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Zisman-Ilani Y, Hasson-Ohayon I, Levy-Frank I, Tuval-Mashiach R, Roe D. Self-stigma, insight, and family burden among Israeli mothers of people with serious mental illness: Ethno-national considerations. Transcult Psychiatry 2017; 54:423-441. [PMID: 28443366 DOI: 10.1177/1363461517703022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current cross-sectional study investigated and compared the associations between insight, self-stigma, and family burden among Jewish and Arab mothers of an adult son or daughter with serious mental illness (SMI) in Israel. A total of 162 Israeli mothers of a person with SMI participated in the study; 95 were Jewish (58.6%), and 67 were Arab (41.4%). Insight, self-stigma, and family burden scales were administered. Jewish mothers reported higher levels of insight into their son's or daughter's illness and reported greater family burden compared to Arab mothers. No significant differences in self-stigma scores were found between Jewish and Arab mothers. The pattern of associations between insight, self-stigma, and burden differed between Jewish and Arab mothers. Self-stigma was found to mediate the relationship between insight and burden among Jewish mothers but not among Arab mothers. Ethno-national affiliation should be taken into consideration regarding how family members conceptualize and experience mental illness, as this might affect care.
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Abstract
Background:Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory.Aims:The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis.Method:Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory.Results:This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice.Conclusion:An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level.
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203
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Chavira DA, Bantados B, Rapp A, Firpo-Perretti YM, Escovar E, Dixon L, Drahota A, Palinkas LA. Parent-reported stigma and child anxiety: A mixed methods research study. CHILDREN AND YOUTH SERVICES REVIEW 2017; 76:237-242. [PMID: 29576669 PMCID: PMC5860669 DOI: 10.1016/j.childyouth.2017.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Stigma has been frequently cited as a barrier to service use for various mental health problems. Studies suggest that stigma may be greater for childhood mental health problems that are perceived as more atypical. AIMS This study utilized a mixed methods research design (qual + QUAN) to examine parental endorsement of stigma and its impact on service utilization among children with significant anxiety-a common childhood problem frequently perceived as normative. METHODS Semi-structured qualitative interviews were conducted with 29 parents of anxious children. Qualitative data were coded using a grounded theory approach, and stigma-related responses were examined for emergent themes. Quantitative data was analyzed with frequency counts and chi-square analysis. RESULTS Stigma related to children's anxiety symptoms and seeking mental health services was reported by 41.3% (n = 12) of parents. Emergent themes included: 1) Parental Concern for Negative Consequences, 2) Parent Internalized Stigma, and 3) Negative Associations with Mental Health Treatment. Latino parents discussed stigma more frequently than non-Latino White parents (70% vs. 17.6%, respectively, X2(1, N = 27) = 5.33, p < 0.05). CONCLUSIONS Although anxiety is a common childhood problem, stigma is still frequently reported by parents and may be an important barrier to mental health service use, especially among Latino youth.
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Affiliation(s)
- Denise A. Chavira
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
- University of California, San Diego, Department of Psychiatry, La Jolla, CA, USA
| | - Brenda Bantados
- Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Amy Rapp
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | | | - Emily Escovar
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Louise Dixon
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, USA
| | - Amy Drahota
- Michigan State University, Department of Psychology, East Lansing, MI, USA
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Vass V, Sitko K, West S, Bentall RP. How stigma gets under the skin: the role of stigma, self-stigma and self-esteem in subjective recovery from psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1300184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Victoria Vass
- Institute of Psychology, Health, & Society, University of Liverpool, Liverpool, UK
| | - Katarzyna Sitko
- Institute of Psychology, Health, & Society, University of Liverpool, Liverpool, UK
| | - Sophie West
- Institute of Psychology, Health, & Society, University of Liverpool, Liverpool, UK
| | - Richard P. Bentall
- Institute of Psychology, Health, & Society, University of Liverpool, Liverpool, UK
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Mervis JE, Fiszdon JM, Lysaker PH, Nienow TM, Mathews L, Wardwell P, Petrik T, Thime W, Choi J. Effects of the Indianapolis Vocational Intervention Program (IVIP) on defeatist beliefs, work motivation, and work outcomes in serious mental illness. Schizophr Res 2017; 182:129-134. [PMID: 27802910 PMCID: PMC5828005 DOI: 10.1016/j.schres.2016.10.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/23/2016] [Accepted: 10/27/2016] [Indexed: 11/15/2022]
Abstract
Defeatist beliefs and amotivation are prominent obstacles in vocational rehabilitation for people with serious mental illnesses (SMI). The CBT-based Indianapolis Vocational Intervention Program (IVIP) was specifically designed to reduce defeatist beliefs related to work functioning. In the current study, we examined the impact of IVIP on defeatist beliefs and motivation for work, hypothesizing that IVIP would be associated with a reduction in defeatist beliefs and greater motivation for work. We also examined the effects of IVIP on these variables as well as work outcomes during a 12-month follow-up. Participants with SMI (n=64) enrolled in a four-month work therapy program were randomized to IVIP or a support therapy group (SG). Assessments were conducted at baseline, post-treatment (4months), and follow-up (1year). Compared to those in SG condition, individuals randomized to IVIP condition reported greater reductions in defeatist beliefs and greater motivation for work at follow-up, along with greater supported employment retention rates. Specifically treating and targeting negative expectations for work therapy improves outcomes, even once active supports of the IVIP program and work therapy are withdrawn.
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Affiliation(s)
- Joshua E. Mervis
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis, MN, USA,Corresponding author
| | - Joanna M. Fiszdon
- Psychology Service, VA Connecticut Healthcare System & Yale University School of Medicine, 950 Campbell Ave, West Haven, CT 06516 USA
| | - Paul H. Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tasha M. Nienow
- Minneapolis VA Health Care System, 1 Veterans Dr., Minneapolis, MN 55417 USA
| | - Laura Mathews
- Department of Psychiatric Vocational Services, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
| | - Patricia Wardwell
- Department of Psychiatric Vocational Services, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
| | - Tammy Petrik
- Department of Psychiatric Vocational Services, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
| | - Warren Thime
- Schizophrenia Rehabilitation Program, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
| | - Jimmy Choi
- Schizophrenia Rehabilitation Program, The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT 06106, USA.
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206
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Scocco P, Preti A, Totaro S, Ferrari A, Toffol E. Stigma and psychological distress in suicide survivors. J Psychosom Res 2017; 94:39-46. [PMID: 28183401 DOI: 10.1016/j.jpsychores.2016.12.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/24/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Suicide bereavement is frequently related to clinically significant psychological distress and affected by stigma. This study was designed to evaluate the relationship between psychological distress by psychopathological domains and stigma, in a sample of individuals bereaved by suicide (suicide survivors). METHODS The data were collected between January 2012 and December 2014 and included information on sociodemographic variables (gender, age, marital status and education level) and responses to the Stigma of Suicide Survivor scale (STOSSS) and the Brief Symptom Inventory (BSI). One hundred and fifty-five suicide survivors completed the evaluation and were included in the study. RESULTS Levels of psychological distress in suicide survivors, as measured by BSI, were positively related to levels of perceived stigma toward suicide survivors, as measured by STOSSS. The association was not affected by age and gender, or by marital status, education level, days from suicide or a personal history of suicide attempt. Participants with higher scores on almost all subscales of the BSI, particularly the interpersonal sensitivity and paranoid ideation subscales, reported the highest levels of perceived stigma toward suicide survivors. CONCLUSION Levels of distress in subjects bereaved by the suicide of a relative or friend were positively associated with levels of perceived stigma toward suicide survivors. Specific interventions dedicated to the bereavement of suicide survivors might help to alleviate not only psychological distress but also stigma towards loss by suicide.
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Affiliation(s)
- Paolo Scocco
- Soproxi Project, via Vesalio 10, Padova, Italy; Mental Health Department, via Buzzaccarini 1, ULSS 6 Euganea, Padova, Italy.
| | - Antonio Preti
- Genneruxi Medical Center, via Costantinopoli 42, 09129 Cagliari, Italy.
| | | | | | - Elena Toffol
- Soproxi Project, via Vesalio 10, Padova, Italy; Department of Health, National Institute for Health and Welfare, Mannerheimintie 166 A, Helsinki, Finland.
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207
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Klaas HS, Clémence A, Marion-Veyron R, Antonietti JP, Alameda L, Golay P, Conus P. Insight as a social identity process in the evolution of psychosocial functioning in the early phase of psychosis. Psychol Med 2017; 47:718-729. [PMID: 27866482 PMCID: PMC5426321 DOI: 10.1017/s0033291716002506] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 08/30/2016] [Accepted: 08/30/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Awareness of illness (insight) has been found to have contradictory effects for different functional outcomes after the early course of psychosis. Whereas it is related to psychotic symptom reduction and medication adherence, it is also associated with increased depressive symptoms. In this line, the specific effects of insight on the evolution of functioning over time have not been identified, and social indicators, such as socio-occupational functioning have barely been considered. Drawing from social identity theory we investigated the impact of insight on the development of psychosocial outcomes and the interactions of these variables over time. METHOD The participants, 240 patients in early phase of psychosis from the Treatment and Early Intervention in Psychosis Program (TIPP) of the University Hospital of Lausanne, Switzerland, were assessed at eight time points over 3 years. Cross-lagged panel analyses and multilevel analyses were conducted on socio-occupational and general functioning [Social and Occupational Functioning Assessment Scale (SOFAS) and Global Assessment of Functioning (GAF)] with insight, time and depressive symptoms as independent variables. RESULTS Results from multilevel analyses point to an overall positive impact of insight on psychosocial functioning, which increases over time. Yet the cross-lagged panel analysis did not reveal a systematic positive and causal effect of insight on SOFAS and GAF scores. Depressive symptoms seem only to be relevant in the beginning of the treatment process. CONCLUSIONS Our results point to a complex process in which the positive impact of insight on psychosocial functioning increases over time, even when considering depressive symptoms. Future studies and treatment approaches should consider the procedural aspect of insight.
