Personal Stigma amongst individuals living with Psychosis related experiences: The role of Social Relationships

Abstract

This thesis aimed to understand the role of social relationships in relation to personal stigma across the psychosis continuum. It presents as three papers: (i) a systematic review examining the relationship between personal stigma and social relationships, including social networks, support, and connection in psychosis (ii) a secondary data analysis examining the direct and indirect (mediatory) effects of stigma appraisals on functioning and distress associated with attenuated psychotic symptoms, via objective and subjective social network indicators for individuals at risk of developing psychosis (iii) a critical appraisal and personal reflection on the research process. The systematic review identified 29 studies that met the inclusion criteria. Personal stigma was categorised as internalised, experienced, anticipated, and perceived stigma, and the relation between social relationships, i.e., the presence and quality of social networks, support, and connection, were examined therein. The majority of studies were weak to moderate in quality. Narrative synthesis revealed that quality relationships satisfaction with relationships and connection (i.e., belonging) and lower perceived loneliness were consistently related to personal stigma, specifically internalised stigma. Evidence was inconclusive for other aspects of personal stigma, highlighting a gap in the literature. Mixed results may be related to the lack of consistency in the literature in the context of stigma and social relationship measures. More high-quality research is required to draw more definitive conclusions. The empirical paper utilised EDIE-2 trial data of 288 participants recruited across the UK who met the at-risk mental state (ARMS) criteria. Structural equation modelling (SEM) was used to model the direct effect of stigma on functioning and distress and the indirect effect of the above through social contact and relationship satisfaction. The hypothesised SEM was partially supported, with 46% of the total effect of stigma on functioning mediated via relationship satisfaction. A direct effect of stigma to distress associated with attenuated symptoms was also seen. Objective social contact had less of a significant role in this study, possible reasons for which are explored. The paper explores the clinical and research implications of the findings and suggests future research directions. A blended approach including individual and multi-system interventions targeting personal stigma and improving social relationships may help ameliorate functioning in the ARMS population. The critical appraisal explores the research decisions made in further detail, considers the presented papers in the context of broader research and clinical practice, and presents personal reflections on the research process.

Date of Award	31 Dec 2021
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anthony Morrison (Supervisor)