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Reciprocal relationships between self-stigma, psychological distress, and suicidality among individuals with schizophrenia: a random intercept cross-lagged panel model with a one-year follow-up
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DOI：10.1007/s00406-026-02299-7.png)
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Abstract
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Self-stigma, psychological distress, and suicidality are interrelated constructs in schizophrenia, yet their temporal relationships remain unclear. This study examined reciprocal relationships among self-stigma, psychological distress, and suicidality in individuals with schizophrenia using a cross-lagged model over one year. Participants with schizophrenia were recruited from a psychiatric teaching hospital in southern Taiwan. Data were collected at five time points, each three months apart, over a one-year follow-up period. Among the 241 participants, 137 completed all five times of measures. Self-stigma was measured using the Self-Stigma Scale-Short (SSS-S), psychological distress using the Depression, Anxiety, Stress Scale-21 (DASS-21), and suicidality using the suicidality module of the Mini International Neuropsychiatric Interview (MINI). Random-intercept cross-lagged panel models were employed to examine bidirectional relationships for two datasets: entire participants (i.e., 241 with full information maximum likelihood handling missing values) and 137 participants. The models demonstrated excellent fit (comparative fit index [CFI] = 0.991 and 0.995, root mean square error of approximation [RMSEA] = 0.051 and 0.032). Significant bidirectional effects were found between self-stigma and psychological distress across multiple waves (β = 0.13–0.36). Psychological distress related to subsequent suicidality (β = 0.16–0.19), while suicidality related to subsequent distress (β = 0.15–0.16) and subsequent self-stigma (β = 0.15–0.19). Self-stigma and suicidality rates remained relatively stable over time. Self-stigma and psychological distress sometimes exhibited reciprocal relationships over time, with distress serving as a key pathway to suicidality in schizophrenia. However, such reciprocal relationships were not consistent throughout the five-wave measures. These findings support integrated interventions targeting both self-stigma and psychological distress to reduce suicide risk.
Keywords:
Schizophrenia
Self-stigma
Psychological distress
Suicidality
Cross-lagged model
Longitudinal study
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