Effect of self-stigma on personal recovery: sex differences in people with psychotic spectrum disorders

Daniela Leon-Morales¹Jose-Blas Navarro²Maria Lamarca^1,3,4,5Fermín González-Higueras⁶Pedro Torres⁶Jordi Cid^7,8Eva Frigola-Capell^7,9Irene Birulés^10,3,4,5Susana Ochoa^3,4,5Carme Vidal¹¹Gemma Garrido¹²Josep Maria Crosas¹³Ana Aznar¹⁴Carolina Palma-Sevillano¹⁵Aina Sastre-Buades¹⁶Julia Sevilla-Llewellyn-Jones¹⁷Oscar Vallina-Fernández¹⁸Enrique Gutiérrez^19,20Ana Calvo²¹ReCoMet Group²²Ana Barajas^23,24*

• ¹Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
• ²Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Barcelona, Spain
• ³Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Spain
• ⁴Grup MERITT, Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
• ⁵Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
• ⁶Comunidad Terapéutica Jaén, Hospital Universitario de Jaén, Jaén, Spain
• ⁷Mental Health and Addictions Network, Institut Assistència Sanitària, Salt, Spain
• ⁸Mental Health and Addictions, Institut d’Investigació Biomèdica de Girona (IDIBGI-CERCA), Parc Hospitalari Martí i Julià, Edifici M2, 17190 Salt, Spain
• ⁹Mental Health and Addictions, Institut d’Investigació Biomèdica de Girona (IDIBGI-CERCA), Parc Hospitalari Martí i Julià, Edifici M2,, 17190 Salt, Spain
• ¹⁰Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
• ¹¹Fundació els Tres Turons, Barcelona, Spain
• ¹²Department of Mental Health, Consorci Sanitari de Terrassa, Barcelona, Spain
• ¹³Department of Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma, Sabadell, Spain
• ¹⁴Associacio Centre d'Higiene Mental Les Corts, Barcelona, Spain
• ¹⁵Grup COMSAL, FPCEE-Blanquerna, Universitat Ramon Llull, Barcelona, Spain
• ¹⁶Department of Psychiatry, Son Llàtzer University Hospital, Palma, Spain
• ¹⁷Instituto de Psiquiatría y Salud Mental, Instituto de Investigación (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
• ¹⁸Sierrallana Hospital, Cantabria Health Service, Torrelavega, Cantabria, Spain
• ¹⁹Department of Applied Mathematics for Information and Communication Technologies, Higher Technical School of Computer Systems Engineering, Polytechnic University of Madrid (NEBULA Research Group), Madrid, Spain
• ²⁰MIT linQ - Massachusetts Institute of Technology, Massachusetts, United States
• ²¹Personality, Assessment and Clinical Psychology Department. School of Psychology. Universidad Complutense de Madrid, Madrid, Spain
• ²²Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
• ²³Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellatera, Cerdanyola del Vallès, Spain
• ²⁴Serra Húnter Programme, Generalitat de Catalunya, Barcelona, Spain

Abstract Recently, there has been growing evidence on self-stigma and personal recovery in people with psychotic spectrum disorders. However, despite the influence of sex on mental health and the social component of self-stigma and recovery, the evidence regarding self-stigma, personal recovery, and sex is limited and inconsistent. This research aims to study the role of sex in the effect that self-stigma has on the personal recovery of people with psychotic spectrum disorders. A sample of 118 patients with a psychosis diagnose participated in the study (55.9% men). They were recruited from 9 clinical centers in Spain. Data were collected through the Internalized Stigma of Mental Illness and the Recovery Assessment Scale. The effect of self-stigma on personal recovery differed according to the sex of the person. Specifically, in women, personal recovery decreased as self-stigma and alienation increased. Also, a higher self-stigma was associated with a lower personal confidence, hope and symptom control. In contrast, in men, a higher alienation was associated with higher personal confidence, hope and success orientation. These results were adjusted for educational level, comorbidity, number of psychotic episodes, and the time between symptom onset and treatment initiation. These findings highlight the urgent need to explore further the role of sex on recovery and to have a sex-sensitive approach in policies and interventions in this population. This would benefit their recovery and, in consequence, their quality of life. Future studies should expand the sample and explore other factors that could be influencing the process of recovery and self-stigma.