Psychological interventions for personal stigma of patients with schizophrenia: A systematic review and network meta-analysis

Trials to assess the efficacy of psychological interventions for personal stigma in patients with schizophrenia are controversial, inconclusive, and limited. Using a systematic review and network meta-analysis, this study aimed to compare the effect of different psychological interventions for reducing personal stigma in patients with schizophrenia both direct and indirect.Relevant randomized controlled trials (RCTs) were obtained from Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, PsycINFO, Embase, Ovid Medline, CNKI, Wanfang, CBM, and Weipu. The focus of this network meta-analysis was on comparing the effects of various psychological interventions for reducing personal stigma in patients with schizophrenia. Standardized mean differences (SMDs) of personal stigma outcomes and 95% confidence intervals (CIs) were used to determine the efficacy. Inconsistency test, network map, surface under the cumulative rankings curve (SUCRA), comparison-adjusted funnel plot, and sensitivity analysis was performed.Twenty-one RCTs involving 1,749 participants and nine psychological interventions were included. In terms of short-term efficacy, group self-assertiveness training ranked as most likely to reduce personal stigma (SUCRA: 97.0%, SMD: 2.15, 95% CI: 1.07 to 3.23), followed by group psychoeducation programs (SUCRA: 60.1%, SMD: 0.90, 95% CI: 0.24 to 1.55). These two interventions were significantly more effective than the treatment as usual.Group self-assertiveness training and psychoeducation programs with higher ranks in short-term efficacy might be favorable to reduce personal stigma in patients with schizophrenia. However, the quality of evidence for pairwise comparison was rated as "very low" to "low" according to the Confidence in Network Meta-Analysis (CINeMA) approach. Further longitudinal studies with larger well-designed multicentric RCTs are needed to verify the efficacy of long-term outcomes.