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Affiliation(s)
- H. S. Klaas
- Swiss National Centre of Competence in Research LIVES, Life Course and Inequality Research Centre (LINES), Faculty of Social and Political Sciences, University of Lausanne, Switzerland
| | - A. Clémence
- Psychology Institute, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - R. Marion-Veyron
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Département de Psychiatrie Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
| | - J.-P. Antonietti
- Psychology Institute, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - L. Alameda
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Département de Psychiatrie Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
| | - P. Golay
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Département de Psychiatrie Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
| | - P. Conus
- Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Département de Psychiatrie Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne, Clinique de Cery, 1008 Prilly, Switzerland
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208
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Al-HadiHasan A, Callaghan P, Lymn JS. Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan. BMC Psychiatry 2017; 17:68. [PMID: 28193197 PMCID: PMC5307804 DOI: 10.1186/s12888-017-1225-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 02/01/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Schizophrenia is a serious form of mental illness that often requires long term care. Empirical findings indicate that combining a psycho-educational intervention (PEI) with neuroleptic medication to treat schizophrenia is effective. However, there is little information on the therapeutic mechanism of PEIs. METHODS A qualitative process evaluation was conducted with a purposive sample of people diagnosed with schizophrenia (PDwS, n = 8) and their Primary Caregivers (PCs, n = 9) who had received PEI as a part of an exploratory randomized controlled trial. Semi-structured interviews were conducted to explore potential processes underpinning any observed effect. Thematic analysis was used to analyze and identify prominent patterns in the data. Interviews were conducted between April 2013 and August 2013. RESULTS Three themes emerged from the qualitative interviews, 'Awareness of schizophrenia', 'Positive impact on health and wellbeing', 'empowerment and enhanced confidence', which described the variety of experiences with the intervention, although most reported that the intervention was acceptable and valued. CONCLUSION This study identified that individual understanding varied between PDwS and PCs and led to differences in the ways that they used knowledge gained from the PEI in everyday situations. These data support the importance of improving understanding of schizophrenia by PDwS and their PCs to enable them to benefit more fully from medication. TRIAL REGISTRATION Current Controlled Trials ISRCTN78084871 . Retrospectively registered 28 December 2015.
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Affiliation(s)
- Abd Al-HadiHasan
- Assistant Professor in Mental Health Nursing, Nursing Department, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
| | - Patrick Callaghan
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
| | - Joanne S. Lymn
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, NG7 2UH UK
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209
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Keen N, George D, Scragg P, Peters E. The role of shame in people with a diagnosis of schizophrenia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 56:115-129. [DOI: 10.1111/bjc.12125] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/03/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Nadine Keen
- Psychological Interventions Clinic for Outpatients with Psychosis (PICuP); South London and Maudsley NHS Foundation Trust; UK
| | - Darren George
- Ganjuu Wellbeing Service; Okinawan Institute of Science & Technology (OIST); Japan
- Department of Clinical, Educational and Health Psychology; University College London; UK
| | - Peter Scragg
- Department of Clinical, Educational and Health Psychology; University College London; UK
| | - Emmanuelle Peters
- Psychological Interventions Clinic for Outpatients with Psychosis (PICuP); South London and Maudsley NHS Foundation Trust; UK
- Department of Psychology; Institute of Psychiatry, Psychology & Neuroscience; King's College London; UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London; UK
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210
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Paraskevoulakou A, Vrettou K, Pikouli K, Triantafillou E, Lykou A, Economou M. Mental Illness Related Internalized Stigma: Psychometric Properties of the Brief ISMI Scale in Greece. Mater Sociomed 2017; 29:211-215. [PMID: 29109669 PMCID: PMC5644194 DOI: 10.5455/msm.2017.29.211-215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Aims Since evaluation regarding the impact of mental illness related internalized stigma is scarce, there is a great need for psychometric instruments which could contribute to understanding its adverse effects among Greek patients with severe mental illness. The Brief Internalized Stigma of Mental Illness (ISMI) scale is one of the most widely used measures designed to assess the subjective experience of stigma related to mental illness. The present study aimed to investigate the psychometric properties of the Greek version of the Brief ISMI scale. In addition to presenting psychometric findings, we explored the relationship of the Greek version of the Brief ISMI subscales with indicators of self-esteem and quality of life. Methods 272 outpatients (108 males, 164 females) meeting the DSM-IV TR criteria for severe mental disorder (schizophrenia, bipolar disorder, major depression) completed the Brief ISMI, the RSES and the WHOQOL-BREF scales. Patients reported age and educational level. A retest was conducted with 124 patients. Results The Chronbach's alpha coefficient was 0 0.83. The test-retest reliability coefficients varied from 0.81 to 0.91, indicating substantial agreement. The ICC was for the total score 0.83 and for the two factors, 0.69 and 0.77 respectively. Factor analysis provided strong evidence for a two factor model. Factors 1 and 2 were named respectively "how others view me" and "how I view myself". They were negatively correlated with both RSES and WHOQOL-BREF scales, as well as with educational level. Factor 2 was significantly associated with the type of diagnosis. Conclusions The Greek version of the Brief ISMI scale can be used as a reliable and valid tool for assessing mental illness related internalized stigma among Greek patients with severe mental illness.
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Affiliation(s)
| | - Kassiani Vrettou
- University Mental Health Research Institute, Athens, Greece. First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Katerina Pikouli
- Center for Community Mental Health, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Evgenia Triantafillou
- First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | | | - Marina Economou
- University Mental Health Research Institute, Athens, Greece. First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece
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211
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Profiles of Relationships Between Subjective and Objective Cognition in Schizophrenia: Associations With Quality of Life, Stigmatization, and Mood Factors. JOURNAL OF COGNITIVE EDUCATION AND PSYCHOLOGY 2017. [DOI: 10.1891/1945-8959.16.1.64] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Justification: Recent studies showed that neurocognitive insight difficulties occur in subjects with schizophrenia. However, little is known about the different profiles of neurocognitive insight, their relations with neurocognitive functioning, and their specific links with mood factors and outcomes. Aim: The study explored profiles of relationships between objective and subjective cognition in persons with schizophrenia spectrum disorders (SSD) and associations with quality of life (QoL), stigmatization, and mood factors. Method: Participants were 69 outpatients with an SSD. Cluster analysis (Ward method) was performed to explore profiles of interactions between subjective complaints and objective cognitive performances. Analyses of variance (ANOVAs) were then conducted to compare groups on anxiety and depression levels, stigmatization, and QoL. Results: Cluster analysis produced 3 groups: high cognitive impairment/moderate cognitive complaints (N = 26), good cognitive functioning/moderate cognitive complaints (N = 22), and moderate cognitive impairment/high cognitive complaints (N = 21). The second group has higher objective QoL, and the third group has higher levels of anxiety, depression, and stigmatization. Our results show that (a) not all patients with SSD have neurocognitive insight difficulties, (b) relation between objective and subjective cognition is not linear, and (c) differences between profiles may have theoretical and clinical implications.
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212
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Common sense model of mental illness: Understanding the impact of cognitive and emotional representations of mental illness on recovery through the mediation of self-stigma. Psychiatry Res 2016; 246:16-24. [PMID: 27644016 DOI: 10.1016/j.psychres.2016.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 09/11/2016] [Accepted: 09/11/2016] [Indexed: 11/20/2022]
Abstract
The present study applied the common sense model to understand the underlying mechanism of how cognitive and emotional representations of mental illness among people in recovery of mental illness would impact their endorsement of self-stigma, and how that would, in turn, affect clinical and personal recovery. A cross-sectional survey was administered to 376 people in recovery. Participants were recruited from seven public specialty outpatient clinics and substance abuse assessment clinics across various districts in Hong Kong. They were asked to report their perception towards their mental illness, self-stigma, symptom severity, and personal recovery. The results of structural equation modeling partially supported the hypothesized mediation model indicating that controllability, consequences, and emotional concern of mental illness, but not cause, timeline, and identity, were associated with self-stigma, which was subsequently negatively associated with clinical and personal recovery. The present study demonstrated the mediating role of self-stigma in the relationship between individuals' illness representations towards their mental illness and their recovery. Illness management programs aimed at addressing the maladaptive mental illness-related beliefs and emotions are recommended. Implications on developing self-directed and empowering mental health services are discussed.
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213
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The Role of Metacognitive Self-Reflectivity in Emotional Awareness and Subjective Indices of Recovery in Schizophrenia. J Nerv Ment Dis 2016; 204:903-908. [PMID: 27668353 PMCID: PMC5125882 DOI: 10.1097/nmd.0000000000000599] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Emotional awareness deficits in people with schizophrenia have been linked to poorer objective outcomes, but no work has investigated the relationship between emotional awareness and subjective recovery indices or metacognitive self-reflectivity. The authors hypothesized that increased emotional awareness would be associated with greater self-esteem, hope, and self-reflectivity and that self-reflectivity would moderate links between emotional awareness and self-esteem and hope-such that significant relationships would only be observed at lower levels of self-reflectivity. Participants were 56 people with schizophrenia spectrum disorders. Correlations revealed that better emotional awareness was significantly associated with increased self-esteem and hope but not self-reflectivity. Self-reflectivity moderated the relationship between emotional awareness and self-esteem but not hope. Overall, findings suggest that emotional awareness may affect self-esteem for those low in self-reflectivity, but other factors may be important for those with greater self-reflectivity. Results emphasize the importance of interventions tailored to enhance self-reflective capacity in clients with schizophrenia.
