Should we be concerned about stigma and discrimination in people at risk for psychosis? A systematic review
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Background: Previous studies have provided initial evidence that people at risk for psychosis (PR) suffer from stigma and discrimination related to their condition. However, no study has systematically reviewed stigma and discrimination associated with being at PR and the potential underlying mechanisms. Methods: This work aimed to systematically review all studies addressing stigma and discrimination in PR people in order to assess: (1) the occurrence of this phenomenon and its different components (public, internalized, perceived, and labeling-related), (2) whether stigma affects outcomes of the PR state, and (3) whether other factors modulate stigma among PR individuals. Results: The reviewed studies ( n = 38) widely differ in their design, methodological quality, and populations under investigation, thus limiting direct comparison of findings. However, converging evidence suggests that the general public endorses stigmatizing attitudes towards PR individuals, and that this is more frequent in people with a low educational level or with no direct experience of the PR state. PR individuals experience more internalized stigma and perceive more discrimination than healthy subjects or patients with non-psychotic disorders. Further, PR labeling is equally associated with both positive (e.g. validation and relief) and negative effects (e.g. status loss and discrimination). Moreover, stigma increases the likelihood of poor outcome, transition to full-psychosis, disengagement from services, and family stigma among PR individuals. Finally, very limited evidence awaiting replication supports the efficacy of cognitive therapies in mitigating the negative effects of stigma. Conclusions: Evidence confirms previous concerns about stigma and its negative consequences for PR individuals, thus having important public health implications.
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Many studies have reported that being labelled at risk may produce stigmatizing and self-stigmatizing attitudes.
“Many studies reported that at-risk labelling may cause stigmatizing and self-stigmatizing attitudes 147 and called for the development of stigma-related interventions 148 .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [147]
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- Authors
- Colizzi, M., Ruggeri, M., & Lasalvia, A.
- Affiliations
- University of Verona (IT)
- Corresponding author
- Colizzi, Marco
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2020-02-17
- Volume
- 50
- Issue
- 5
- Pages
- 705-726
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W3008132719
- Cited by
- 86
- References
- 59
- Citations by year
- 2026: 6 · 2025: 21 · 2024: 14 · 2023: 16 · 2022: 14 · 2021: 12 · 2020: 3
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Psychological Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion)
- Iris (University of Trento) (submittedVersion)
- INFM-OAR (INFN Catania) (submittedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- psychosis risk, stigma, discrimination, self-stigma, public stigma, labeling, family stigma, transition to psychosis, cognitive therapy, educational attainment
- MeSH terms
- Adolescent, Adult, Aged, Child, Female, Humans, Male, Middle Aged, Psychotic Disorders, Stereotyping, Young Adult, Social Stigma
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