Stereotype awareness impacts self-esteem in schizophrenia

By Eleanor McDermid, Senior medwireNews Reporter

Patients with psychosis with higher self-esteem have less awareness of the stereotypes associated with mental health patients and their families, research shows.

“Positive self-esteem is not only seen as a basic feature of mental health, but also as a protective factor that contributes to better mental health and positive social behavior through its role as a buffer against the impact of negative cognitions, emotions and dysfunctional behavioral responses,” say lead study author Catherine van Zelst (Maastricht University Medical Centre, the Netherlands) and colleagues.

They therefore believe that stereotype awareness and self-esteem may be worth targeting, particularly in patients with early psychosis symptoms.

“Targeted interventions at this stage may alter illness outcomes,” they write in PLoS One. “Perceived stereotyping may exacerbate early psychopathology in the case of incipient illness, or increase the probability of relapse in case of established illness, for instance, by inducing a vicious circle of self-blame, attributing negative feedback to the self or by increasing stigma consciousness.”

The team assessed 186 patients, aged an average of 29.8 years, from the Dutch Genetic Risk and OUtcome of Psychosis project. They found that patients’ self-esteem, measured on the Rosenberg Self-Esteem scale, correlated significantly with their awareness of stereotypes, as assessed from their responses on the Devaluation of Consumers Scale (DCS) and the Devaluation of Consumers Families Scale (DCFS).

The average rate of agreement with statements relating to stereotypes was 58% for the DCS and 31% for the DCFS.

Patients’ symptoms on an extended version of the Brief Psychiatric Rating Scale correlated with their awareness of family stereotypes (DCFS scores), despite most patients disagreeing with DCFS statements, but not their awareness of patient stereotypes (DCS scores).

“When people with mental illness not only perceive stereotypes about patients but also about families, stigma experiences may be even more pervasive for the individual,” says the team.

Older age was associated with more awareness of patient stereotypes, but gender, illness duration and ethnicity were not associated with awareness of either patient or family stereotypes. The factors that were associated with stereotype awareness together accounted for about 20% of the variability.

“In tandem with the individual approach in patients, the public should be informed about mental illness and stigma, including the negative consequences of uncritical stereotyping,” say the researchers.

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