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214
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Makanjuola V, Esan Y, Oladeji B, Kola L, Appiah-Poku J, Harris B, Othieno C, Price L, Seedat S, Gureje O. Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1645-1654. [PMID: 27491966 PMCID: PMC6311698 DOI: 10.1007/s00127-016-1274-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most cultures in sub-Saharan Africa subscribe to the belief that the root cause of psychosis is supernatural. Individuals in the community who hold a religiomagical explanatory model of causation have been shown to exhibit more stigmatizing attitudes towards people with psychosis. Self-stigma among individuals with psychosis is less frequently studied. METHOD We used a mixed-method approach, consisting of key informant's interviews to elicit information on explanatory models of causation of psychosis and questionnaire assessment of internalized stigma with an adapted version of the Scale for Internalized Stigma of Mental Illness. Twenty-four, 31, and 30 subjects with recent experience of utilizing the service of traditional or faith healers for severe mental disorders in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya), respectively, were interviewed. RESULTS About 44 % (42.1 %) of the Nigerian respondents had a high (severe) level of self-stigma with the respective proportions among Ghanaian and Kenyan respondents being 20.7 and 37.5 %. Compared with 4 out of a total of 12 respondents (33.3 %) who reported low self-stigma reported supernatural attribution, 14 out of 20 respondents (70 %) with the highest level of self-stigma reported supernatural attribution across the three sites. When low scorers ascribed supernatural causation, it was often with a religious focus. CONCLUSION There is a greater tendency for persons with high levels of self-stigma than those with low levels to ascribe supernatural attribution to their experience of a severe mental health condition.
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Affiliation(s)
| | - Yomi Esan
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | - Lola Kola
- World Health Organization Country Office, Abuja, Nigeria
| | - John Appiah-Poku
- Kwame Nkuruma University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
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215
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Positive beliefs about mental illness: Associations with sex, age, diagnosis, and clinical outcomes. J Affect Disord 2016; 204:197-204. [PMID: 27367308 DOI: 10.1016/j.jad.2016.06.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 06/11/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Beliefs about mental illness affect how individuals cope with their symptoms. Positive beliefs about mental illness (PBMI) refer to perceptions of positive attributes individuals may identify in their illness, such as beneficial consequences, enhanced creativity or cognition, or growth through adversity. METHODS The present study developed and tested a brief measure of PBMI in 332 adults presenting for partial hospitalization with a variety of acute psychiatric conditions. RESULTS Results indicated that older individuals and women had lower levels of PBMI than others, while individuals with bipolar disorder had higher levels of PBMI than others. PBMI significantly increased over the course of brief standard treatment. Baseline levels of PBMI, as well as changes in PBMI over the course of treatment, were associated with clinical outcomes including, but not limited to, depression and well-being. A diagnosis of bipolar disorder moderated the relationship between PBMI and only one clinical outcome, emotional lability. Increases in PBMI during treatment were associated with reduced emotional lability only in participants without bipolar disorder. LIMITATIONS Our findings are limited by the naturalistic study design. In addition, the lack of ethnoracial diversity in our sample limits the generalization of results. CONCLUSIONS Our results suggest that PBMI are a distinct set of beliefs that meaningfully relate to demographic characteristics, diagnostic characteristics, and clinical outcomes. Future research should examine the mechanisms through which PBMI and outcomes are related, as well as determine whether interventions designed to address PBMI (and perhaps tailored for different diagnostic groups) have clinical utility.
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Wood L, Burke E, Byrne R, Enache G, Morrison AP. Semi-structured Interview Measure of Stigma (SIMS) in psychosis: Assessment of psychometric properties. Schizophr Res 2016; 176:398-403. [PMID: 27424267 DOI: 10.1016/j.schres.2016.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/28/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
Stigma is a significant difficulty for people who experience psychosis. To date, there have been no outcome measures developed to examine stigma exclusively in people with psychosis. The aim of this study was develop and validate a semi-structured interview measure of stigma (SIMS) in psychosis. The SIMS is an eleven item measure of stigma developed in consultation with service users who have experienced psychosis. 79 participants with experience of psychosis were recruited for the purposes of this study. They were administered the SIMS alongside a battery of other relevant outcome measures to examine reliability and validity. A one-factor solution was identified for the SIMS which encompassed all ten rateable items. The measure met all reliability and validity criteria and illustrated good internal consistency, inter-rater reliability, test retest reliability, criterion validity, construct validity, sensitivity to change and had no floor or ceiling effects. The SIMS is a reliable and valid measure of stigma in psychosis. It may be more engaging and acceptable than other stigma measures due to its semi-structured interview format.
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Affiliation(s)
- Lisa Wood
- North East London Foundation Trust, Goodmayes Hospital, Barley Lane, Ilford IG3 8XJ, United Kingdom; University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom.
| | - Eilish Burke
- University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Rico House, Prestwich, Manchester M25 9WL, United Kingdom
| | - Gabriela Enache
- North East London Foundation Trust, Goodmayes Hospital, Barley Lane, Ilford IG3 8XJ, United Kingdom
| | - Anthony P Morrison
- University of Manchester, School of Psychological Sciences, Zochonis Building, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West NHS Foundation Trust, Rico House, Prestwich, Manchester M25 9WL, United Kingdom
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217
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Howland M, Levin J, Blixen C, Tatsuoka C, Sajatovic M. Mixed-methods analysis of internalized stigma correlates in poorly adherent individuals with bipolar disorder. Compr Psychiatry 2016; 70:174-80. [PMID: 27557395 PMCID: PMC5317182 DOI: 10.1016/j.comppsych.2016.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/22/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Internalized stigma, which occurs when stigmatized individuals accept society's assessment and incorporate this assessment into their sense of self, is prevalent in individuals with bipolar disorder (BD). This study explored the correlates of internalized stigma in a research sample of patients with BD who were poorly adherent to their medications. METHODS Both quantitative and qualitative analyses were performed. Scores of 115 individuals with BD on the Internalized Stigma of Mental Illness (ISMI) scale were correlated with scores on the General Self-Efficacy (GSE) Scale, Brief Psychiatric Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Young Mania Rating Scale (YMRS). Regression was run for GSE (dependent variable) and ISMI (independent variable). In-depth qualitative interviews were conducted on a representative subsample (N=21). RESULTS Internalized stigma levels were moderately high. Internalized stigma and self-efficacy correlated, and internalized stigma related to self-efficacy after adjusting for demographic variables (age, gender, years of education), comorbidities, and symptom severity (BPRS and MADRS). Internalized stigma was also associated with the BD symptoms of depression, anxiety, guilt feelings, suspiciousness, and hallucinogenic behaviors. No association was found with mania. CONCLUSIONS Because internalized stigma has strong psychosocial and psychiatric symptom associations, it is recommended that clinicians address both societal stigma and internalized stigma. Strategies such as cognitive-behavioral therapy may help modify BD patients' internalized stigma.
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Affiliation(s)
- Molly Howland
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106.
| | - Jennifer Levin
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106.
| | - Carol Blixen
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106.
| | - Curtis Tatsuoka
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106; Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, 44106; Department of Neurology, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106.
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, 10524 Euclid Avenue, Cleveland, OH, 44106; Department of Neurology, Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH, 44106; Department of Psychiatry, Case Western Reserve University School of Medicine, 10524 Euclid Ave, Cleveland, OH, 44106.
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218
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Schapir L, Zalsman G, Hasson-Ohayon I, Gaziel M, Morag-Yaffe M, Sever J, Weizman A, Shoval G. Suicide, Satisfaction With Life, and Insight Capacity Among Adolescents With Mental Disorders. CRISIS 2016; 37:347-352. [DOI: 10.1027/0227-5910/a000403] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract. Background: Little is known about the role of insight and satisfaction with life in adolescent suicidal behavior. Aims: The objective of this study was to examine the relationship between suicide risk, insight, and satisfaction with life among adolescents with mental disorders. Method: A total of 30 adolescents were evaluated using self-report measures of insight, satisfaction with life, and suicide risk. Regression analysis was used to assess the contribution of each factor to suicide risk. Results: Positive correlations were found between suicide risk and insight dimensions. Satisfaction with life correlated negatively with suicide risk and insight dimensions. Insight explained 27.3% of suicide risk (p = .003). Both insight and satisfaction with life explained 39.0% of suicide risk (p = .031). Conclusion: Among adolescents with mental disorders, insight is a risk factor, whereas satisfaction with life is a protective factor for suicidality. Insight affects suicide risk of adolescents with mental disorders via reduction of satisfaction with life.
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Affiliation(s)
- Lior Schapir
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Zalsman
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - Meyrav Gaziel
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | | | - Jonathan Sever
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Weizman
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Shoval
- Child and Adolescent Division, Geha Mental Health Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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219
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Self-stigma and affiliate stigma in first-episode psychosis patients and their caregivers. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1225-31. [PMID: 27118543 DOI: 10.1007/s00127-016-1221-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 04/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Stigma is a major factor causing delayed help-seeking and poor treatment adherence in patients with psychotic disorders. Previous research has mostly focused on chronic samples and the impact of culturally-relevant variables on both patients' and their caregivers' stigmatization is understudied. This study aimed to examine the relationships between various forms of stigma, "face concern", and clinical characteristics in a group of Chinese first-episode psychosis (FEP) patients and their caregivers. METHODS Forty-four Hong Kong Chinese aged 15-54 years presenting with FEP to psychiatric services and their caregivers were recruited. Assessments on self-stigma, affiliate stigma, perceived public stigma, "face concern", symptom severity and subjective quality of life (QoL) were conducted. RESULTS Self-stigma of FEP patients was correlated with perceived public stigma, "face concern", insight and psychological health of QoL. Multiple regression analysis revealed that perceived public stigma and "face concern" independently predicted self-stigma. Mediation analysis further suggested that "face concern" partially mediated the relationship between perceived public stigma and self-stigma. Caregivers' affiliate stigma was significantly associated with higher levels of stress, and symptoms of depression and anxiety. Affiliate stigma did not correlate with perceived public stigma and "face concern". CONCLUSION Our results indicate a critical role of perceived public stigma and fear of losing face in determining self-stigma in Chinese patients with FEP. Caregivers with greater degree of affiliate stigma experience increased stress and emotional distress. Our findings highlight the importance to examine culturally specific factors that may contribute to the development of self-stigma in first-episode populations of different ethnicities.
