Internalized Stigma in Patients With Schizophrenia in Rural China: Prevalence and Associated Factors

Background: Internalized stigma among patients with schizophrenia can harm self-esteem, hinder social participation, and worsen psychiatric symptoms. This study aims to examine the prevalence of high internalized stigma and identify its associated factors among patients with schizophrenia in rural China to inform future interventions. Methods: This cross-sectional study included 335 inpatients with schizophrenia from a specialized mental health hospital in Shanglin County, Nanning City, China. Internalized stigma was measured using the Chinese-revised Internalized Stigma of Mental Illness (ISMI) scale, psychiatric symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS), and perceived social support was evaluated using the Multidimensional Scale of Perceived Social Support (MSPSS). Results: The prevalence of high internalized stigma among participants was 37.0% (124/335). Univariate analysis indicated that female patients were more likely to experience high internalized stigma than males and that higher internalized stigma was associated with increased total scores on the Positive and Negative Syndrome Scale and its four subscales: positive symptoms, cognitive symptoms, excitatory symptoms, and depressive symptoms. Multivariable analysis further identified being female ( OR = 1.67, 95% CI [1.02, 2.73], p = .042) and having more severe cognitive symptoms ( OR = 1.10, 95% CI [1.01, 1.20], p = .030) as significant predictors of high internalized stigma. Conclusions: High internalized stigma is common among patients with schizophrenia in rural China, with female patients and those with cognitive impairment at higher risk. Targeted interventions are needed to reduce stigma in these groups.