Davies Kimberley, Lappin Julia M, Gott Chloe, Steel Zachary
Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia.
The Tertiary Referral Service for Psychosis, Prince of Wales Hospital, Randwick 2031, NSW, Australia.
Schizophr Bull. 2024 Aug 23. doi: 10.1093/schbul/sbae139.
Shame has been linked to the experience of psychosis, with implications for clinical outcomes, however, a meta-analysis of the relationship has not yet been conducted. This systematic review and meta-analysis aimed to examine the strength of the association between shame and psychosis, and any variations between clinical and non-clinical populations and shame type (internal vs external shame).
Searches were conducted in CINAHL, EMBASE, PsycInfo, PubMed, Scopus, and Web of Science from the inception of the e-databases until July 2023. For inclusion, studies reported a quantitative association between psychosis and shame, or data that could be used to identify a relationship. From 11 372 unique retrieved records, 40 articles met the inclusion criteria and 38 were included in the meta-analyses.
A significant large pooled estimate of the psychosis-shame association was identified (Zr = 0.36, [95% CI: 0.28, 0.44], P < .001), indicating that higher levels of shame were associated with greater severity of psychotic symptoms. The strength of the association was similar across clinical and non-clinical populations, however, differed by type of shame and psychosis symptom measured. External shame was strongly associated with paranoia suggesting possible confounding. Only a minority of studies met the highest quality criteria.
Shame is strongly associated with the severity of psychotic symptoms in clinical and non-clinical populations. Given the overlap with paranoia, measurement of external shame alone is not advised. Larger studies in clinical populations, with measures of a range of psychosis symptoms, are needed to better understand the relationship between shame and specific symptoms.
羞耻感与精神病体验有关，对临床结果有影响，然而，尚未对这种关系进行荟萃分析。本系统评价和荟萃分析旨在检验羞耻感与精神病之间关联的强度，以及临床和非临床人群之间以及羞耻类型（内在羞耻与外在羞耻）之间的任何差异。
从电子数据库建立至2023年7月，在CINAHL、EMBASE、PsycInfo、PubMed、Scopus和Web of Science中进行检索。纳入标准为研究报告了精神病与羞耻感之间的定量关联，或可用于确定两者关系的数据。从11372条独特的检索记录中，40篇文章符合纳入标准，38篇被纳入荟萃分析。
确定了精神病与羞耻感关联的显著大合并估计值（Zr = 0.36，[95%置信区间：0.28，0.44]，P <.001），表明更高水平的羞耻感与更严重的精神病症状相关。临床和非临床人群中这种关联的强度相似，然而，因所测量的羞耻类型和精神病症状不同而有所差异。外在羞耻与偏执狂密切相关，提示可能存在混杂因素。只有少数研究符合最高质量标准。
羞耻感与临床和非临床人群中精神病症状的严重程度密切相关。鉴于与偏执狂的重叠，不建议仅测量外在羞耻感。需要在临床人群中进行更大规模的研究，并测量一系列精神病症状，以更好地理解羞耻感与特定症状之间的关系。
