Internal Experiences of Self-Stigma Among Patients with Schizophrenia Based on the Common-Sense Model: A Qualitative Study

Patients with schizophrenia endure not only severe symptom burden but also prolonged exposure to public stigma, with self-stigma emerging as a critical psychological barrier to recovery. Previous studies have primarily examined the association between illness perception and self-stigma using quantitative approaches, yet the underlying mechanisms and dynamic interactions remain insufficiently understood. Guided by the Common-Sense Model (CSM), this study focuses on how illness perceptions shape and reinforce self-stigma experiences, thereby addressing the gap in mechanistic understanding. This study aims to explore the characteristics of illness perceptions in patients with schizophrenia and elucidate the mechanisms by which illness perceptions contribute to self-stigma so as to inform the development of individualised stigma reduction and empowerment-oriented interventions. A purposive sampling strategy was used to recruit patients with schizophrenia between February and April 2024, and semi-structured interviews were conducted, with data analysed using thematic analysis. Fourteen participants were enrolled. Three core themes were derived: (1) fragmented illness perceptions and impaired insight, (2) multidimensional internalisation and dynamic reinforcement of self-stigma, and (3) adaptation difficulties under the reciprocal interaction between illness perceptions and self-stigma. Illness perceptions in patients with schizophrenia are generally deficient and create a vicious cycle with self-stigma, which significantly undermines rehabilitation motivation and social functioning. Grounded in the CSM, this study proposes an "illness perception reconstruction-stigma deconstruction" intervention pathway, offering a novel theoretical framework for targeted psychological interventions and rehabilitation support.