Koparal Buket, Kiraz Avci İlknur
Department of Psychiatry, Faculty of Medicine, Gazi University, Ankara, Turkey.
Rize State Hospital, Rize, Turkey.
Psychiatr Q. 2025 Apr 4. doi: 10.1007/s11126-025-10140-y.
Schizophrenia is a chronic mental illness that affects daily functioning and quality of life. Many patients experience internalized stigma, which worsens symptoms and quality of life. Psychological flexibility may help reduce stigma's negative effects. This study explores how psychological flexibility, internalized stigma, and illness knowledge relate to symptom severity in schizophrenia. We hypothesized that internalized stigma mediates the link between psychological flexibility and symptoms, and that greater illness knowledge leads to lower stigma and better outcomes. This cross-sectional study included patients diagnosed with schizophrenia at a Community Mental Health Center (CMHC) in Turkey. 253 participants completed standardized scales of psychological flexibility(AAQ-II), internalized stigma(ISMI), knowledge about schizophrenia(KASQ), and symptom severity(PANSS). Mediation analysis was performed using the PROCESS macro for SPSS to assess the indirect effects of stigma and illness knowledge on symptom severity. Psychological flexibility was significantly associated with lower levels of internalized stigma (β = -1.046, p < 0.001). Internalized stigma mediated the relationship between psychological flexibility and symptom severity(β = 0.506, p < 0.001), whereas illness knowledge had a protective effect on symptom severity(β = -1.582, p < 0.001). However, illness knowledge did not significantly mediate the relationship between psychological flexibility and stigma. The findings highlight the critical role of psychological flexibility in mitigating the negative impact of internalized stigma, suggesting that interventions aimed at enhancing flexibility could improve clinical outcomes. Psychoeducation programs may further reduce symtom severity by increasing ilness knowledge. Future research should explore longitudinal interventions targeting stigma reduction and psychological flexibility to enhance functional recovery in schizophrenia.
精神分裂症是一种影响日常功能和生活质量的慢性精神疾病。许多患者存在内化耻辱感，这会使症状和生活质量恶化。心理灵活性可能有助于减少耻辱感的负面影响。本研究探讨心理灵活性、内化耻辱感和疾病知识与精神分裂症症状严重程度之间的关系。我们假设内化耻辱感介导了心理灵活性与症状之间的联系，并且更多的疾病知识会导致更低的耻辱感和更好的结果。这项横断面研究纳入了在土耳其一家社区心理健康中心（CMHC）被诊断为精神分裂症的患者。253名参与者完成了心理灵活性（AAQ-II）、内化耻辱感（ISMI）、精神分裂症知识（KASQ）和症状严重程度（PANSS）的标准化量表。使用SPSS的PROCESS宏进行中介分析，以评估耻辱感和疾病知识对症状严重程度的间接影响。心理灵活性与较低水平的内化耻辱感显著相关（β = -1.046，p < 0.001）。内化耻辱感介导了心理灵活性与症状严重程度之间的关系（β = 0.506，p < 0.001），而疾病知识对症状严重程度有保护作用（β = -1.582，p < 0.001）。然而，疾病知识并未显著介导心理灵活性与耻辱感之间的关系。研究结果突出了心理灵活性在减轻内化耻辱感负面影响方面的关键作用，表明旨在提高灵活性的干预措施可能会改善临床结果。心理教育项目可能通过增加疾病知识进一步降低症状严重程度。未来的研究应探索针对减少耻辱感和心理灵活性的纵向干预措施，以促进精神分裂症患者的功能恢复。
