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Stigma experiences and perceived stigma in patients with first-episode schizophrenia in the course of 1 year after their first in-patient treatment

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Abstract

Patients with schizophrenia suffer from stigma and discrimination due to their illness. Yet it is not well examined how experiences of stigma and discrimination express at the early illness stage and how they develop subsequently. Therefore, clinical and psycho-social correlates of stigma experiences and perceived stigma are analyzed in patients with first-episode schizophrenia over the course of 1 year after their first in-patient treatment. Questionnaire data assessed within the multi-centre-RCT “First-Episode Study” of the German Research Network on Schizophrenia were analyzed. Patients with first-episode schizophrenia were assessed 8 weeks after their first in-patient treatment (post-acute assessment) and 1 year later. N = 48 (post-acute) and N = 24 (1-year follow-up) patients provided questionnaire data appropriate for analyses, with N = 12 dyads. These data included burden due to stigma experiences (B-STE), perceived stigma (PDDQ), clinical (PANSS, CDSS, CGI, GAF, SAS) and psycho-social factors (LQLP, FSNK-self-esteem, KK-Scale). Cross-lag-correlation models showed a causal relation between stigma experiences (post-acute) and reduced self-esteem after 1 year. Multiple regression models revealed different models for experienced and perceived stigma. Factors associated with higher stigma experiences were older age, worse clinical global impression, better social adjustment, lower self-esteem, and the belief that illness is not driven by chance or fate. The different associations between psycho-social factors and stigma experiences and perceived stigma demonstrate the complexity of this inter-relationship. The results have practical implications for psycho-educational and other therapeutic interventions addressing stigma coping. Since the sample was small and selective, replication studies are needed.

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Acknowledgements

The authors are much obliged to the members of the German Study Group on First-Episode Schizophrenia as well as to the members of the scientific advisory board of the German Research Network on Schizophrenia for all their contributions. The German Study Group on First-Episode Schizophrenia consists of: W. Gaebel (P.I.), W. Wölwer, M. von Wilmsdorff, R. Krohmer, J. Brinkmeyer, and M. Riesbeck (Duesseldorf); (A) Klimke (Offenbach) and M. Eickhoff (Warstein/Lippstadt); H.-J. Moeller and M. Jäger (Munich); G. Buchkremer, S. Klingberg, and M. Mayenberger (Tuebingen); P. Hoff and F. Schneider (Aachen; recruitment until 6/2002); W. Maier, M. Lemke, (B) Johannwerner and K.-U. Kühn (Bonn); I. Heuser and M.C. Jockers-Scherübl (Berlin); J. Klosterkötter, A. Bechdolf, and W. Huff (Cologne); M. Gastpar, S. Bender, and V. Reissner (Essen); E. Rüther and D. Degner (Goettingen); P. Falkai (Goettingen); H. Sauer, R. Schlösser, and G.Wagner (Jena); F. A. Henn, H. Häfner, K. Maurer, H. Salize, and A. Schmitt (Mannheim); and L.G. Schmidt (Mainz; recruitment until 2/2002). The members of the scientific advisory board of the German Research Network on Schizophrenia are as follows: Prof. Dr. A. G. Awad, Toronto (CAN); Prof. Dr. W. Fleischhacker, Innsbruck (A); Prof. Dr. R. Holle, Neuherberg (D); Prof. Dr. S.R. Marder, Los Angeles (USA); Prof. Dr. P.D. McGorry, Melbourne (AUS); Prof. Dr. F. Müller-Spahn, Basel (CH); Prof. Dr. W. Rössler, Zürich (CH); and Prof. Dr. H. van den Bussche, Hamburg (D).

Funding

This study was conducted within the framework of the German Research Network on Schizophrenia, funded by the German Federal Ministry for Education and Research BMBF (Grants 01 GI 9932 and 01 GI 0232).

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Correspondence to Harald Zäske.

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A. Schmitt has been an honorary speaker for TAD Pharma and Roche and a member of advisory boards for Roche. On behalf of all further authors, the corresponding author states that there is no conflict of interest.

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Zäske, H., Linden, M., Degner, D. et al. Stigma experiences and perceived stigma in patients with first-episode schizophrenia in the course of 1 year after their first in-patient treatment. Eur Arch Psychiatry Clin Neurosci 269, 459–468 (2019). https://doi.org/10.1007/s00406-018-0892-4

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