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220
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Belvederi Murri M, Amore M, Calcagno P, Respino M, Marozzi V, Masotti M, Bugliani M, Innamorati M, Pompili M, Galderisi S, Maj M. The "Insight Paradox" in Schizophrenia: Magnitude, Moderators and Mediators of the Association Between Insight and Depression. Schizophr Bull 2016; 42:1225-33. [PMID: 27069064 PMCID: PMC4988746 DOI: 10.1093/schbul/sbw040] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The so-called "insight paradox" posits that among patients with schizophrenia higher levels of insight are associated with increased levels of depression. Although different studies examined this issue, only few took in account potential confounders or factors that could influence this association. In a sample of clinically stable patients with schizophrenia, insight and depression were evaluated using the Scale to assess Unawareness of Mental Disorder and the Calgary Depression Scale for Schizophrenia. Other rating scales were used to assess the severity of psychotic symptoms, extrapyramidal symptoms, hopelessness, internalized stigma, self-esteem, and service engagement. Regression models were used to estimate the magnitude of the association between insight and depression while accounting for the role of confounders. Putative psychological and sociodemographic factors that could act as mediators and moderators were examined using the PROCESS macro. By accounting for the role of confounding factors, the strength of the association between insight into symptoms and depression increased from 13% to 25% explained covariance. Patients with lower socioeconomic status (F = 8.5, P = .04), more severe illness (F = 4.8, P = .03) and lower levels of service engagement (F = 4.7, P = .03) displayed the strongest association between insight and depression. Lastly, hopelessness, internalized stigma and perceived discrimination acted as significant mediators. The relationship between insight and depression should be considered a well established phenomenon among patients with schizophrenia: it seems stronger than previously reported especially among patients with lower socioeconomic status, severe illness and poor engagement with services. These findings may have relevant implications for the promotion of insight among patients with schizophrenia.
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Affiliation(s)
- Martino Belvederi Murri
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy; Department of Psychological Medicine, King's College London, London, UK; These authors contributed equally to this work.
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy;,These authors contributed equally to this work
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy
| | - Matteo Respino
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy
| | - Valentina Marozzi
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy
| | - Mattia Masotti
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy
| | - Michele Bugliani
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genova, Italy
| | - Marco Innamorati
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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221
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Stigma resistance is positively associated with psychiatric and psychosocial outcomes: A meta-analysis. Schizophr Res 2016; 175:118-128. [PMID: 27102423 DOI: 10.1016/j.schres.2016.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 01/21/2023]
Abstract
To better understand how stigma resistance impacts functioning-related domains, we examined mean effect sizes between stigma resistance and: 1) symptoms (overall, positive, negative, and mood symptoms); 2) self-stigma; 3) self-efficacy; 4) quality of life; 5) recovery; 6) hope; 7) insight, and 8) overall outcomes (the average effect size across the constructs examined in each study). The mean effect size between stigma resistance and overall outcomes was significant and positive (r=0.46, p<0.001, k=48). A large, negative effect size was found between stigma resistance and self-stigma (r=-0.57, p<0.001, k=40). Large, positive effect sizes were found with self-efficacy (r=0.60, p<0.001, k=25), quality of life (r=0.51, p<0.001, k=17), hope (r=0.54, p<0.001, k=8), and recovery (r=0.60, p<0.001, k=7). Stigma resistance had a significant medium and small relationship with insight and symptoms, respectively. Race significantly moderated overall outcomes, self-stigma, mood symptoms, functioning, and hope associations. Education significantly moderated symptoms, functioning, and mood symptoms associations, and age significantly moderated self-stigma and negative symptom associations. Stigma resistance may be a key requirement for recovery. Individual characteristics influence resisting stigma and future work should prioritize cultural factors surrounding stigma resistance.
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222
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Wong-Anuchit C, Mills AC, Schneider JK, Rujkorakarn D, Kerdpongbunchote C, Panyayong B. Internalized Stigma of Mental Illness Scale - Thai Version: Translation and Assessment of Psychometric Properties Among Psychiatric Outpatients in Central Thailand. Arch Psychiatr Nurs 2016; 30:450-6. [PMID: 27455917 DOI: 10.1016/j.apnu.2016.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 01/05/2016] [Accepted: 01/17/2016] [Indexed: 12/26/2022]
Abstract
This paper reports the translation of the English Internalized Stigma of Mental Illness scale into Thai and assessment of its psychometric properties. After forward- and backward-translation, Thai experts completed the content validity index with item agreements of .86 to 1.00. Data were collected from 390 psychiatric clinic patients in central Thailand using systematic random sampling. Unweighted least squares factor analysis with Promax rotation identified five subscales. Cronbach's alpha for scale reliability was .88, and correlations for construct validity ranged from r=.55 to .69. These findings support the validity and reliability of the Thai version of the scale.
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223
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Effects of antipsychotics on insight in schizophrenia: results from independent samples of first-episode and acutely relapsed patients. Int Clin Psychopharmacol 2016; 31:185-91. [PMID: 26836264 DOI: 10.1097/yic.0000000000000120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We aimed to investigate whether antipsychotics differentially impact insight and whether these effects appear because of improvement in psychopathological manifestation in 132 first-episode schizophrenia patients and 201 acutely relapsed schizophrenic patients, who were followed up for 12 weeks. Olanzapine and risperidone were administered to first-episode schizophrenia patients, whereas acutely relapsed schizophrenic patients were treated with olanzapine, perazine and ziprasidone. The Positive And Negative Syndrome Scale (PANSS) was used to assess psychopathology. Insight was assessed using the G12 item of PANSS. Unadjusted mixed-model regression analysis indicated a significant improvement in the PANSS G12 item score in both groups. There were no significant differences between distinct treatment subgroups of patients in terms of improvement in the PANSS G12 item score. After adjustment for the trajectories of changes in symptom dimensions, a decrease in the PANSS G12 item score was because of an improvement in positive, negative and excitement symptoms. A decrease in the PANSS G12 item score was also related to an increase in the severity of depressive symptomatology. Our results indicate that antipsychotics exert similar effects on insight in acute psychosis. These effects are likely because of an improvement in psychopathological manifestation. The improvement in insight might be related to the development of depressive symptoms.
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224
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Singh A, Mattoo SK, Grover S. Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit. Indian J Psychiatry 2016; 58:291-300. [PMID: 28066007 PMCID: PMC5100121 DOI: 10.4103/0019-5545.192024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Very few studies from India have studied stigma experienced by patients with schizophrenia. AIM OF THE STUDY To study stigma in patients with schizophrenia (in the form of internalized stigma, perceived stigma and social-participation-restriction stigma) and its relationship with specified demographic and clinical variables (demographic variables, clinical profile, level of psychopathology, knowledge about illness, and insight). MATERIALS AND METHODS Selected by purposive random sampling, 100 patients with schizophrenia in remission were evaluated on internalized stigma of mental illness scale (ISMIS), explanatory model interview catalog stigma scale, participation scale (P-scale), positive and negative syndrome scale for schizophrenia, global assessment of functioning scale, scale to assess unawareness of mental disorder, and knowledge of mental illness scale. RESULTS On ISMIS scale, 81% patients experienced alienation and 45% exhibited stigma resistance. Stereotype endorsement was seen in 26% patients, discrimination experience was faced by 21% patients, and only 16% patients had social withdrawal. Overall, 29% participants had internalized stigma when total ISMIS score was taken into consideration. On P-scale, 67% patients experienced significant restriction, with a majority reporting moderate to mild restriction. In terms of associations between stigma and sociodemographic variables, no consistent correlations emerged, except for those who were not on paid job, had higher participation restriction. Of the clinical variables, level of functioning was the only consistent predictor of stigma. While better knowledge about the disorder was associated with lower level of stigma, there was no association between stigma and insight. CONCLUSION Significant proportion of patients with schizophrenia experience stigma and stigma is associated with lower level of functioning and better knowledge about illness is associated with lower level of stigma.
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Affiliation(s)
- Aakanksha Singh
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surendra K Mattoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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225
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Self-clarity and different clusters of insight and self-stigma in mental illness. Psychiatry Res 2016; 240:308-313. [PMID: 27138823 DOI: 10.1016/j.psychres.2016.04.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 11/22/2022]
Abstract
The current study explored the self-experience of persons with Serious Mental Illness (SMI) by investigating the associations between different insight and self-stigma clusters, self-clarity, hope, recovery, and functioning. One hundred seven persons diagnosed with a SMI were administered six scales: self-concept clarity, self-stigma, insight into the illness, hope, recovery, and functioning. Correlations and cluster analyses were performed. Insight, as measured by a self-report scale was not related to any other variable. Self-stigma was negatively associated with self-clarity, hope, recovery and functioning. Three clusters emerged: moderate stigma/high insight (n=31), high stigma/moderate insight (n=28), and low stigma/low insight (n=42). The group with low stigma and low insight had higher mean levels of self-clarity and hope than the other two groups. There were no significant differences between cluster 1 (moderate stigma/high insight) and cluster 2 (high stigma/moderate insight) in all the variables beside self-clarity. The group with moderate stigma and high insight had significantly higher mean levels of self-clarity than the group with high stigma and moderate insight. Results reveal that when people diagnosed with SMI do not have high levels of self-stigma they often report a positive and clear sense of self accompanied with hope, regardless of having low insight.
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226
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Kao YC, Lien YJ, Chang HA, Wang SC, Tzeng NS, Loh CH. Evidence for the indirect effects of perceived public stigma on psychosocial outcomes: The mediating role of self-stigma. Psychiatry Res 2016; 240:187-195. [PMID: 27111212 DOI: 10.1016/j.psychres.2016.04.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 02/20/2016] [Accepted: 04/13/2016] [Indexed: 11/20/2022]
Abstract
This study examined the possible mediating role of self-stigma in the relationship between perceived public stigma and psychosocial outcomes and how this mechanism may be contingent on illness severity in a non-Western (Chinese) sample. A total of 251 participants, namely 151 psychiatric outpatients with psychotic disorders and 100 psychiatric outpatients without psychotic disorders, completed a questionnaire on stigma and psychosocial outcomes that covered topics such as self-esteem, depressive symptoms, and subjective quality of life (QoL). Using a cross-sectional design, ordinary least squares regression and bootstrapping mediation analyses were used to test whether self-stigma mediated the relationship between perceived public stigma and psychosocial outcomes and whether this mediating process was moderated by diagnostic status. The results indicated that self-stigma mediated the effect of perceived public stigma on psychosocial outcomes such as self-esteem, depressive symptoms, and subjective QoL among both patients with psychotic disorders and those without psychotic disorders after controlling for demographic and clinical characteristics. Further, moderated mediation analyses revealed that the indirect effect of perceived public stigma on psychosocial outcomes were not moderated by the status of psychotic diagnoses. Self-stigma might be an essential and tractable target for interventions aimed at breaking the vicious cycle of discrimination and stigmatization toward people with mental illness regardless of their diagnoses.
