An integrative model of internalized stigma and recovery-related outcomes among people diagnosed with schizophrenia in rural China

  • Tian-Ming Zhang
  • Irene Yin-Ling Wong
  • Yue-Hui Yu
  • Shi-Guang Ni
  • Xue-Song He
  • John Bacon-Shone
  • Ke Gong
  • Chao-Hua Huang
  • Yan Hu
  • Ming-Min Tang
  • Wan Cao
  • Cecilia Lai-Wan Chan
  • Mao-Sheng RanEmail author
  • CMHP Study Group
Original Paper



Internalized stigma, an adverse psychological process, severely impedes the lives of people diagnosed with schizophrenia and restricts them from social integration and recovery. The aim of this study was to empirically evaluate an integrative model of relationship between internalized stigma and patients’ recovery-related outcomes among people diagnosed with schizophrenia in a rural Chinese community.


A total of 232 people diagnosed with schizophrenia in Xinjin, Chengdu, participated in this study and completed measures of internalized stigma, social interaction, perceived social support, social functioning, and symptoms. The internalized stigma of mental illness scale (ISMI) was used to measure the internalized stigma. Path analysis was used to test the association between internalized stigma and recovery-related outcomes.


There were no significant differences in mean scores of ISMI by gender, age (18–64 years and ≥ 65 years), education, marital status, or economic capacity. Internalized stigma was negatively associated with perceived social support and social interaction. Furthermore, higher level of internalized stigma was associated with impaired social functioning, and a lower level of social functioning was significantly associated with more severe symptoms.


Internalized stigma is associated with poor social interaction and weakened perceived social support in people diagnosed with schizophrenia, and is linked negatively to outcomes in their recovery. It is essential to tailor interventions related to reducing internalized stigma within a Chinese context and evaluate the effectiveness of anti-stigma intervention on recovery for people diagnosed with schizophrenia.


Internalized stigma People diagnosed with schizophrenia Recovery Rural China 



The authors thank all the collaborative institutes (e.g., Peking University, Sichuan College of Traditional Chinese Medicine, Xinjin Mental Hospital, Chengdu Mental Health Center, Sichuan Veterans Hospital, Jingzhou Mental Health Center, Guangyuan Mental Health Center, Southwest Medical University, Chongqing Medical University, Chengdu Mental Hospital, Panzhihua Mental Health Center, Santai Mental Health Center) and CMHP Study group for collaboration, support and data collection.

Author contributions

Dr. Ran designed the study and Miss. Zhang wrote the first draft. The draft was modified by Dr. Wong, Dr. Ran, Mrs. Yu, Dr. Ni, Prof. He, Prof. Chan. and Prof. Bacon-Shone. In addition, Dr. Gong, Dr. Huang, Ms. Hu, Ms. Tang, and Dr. Cao made contribution to the data collection. The data were derived from Dr. Ran’s Chengdu Mental Health Project (CMHP). All authors made a significant intellectual contribution to the paper.


The mental health survey in 2015 was supported in part by Seed Funding Programme for Basic Research (HKU, 2014–2016, PI: Ran), Seed Funding Programme for Applied Research (HKU, 2014–2016, PI: Ran), Strategic Research Theme: Contemporary China Seed Funding (HKU, 2014–2016, PI: Ran), Small Project Funding (HKU, 2014–2016, PI: Chan), and Mental Health Research in Chengdu, China (Dept. Matching Fund, 2015–2017, PI: Ran).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Tian-Ming Zhang
    • 1
  • Irene Yin-Ling Wong
    • 2
  • Yue-Hui Yu
    • 1
  • Shi-Guang Ni
    • 3
  • Xue-Song He
    • 4
  • John Bacon-Shone
    • 5
  • Ke Gong
    • 6
  • Chao-Hua Huang
    • 6
  • Yan Hu
    • 7
  • Ming-Min Tang
    • 7
  • Wan Cao
    • 8
  • Cecilia Lai-Wan Chan
    • 1
  • Mao-Sheng Ran
    • 1
    Email author return OK on get
  • CMHP Study Group
  1. 1.Department of Social Work and Social AdministrationThe University of Hong KongHong KongChina
  2. 2.School of Social Policy and PracticeUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Graduate School at ShenzhenTsinghua UniversityShenzhenChina
  4. 4.School of Society and Public AdministrationEast China University of Science and TechnologyShanghaiChina
  5. 5.Social Sciences Research Centre, Faculty of Social SciencesThe University of Hong KongHong KongChina
  6. 6.Department of PsychiatrySouthwest Medical UniversitySichuanChina
  7. 7.Sichuan Veterans HospitalSichuanChina
  8. 8.Chongqing Medical UniversityChongqingChina

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