Exploring the Role of Stigma and Reduced Facial Expressions in Shaping First Impressions of Individuals with Schizophrenia.

Background and hypothesis: First impressions are rapid judgments based on limited information, significantly influencing one's willingness to interact. Social difficulties in schizophrenia may stem from negative first impressions formed by healthy individuals. We hypothesized that healthy individuals would quickly develop negative first impressions of those with schizophrenia, driven in part by reduced facial expressions and stigma.

Study design: Twenty individuals with schizophrenia and 20 age- and sex-matched healthy controls were filmed responding to a question for 30 seconds. Three hundred participants from the general population rated their first impressions of the 40 video recordings. The diagnosis of individuals with schizophrenia was either retained, disclosed, or misrepresented as autistic. To isolate the effect of facial expressions, stimuli were presented without sound using a point light display.

Study results: Individuals with schizophrenia received more negative first impression ratings than healthy controls, and higher negative symptoms were linked to poorer first impression ratings. OpenFace analysis confirmed that facial expressions significantly shaped impressions, particularly mouth movement. Additionally, ratings worsened when participants' schizophrenia diagnosis was disclosed, highlighting the harmful impact of stigma. Conversely, when mislabeled as having autism, first impression ratings improved.

Conclusions: This study highlights the compounded negative effects of facial expressions and schizophrenia-related stigma on first impressions. Given their significant influence on social interactions, future research should explore strategies to mitigate these effects.