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Affiliation(s)
- Yu-Chen Kao
- Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan; Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
| | - Hsin-An Chang
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-service General Hospital, Taipei, Taiwan
| | - Sheng-Chiang Wang
- Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan; Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-service General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
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227
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Vohs JL, George S, Leonhardt BL, Lysaker PH. An integrative model of the impairments in insight in schizophrenia: emerging research on causal factors and treatments. Expert Rev Neurother 2016; 16:1193-204. [PMID: 27278672 DOI: 10.1080/14737175.2016.1199275] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Poor insight, or unawareness of some major aspect of mental illness, is a major barrier to wellness when it interferes with persons seeking out treatment or forming their own understanding of the challenges they face. One barrier to addressing impaired insight is the absence of a comprehensive model of how poor insight develops. AREAS COVERED To explore this issue we review how poor insight is the result of multiple phenomena which interfere with the construction of narrative accounts of psychiatric challenges, rather than a single social or biological cause. Expert commentary: We propose an integrative model of poor insight in schizophrenia which involves the interaction of symptoms, deficits in neurocognition, social cognition, metacognition, and stigma. Emerging treatments for poor insight including therapies which focus on the development of metacognition are discussed.
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Affiliation(s)
- Jenifer L Vohs
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Sunita George
- b School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,c Roudebush VA Medical Hospital , Indianapolis , IN , USA
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228
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Corker E, Henderson RC, Lempp H, Brown JSL. Internalised stigma in people with rheumatoid arthritis: a cross sectional study to establish the psychometric properties of the ISMI-RA. BMC Musculoskelet Disord 2016; 17:244. [PMID: 27256290 PMCID: PMC4890287 DOI: 10.1186/s12891-016-1089-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/19/2016] [Indexed: 01/29/2023] Open
Abstract
Background Internalised stigma is theorized to be the internalisation and legitimisation of stereotypes of the diagnosis held in society and has not been quantified within patients with Rheumatoid Arthritis. This study aimed to: validate a modified version of a measure of internalised stigma, (the Internalised Stigma of Mental Illness scale, ISMI) for use in a group of patients diagnosed with rheumatoid arthritis; establish the consistency of the construct being measured, and to explore the levels of internalised stigma within this group. Methods A cross-sectional survey was conducted in London, UK with participants receiving out-patient treatment for Rheumatoid Arthritis. Participants completed the ISMI-Rheumatoid Arthritis (ISMI-RA) and a measure of self-esteem. Results One hundred respondents were interviewed by phone. The ISMI-RA was found to be reliable using a measure of internal consistency (α = 0.85) showed concurrent validity with the Index of Self Esteem (r = 0.58, p < 0.01) and discriminant validity with no association with gender (t = 1.43, p = 0.61). A quarter of respondents reported internalised stigma to a ‘severe’ level. Acceptability and feasibility were established. A confirmatory factor analysis provided some support for the model of internalised stigma. Conclusions The application of the ISMI-RA among the Rheumatoid Arthritis population looks promising. Internalised stigma was found to be present within this group. More research is needed to generalize these results and to explore the effects of internalised stigma on treatment adherence and quality of life.
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Affiliation(s)
- Elizabeth Corker
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
| | - R Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Heidi Lempp
- Academic Rheumatology, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - June S L Brown
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
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Expériences traumatiques et état de stress post traumatique dans la schizophrénie. Encephale 2016; 42 Suppl 3:S7-S12. [DOI: 10.1016/s0013-7006(16)30216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Delivering recovery focused mental health care in Ireland: implications for services and practice development. Ir J Psychol Med 2016; 33:121-128. [PMID: 30115137 DOI: 10.1017/ipm.2014.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction The recovery approach provides a key organising principle underlying mental health policy throughout the English speaking world with endorsement by agencies such as the World Health Organisation. In Ireland, personal recovery is one of the quality markers identified by users of mental health services and has become central to national mental health policy. Aim and objective The aim of this study was to explore the implications for mental health services and professional practice arising from a structured investigation of what personal recovery means for people using specialist mental health services and the extent to which services support their individual recovery. METHOD Ten service user participants in a service initiative were assessed using a novel measure based on an empirically based conceptual framework of recovery. The INSPIRE determines the level of recovery promoting support received from mental health staff and the quality of the supportive relationship as perceived by individual service users. RESULTS A consistent pattern of beliefs about recovery in keeping with national guidelines and the international literature was apparent. All respondents indicated that support by other people was an important part of their recovery with high levels of support received from mental health professionals. There was less consistent endorsement of the quality of relationships with professionals and recovery-oriented practice as perceived by participants. CONCLUSION The findings are highly relevant to the development of recovery focused, clinically excellent services. Further work is needed to improve the process of translating recovery guidance into mental health practice.
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Krupchanka D, Katliar M. The Role of Insight in Moderating the Association Between Depressive Symptoms in People With Schizophrenia and Stigma Among Their Nearest Relatives: A Pilot Study. Schizophr Bull 2016; 42:600-7. [PMID: 26970100 PMCID: PMC4838116 DOI: 10.1093/schbul/sbw024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is evidence of a positive association between insight and depression among patients with schizophrenia. Self-stigma was shown to play a mediating role in this association. We attempted to broaden this concept by investigating insight as a potential moderator of the association between depressive symptoms amongst people with schizophrenia and stigmatizing views towards people with mental disorders in their close social environment. METHOD In the initial sample of 120 pairs, data were gathered from 96 patients with a diagnosis of "paranoid schizophrenia" and 96 of their nearest relatives (80% response rate). In this cross-sectional study data were collected by clinical interview using the following questionnaires: "The Scale to Assess Unawareness of Mental Disorder," "Calgary Depression Scale for Schizophrenia," and "Brief Psychiatric Rating Scale." The stigmatizing views of patients' nearest relatives towards people with mental disorders were assessed with the "Mental Health in Public Conscience" scale. RESULTS Among patients with schizophrenia depressive symptom severity was positively associated with the intensity of nearest relatives' stigmatizing beliefs ("Nonbiological vision of mental illness," τ = 0.24; P < .001). The association was moderated by the level of patients' awareness of presence of mental disorder while controlling for age, sex, duration of illness and psychopathological symptoms. CONCLUSIONS The results support the hypothesis that the positive association between patients' depression and their nearest relatives' stigmatizing views is moderated by patients' insight. Directions for further research and practical implications are discussed.
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Affiliation(s)
- Dzmitry Krupchanka
- Department of Social Psychiatry, National Institute of Mental Health, Klecany, Czech Republic; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry and Narcology, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus;
| | - Mikhail Katliar
- Department of Human Perception, Cognition, and Action, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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Jacob KS. Insight in Psychosis: An Indicator of Severity of Psychosis, an Explanatory Model of Illness, and a Coping Strategy. Indian J Psychol Med 2016; 38:194-201. [PMID: 27335513 PMCID: PMC4904754 DOI: 10.4103/0253-7176.183078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Recent studies related to insight, explanatory models (EMs) of illness and their relationship to outcome of psychosis are reviewed. The traditional argument that insight predicts outcome in psychosis is not supported by recent longitudinal data, which has been analyzed using multivariable statistics that adjust for severity and quality of illness. While all cognition will have a neurobiological representation, if "insight" is related to the primary psychotic process, then insight cannot be seen as an independent predictor of outcome but a part of the progression of illness. The evidence suggests insight, like all EMs, is belief which interacts with the trajectory of the person's illness and the local culture to produce a unique understanding of the illness for the particular individual and his/her family.
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Affiliation(s)
- K S Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract
Self-stigma in individuals with anorexia nervosa (AN) may affect engagement in intensive treatment. The objective of this study was to test a Model of Self-Stigma to identify the influence of public stigma, internalized stigma, self-esteem, and self-efficacy on recovery attitudes in individuals in inpatient treatment for AN. Using a cross-sectional design, 36 female participants with AN completed questionnaires during the first week of intensive inpatient treatment. Better attitude towards recovery was positively correlated with higher self-esteem and self-efficacy and negatively correlated with greater internalized stigma and perceptions of others devaluing families of individuals with AN. Together, these factors accounted for 63% of the variance in recovery attitudes. Findings demonstrate the adverse effects perceived stigma towards families, self-stigma, and self-esteem have on recovery attitudes in individuals with AN. Clinical interventions are needed to challenge internalized stigma and bolster self-esteem to enhance individuals' recovery efforts.
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234
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Tanabe Y, Hayashi K, Ideno Y. The Internalized Stigma of Mental Illness (ISMI) scale: validation of the Japanese version. BMC Psychiatry 2016; 16:116. [PMID: 27129370 PMCID: PMC4850681 DOI: 10.1186/s12888-016-0825-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/22/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The present study investigated the reliability and validity of a Japanese version of the Internalized Stigma of Mental Illness (ISMI) scale, designed to assess internalized stigma experienced by people with mental illness. METHODS A survey was conducted with 173 outpatients with mental illness who attended psychiatric clinics on a regular basis. A retest was conducted with 51 participants to evaluate the scale's psychometric properties. RESULTS The alpha coefficient for the overall internal consistency was 0.91, and the coefficients of the individual ISMI subscales ranged from 0.57 to 0.81. The test-retest reliability was r = 0.85 (n = 51, P < 0.01). In terms of criterion-related validity, the Japanese version of the ISMI scale was significantly correlated with the Beck Depression Inventory (r = 0.61, P < 0.01), the Rosenberg Self-Esteem Scale (r = -0.53, P < 0.01), and the Empowerment Scale (r = -0.52, P < 0.01). In addition, factor analyses of the ISMI items demonstrated a four-factor solution for the alienation, stereotype endorsement, discrimination experience, and social withdrawal subscales, with the stigma resistance items excluded. CONCLUSIONS The Japanese version of the ISMI scale demonstrated similar reliability and validity to the original English version. Therefore, the Japanese version of the ISMI scale may be an effective and valid tool to measure internalized stigma among Japanese people who have a mental illness.
