The interrelationships of motivation, positive symptoms, stigma, and role functioning in early psychosis

Abstract

Aim: Avolition, or the lack of motivation, has consistently been shown to be a significant predictor of poor psychosocial outcome, with decreased overall motivation as the single strongest predictor of poor work or school outcome in first episode psychosis. This study aimed to better understand the ways in which motivation impacts work and school functioning. This study first examined the factors related to motivation in people recovering from a recent onset of psychosis, then explored the unique interrelationships between positive symptoms, stigma, and motivation and how they influence role functioning.Methods: A total of 40 participants with early psychosis were recruited for this cross-sectional design study; with a mean of 14.5 months of treatment prior to study assessment.Results: Neither experienced nor internalized stigma were related to motivation in this sample, but internalized stigma was related to work and school functioning. Positive symptoms were significantly inversely related to both work and school functioning and motivation, with mediation analyses showing that motivation significantly mediates the relationship between positive symptoms and role functioning. Conclusion:This relationship may shed light on the link between motivational deficits and work and school outcomes early in the course of psychosis, an area of critical importance for early intervention.

Systematic review and meta-analysis of internalised stigma and stigma resistance in patients with psychosis: The impact of individualism-collectivism culture and other individual factors

“…A total of 1,132 articles were identified, of which 73 were included for the meta-analysis and meta-regression, and 35 for the systematic review (Figure 1). The mean duration of illness of participants from all included studies was 12.49 years ( SD = 10.98), and only three papers assessed participants with <5 years of duration of illness (Chan et al, 2017; DeTore et al, 2022; Lv et al, 2013). One paper assessed patients with first-episode psychosis, but the duration of illness was not reported (Mersh et al, 2015).…”

Associations of internalized stigma with psychosocial functioning and quality of life in people with schizophrenia

“…Internalized stigma has been found to be associated with an array of negative consequences, including lower levels of self-esteem, quality of life, and psychosocial/ vocational functioning in people with schizophrenia (Dubreucq et al, 2021;Gerlinger et al, 2013).The association between higher levels of internalized stigma with poorer subjective quality of life in people with schizophrenia and severe mental illness has been consistently found in previous studies, in which various measures of quality of life were applied (Li et al, 2017;Lien et al, 2018;Mashiach-Eizenberg et al, 2013;Sibitz et al, 2011). In contrast, studies that investigated the association between internalized stigma and objective recovery outcomes did not consistently show that patients with schizophrenia endorse higher levels of internalized stigma had poorer functioning (DeTore et al, 2021;Li, et al, 2017;Rossi et al, 2017;Switaj et al, 2009). Although existing evidence was weaker for the association between internalized stigma and objective outcomes than that between internalized stigma and subjective outcomes in people living with severe mental illness (Yanos et al, 2020), limited studies (Li et al, 2017) examined subjective and objective outcomes simultaneously in the same population.…”

“…However, GAF has the disadvantage of being confounded by psychopathology. In addition, although neurocognition and psychiatric symptoms were both known to be associated with functioning (Galderisi et al, 2013(Galderisi et al, , 2014(Galderisi et al, , 2018, few existing studies controlled for these variables when exploring the association between internalized stigma and functioning (DeTore, et al, 2021;Firmin et al, 2019;Galderisi, et al, 2014Galderisi, et al, , 2018Li, et al, 2017;Yanos et al, 2012).…”