DOI: 10.4103/ijsp.ijsp_252_25 ISSN: 0971-9962

Clinical Correlates of Stigma Resistance among Patients with Schizophrenia in Remission: A Structural Equation Modeling and Mediation Analysis

Sai Kumar Sajja, Shabeeba Z. Kailash, Kailash Sureshkumar, Aravindh Manogaran
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Abstract

Background:

Stigma resistance, the ability to withstand internalized stigma, is a critical yet underexplored component of recovery in schizophrenia.

Aim:

This study aims to determine the levels of stigma resistance, insight, and metacognition and to determine the sociodemographic, clinical characteristics that predict stigma resistance among patients with schizophrenia in remission.

Materials and Methods:

This was a single-center, hospital-based cross-sectional study involving 60 patients with schizophrenia in remission. Insight was assessed using the Schedule for the Assessment of Insight-Expanded Version. Metacognitive beliefs and processes were measured using the Metacognitions Questionnaire-30 and the Stigma resistance by Stigma Resistance subscale of the Internalized Stigma of Mental Illness Inventory (ISMI).

Results:

The majority were females (56.7%). Correlation analysis showed significant negative relationships between insight and stigma resistance ( r = −0.494, P < 0.001), insight and metacognitive dysfunction ( r = −0.731, P < 0.001), metacognitive dysfunction and stigma resistance ( r = −0.375, P = 0.003). Female gender and metacognitive dysfunction were significant predictors of stigma resistance in both univariate and multivariate models. Structural equation modelling confirmed a significant negative path from metacognition to stigma resistance (β = −0.42, P < 0.001) and from female gender (β = −0.20, P = 0.030). Mediation analysis revealed that metacognition mediated 39.4% of the total effect of gender on stigma resistance, with significant direct and indirect effects.

Conclusion:

Female gender and impaired metacognition are significant predictors of lower stigma resistance in patients with schizophrenia in remission. Enhancing metacognitive capacity may serve as a potential intervention to strengthen stigma resistance, particularly among women.

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