The clinical and psychosocial correlates of self-stigma among people with schizophrenia spectrum disorders across cultures: A systematic review and meta-analysis

Background: Individuals with schizophrenia spectrum disorders (SSD) are at heightened risk of experiencing self-stigma, and some cultures are more stigmatizing towards SSD than others. The first purpose of this review is to provide an estimate of the relationship between self-stigma and clinical and psychosocial outcomes. The second purpose is to examine how these relationships vary across cultures. Method: Studies reporting correlations between self-stigma and outcome variable(s) were identified through electronic database searches from June 1, 2021, to January 2, 2022. Mean effect sizes were calculated using Fisher's r-to-Z-transformation. Results: Sixty-three articles (N = 8925, 22 countries) were included in the systematic review and fifty-three articles (N = 7756) were included in the meta-analysis. For the most studied clinical correlates, self-stigma had a moderate, positive correlation with depressive symptoms (r = 0.49, p <.001), a moderate, negative correlation with functioning (r = -0.39, p <.001), and a positive, small correlation with severity of psychotic symptoms (r = 0.29, p <.001), negative symptoms (r = 0.18, p <.001) and positive symptoms (r = 0.13, p =.01). For the most studied psychosocial correlates, self-stigma had a strong, negative correlation with quality of life (r = 0.52, p <.001) and self-esteem (r = 0.55, p <.001). The correlates of self-stigma were similar across cultures. Discussion: Self-stigma shows strong to small correlations with clinical and psychosocial variables similarly across cultures. More research is needed to examine underlying mechanisms to develop effective interventions.