Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia.

The concept of internalized stigma or self-stigma is central to the understanding of the psychological harm caused by stigma. In this study, we aim to demonstrate how the evaluative dimension of self-concept (self-efficacy and empowerment) mediates the psychological effects of self-stigmatizing and coping with stigma. As important examples of psychological effects, depression and quality of life were focussed on. In 172 outpatients with DSM-IV schizophrenia, measures of self-stigma and devaluation, coping with stigma, self-efficacy, empowerment, quality of life and depression were assessed. It was hypothesized that withdrawal and secrecy as important coping strategies yielded to higher levels of anticipatory anxiety of future stigmatizing. Higher levels of perceived discrimination and devaluation were hypothesised to undermine self-efficacy and illness-related empowerment. Lowering of empowerment was supposed to enhance depression and reduce quality of life. This hypothesis was tested by Structural Equation Modeling as a method of data analysis. The results supported the hypothesized model; i.e., 46% of depression and 58% of quality of life reduction could be explained by eroded empowerment. Moreover, 51% of the empowerment reduction was explained by reduction in self-efficacy at a more general level by dysfunctional coping and higher levels of anticipated stigma. Taken together, our data suggest an avoidant coping style as a risk factor for anticipatory stigma, which erodes self-efficacy and empowerment. These data have implications for cognitive behavioral approaches, which should focus on anticipated stigma to improve recovery in schizophrenia.