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Li Y, Qiu D, Wu Q, Ni A, Tang Z, Xiao S. Affiliate stigma and its association with family burden among family members of people living with schizophrenia in China. Schizophr Res 2024; 267:193-200. [PMID: 38569392 DOI: 10.1016/j.schres.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Understanding affiliate stigma and its impact on family of people living with schizophrenia (PLS) in China is important for culturally informed intervention. This study aims to describe the pattern of affiliate stigma of family members of PLS in China and investigated the association between affiliate stigma and family burden. METHODS PLS and their family members dwelling in community were randomly recruited from four cities across China and completed measures of affiliate stigma and family burden. Linear regression analyses were used to determine the association between affiliate stigma and family burden. RESULTS A total of 493 dyads of family member and PLS were include in this study. The mean affiliate stigma in family members was 2.21 (SD = 0.61). The vast majority of family members reported the feeling of inferiority, helpless and sad because of their family members' schizophrenia, but few family members refusing to communicate or contact with the PLS. The mean score of overall family burden was 22.25 (SD = 14.90), with 98 % of participants reported moderate or severe burden. A higher level of affiliate stigma was associated with more family burden (b = 7.837, 95CI: 5.240 to 8.747). Affiliate stigma was significantly associated with family daily activities, entertainment activities, family relationship, physical health and mental health of family members, but not family economic burden. CONCLUSION A higher level of affiliate stigma was associated with more family burden among family with PLS. Anti-stigma intervention of mental illness should be consider not only PLS but also their family members.
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Affiliation(s)
- Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiuyan Wu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Anyan Ni
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zixuan Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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2
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Elgendy H, Shalaby R, Owusu E, Nkire N, Agyapong VIO, Wei Y. A Scoping Review of Adult Inpatient Satisfaction with Mental Health Services. Healthcare (Basel) 2023; 11:3130. [PMID: 38132021 PMCID: PMC10743343 DOI: 10.3390/healthcare11243130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Patient satisfaction with hospital services has been increasingly discussed as an important indicator of healthcare quality. It has been demonstrated that improving patient satisfaction is associated with better compliance with treatment plans and a decrease in patient complaints regarding doctors' and nurses' misconduct. This scoping review's objective is to investigate the pertinent literature on the experiences and satisfaction of patients with mental disorders receiving inpatient psychiatric care. Our goals are to highlight important ideas and explore the data that might serve as a guide to enhance the standard of treatment and patient satisfaction in acute mental health environments. This study is a scoping review that was designed in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) statement. A systematic search was conducted in the following databases: PubMed, MEDLINE, PsycINFO, CINAHL, and EMBASE. A comprehensive review was completed, including articles from January 2012 to June 2022. Qualitative and quantitative studies were included in this review based on our eligibility criteria, such as patient satisfaction as a primary outcome, adult psychiatric inpatients, and non-review studies published in the English language. Studies were considered ineligible if they included nonpsychiatric patients or patients with neurocognitive disorders, review studies, or study measure outcomes other than inpatient satisfaction. For the eligible studies, data extraction was conducted, information was summarized, and the findings were reported. A total of 31 studies representing almost all the world's continents were eligible for inclusion in this scoping review. Different assessment tools and instruments were used in the included studies to measure the level of patients' satisfaction. The majority of the studies either utilized a pre-existing or newly created inpatient satisfaction questionnaire that appeared to be reliable and of acceptable quality. This review has identified a variety of possible factors that affect patients' satisfaction and can be used as a guide for service improvement. More than half of the included studies revealed that the following factors were strongly recommended to enhance inpatient satisfaction with care: a clear discharge plan, less coercive treatment during the hospital stay, more individualized, higher quality information and teaching about the mental disorder to patients by staff, better therapeutic relationships with staff, and specific treatment components that patients enjoy, such as physical exercise sessions and music therapy. Patients also value staff who spend more time with them. The scope of patient satisfaction with inpatient mental health services is a growing source of concern. Patient satisfaction is associated with better adherence to treatment regimens and fewer complaints against health care professionals. This scoping review has identified several patient satisfaction research gaps as well as important determinants of satisfaction and how to measure and utilize patient satisfaction as a guide for service quality improvement. It would be useful for future research and reviews to consider broadening their scope to include the satisfaction of psychiatric patients with innovative services, like peer support groups and other technologically based interventions like text for support. Future research also could benefit from utilizing additional technological tools, such as electronic questionnaires.
