Effectiveness of Non-Pharmacological Interventions for Reducing Self-Stigma in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis

Aim: Self-stigma represents a major barrier to recovery among individuals with severe mental illness (SMI). This review aimed to identify and synthesize the available evidence on the effectiveness of non-pharmacological interventions for reducing self-stigma in adults with SMI, while also exploring physical appearance care as a potentially relevant but under-researched area. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and the Cochrane Handbook recommendations. The review protocol was registered in PROSPERO (CRD420251013333). Data Sources: A comprehensive search was conducted across multiple databases, including the Virtual Health Library, PubMed, Web of Science, the Cochrane Library, and EBSCOhost databases. A snowball search of reference lists was also performed. Studies published in English or Spanish within the past ten years were included. Review Methods: Two independent reviewers screened titles, abstracts, and full texts according to predefined criteria. Methodological quality was assessed using the Critical Appraisal Skills Programme España (CASPe). A qualitative synthesis was conducted for all included studies, and a random-effects meta-analysis was performed for studies providing sufficient quantitative data. Standardized mean differences and heterogeneity statistics were calculated. Results: Twenty-eight studies were included in the qualitative synthesis, and twelve were eligible for meta-analysis. Multicomponent interventions integrating psychoeducation, cognitive restructuring, narrative approaches, and social support showed the most consistent effects across the evaluated outcome domains. Meta-analytic findings indicated small-to-moderate reductions in self-stigma and improvements in hope, with low levels of statistical heterogeneity across outcomes. Effects on self-esteem, quality of life, self-efficacy, and psychiatric symptomatology were limited or inconsistent across studies. No studies specifically evaluated interventions focused on physical appearance care. Conclusions: Non-pharmacological interventions appear to produce modest but potentially meaningful reductions in self-stigma among individuals with SMI, particularly when delivered through multicomponent psychosocial approaches that integrate psychoeducation, cognitive restructuring, narrative techniques, and social support.