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21-12-2010 | Mental health | Article

Stigma, empowerment, social network influence QoL in schizophrenia


Free abstract

MedWire News: Schizophrenia patients with a poor social network experience stigma and a lack of empowerment that results in depression and, in turn, in poor quality of life (QoL), study results show.

However, data modelling showed that, while depression and empowerment directly affected QoL, social network and stigma did not, suggesting interventions should be aimed at all factors but especially the development of personal strength.

"The QoL of patients with schizophrenia is worse than that of the general population and that of many patients with physical and other mental disorders," write Ingrid Sibitz (Medical University of Vienna, Austria) and colleagues in the journal European Psychiatry.

Existing data show that QoL is influenced by clinical factors such as depression as well as stigma, social network, and empowerment.

Stigma can be internalized - ie, the inner subjective experience of stigma and its psychological effects resulting from applying negative stereotypes and attitudes to oneself - or perceived, that is the expectance that the public holds negative attitudes toward people with mental disorders and discriminate against them.

Empowerment refers to an individual's strengths, the ability to sustain control over their life, and the conviction that one's actions have an influence on one's life.

Noting that the precise relationship between these related variables is currently unknown, the researchers examined data from 157 patients with schizophrenia recruited from inpatient and day clinic mental health centers.

Around half of the participants had a social network that they considered to be a sufficient number of friends. Average internalized stigma was low, at 2.09 (range 1-4), while perceived devaluation and discrimination was 3.20 (range 1-5), indicating higher levels of perceived stigma in society. Participants showed a rather high endorsement of empowerment, at 2.82 (range 1-4).

Depression levels were low, at 1.09 (range 0-3), while global QoL and general health was moderate, at 3.04 (range 1-5).

Structural equation modelling (SEM) was used to assess the causal chains of associations among factors influencing QoL.

This demonstrated that a poor social network contributed to a lack of empowerment and stigma, which resulted in depression and, in turn, in poor QoL. Depression and empowerment directly affected QoL, whilesocial network and stigma did not.

The findings suggest that a few resilient patients may experience a good QoL despite a poor social network, perhaps because they may feel competent and powerful while being resistant to stigma.

"Following a recovery approach in mental health services by focusing on the improvement of the social network, stigma reduction, and especially on the development of personal strength has the potential to reduce depression in patients with psychosis and improving their QoL," Sibitz et al conclude.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Andrew Czyzewski

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