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Affiliation(s)
- Hossam Elgendy
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (R.S.); (E.O.); (N.N.); (V.I.O.A.); (Y.W.)
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (R.S.); (E.O.); (N.N.); (V.I.O.A.); (Y.W.)
| | - Ernest Owusu
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (R.S.); (E.O.); (N.N.); (V.I.O.A.); (Y.W.)
| | - Nnamdi Nkire
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (R.S.); (E.O.); (N.N.); (V.I.O.A.); (Y.W.)
- Addiction and Mental Health, Alberta Health Services, Edmonton, AB T5J E34, Canada
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (R.S.); (E.O.); (N.N.); (V.I.O.A.); (Y.W.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Yifeng Wei
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (R.S.); (E.O.); (N.N.); (V.I.O.A.); (Y.W.)
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3
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Manesh AE, Dalvandi A, Zoladl M. The experience of stigma in family caregivers of people with schizophrenia spectrum disorders: A meta-synthesis study. Heliyon 2023; 9:e14333. [PMID: 36938397 PMCID: PMC10015248 DOI: 10.1016/j.heliyon.2023.e14333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Schizophrenia is a chronic disabling and the most stigmatizing mental disorder worldwide. The stigma experienced by family caregivers impacts their lives in different ways. This study reports the results of qualitative synthesis to understand the perceptions and experiences of stigma in families of people with schizophrenia spectrum disorders across various socio-cultural contexts. Methods An initial comprehensive search was performed in databases like Web of Science, PsycINFO, CINAHL, Scopus, and Ovid-based MEDLINE. By searching, 3560 studies were found, of which 16 articles were included in the present study. A meta-synthesis was done according to the meta-ethnographic approach. Result Three themes were generated: perpetuated stigma by general misunderstandings about schizophrenia, mental health inequality contributes to structural stigma, and long-term family caregiving stigmas, attitudes, and coping strategies. These themes indicated the essential experiences of stigma in families of people with schizophrenia, which appeared due to unknown and socio-cultural misconceptions of schizophrenia that led to emotional challenges for family caregivers. Conclusion This study addresses stigma-related issues, and coping strategies used almost exclusively by family caregivers. Health policymakers and healthcare professionals working in mental health institutions should consider this data. Substantial steps must be taken to combat stigma, with education initiatives topping the list.
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Affiliation(s)
- Azadeh Eghbal Manesh
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Science, Islamic Azad University, Tehran, Iran
| | - Asghar Dalvandi
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Science, Islamic Azad University, Tehran, Iran
- Corresponding author.
| | - Mohammad Zoladl
- Associate Professor of Nursing, Yasuj University of Medical Sciences, Yasuj, Iran
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Forcheron V, Sacareau E, Bourgeois J, Pouchon A, Polosan M, Gaboreau Y, Dondé C. Experience, impact and needs of informal parental caregivers around the communication of a diagnosis of schizophrenia. Int J Soc Psychiatry 2023; 69:101-110. [PMID: 34991395 DOI: 10.1177/00207640211068978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To qualitatively characterize the experience, impact and needs of informal family caregivers around the communication of a diagnosis of schizophrenia. METHODS In all, 13 informal family caregivers were recruited. All were parents. Semi-structured interviews were used to explore their experience of the diagnosis of schizophrenia, the impacts of the diagnosis and the needs related to the diagnosis around its communication. Interviews were recorded, transcribed, codes generated and mixed deductive-inductive thematic analysis undertaken. RESULTS Participants described receiving the diagnosis of schizophrenia for their relative as a devastating experience, although some nuanced the experience with a sense of relief of finally naming the disorder and getting access to care. Caregivers' experience and representations prior to hearing the diagnosis played an important role in the way the 'news' was internalized. The communication of the diagnosis constituted a starting point for acceptance of the reality of the illness in participants. Numerous unmet needs around the communication of the diagnosis were reported by participants, including personnalized support, specific explanations about the disorder and guidance on their role as caregiver. CONCLUSION A specific attention must be given to the communication of the diagnosis of schizophrenia to the informal family caregivers. Information giving must be early, comprehensive, personalized and embedded into tailored education and support programmes for caregivers to facilitate illness acceptance and adaptation.