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Affiliation(s)
- Yosuke Tanabe
- Department of Laboratory Science and Environmental Health Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma, 371-8514, Japan. .,Department of Nursing, Takasaki University of Health and Welfare, Takasaki, Gunma, 370-0033, Japan.
| | - Kunihiko Hayashi
- Department of Laboratory Science and Environmental Health Sciences, Graduate School of Health Sciences, Gunma University, Maebashi, Gunma 371-8514 Japan
| | - Yuki Ideno
- Center for Medical Education, Gunma University, Maebashi, Gunma 371-8511 Japan
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235
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Moe AM, Breitborde NJK, Shakeel MK, Gallagher CJ, Docherty NM. Idea density in the life-stories of people with schizophrenia: Associations with narrative qualities and psychiatric symptoms. Schizophr Res 2016; 172:201-5. [PMID: 26925799 DOI: 10.1016/j.schres.2016.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/07/2016] [Accepted: 02/10/2016] [Indexed: 11/18/2022]
Abstract
Disordered speech and language deficits are well-documented in schizophrenia-spectrum disorders. Researchers often assess speech samples using manualized rating systems, though recently computerized language assessment methods have been used more frequently in the study of speech from people with schizophrenia. Most typically, these computerized assessments measure aspects of expressivity (i.e., pause durations, prosody) or use word-count technology; less attention has focused on similar methods that can capture more sophisticated aspects of linguistic complexity (e.g., idea density). The primary objective of the present study was to assess idea density - via a computerized measure - in the life-story narratives of people with schizophrenia (n=32) compared to a group of community control participants (n=15). In the schizophrenia group, we also examined associations between idea density, narrative qualities rated via a manualized measure, and psychiatric symptoms. Our findings indicate that idea density is diminished in individuals with schizophrenia compared to controls. Further, our results suggest that though people with schizophrenia with richer idea density tended to have more developed insight into illness, they also had higher levels of depression, anxiety, and avolition. Implications of these results and suggestions for future research are discussed.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
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Eneman M, Vanhee L, Liessens D, Luyten P, Sabbe B, Corveleyn J. Humanistic Psychiatry and Psychotherapy: Listening to Patients as Persons in Search of Meaning. The Case of Schizophrenia. JOURNAL OF HUMANISTIC PSYCHOLOGY 2016. [DOI: 10.1177/0022167816637291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Confronted with any kind of critical event, people tend to develop an urgent need for answers that provide a useful interpretation of what they experience as a painfully intruding disaster. This urge results from the often-unbearable suffering and the disruption of everyday life, routines, and relations. Moreover, dreams and aspirations one had for the future, the realization of which they perceived as important in leading a meaningful life, may be lost or have to be reconsidered. Accompanying feelings of disappointment, demoralization, or even desperation are often treated as symptoms of depression. This approach is called into question by the concept of demoralization, which points to the presence of healthy modes of functioning in a state of lucid awareness of one’s condition. In this article, we focus on the case of schizophrenia, as we suppose that having to deal with recurring psychotic episodes constitutes such a pervasive experience, possibly leading to meaning deficiency. We propose then a treatment perspective that integrates care for the processes of mourning and of meaning making. This view, described here in the case of schizophrenic psychosis, is offered as a paradigm that can serve the approach to other serious conditions requiring prolonged care.
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Affiliation(s)
- Marc Eneman
- University Psychiatric Center St.-Kamillus, Bierbeek, Belgium
| | - Lieve Vanhee
- University Psychiatric Center St.-Kamillus, Bierbeek, Belgium
| | - Dirk Liessens
- University Psychiatric Center St.-Kamillus, Bierbeek, Belgium
| | | | - Bernard Sabbe
- University of Antwerp, Antwerp, Belgium
- University Psychiatric Center Duffel-UZA, Duffel, Belgium
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Hasson-Ohayon I, Kravetz S, Lysaker PH. The Special Challenges of Psychotherapy with Persons with Psychosis: Intersubjective Metacognitive Model of Agreement and Shared Meaning. Clin Psychol Psychother 2016; 24:428-440. [PMID: 26987691 DOI: 10.1002/cpp.2012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/15/2015] [Accepted: 02/16/2016] [Indexed: 01/28/2023]
Abstract
Agreement between client and therapist is an essential part of the therapeutic alliance. While there are general challenges to the creation of agreement and shared meaning in all psychotherapies, there are specific challenges while working with persons with psychosis. These challenges include the different narratives of the client and the therapist with regard to their roles and the description of the condition or problem, as well as possible stigmatic views and theoretical bias. Here we present a metacognitive intersubjective model as a framework for the understanding and resolutions of these challenges. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Goal consensus, agreement and shared meaning are essential for a collaborative process and positive outcome in psychotherapy. Challenges to psychotherapy with persons with psychosis include the different narratives of the client and the therapist with regard to their roles and the description of the condition or problem, as well as possible stigmatic views and theoretical bias. In the intersubjective exchange, the concepts of metacognition and empathy can act as a framework for navigating between the possible challenges and the desired shared meaning and agreement.
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Affiliation(s)
| | - Shlomo Kravetz
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center and the Indiana University School of Medicine, Indianapolis, IN, USA
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Hofer A, Mizuno Y, Frajo-Apor B, Kemmler G, Suzuki T, Pardeller S, Welte AS, Sondermann C, Mimura M, Wartelsteiner F, Fleischhacker WW, Uchida H. Resilience, internalized stigma, self-esteem, and hopelessness among people with schizophrenia: Cultural comparison in Austria and Japan. Schizophr Res 2016; 171:86-91. [PMID: 26805413 DOI: 10.1016/j.schres.2016.01.027] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 12/27/2015] [Accepted: 01/14/2016] [Indexed: 11/26/2022]
Abstract
Resilience is becoming an important topic in people with schizophrenia since there is evidence that it increases the probability for long-term recovery. The current study investigated transcultural differences in resilience across schizophrenia patients from two different geographical regions, Austria and Japan. Another objective was to examine transcultural differences in internalized stigma, self-esteem, and hopelessness, which can be expected to be relevant in this context, as well as the interrelations between these subjective elements of recovery and symptom severity. To this end, patients from outpatient mental health services in Innsbruck, Austria (N=52) and Tokyo, Japan (N=60) as well as 137 healthy comparison subjects from both countries were included into this cross-sectional study. Notably, we detected a significant country effect with markedly lower resilience (F=74.4, p<0.001) and self-esteem scores (F=226.0, p<0.001) as well as higher hopelessness scores (F=37.4, p<0.001) among Japanese subjects in general. In addition, both Austrian and Japanese patients indicated significantly lower degrees of resilience (F=57.5, p<0.001), self-esteem (F=51.8, p<0.001), and hope (F=29.5, p<0.001) compared to healthy control subjects. The inter-correlations between subjective elements of recovery were comparable in size in the two patient samples, but the inter-correlations between these issues and residual symptoms of schizophrenia as objective domains of recovery were markedly higher in Austrian subjects. This suggests that schizophrenia patients from Western European and Japanese cultures may have different needs to achieve recovery. In conclusion, it will be critical to develop culture-specific psychosocial programs and to examine their feasibility and effectiveness among these patients.
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Affiliation(s)
- Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria.
| | - Yuya Mizuno
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Beatrice Frajo-Apor
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria
| | - Takefumi Suzuki
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Silvia Pardeller
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria
| | - Anna-Sophia Welte
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria
| | - Catherine Sondermann
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria
| | - Masaru Mimura
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
| | - Fabienne Wartelsteiner
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy, and Psychosomatics, Innsbruck, Austria
| | - Hiroyuki Uchida
- Keio University School of Medicine, Department of Neuropsychiatry, Tokyo, Japan
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Hanlon C, Alem A, Medhin G, Shibre T, Ejigu DA, Negussie H, Dewey M, Wissow L, Prince M, Susser E, Lund C, Fekadu A. Task sharing for the care of severe mental disorders in a low-income country (TaSCS): study protocol for a randomised, controlled, non-inferiority trial. Trials 2016; 17:76. [PMID: 26865254 PMCID: PMC4750210 DOI: 10.1186/s13063-016-1191-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/21/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Task sharing mental health care through integration into primary health care (PHC) is advocated as a means of narrowing the treatment gap for mental disorders in low-income countries. However, the effectiveness, acceptability, feasibility and sustainability of this service model for people with a severe mental disorder (SMD) have not been evaluated in a low-income country. METHODS/DESIGN A randomised, controlled, non-inferiority trial will be carried out in a predominantly rural area of Ethiopia. A sample of 324 people with SMD (diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder) with an ongoing need for mental health care will be recruited from 1) participants in a population-based cohort study and 2) people attending a psychiatric nurse-led out-patient clinic. The intervention is a task-sharing model of locally delivered mental health care for people with SMD integrated into PHC delivered over 18 months. Participants in the active control arm will receive the established and effective model of specialist mental health care delivered by psychiatric nurses at an out-patient clinic within a centrally located general hospital. The hypothesis is that people with SMD who receive mental health care integrated into PHC will have a non-inferior clinical outcome, defined as a mean symptom score on the Brief Psychiatric Rating Scale, expanded version, of no more than six points higher, compared to participants who receive the psychiatric nurse-led service, after 12 months. The primary outcome is change in symptom severity. Secondary outcomes are functional status, relapse, service use costs, service satisfaction, drop-out and medication adherence, nutritional status, physical health care, quality of care, medication side effects, stigma, adverse events and cost-effectiveness. Sustainability and cost-effectiveness will be further evaluated at 18 months. Randomisation will be stratified by health centre catchment area using random permuted blocks. The outcome assessors and investigators will be masked to allocation status. DISCUSSION Evidence about the effectiveness of task sharing mental health care for people with SMD in a rural, low-income African country will inform the World Health Organisation's mental health Gap Action Programme to scale-up mental health care globally. TRIAL REGISTRATION NCT02308956 (ClinicalTrials.gov). Date of registration: 3 December 2014.
