Insight, internalized stigma, self-esteem, and social functioning in patients with schizophrenia receiving rehabilitation services

The aim of this study is to examine the levels of insight, internalized stigma, self-esteem, and social functioning in individuals diagnosed with schizophrenia who receive rehabilitation services; and to evaluate the impact of regular participation in rehabilitation by comparing this group with individuals with schizophrenia who do not utilize such services. This study was planned in a cross-sectional and case-control design. The study included 35 patients diagnosed with schizophrenia according to DSM-5 diagnostic criteria, who met clinical remission criteria and regularly participated in rehabilitation programs at Akdeniz University Psychiatric Day Hospital, and 35 patients with the same diagnosis who were followed on an outpatient basis without participating in any type of rehabilitation intervention. The study was conducted with a total of 70 participants. For data collection, the Positive and Negative Syndrome Scale (PANSS), the Internalized Stigma of Mental Illness Scale (ISMI), the Rosenberg Self-Esteem Scale (RSES), the Schedule for Assessing the Three Components of Insight (SAI), the Personal and Social Performance Scale (PSP), and a sociodemographic data form developed by the researchers were used. The mean age was 40.91±9.49 years in the rehabilitation group and 40.46±9.06 years in the non-rehabilitation group (p=0.837). In the rehabilitation group, the PANSS negative syndrome subscale score (p=0.004), ISMI total score (p=0.007), ISMI social withdrawal subscale (p=0.006), and ISMI stigma resistance subscale (p=0.008) were significantly lower. In the rehabilitation group, the PSP score (p<0.001) and the RSES score (p=0.040) were significantly higher. A correlation was found between the duration of rehabilitation and the PSP score (r=0.482; p=0.003), ISMI perceived discrimination subscale score (r=-0.509; p=0.002), and RSES score (r=0.526; p=0.001). According to linear regression analysis, the factors associated with the PSP score were participation in the rehabilitation program (p<0.001), having a rehabilitation duration of more than 12 months (p=0.020), duration of rehabilitation (p=0.006), PANSS total score (p<0.001), PANSS negative syndrome score (p<0.001), PANSS general psychopathology score (p<0.001), SAI score (p<0.001), ISMI total score (p<0.001), ISMI alienation subscale (p=0.017), ISMI stereotype endorsement subscale (p=0.014), ISMI perceived discrimination subscale (p=0.019), ISMI social withdrawal subscale (p<0.001), ISMI stigma resistance subscale (p=0.005), and RSES score (p<0.001). The findings of this study indicate that rehabilitation interventions in individuals diagnosed with schizophrenia are not limited to providing symptom control but also have positive effects on functional and individual recovery through psychosocial variables such as insight, self-esteem, and social functioning. The sustainable implementation of psychosocial approaches, such as occupational therapy and social skills training group therapies, has been found to be effective in reducing internalized stigma, enhancing self-esteem, and improving social functioning. These results emphasize the clinical and societal importance of rehabilitation services. Therefore, increasing studies aimed at evaluating the effectiveness of rehabilitation interventions and generating evidence-based data in this field is essential for the continuity and expansion of community-based mental health services.