Exploring the Relationships Between Negative Symptoms, Self-Stigma, and Quality of Life in Patients With Schizophrenia: A Stratified Cross-Sectional Study

Background: This study examined the relationships among negative symptoms, self-stigma, and quality of life in individuals with schizophrenia, and investigated whether these relationships differ between patients with high versus low levels of negative symptoms. Methods: This cross-sectional study included 403 inpatients with schizophrenia. Participants were assessed using the Positive and Negative Syndrome Scale (PANSS), the Internalized Stigma of Mental Illness Scale (ISMI), the Schizophrenia Quality of Life Scale (SQLS), and other relevant measures. Descriptive statistics, correlation analyses, and multiple regression models were conducted. Of the 500 inpatients with schizophrenia who were screened, 403 met the inclusion criteria and were included in the final analysis. Results: Negative symptoms were significantly associated with overall self-stigma and its subdimensions. Among participants with high levels of negative symptoms, self-stigma was significantly associated with general psychopathology, objective support, and avoidance coping. In contrast, only avoidance coping showed a significant association in the low-symptom group. Regarding quality of life, stereotype endorsement and stigma resistance were significantly associated with higher SQLS scores (indicating worse quality of life) in the low-symptom group, whereas no significant associations were observed in the high-symptom group. Conclusions: Negative symptoms are closely associated with internalized stigma in individuals with schizophrenia. The psychosocial correlates and consequences of self-stigma appear to vary according to the severity of negative symptoms. These findings highlight the importance of tailored interventions, such as enhancing social support for individuals with prominent negative symptoms and promoting adaptive coping strategies for those with milder symptoms.