The role of self-esteem for outcome in first-episode psychosis

Background: Self-esteem may be associated with a wide range of psychiatric disorders, including psychotic disorders. However, the relationship between self-esteem and outcome in psychosis has not been adequately examined, especially early in the course of the illness.

Aim: The aim of the study was to examine the impact of self-esteem in individuals who presented for treatment of a first episode of psychosis on outcome early in the course of the illness.

Methods: The Self-Esteem Rating Scale (SERS) was administered to 121 individuals with first-episode psychosis following entry into a specialized programme. Symptoms and the Global Assessment of Functioning (GAF) were assessed at six months after beginning treatment. A correlational analysis was followed by a linear regression controlling for potential confounds.

Results: Self-esteem assessed early in the course of treatment was positively correlated with GAF at six months (r = 0.281, p < 0.01). A linear regression analysis conducted with GAF and depression at baseline in addition to gender, pre-morbid adjustment, duration of untreated psychosis (DUP), and self-esteem as predictors and GAF at six months as the outcome variable revealed only self-esteem to be a significant predictor of GAF at six months (β = 0.290, p < 0.01). However, no association was found between self-esteem and remission at six months (β = 0.003, p > 0.05).

Conclusion: Self-esteem is associated with global functional outcome at six months but not with remission of symptoms. Efforts should be made to provide interventions that may improve low self-esteem in the attempt to influence functional outcome.