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Affiliation(s)
- Charlotte Hanlon
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia.
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College, London, UK.
| | - Atalay Alem
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia.
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Teshome Shibre
- Horizon Health Network, Dr Everett Chalmers Regional Hospital, Psychiatry, Fredericton, New Brunswick, Canada.
| | - Dawit A Ejigu
- Department of Pharmacology, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Hanna Negussie
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia.
| | - Michael Dewey
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College, London, UK.
| | - Lawrence Wissow
- Department of Health, Behaviour and Society, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | - Martin Prince
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College, London, UK.
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, USA.
- New York State Psychiatric Institute, New York, USA.
| | - Crick Lund
- Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King's College, London, UK.
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, South Africa.
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia.
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, Psychology and Neuroscience, Centre for Affective Disorders, London, UK.
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Rocca P, Montemagni C, Mingrone C, Crivelli B, Sigaudo M, Bogetto F. A cluster-analytical approach toward real-world outcome in outpatients with stable schizophrenia. Eur Psychiatry 2016; 32:48-54. [PMID: 26803615 DOI: 10.1016/j.eurpsy.2015.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/25/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND This study aims to empirically identify profiles of functioning, and the correlates of those profiles in a sample of patients with stable schizophrenia in a real-world setting. The second aim was to assess factors associated with best profile membership. METHODS Three hundred and twenty-three outpatients were enrolled in a cross-sectional study. A two-step cluster analysis was used to define groups of patients by using baseline values for the Heinrichs-Carpenter Quality of Life Scale (QLS) total score. Logistic regression was used to construct models of class membership. RESULTS Our study identified three distinct clusters: 50.4% of patients were classified in the "moderate" cluster, 27.9% in the "poor" cluster, 21.7% in the "good" cluster. Membership in the "good" cluster versus the "poor" cluster was characterized by less severe negative (OR=.832) and depressive symptoms (OR=.848), being employed (OR=2.414), having a long-term relationship (OR=.256), and treatment with second-generation antipsychotics (SGAs) (OR=3.831). Nagelkerke R(2) for this model was .777. CONCLUSIONS Understanding which factors are associated with better outcomes may direct specific and additional therapeutic interventions, such as treatment with SGAs and supported employment, in order to enhance benefits for patients, as well as to improve the delivery of care in the community.
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Affiliation(s)
- P Rocca
- Department of Neuroscience, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1-A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.
| | - C Montemagni
- Department of Neuroscience, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1-A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - C Mingrone
- Department of Neuroscience, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1-A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - B Crivelli
- Department of Neuroscience, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1-A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - M Sigaudo
- Department of Neuroscience, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1-A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - F Bogetto
- Department of Neuroscience, University of Turin, Struttura Semplice di Coordinamento a Valenza Dipartimentale (SSCVD), Department of Mental Health ASL TO1-A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
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Oliveira SEH, Carvalho H, Esteves F. Internalized stigma and quality of life domains among people with mental illness: the mediating role of self-esteem. J Ment Health 2016; 25:55-61. [DOI: 10.3109/09638237.2015.1124387] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kamaradova D, Latalova K, Prasko J, Kubinek R, Vrbova K, Mainerova B, Cinculova A, Ociskova M, Holubova M, Smoldasova J, Tichackova A. Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient Prefer Adherence 2016; 10:1289-98. [PMID: 27524884 PMCID: PMC4966500 DOI: 10.2147/ppa.s99136] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Self-stigma plays a role in many areas of the patient's life. Furthermore, it also discourages therapy. The aim of our study was to examine associations between self-stigma and adherence to treatment and discontinuation of medication in patients from various diagnostic groups. METHODS This cross-sectional study involved outpatients attending the Department of Psychiatry, University Hospital Olomouc, Czech Republic. The level of self-stigma was measured with the Internalized Stigma of Mental Illness and adherence with the Drug Attitude Inventory. The patients also anonymously filled out a demographic questionnaire which included a question asking whether they had discontinued their medication in the past. RESULTS We examined data from 332 patients from six basic diagnostic categories (substance abuse disorders, schizophrenia, bipolar disorders, depressive disorders, anxiety disorders, and personality disorders). The study showed a statistically significant negative correlation between self-stigma and adherence to treatment in all diagnostic groups. Self-stigma correlated positively and adherence negatively with the severity of disorders. Another important factor affecting both variables was partnership. Self-stigma positively correlated with doses of antidepressants and adherence with doses of anxiolytics. Self-stigma also negatively correlated with education, and positively with a number of hospitalizations and number of psychiatrists visited. Adherence was further positively correlated with age and age of onset of disorders. Regression analysis showed that self-stigma was an important factor negatively influencing adherence to treatment and significantly contributing to voluntary discontinuation of drugs. The level of self-stigma did not differ between diagnostic categories. Patients suffering from schizophrenia had the lowest adherence to treatment. CONCLUSION The study showed a significant correlation between self-stigma and adherence to treatment. High levels of self-stigma are associated with discontinuation of medications without a psychiatrist's recommendation. This connection was present in all diagnostic groups.
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Affiliation(s)
- Dana Kamaradova
- Department of Psychiatry, University Hospital Olomouc
- Correspondence: Dana Kamaradova, Department of Psychiatry, University Hospital Olomouc, I.P. Pavlova 6, Olomouc, 779 00, Czech Republic, Tel +420 588 44 3519, Email
| | | | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc
| | - Radim Kubinek
- Department of Psychiatry, University Hospital Olomouc
| | | | | | | | | | - Michaela Holubova
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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Shin YJ, Joo YH, Kim JH. Self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia. Neuropsychiatr Dis Treat 2016; 12:1411-7. [PMID: 27366073 PMCID: PMC4913959 DOI: 10.2147/ndt.s108537] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We investigated self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia in order to shed light on the clinical correlates of subjective cognitive deficits in schizophrenia. METHODS Seventy outpatients with schizophrenia were evaluated. Patients' self-perceived cognitive deficits, internalized stigma, and subjective quality of life were assessed using the Scale to Investigate Cognition in Schizophrenia (SSTICS), the Internalized Stigma of Mental Illness Scale (ISMI), and the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4), respectively. Correlation and regression analyses controlling for the severity of symptoms of schizophrenia were performed, and a mediation analysis was conducted to examine the hypothesis that internalized stigma mediates the relationship between self-perceived cognitive deficits and subjective quality of life. RESULTS Pearson's partial correlation analysis showed significant correlations among the SSTICS, ISMI, and SQLS-R4 scores (P<0.01). Multiple regression analysis showed that the SSTICS and ISMI scores significantly predicted the SQLS-R4 score (P<0.01). Mediation analysis revealed that the strength of the association between the SSTICS and SQLS-R4 scores decreased from β=0.74 (P<0.01) to β=0.56 (P<0.01), when the ISMI score was statistically controlled. The Sobel test revealed that this difference was significant (P<0.01), indicating that internalized stigma partially mediated the relationship between self-perceived cognitive deficits and quality of life. CONCLUSION The present study indicates that self-perceived cognitive deficits are significantly associated with internalized stigma and quality of life. Furthermore, internalized stigma was identified as a partial mediator of the relationship between self-perceived cognitive deficits and quality of life. These findings suggest that clinicians should be aware that patients with schizophrenia experience significantly greater self-stigma when they suffer subjective cognitive deficits, and that this may further compromise their quality of life.
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Affiliation(s)
- Yeon-Jeong Shin
- Neuroscience Research Institute, Gachon University School of Medicine, Gachon University, Incheon, Republic of Korea; Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences & Technology, Gachon University School of Medicine, Gachon University, Incheon, Republic of Korea
| | - Yo-Han Joo
- Neuroscience Research Institute, Gachon University School of Medicine, Gachon University, Incheon, Republic of Korea
| | - Jong-Hoon Kim
- Neuroscience Research Institute, Gachon University School of Medicine, Gachon University, Incheon, Republic of Korea; Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences & Technology, Gachon University School of Medicine, Gachon University, Incheon, Republic of Korea; Department of Psychiatry, Gil Medical Center, Gachon University School of Medicine, Gachon University, Incheon, Republic of Korea
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244
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Grambal A, Prasko J, Kamaradova D, Latalova K, Holubova M, Marackova M, Ociskova M, Slepecky M. Self-stigma in borderline personality disorder - cross-sectional comparison with schizophrenia spectrum disorder, major depressive disorder, and anxiety disorders. Neuropsychiatr Dis Treat 2016; 12:2439-2448. [PMID: 27703362 PMCID: PMC5036602 DOI: 10.2147/ndt.s114671] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Self-stigma arises from one's acceptance of societal prejudices and is common in psychiatric patients. This investigation compares the self-stigma of a sample of patients with borderline personality disorder (BPD), schizophrenia spectrum disorder (SCH), major depressive disorder (MDD), bipolar affective disorder (BAD), and anxiety disorders (AD) and explores of the self-stigma with the subjective and objective measures of the severity of the disorder and demographic factors. METHODS The total of 184 inpatients admitted to the psychotherapeutic department diagnosed with BPD, SCH, MDD, BAP, and AD were compared on the internalized stigma of mental illness (ISMI) scale. The ISMI-total score was correlated with the subjective and objective evaluation of the disorder severity (clinical global impression), and clinical and demographic factors. RESULTS The self-stigma levels were statistically significantly different among the diagnostic groups (BPD 71.15±14.74; SCH 63.2±13.27; MDD 64.09±12.2; BAD 62.0±14.21; AD 57.62±15.85; one-way analysis of variance: F=8.698, df=183; P<0.005). However after applying the Bonferroni's multiple comparison test, the only significant difference was between the BPD patients and the patients with AD (P<0.001). Stepwise regression analysis showed that the strongest factors connected with the higher level of self-stigma were being without partner, the number of hospitalization, and the severity of the disorder. CONCLUSION The BPD patients suffer from a higher level of self-stigma compared to patients with AD. In practice, it is necessary to address the reduction of self-stigma by using specific treatment strategies, such as cognitive therapy.
