Self-stigma and suicide risk mediates the associations of inattention/impulsivity symptoms with psychological distress and quality of life among people with schizophrenia

PURPOSE: The present study examined whether self-stigma mediated the associations from inattention/impulsivity symptoms and suicide risk to psychological distress and quality of life (QoL) among individuals with schizophrenia. METHODS: A longitudinal study was conducted comprising 241 individuals with schizophrenia who were recruited from daycare and outpatient units in Southern Taiwan. Eligible participants were adults (≥ 20 years) diagnosed with schizophrenia and enrolled in a daycare program or receiving regular outpatient follow-up. After providing informed consent, participants were interviewed to assess self-stigma, inattention and impulsivity symptoms, suicide risk, psychological distress, and QoL. Individuals with a history of moderate to severe substance use disorder (except tobacco use disorder) or head injury were excluded. RESULTS: Self-stigma mediated the relationships between inattention and impulsivity symptoms and both psychological distress and QoL among Taiwanese individuals with schizophrenia. More specifically, the indirect effect of inattention and impulsivity symptoms at Time 1 (T1) on each QoL domain (physical, psychological, social, and environment QoL at T3 through self-stigma at T2 was significant (β = - 0.05 to - 0.03, p < 0.05). The indirect effect on psychological distress at T3 was also significant (β = 0.06, 95% CI [0.01, 0.12], p = 0.019). In addition, self-stigma at T1 significantly predicted each QoL domain (β = - 0.19 to - 0.13, p < 0.001) and psychological distress at T3 (β = 0.24, 95% CI [1.94, 4.10], p < 0.001) through self-stigma at T2. CONCLUSION: The present study demonstrated the robust influence of self-stigma in increasing psychological distress and poor QoL in each specific domain, suggesting clinical approaches are needed for managing self-stigma, inattention and impulsivity symptoms, and suicide risk among individuals with schizophrenia.