Does stigma leave its mark? The interplay between negative effects of perceived stigma with positive effect of self-esteem on long-term social functioning in schizophrenia

Background: Individuals with schizophrenia commonly experience poor social functioning (SF), influenced by stigmatization and linked to low self-esteem. The intricate role of self-esteem in this context remains insufficiently explored. This study delves into the short and long-term impact of perceived stigma on SF, investigating the mediating or moderating effects of self-esteem and momentary fluctuations in self-esteem. Methods: Data were derived from a longitudinal cohort of individuals with schizophrenia and related disorders from the 2nd (T1) and 3rd (T2) waves. Perceived stigma and self-esteem were measured at T1 with self-report questionnaires. Self-esteem at T2 was measured with the experience sampling method. SF was measured at both time points. Multiple regression was applied to analyse the effect of perceived stigma and the role of (fluctuations in) self-esteem on SF. Results: Perceived stigma significantly correlated with SF in the short-term (ß = -4.66, SE = 1.24, p < 0.001) and long-term (ß = -3.77, SE = 0.51, p < 0.001). Once we analysed samples with self-esteem (N = 157), stigma was still associated with SF (ß = -2.78, SE = 1.36, p = 0.043), but not when self-esteem was controlled for (ß = -2.13, SE = 1.34, p < 0.100). Self-esteem significantly mediated stigma-SF relationship in T1 whereas in T2 it only significantly predicted SF (ß = 2.17, SE = 0.70, p = 0.002). Fluctuations in self-esteem did not show mediating/moderating effects. Conclusion: Perceived stigma significantly predicts poor SF both concurrently and, to some extent, over the long term. Moreover, self-esteem may serve as a buffer that mitigates the negative impact of perceived stigma. Early interventions aimed at reducing stigma and enhancing self-esteem through anti-stigma initiatives are essential for improving SF.