Background and Hypothesis Shame has been linked to the experience of psychosis, with implications for clinical outcomes, however, a meta-analysis of the relationship has not yet been conducted. This systematic review and meta-analysis aimed to examine the strength of the association between shame and psychosis, and any variations between clinical and non-clinical populations and shame type (internal vs external shame). Study Design Searches were conducted in CINAHL, EMBASE, PsycInfo, PubMed, Scopus, and Web of Science from the inception of the e-databases until July 2023. For inclusion, studies reported a quantitative association between psychosis and shame, or data that could be used to identify a relationship. From 11 372 unique retrieved records, 40 articles met the inclusion criteria and 38 were included in the meta-analyses. Study Results A significant large pooled estimate of the psychosis-shame association was identified (Zr = 0.36, [95% CI: 0.28, 0.44], P < .001), indicating that higher levels of shame were associated with greater severity of psychotic symptoms. The strength of the association was similar across clinical and non-clinical populations, however, differed by type of shame and psychosis symptom measured. External shame was strongly associated with paranoia suggesting possible confounding. Only a minority of studies met the highest quality criteria. Conclusions Shame is strongly associated with the severity of psychotic symptoms in clinical and non-clinical populations. Given the overlap with paranoia, measurement of external shame alone is not advised. Larger studies in clinical populations, with measures of a range of psychosis symptoms, are needed to better understand the relationship between shame and specific symptoms.

中文翻译：

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经历精神病和羞耻：对关联强度和模式的系统回顾和荟萃分析


背景和假设 羞耻感与精神病经历有关，对临床结果有影响，但尚未对这种关系进行荟萃分析。这项系统评价和荟萃分析旨在检查羞耻与精神病之间关联的强度，以及临床和非临床人群以及羞耻类型（内部羞耻与外部羞耻）之间的任何差异。研究设计 从电子数据库建立之初到 2023 年 7 月，在 CINAHL、EMBASE、PsycInfo、PubMed、Scopus 和 Web of Science 中进行了研究设计搜索。为了纳入研究，研究报告了精神病与羞耻感之间的定量关联，或可能的数据用于识别关系。从 11 372 条独特的检索记录中，40 篇文章符合纳入标准，38 篇纳入荟萃分析。研究结果确定了精神病与羞耻关联的显着性大汇总估计（Zr = 0.36，[95% CI：0.28, 0.44]，P < .001），表明羞耻程度越高，精神病的严重程度越高。症状。临床和非临床人群之间的关联强度相似，但因羞耻类型和测量的精神病症状而异。外部羞耻与偏执密切相关，表明可能存在混淆。只有少数研究符合最高质量标准。结论 在临床和非临床人群中，羞耻感与精神病症状的严重程度密切相关。鉴于与偏执狂的重叠，不建议单独测量外部羞耻感。需要对临床人群进行更大规模的研究，测量一系列精神病症状，以更好地了解羞耻感与特定症状之间的关系。