia severity on self-esteem and its indirect effect through disability and depression, the mediating effect of depression in the relationship between schizophrenia severity and disability, and the mediator effect of disability in the bidirectional relationship between self-esteem and depression. Statistically significant results were obtained. In multivariate regression analysis, significant effects on disability were demonstrated for PANSS General Psychopathology subscale, CDSS, and RSES. These data suggest that attention should be focused on concepts such as depression, disability, and self-esteem in schizophrenia patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Holding JC, Tarrier N, Gregg L, Barrowclough C. Self-esteem and relapse in schizophrenia. J Nerv Ment Dis. 2013;201(8):653–8. https://doi.org/10.1097/nmd.0b013e31829c4ffc.

    Article  PubMed  Google Scholar 

  2. Tandon R, Keshavan MS, Nasrallah HA. Schizophrenia,”just the facts”: what we know in 2008: part 1: overview. Schizophrenia Res. 2008;100(1–3):4–19.

  3. Dai J, Du X, Yin G, Zhang Y, Xia H, Li X, et al. Prevalence, demographic and clinical features of comorbid depressive symptoms in drug naive patients with schizophrenia presenting with first episode psychosis. Schizophrenia Res. 2018;193:182–7. https://doi.org/10.1016/j.schres.2017.06.029.

    Article  Google Scholar 

  4. Upthegrove R, Marwaha S, Birchwood M. Depression and schizophrenia: cause, consequence, or trans-diagnostic issue? Schizophrenia Bul. 2017;43(2):240–4. https://doi.org/10.1093/schbul/sbw097.

    Article  Google Scholar 

  5. Hou CL, Ma XR, Cai MY, Li Y, Zang Y, Jia FJ, et al. Comorbid moderate–severe depressive symptoms and their association with quality of life in Chinese patients with schizophrenia treated in primary care. Community Ment Health J. 2016;52(8):921–6. https://doi.org/10.1007/s10597-016-0023-5.

    Article  PubMed  Google Scholar 

  6. Lançon C, Auquier P, Reine G, Bernard D, Addington D. Relationships between depression and psychotic symptoms of schizophrenia during an acute episode and stable period. Schizophrenia Res. 2001;47(2–3):135–40. https://doi.org/10.1016/S0920-9964(00)00002-5.

    Article  Google Scholar 

  7. Bowie CR, Depp C, McGrath JA, Wolyniec P, Mausbach BT, Thornquist MH, et al. Prediction of real-world functional disability in chronic mental disorders: a comparison of schizophrenia and bipolar disorder. Am J Psychiatry. 2010;167(9):1116–24.

    Article  Google Scholar 

  8. Sabbag S, Twamley EW, Vella L, Heaton RK, Patterson TL, Harvey PD. Predictors of the accuracy of self assessment of everyday functioning in people with schizophrenia. Schizophrenia Res. 2012;137(1–3):190–5. https://doi.org/10.1016/j.schres.2012.02.002.

    Article  Google Scholar 

  9. Uluğ B, Ertuğrul A, Göğüş A, Kabakçı E. Yetiyitimi değerlendirme çizelgesinin (WHO-DAS-II) şizofreni hastalarında geçerlilik ve güvenilirliği. Turk Psikiyatri Derg. 2001;12:121–30.

    Google Scholar 

  10. Ritsner MS, Gibel A. Quality of life impairment syndrome in schizophrenia. In: Ritsner MS, Awad AG, editors. Quality of life impairment in schizophrenia, mood and anxiety disorders. Dordrecht: Springer; 2007. p. 173–226. https://doi.org/10.1007/978-1-4020-5779-3_10.

    Chapter  Google Scholar 

  11. Świtaj P, Anczewska M, Chrostek A, Sabariego C, Cieza A, Bickenbach J, et al. Disability and schizophrenia: a systematic review of experienced psychosocial difficulties. BMC Psychiatry. 2012;12(1):193.

    Article  Google Scholar 

  12. Leung WW, Bowie CR, Harvey PD. Functional implications of neuropsychological normality and symptom remission in older outpatients diagnosed with schizophrenia: a cross-sectional study. J Int Neuropsychol Soc. 2008;14(3):479–88.

    Article  Google Scholar 

  13. Bowie CR, Leung WW, Reichenberg A, McClure MM, Patterson TL, Heaton RK, et al. Predicting schizophrenia patients' real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry. 2008;63(5):505–11. https://doi.org/10.1016/j.biopsych.2007.05.022.

