Internalized Stigma, Insight, Social Anxiety and Quality of Life in First-Episode Psychosis: A Cross-Sectional Study

Background: People with schizophrenia are one of the most stigmatized social groups. The purpose of this study was to assess stigma, quality of life, social anxiety and illness insight in a sample of first-episode psychosis (FEP) patients and to investigate possible correlations between these variables and psychopathology/socio-demographic factors of the study group. Methods: This observational cross-sectional study included 90 patients (55 males, 35 females) with a mean age of 31.8 ± 8.6 years (18-52) experiencing a first episode of psychosis. The mean ± SD duration of untreated psychosis was 13.4 ± 6.2 weeks. The medications used were risperidone (n = 24; 26.7%), clozapine (n = 34; 37.8%), and olanzapine (n = 32; 35.6%). The tools used for this study were the Internalized Stigma for Mental Illness Scale (ISMI), World Health Organization Quality of Life Assessment-BREF (WHOQoL-BREF), Liebowitz Social Anxiety Scale (LSAS-SR), Schedule for the Assessment of Insight-Expanded version (SAI-E), and Positive and Negative Syndrome Scale (PANSS). Results: The mean ISMI total score was 50.9 ± 7.9 (range: 29-84), with 56.6% of patients scoring greater than 50, indicative of internalized stigma. Mean PANSS total scores improved from 76.1 ± 7.2 at baseline to 44.9 ± 6.3 after six months of follow-up (p < 0.001). Patients demonstrated insight of (mean ± SD) 20.3 ± 4.5, measured by SAI-E, and moderate-to-good quality of life across WHOQOL-BREF domains. The results of this study indicated that the ISMI scale showed statistically significant linear correlations with the LSAS-SR [anxiety (r = 0.399, p < 0.001) and avoidance (r = 0.421, p < 0.001)], with positive correlations and approximately medium associations. In the multivariable analyses, ISMI was inversely associated with all WHOQoL-BREF domains (physical health: -0.72 units 95% CI: -1.09 to -0.35, p < 0.001; mental health:-1.04, 95% CI: -1.45 to -0.63, p < 0.001; social relationships: -0.79, 95% CI: -1.39 to -0.18, p = 0.012; environmental health: -0.70, 95% CI: -1.00 to -0.39, p < 0.001). Multivariable models were adjusted for age, gender, medication, marital status, having children, employment, residence, DUP, SAI-E, ISMI, and LSAS-SR. Conclusions: Stigma is positively correlated with social anxiety. Higher stigma levels were independently linearly associated with lower levels of quality of life, even after adjusting for other predictor variables. Our results also indicated an association between higher insight levels and elevated odds of high internalized stigma. Stigma in first-episode psychosis patients is negatively associated with quality of life and positively associated with social anxiety/avoidance.