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Self-Esteem and Resilience in Patients With Schizophrenia
Improvements in self-esteem and resilience can reduce the negative impact of internalized stigma on quality of life (QOL) in patients with schizophrenia, a new study found. The study examined the mediating effects of self-esteem and resilience on the relationship between internalized stigma and QOL in this population. Participants were 123 people with schizophrenia (mean age 41.87 years, 62.6% male). Using a cross-sectional survey, participants completed structured questionnaires with psychometric adequacy. Researchers found:
- Self-esteem and resilience were found to be full and partial mediators, respectively, in the relationship between internalized stigma and QOL in people with schizophrenia.
- Future intervention strategies should target improvements in self-esteem and resilience in order to reduce the negative impact of internalized stigma and QOL.
Kim EY, et al. The mediating effects of self-esteem and resilience on the relationship between internalized stigma and quality of life in people with schizophrenia. [Published online ahead of print September 30, 2019]. Asian Nurs Res. doi: 10.1016/j.anr.2019.09.004.

Resilience in people with schizophrenia is the ability to identify and to apply their talents and strengths to manage the challenges of psychiatric symptoms and stigma. Internalized stigma occurs when people accept and apply negative and stigmatizing societal attitudes towards themselves. While the literature on stigma and mental illness is extensive, there is a more limited literature on how best to combat stigma so that people who experience both societal (external) and self (internal) stigma can have a better quality of life. An important contribution of this report is insight into potentially modifiable engagement targets for interventional approaches that have potential to positively impact health outcomes and quality of life for people with schizophrenia. Future research might, for example, assess whether patient-facing approaches such as self-management training engages and improves self-esteem and resilience. The report also underscores the complex nature of recovery beyond symptoms and functional status that are standard outcomes in schizophrenia clinical trials. —Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.