Internalised stigma mediates the relationship between expressed emotion and psychotic symptoms exacerbation among schizophrenic patients

  • Chuka Mike Ifeagwazi
  • Anthony Onovo
  • Chinenye Joseph Aliche


Empirical evidence in western and non-western cultures have consistently shown that Expressed emotion (EE) is a robust and valuable predictor of psychotic symptom exacerbation, but very little attention has been given to the mechanism through which EE leads to symptom severity. The present study examines the mediating role of internalised stigma of mental illness on the relationship between Expressed emotion (EE) and psychotic symptoms among patients with schizophrenic spectrum disorders. Two hundred and nineteen schizophrenic patients (76.7% males and 23.2% females) participated in the study. They completed the following self-report measures: Positive and Negative Syndrome Scale, Patient’s version of Level of Expressed Emotion Scale, and Internalised Stigma of Mental Illness Scale. Hayes PROCESS macro for SPSS was used in testing for the mediation model. Results showed that expressed emotion (EE criticism, hostility, and over-involvement) was significantly and positively associated with psychotic symptoms severity (negative symptoms and positive symptoms), and this association was mediated by internalised stigma of mental illness. Findings underscore the potential mechanism through which EE may adversely impact on
symptoms severity and the importance of designing adequate interventions to decrease familial EE, and to help patients develop resilience skills needed to cope with their mental health status