    Article  PubMed  Google Scholar 

  14. Harvey PD, Strassing M. Predicting the severity of everyday functional disability in people with schizophrenia: cognitive deficits, functional capacity, symptoms, and health status. World Psychiatry. 2012;11(2):73–9. https://doi.org/10.1016/j.wpsyc.2012.05.004.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Llorca PM, Lançon C, Lancrenon S, Bayle FJ, Caci H, Rouillon F, et al. The “functional remission of general schizophrenia” (FROGS) scale: development and validation of a new questionnaire. Schizophrenia Res. 2009;113(2–3):218–25.

    Article  Google Scholar 

  16. Romm KL, Rossberg JI, Hansen CF, Haug E, Andreassen OA, Melle I. Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis. BMC Psychiatry. 2011;11(1):136. https://doi.org/10.1186/1471-244X-11-136.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kumar S, Mohanty S. Factors associated with self esteem in patients with chronic schizophrenia. SIS J Project Psychol Mental Health. 2016;23(1):56–60.

    Google Scholar 

  18. Silverstone PH, Salsali M. Low self-esteem and psychiatric patients: part I – the relationship between low self-esteem and psychiatric diagnosis. Ann Gen Hosp Psychiatry. 2003;2(1):2. https://doi.org/10.1186/1475-2832-2-2.

    Article  PubMed  PubMed Central  Google Scholar 

  19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Publishing; 2013.

    Book  Google Scholar 

  20. Qiu W, Qiu MW. Package ‘powerMediation’. R Foundation for Statistical Computing. 2018. ftp://sourceforge.mirror.ac.za/cran/web/packages/powerMediation/powerMediation.pdf. Accessed 2 May 2019.

  21. Kaplan HI, Sadock JB. Clinical examination of the psychiatric patients. Kaplan and Sadock's synopsis of psychiatry, 10th ed. Philadelphia: Lippincott Williams and Wilkins and Wolter Kluwer Health; 2009.

    Google Scholar 

  22. Addington D, Addington J, Maticka-Tyndale E. Assessing depression in schizophrenia: the Calgary depression scale. Br J Psychiatry. 1993;163(S22):39–44.

    Article  Google Scholar 

  23. Aydemir Ö, Esen Danacı A, Deveci A, İçelli İ. Calgary Şizofrenide Depresyon Ölçeği'nin Türkçe versiyonunun güvenilirliği ve geçerliliği (reliability and validity of the Turkish version of Calgary depression scale for schizophrenia). Nöropsikiyatri Arşivi. 2000;37(1):82–6.

    Google Scholar 

  24. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bull. 1987;13(2):261–76.

    Article  CAS  Google Scholar 

  25. Kostakoğlu AE, Batur S, Tiryaki A, Göğüş A. Pozitif ve negatif sendrom ölçeğinin (PANSS) Türkçe uyarlamasının geçerlilik ve güvenilirliği. Turk Psikol Derg. 1999;14:23–32.

    Google Scholar 

  26. Üstün TB, Kostanjsek N, Chatterji S, Rehm J. Measuring health and disability: manual for WHO disability assessment schedule WHODAS 2.0. Geneva: World Health Organization; 2010.

    Google Scholar 

  27. Kunt DA, Dereboy F. Dünya Sağlık Örgütü Yetiyitimi Değerlendirme Çizelgesinin (WHODAS 2.0) Türkçe çevirisinin geçerlik ve güvenirliğinin psikiyatri hastaları ve sağlıklı kontrollerde incelenmesi (Validity and reliability of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in Turkish psychiatry patients and healthy controls). Türk Psikiyatri Derg 2018;29(4):248–257. https://doi.org/10.5080/u20481.

  28. Rosenberg M. Society and the adolescent self-image. Princeton University Press: Princeton; 1965.

    Book  Google Scholar 

  29. Çuhadaroğlu F. Adolesanlarda benlik saygısı (self-esteem in adolescence). Unpublished doctoral dissertation. Ankara: Hacettepe University; 1986.

    Google Scholar 

  30. Stevens JP. Applied multivariate statistics for the social sciences. 5th ed. New York: Routledge; 2009.

    Google Scholar 

  31. Kline RB. Principles and practice of structural equation modeling. 2nd ed. New York: Guilford Press; 2005.

    Google Scholar 

  32. Byrne BM. Structural equation modeling with AMOS: basic concepts, applications, and programming. 2nd ed. New York: Taylor & Francis; 2010.

    Google Scholar 

  33. Kelloway EK. Using LISREL for structural equation modeling: a researcher's guide. Thousand Oaks: Sage Publications; 1998.

    Google Scholar 

  34. Silber E, Tippett JS. Self-esteem: clinical assessment and measurement validation. Psychol Rep. 1965;16:1017–71. https://doi.org/10.2466/pr0.1965.16.3c.1017.

