The Mediation Role of Self-Esteem for Self-Stigma on Quality of Life for People With Schizophrenia: A Retrospectively Longitudinal Study

People with schizophrenia usually suffer from their psychotic symptoms and impaired social functioning. Therefore, their health outcomes are generally lower than that of the general population. The subjective quality of life or S-Q-o-L (SQoL) is one of the most important outcomes among the impaired health-related outcomes for people with schizophrenia. The World Health Organization defines SQoL as a broad-ranging concept containing the following dimensions: physical health, psychological health, social relationships, and salient features in the individual's environment. Therefore, SQoL could be used as an indicator of health outcomes for people with mental illness. Among patients with schizophrenia, there is evidence of a negative association between self-stigma and subjective quality of life. Self-esteem is also an important mediator in this association. In this article, the researchers attempted to use a longitudinal study to investigate the aforementioned mediation on a sample with schizophrenia.

The researchers used longitudinal data retrieved from medical records of a psychiatric center between June 2014 and December 2015. In the data, they retrieved information of self-stigma using the Self-Stigma Scale; and self-esteem using the Rosenberg Self-Esteem Scale. All the measures were evaluated five times. Linear mixed-effect models accompanied by Sobel tests were used to tackle the mediating effects.

Data from 74 patients with schizophrenia were eligible for analysis; their mean age was 39.53 while the mean age of onset was 22.95. Self-esteem was a mediator for patients in physical, psychological , and social SQoL; but not in environment SQoL. The results agree with previous findings that self-stigma reduces the self-esteem of an individual with mental illness. Also, these findings were aligned with studies that found negative impacts of self-stigma on an individual's SQoL. It also agrees with the mediation model that self-esteem is a mediating factor between an individual's self-stigma and his or her SQoL. However, the mediated effect of self-esteem between self-stigma and environment SQoL was not fully supported by the Sobel test. A possible explanation is the role of self-esteem under different cultures. A controversy is that different cultures may not value self-esteem similarly.

In conclusion, self-esteem mediated the causal relationship between self-stigma and the physical and psychological domains of the SQoL in people with schizophrenia. In this study, mediation models were supported for the physical, psychological, and social domains but not for the environment domain of an individual's SQoL. Some studies treated the SQoL as a unidimensional concept. This is beneficial when mental health professionals want to evaluate an individual's overall health and wellbeing. However, using different dimensions of SQoL can help mental health professionals design interventions to address specific needs. Moving forward, mental health professionals could tailor programs to patients with schizophrenia by providing self-stigma reduction and self-esteem improvement programs.