Automatic Thoughts,Self-stigma,and Resilience Among Schizophrenia Patients With Metabolic Syndrome:A Cross-sectional Study

Objective: Schizophrenia(SCZ)is a debilitating psychiatric disorder with unknown etiology affecting ～1% of the population worldwide;it is also considered one of the most incapacitating diseases.Evidence from epidemiological studies suggests that patients with SCZ continue to have two-to three-fold higher metabolic syndrome(Met S)than the general population.Studies also indicated that the Met S in persons with SCZ would increase their risk of developing cardiovascular disease,consequently reducing their life expectancy by approximately 10 to 25 years.The study aims to clarify the negative psychological state and resilience impairments of schizophrenia(SCZ)with metabolic syndrome(Met S)while evaluating their potential as risk factors.Method: We recruited 143 individuals and divided them into three groups according to the criteria on the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition,and the guideline standards for the prevention and treatment of dyslipidemia in Chinese adults in 2007 Met S,as follows: healthy control group(n=48),non-Met S group(n=48),and Mets group(n=47).Clinical symptoms were evaluated using the Positive and Negative Syndrome Scale(PANSS),and Hamilton Depression Rating Scale(HAMD)-24 and Hamilton Anxiety Rating Scale(HAMA)-14 were used by professional psychiatrists to evaluate the severity of depression and anxiety.Psychological structure was evaluated by the Automatic Thoughts Questionnaire(ATQ),Stigma of Mental Illness scale,and Connor–Davidson Resilience Scale(CD-RISC).Serum biochemical parameters were measured by automatic biochemistry analyzer.Results: Results showed that the proportion of internalized stigma is as high as 58.33%and 65.96% in the non-Met S group and Met S group,respectively.The score of ATQ was highest in the Met S group(F=14.5,p<0.001),and the total score of CD-RISC,subscale tenacity score of CD-RISC,and subscale strength score of CD-RISC were lowest in the Met S group(F=8.54,p < 0.001;F=5.79,p=0.004;F=10.9,p < 0.001).A stepwise regression analysis further demonstrated that a negative correlation was observed among the ATQ with employment status,high-density lipoprotein(HDL-C),and CD-RISC(β=-0.190,t=-2.297,p=0.023;β=-0.278,t=-3.437,p=0.001;β=-0.238,t=-2.904,p=0.004).In the meantime,a positive correlation was observed among the ATQ with waist,TG,WBC,and stigma(β=0.271,t=3.340,p=0.001;β=0.283,t=3.509,p=0.001;β=0.231,t=2.815,p=0.006;β=0.251,t=-2.504,p=0.014).The area under the receiveroperating characteristic curve analysis showed that among all independent predictors of ATQ,the TG,waist,HDL-C,CD-RISC,and stigma presented excellent specificity at0.918,0.852,0.759,0.633,and 0.605,respectively.Conclusion: Our results suggested that the non-Met S and Met S groups had grievous sense of stigma,particularly,high degree of ATQ and resilience impairment was shown by the Met S group.The TG,waist,HDL-C of metabolic parameters,CD-RISC,and stigma presented excellent specificity to predict ATQ,and the waist showed excellent specificity to predict low resilience level.