    Article  Google Scholar 

  35. Link BG, Struening EL, Neese-Todd S, Asmussen S, Phelan JC. Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatr Serv. 2001;52:1621–6.

    Article  CAS  Google Scholar 

  36. Brekke JS, Kohrt B. Neuropsychological functioning as a moderator of the relationship between psychosocial functioning and the subjective experience of self and life in schizophrenia. Schizophrenia Bull. 2001;27(4):697–705.

    Article  CAS  Google Scholar 

  37. Smith B, Fowler DG, Freeman D, Bebbington P, Bashforth H, Garety P, et al. Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophrenia Res. 2006;86(1–3):181–8. https://doi.org/10.1016/j.schres.2006.06.018.

    Article  Google Scholar 

  38. Barrowclough C, Tarrier N, Humphreys L, Ward J, Gregg L, Andrews B. Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology. J Abnorm Psychol. 2003;112(1):92–9.

    Article  Google Scholar 

  39. Milev P, Ho BC, Arndt S, Andreasen NC. Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry. 2005;162(3):495–506. https://doi.org/10.1176/appi.ajp.162.3.495.

    Article  PubMed  Google Scholar 

  40. Buchanan RW. Persistent negative symptoms in schizophrenia: an overview. Schizophrenia Bull. 2007;33(4):1013–22. https://doi.org/10.1093/schbul/sbl057.

    Article  Google Scholar 

  41. Üçok A, Polat A, Çakir S, Genç A. One year outcome in first episode schizophrenia: predictors of relapse. Eur Arch Psychiatry Clin Neurosci. 2006;256(1):37–43. https://doi.org/10.1007/s00406-005-0598-2.

    Article  PubMed  Google Scholar 

  42. Galderisi S, Rossi A, Rocca P, Bertolino A, Mucci A, Bucci P, et al. The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry. 2014;13(3):275–87. https://doi.org/10.1002/wps.20167.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Karatzias T, Gumley A, Power K, O'Grady M. Illness appraisals and self-esteem as correlates of anxiety and affective comorbid disorders in schizophrenia. Compr Psychiatry. 2007;48(4):371–5. https://doi.org/10.1016/j.comppsych.2007.02.005.

    Article  PubMed  Google Scholar 

  44. Siris S, Bench C. Depression and schizophrenia. In: Hirsch SR, Weinberger DR, editors. Schizophrenia. 2nd ed. Malden: Blackwell Science; 2003. p. 142–67. https://doi.org/10.1002/9780470987353.ch9.

    Chapter  Google Scholar 

  45. Rosenberg M, Schoenbach C, Shooler C, Rosenberg F. Global self-esteem and specific self-esteem: different concepts, different outcomes. Am Sociol Rev. 1995;60(1):141–56.

    Article  Google Scholar 

  46. Maxwell SE, Cole DA. Bias in cross sectional analyses of longitudinal mediation. Pscyhol Methods. 2007;12(1):23–44.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Çukurova University Medical School, Psikiyatri Anabilim Dalı, Çukurova Üniversitesi Tıp Fakültesi Balcalı Hastanesi 01330 Sarıçam, Adana, Turkey

    Mehmet Emin Demirkol & Lut Tamam

  2. Department of Psychiatry, Şanlıurfa Mehmet Akif Inan State Hospital, Şanlıurfa, Turkey

    Zeynep Namlı

  3. Department of Psychiatry, Malatya Training and Research Hospital, Malatya, Turkey

    Kerim Uğur

  4. Department of Psychiatry, Dr Ekrem Tok Hospital for Mental and Nervous Disesase, Adana, Turkey

    Mahmut Onur Karaytuğ

Authors
  1. Mehmet Emin Demirkol
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lut Tamam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zeynep Namlı
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kerim Uğur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mahmut Onur Karaytuğ
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Finding the subject: LT, MED; Literature review: MED, LT, ZN; Conducting research: MED, LT, ZN, MOK, KU; Applying scales: MED; Statistical Analysis: LT, MED; Writing the manuscript: MED, LT, ZN, KU, MOK; Review the manuscript: LT, MED, ZN, KU, MOK.

All authors have seen and approved the final version of the manuscript and believe that the manuscript represents honest work.

Corresponding author

Correspondence to Lut Tamam.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Ethics Committee for Non-interventional Studies at Çukurova University School of Medicine.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Demirkol, M.E., Tamam, L., Namlı, Z. et al. The Mediating Effect of Depression and Disability in the Relationship Between Schizophreniaand Self-Esteem. Psychiatr Q 91, 363–378 (2020). https://doi.org/10.1007/s11126-019-09706-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-019-09706-4

Keywords

Search

Navigation