ArticleEuropean archives of psychiatry and clinical neuroscience2026
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.
Article in European archives of psychiatry and clinical neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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