Internalized stigma and its impact on schizophrenia quality of life

The internalization of schizophrenia-related stigma highly affects people living with this disease, hindering their recovery process. The aim of this work is to study the effect of alienation and stereotype endorsement on the specific dimensions of schizophrenia-specific quality of life (SQoL), through the damage on self-esteem and self-efficacy. The model was tested in 167 patients with schizophrenia by path analysis using maximum likelihood procedure. The data fit the proposed model, but not all hypothesized predictions were met. A negative effect of alienation on self-esteem and self-efficacy was shown, while the negative effect of stereotype endorsement on these self-concept-related variables was non-significant. Self-esteem significantly contributed to the variance of the three dimensions of SQoL, while self-efficacy seems not to be involved in the model. Our results suggest that both alienation and stereotype endorsement have a direct effect on psychosocial SQoL and physical SQoL, while motivation and energy-related SQoL is affected only indirectly by alienation (through the decrease of self-esteem). Finally, we found that self-esteem significantly mediates the negative effect of alienation on the three dimensions of SQoL. We propose that the strengthening of self-esteem would mitigate the damage on SQoL, protecting specially the motivation and energy dimension, which may favor recovery.