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Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis.

ABSTRACT: Despite advances that the psychosis "clinical high-risk" (CHR) identification offers, risk of stigma exists. Awareness of and agreement with stereotypes has not yet been evaluated in CHR individuals. Furthermore, the relative stigma associated with symptoms, as opposed to the label of risk, is not known, which is critical because CHR identification may reduce symptom-related stigma.Thirty-eight CHR subjects were ascertained using standard measures from the Center of Prevention and Evaluation/New York State Psychiatric Institute/ Columbia University. Labeling-related measures adapted to the CHR group included "stereotype awareness and self-stigma" ("Stereotype awareness", "Stereotype Agreement", "Negative emotions [shame]"), and a parallel measure of "Negative emotions (shame)" for symptoms. These measures were examined in relation to symptoms of anxiety and depression, adjusting for core CHR symptoms (e.g. attenuated psychotic symptoms).CHR participants endorsed awareness of mental illness stereotypes, but largely did not themselves agree with these stereotypes. Furthermore, CHR participants described more stigma associated with symptoms than they did with the risk-label itself. Shame related to symptoms was associated with depression, while shame related to the risk-label was associated with anxiety.Both stigma of the risk-label and of symptoms contribute to the experience of CHR individuals. Stereotype awareness was relatively high and labeling-related shame was associated with increased anxiety. Yet limited agreement with stereotypes indicated that labeling-related stigma had not fully permeated self-conceptions. Furthermore, symptom-related stigma appeared more salient overall and was linked with increased depression, suggesting that alleviating symptom-related shame via treating symptoms might provide major benefit.

SUBMITTER: Yang LH

PROVIDER: S-EPMC4751087 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis.

Yang Lawrence H LH Link Bruce G BG Ben-David Shelly S Gill Kelly E KE Girgis Ragy R RR Brucato Gary G Wonpat-Borja Ahtoy J AJ Corcoran Cheryl M CM

Schizophrenia research 20150825 1-2

<h4>Background</h4>Despite advances that the psychosis "clinical high-risk" (CHR) identification offers, risk of stigma exists. Awareness of and agreement with stereotypes has not yet been evaluated in CHR individuals. Furthermore, the relative stigma associated with symptoms, as opposed to the label of risk, is not known, which is critical because CHR identification may reduce symptom-related stigma.<h4>Methods</h4>Thirty-eight CHR subjects were ascertained using standard measures from the Cent ...[more]

PMID: 26314731

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Project description:A major public health concern associated with schizophrenia and psychotic disorders is the long-term disability that involves impaired cognition, lack of social support, and an inability to function independently in the community. A critical goal of early detection and intervention studies in psychosis is therefore to understand the factors leading to this often profound impairment.To develop a predictive model of functional (social and role) outcome in a clinical high-risk sample for psychosis.Prospective, naturalistic, longitudinal 3- to 5-year follow-up study.The Recognition and Prevention Program in New York, a research clinic located in the Zucker Hillside Hospital in New York.One hundred one treatment-seeking patients at clinical high risk for psychosis. Ninety-two (91%) were followed up prospectively for a mean (SD) of 3 (1.6) years.Neurocognitive and clinical assessment.The primary outcome variables were social and role functioning at the last follow-up visit.Poor social outcome was predicted by reduced processing speed (odds ratio [OR], 1.38; 95% CI, 1.050-1.823; P?=?.02), impaired social functioning at baseline (OR, 1.85; 95% CI, 1.258-2.732; P?=?.002), and total disorganized symptoms (OR, 5.06; 95% CI, 1.548-16.527; P?=?.007). Reduced performance on tests for verbal memory (OR, 1.74; 95% CI, 1.169-2.594; P?=?.006), role functioning at baseline (OR, 1.34; 95% CI, 1.053-1.711; P?=?.02), and motor disturbances (OR, 1.77; 95% CI, 1.060-2.969; P?=?.03) predicted role outcome. The areas under the curve for the social and role prediction models were 0.824 (95% CI, 0.736-0.913; P?<?.001) and 0.77 (95% CI, 0.68-0.87; P?<?.001), respectively, demonstrating a high discriminative ability. In addition, poor functional outcomes were not entirely dependent on the development of psychosis, because 40.3% and 45.5% of nonconverters at clinical high risk had poor social and role outcomes, respectively.Results from this study support the increasing emphasis on functional decline as a critically important outcome that parallels conversion to psychosis and suggest that both psychosis and long-term functional disability are equally important targets for prevention. Reduced neurocognitive performance, functional impairments, and nonpositive attenuated symptoms at baseline were associated with an increased risk of poor functional outcomes in our sample. Poor functional outcomes were not entirely dependent on positive symptoms and the development of psychosis, further highlighting the need for intervention at this early stage of development for those who do and do not convert to a full-blown psychotic disorder.

Dataset Information

Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis.

Publications

Stigma related to labels and symptoms in individuals at clinical high-risk for psychosis.

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