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Affiliation(s)
- Ales Grambal
- Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc
| | - Jan Prasko
- Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc
| | - Dana Kamaradova
- Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc
| | - Klara Latalova
- Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc
| | - Michaela Holubova
- Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc; Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic
| | - Marketa Marackova
- Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc
| | - Marie Ociskova
- Faculty of Medicine and Dentistry, Department of Psychiatry, Palacky University Olomouc, University Hospital Olomouc, Olomouc
| | - Milos Slepecky
- Faculty of Social Science and Health Care, Department of Psychology Sciences, Constantine the Philosopher University, Nitra, Slovak Republic
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245
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Abstract
OBJECTIVE To investigate the correlation between insight and recovery in schizophrenic patients according to criteria for both symptomatic and functional remission. METHODS Seventy patients affected by paranoid schizophrenia were recruited and treated with olanzapine, risperidone, aripiprazole, haloperidol and ziprasidone; visits were scheduled at baseline, 12 and 36 months. We administered PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of Functioning), SF-36 (Short Form 36 Health Survey), PGWBI (Psychological General Well-Being index) and SAI (Schedule for the Assessment of Insight). RESULTS After 1 year, 50% of the subjects obtained symptom remission and 25.5% had adequate social functioning for 2 years or more. Only 12% of subjects met full recovery criteria for 2 years or longer. The recovery group also showed an improvement in insight levels, especially patients treated with second-generation antipsychotics (SGA). Recovery was predicted by female sex, higher age, SGA treatment, pre-morbid social adaptation and low level of negative symptoms at baseline. CONCLUSIONS Only a small proportion of schizophrenic patients achieved recovery, therefore greater patient's insight could have prognostic validity in terms of treatment outcome. More sensitive instruments and a larger sample are necessary to confirm these results.
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Affiliation(s)
- Dario Cannavò
- a Psychiatry Unit , Department of Clinical and Experimental Medicine - 'Policlinico - Vittorio Emanuele' University Hospital of Catania , Catania , Italy
| | - Giuseppe Minutolo
- a Psychiatry Unit , Department of Clinical and Experimental Medicine - 'Policlinico - Vittorio Emanuele' University Hospital of Catania , Catania , Italy
| | - Eliana Battaglia
- a Psychiatry Unit , Department of Clinical and Experimental Medicine - 'Policlinico - Vittorio Emanuele' University Hospital of Catania , Catania , Italy
| | - Eugenio Aguglia
- a Psychiatry Unit , Department of Clinical and Experimental Medicine - 'Policlinico - Vittorio Emanuele' University Hospital of Catania , Catania , Italy
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246
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Phalen PL, Viswanadhan K, Lysaker PH, Warman DM. The relationship between cognitive insight and quality of life in schizophrenia spectrum disorders: Symptom severity as potential moderator. Psychiatry Res 2015; 230:839-45. [PMID: 26599388 DOI: 10.1016/j.psychres.2015.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/03/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
Cognitive insight is implicated in the formation and maintenance of hallucinations and delusions. However, it is not yet known whether cognitive insight relates to broader outcome measures like quality of life. In the current study, we investigated whether the component elements of cognitive insight-self-certainty and self-reflectiveness-were related to quality of life for 43 outpatients with schizophrenia or schizoaffective disorder. Cognitive insight was assessed using the Beck Cognitive Insight Scale (BCIS) while quality of life was assessed with Quality of Life Scale (QLS). We tested whether this relationship was moderated by clinical insight and symptom severity using the Scale to Assess Unawareness of Mental Disorder (SUMD) and the Positive and Negative Syndrome Scale (PANSS). We found that self- reflectiveness had an unmoderated positive relationship with quality of life. Self-certainty was associated with better quality of life for people with more severe symptoms. Theoretical and clinical implications of these findings are discussed and areas of future research are proposed.
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Affiliation(s)
- Peter L Phalen
- School of Psychological Sciences, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227, USA.
| | - Katya Viswanadhan
- School of Psychological Sciences, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227, USA
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center, 1481W 10th St, Indianapolis, IN 46202, USA
| | - Debbie M Warman
- School of Psychological Sciences, University of Indianapolis, 1400 E Hanna Ave, Indianapolis, IN 46227, USA
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247
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Vass V, Morrison AP, Law H, Dudley J, Taylor P, Bennett KM, Bentall RP. How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatry Res 2015; 230:487-95. [PMID: 26454406 DOI: 10.1016/j.psychres.2015.09.042] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
Abstract
This study aimed to examine how stigma impacts on symptomatic and subjective recovery from psychosis, both concurrently and longitudinally. We also aimed to investigate whether self-esteem and hopelessness mediated the observed associations between stigma and outcomes. 80 service-users with psychosis completed symptom (Positive and Negative Syndrome Scale) and subjective recovery measures (Process of Recovery Questionnaire) at baseline and 6-months later, and also completed the King Stigma Scale, the Self-Esteem Rating Scale and the Beck Hopelessness Scale at baseline. In cross sectional regression and multiple mediation analyses of the baseline data, we found that stigma predicted both symptomatic and subjective recovery, and the effects of stigma on these outcomes were mediated by hopelessness and self-esteem. When the follow-up data were examined, stigma at baseline continued to predict recovery judgements and symptoms. However, self-esteem only mediated the effect of stigma on PANSS passive social withdrawal. Self-esteem and hopelessness should be considered in interventions to reduce the effects of stigma. Interventions that address the current and long-term effects of stigma may positively affect outcome for people being treated for psychosis.
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Affiliation(s)
- Victoria Vass
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom.
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom
| | - Heather Law
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom
| | - James Dudley
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom
| | - Pamela Taylor
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom
| | - Kate M Bennett
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
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248
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Dequelson A, Saloppé X, Bandinelli A. Insight, Stigma et Auto-stigmatisation : l’intime conviction appliquée aux patients schizophrènes hospitalisés au sein d’un hôpital psychiatrique sécurisé. ANNALES MEDICO-PSYCHOLOGIQUES 2015. [DOI: 10.1016/j.amp.2015.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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249
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Ochoa S, Martínez-Zambrano F, Garcia-Franco M, Vilamala S, Ribas M, Arenas O, Garcia-Morales E, Álvarez I, Escartin G, Villellas R, Escandell MJ, Martínez-Raves M, López-Arias E, Cunyat C, Haro JM. Development and validation of the Self-Stigma Questionnaire (SSQ) for people with schizophrenia and its relation to social functioning. Compr Psychiatry 2015; 62:93-9. [PMID: 26343472 DOI: 10.1016/j.comppsych.2015.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/05/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022] Open
Abstract
Self-stigma specifically in people with schizophrenia has been little studied. The aims of the present study were to validate a new instrument for the assessment of self-stigma (SSQ) and to assess the relationship between self-stigma and social functioning in people with schizophrenia. A sample of 76 people with schizophrenia was assessed at two moments in time with the SSQ, the PDD (stigma), two scales of social functioning (LSP, SFS), and a scale of general functioning (GAF). The results indicated that SSQ presented good psychometric properties, with Cronbach's alpha ranging between 0.75 and 0.901. The stability of the instrument was between 0.836 and 0.402. Three factors were found in the factor analysis (social discrimination, perceived capabilities, concealment of the disease), explaining 62.66% of the total variance. A relationship was found between self-stigma and social functioning in people with schizophrenia, especially in relation to social contact. In conclusion, the SSQ seems to be a valid and reliable questionnaire for the assessment of self-stigma in people with schizophrenia, and interventions should be designed to cope with self-stigma in order to improve the social functioning of people who suffer schizophrenia.
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Affiliation(s)
- Susana Ochoa
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Francisco Martínez-Zambrano
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Mar Garcia-Franco
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Sonia Vilamala
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Maria Ribas
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Oti Arenas
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Esther Garcia-Morales
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Irene Álvarez
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Gemma Escartin
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Raul Villellas
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Maria Jose Escandell
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Mónica Martínez-Raves
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Elisabeth López-Arias
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Christian Cunyat
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
| | - Josep Maria Haro
- Unidad de Investigación y Desarrollo del Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujades, 42, 08330 Sant Boi de Llobregat, Barcelona, Spain CIBERSAM
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250
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Kira IA, Ramaswamy V, Lewandowski L, Mohanesh J, Abdul-Khalek H. Psychometric assessment of the Arabic version of the Internalized Stigma of Mental Illness (ISMI) measure in a refugee population. Transcult Psychiatry 2015; 52:636-58. [PMID: 25665586 DOI: 10.1177/1363461515569755] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study explored the psychometric properties of the Arabic version of the ISMI measure on an Arab sub-sample (N = 330) in a health clinic that served mostly refugees in Michigan, USA. Study measures included the ISMI, PTSD, depression, anxiety, CTD (Cumulative Trauma Disorders), and traumatic stress measures. Data analysis included factor analysis, correlation, and multiple regression analysis. The Arabic form of the measure was found to have robust psychometric qualities, with high reliability construct and predictive validity. Factor analysis identified a general stigma factor and different levels of stigma resistance factors. General stigma was significantly associated with and predicted post-trauma symptoms of depression, anxiety, PTSD and CTD (complex PTSD), while tough stigma resistance was associated negatively with PTSD and depression and positively with positive appraisal of traumatic events.
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Affiliation(s)
| | | | | | - Jamal Mohanesh
- Center for Cumulative Trauma Studies and Access Community Health and Research Center
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