Sex-specific predictors of self-stigma reduction in psychosis resulting from metacognitive interventions: Results from a randomized clinical trial.

BACKGROUND

Research on gender differences in self-stigma among individuals with psychosis is limited. Gender differences have been found in factors associated with self-stigma, such as self-esteem, quality of life, and cognitive insight.

OBJECTIVES

This study aimed to determine predictors of self-stigma reduction in men and women after receiving Metacognitive Training (MCT) or a combined intervention delivering MCT alongside cognitive rehabilitation.

DESIGN

Randomized clinical trial with two intervention branches.

METHODS

Participants were randomly allocated to one of two conditions: MCT or MCT alongside cognitive rehabilitation. Assessments were carried out before and after the intervention by blinded professionals. Linear mixed models, correlation analyses, and regressions were employed to examine the effect of treatment, relationships between variables, and potential predictors of treatment response in both groups for men and women, respectively.

RESULTS

Self-stigma was reduced in both intervention groups, with no significant differences between them, suggesting both interventions were effective. Descriptive analyses revealed women reported higher self-stigma (n = 37, M = 63.78, SD = 14.01) than men (n = 40, M = 59.40, SD = 14.52). Regression analyses suggest that post-treatment self-stigma was predicted by different predictors according to sex. In women, self-esteem (R2 = 0.25, β = -2.31, p = 0.023) was a significant predictor of post-treatment self-stigma, while in men, quality of life significantly predicted self-stigma scores post-treatment (R2 = 0.37, β = -0.62, p < 0.001). Cognitive insight was not a significant predictor for either sex.

CONCLUSION

Distinct pathways of self-stigma recovery emerged for women and men, underscoring the need for gender-sensitive interventions. These findings underscore the need for tailored stigma-reduction interventions that consider gender-specific factors influencing mental health outcomes. Longitudinal research should assess durability and further clarify gender-related mechanisms.

REGISTRATION: https://clinicaltrials.gov/study/NCT06423651, Registration Number NCT06423651, 23/05/24.