Change in self-stigma among persons with schizophrenia enrolled in rehabilitation: associations with self-esteem and positive and emotional discomfort symptoms

Self-stigma is a barrier to the recovery of persons with schizophrenia. Little is known about whether participation in rehabilitation is naturalistically linked to declines in self-stigma, and if so, what is correlated with changes in self-stigma. The current study examined in a quasi-experimental design the rate of change of self-stigma and whether changes were correlated with self-esteem, positive symptoms, and emotional distress for persons enrolled in rehabilitation. Symptoms were measured using the Positive and Negative Syndrome Scale (Kay, Fizsbein, & Opler, 1987), self-esteem was measured with the Multidimensional Self-Esteem Inventory (Lysaker, Ringer, & Davis, 2008), and self-stigma was assessed using the Internalized Stigma of Mental Illness Scale (Ritsher, Otilingam, & Grajales, 2003). Seventy persons with schizophrenia who worked at least one month in a vocational rehabilitation program were assessed on all measures at baseline and five months later. Results indicated a 25% decrease in self-stigma for 38% of the sample; these individuals tended to have less emotional distress both at baseline and follow-up, and had higher levels of self-esteem at follow-up. No differences in positive symptoms were found for groups whose stigma did or did not decrease. Results suggest that decreases in self-stigma may be correlated with increased self-esteem, while higher levels of emotional distress may be a barrier to stigma reduction.