Should we be concerned about stigma and discrimination in people at risk for psychosis? A systematic review.

Abstract:

BACKGROUND:Previous studies have provided initial evidence that people at risk for psychosis (PR) suffer from stigma and discrimination related to their condition. However, no study has systematically reviewed stigma and discrimination associated with being at PR and the potential underlying mechanisms. METHODS:This work aimed to systematically review all studies addressing stigma and discrimination in PR people in order to assess: (1) the occurrence of this phenomenon and its different components (public, internalized, perceived, and labeling-related), (2) whether stigma affects outcomes of the PR state, and (3) whether other factors modulate stigma among PR individuals. RESULTS:The reviewed studies (n = 38) widely differ in their design, methodological quality, and populations under investigation, thus limiting direct comparison of findings. However, converging evidence suggests that the general public endorses stigmatizing attitudes towards PR individuals, and that this is more frequent in people with a low educational level or with no direct experience of the PR state. PR individuals experience more internalized stigma and perceive more discrimination than healthy subjects or patients with non-psychotic disorders. Further, PR labeling is equally associated with both positive (e.g. validation and relief) and negative effects (e.g. status loss and discrimination). Moreover, stigma increases the likelihood of poor outcome, transition to full-psychosis, disengagement from services, and family stigma among PR individuals. Finally, very limited evidence awaiting replication supports the efficacy of cognitive therapies in mitigating the negative effects of stigma. CONCLUSIONS:Evidence confirms previous concerns about stigma and its negative consequences for PR individuals, thus having important public health implications.

journal_name

Psychol Med

journal_title

Psychological medicine

authors

Colizzi M,Ruggeri M,Lasalvia A

doi

10.1017/S0033291720000148

subject

Has Abstract

pub_date

2020-04-01 00:00:00

pages

705-726

issue

5

eissn

0033-2917

issn

1469-8978

pii

S0033291720000148

journal_volume

50

pub_type

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