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Affiliation(s)
- Véra Forcheron
- Université Grenoble Alpes, Grenoble, France.,Adult Psychiatry Department, Alpes-Isère Psychiatric Hospital, Saint-Egrève, France
| | - Elodie Sacareau
- Université Grenoble Alpes, Grenoble, France.,Adult Psychiatry Department, Alpes-Isère Psychiatric Hospital, Saint-Egrève, France
| | - Jérôme Bourgeois
- Adult Psychiatry Department, Alpes-Isère Psychiatric Hospital, Saint-Egrève, France
| | - Arnaud Pouchon
- Université Grenoble Alpes, Grenoble, France.,INSERM, U1216, Grenoble, France.,Adult Psychiatry Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Mircea Polosan
- Université Grenoble Alpes, Grenoble, France.,INSERM, U1216, Grenoble, France.,Adult Psychiatry Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Yoann Gaboreau
- Université Grenoble Alpes, Grenoble, France.,Department of General Practice, Faculty of Medicine, University of Grenoble, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications (TIMC-IMAG)
| | - Clément Dondé
- Université Grenoble Alpes, Grenoble, France.,Adult Psychiatry Department, Alpes-Isère Psychiatric Hospital, Saint-Egrève, France.,INSERM, U1216, Grenoble, France.,Adult Psychiatry Department, Grenoble Alpes University Hospital, Grenoble, France
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5
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Dobener LM, Fahrer J, Purtscheller D, Bauer A, Paul JL, Christiansen H. How Do Children of Parents With Mental Illness Experience Stigma? A Systematic Mixed Studies Review. Front Psychiatry 2022; 13:813519. [PMID: 35250666 PMCID: PMC8894251 DOI: 10.3389/fpsyt.2022.813519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023] Open
Abstract
Stigma can have devastating health and wellbeing impacts, not just on people with mental health problems, but on people associated with the stigmatized person. This is called stigma-by-association. Children whose parents have mental health problems are a particularly vulnerable group, and stigma acts as a mechanism, contributing to the transgenerational transmission of mental disorders. The current study is a systematic mixed studies review, synthesizing knowledge about how this group of children experience stigma-by-association. Overall, 32 studies were included, after a systematic search including quantitative, qualitatative, and mixed methods studies. The methodological quality was assessed and qualitative content analysis undertaken. We grouped children's stigma experiences into four dimensions, i.e., experienced stigma, anticipated stigma, internalized stigma, and structural discrimination. Results show that stigma is an important factor in those children's lives, and needs further investigation in qualitative and quantitative research. The current study emphasizes the importance of anti-stigma interventions and campaigns.
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Affiliation(s)
- Lisa-Marie Dobener
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany.,Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
| | - Julia Fahrer
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Daniel Purtscheller
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Annette Bauer
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, United Kingdom
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany.,Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria
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Guan Z, Wang Y, Lam L, Cross W, Wiley JA, Huang C, Bai X, Sun M, Tang S. Severity of illness and distress in caregivers of patients with schizophrenia: Do internalized stigma and caregiving burden mediate the relationship? J Adv Nurs 2020; 77:1258-1270. [PMID: 33231315 DOI: 10.1111/jan.14648] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/25/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
AIMS To test a multiple mediation model of internalized stigma and caregiving burden in the relationship between severity of illness and distress among family caregivers of persons living with schizophrenia. DESIGN This is a cross-sectional study. METHODS Data were collected from a consecutive sample of 344 Chinese family caregivers of persons living with schizophrenia between April-August 2018. Instruments used in this research included the Clinical Global Impression-Severity of Illness, the Internalized Stigma of Mental Illness Scale, the Caregiver Burden Inventory, and the Distress Thermometer. Data analysis was conducted using descriptive statistics, the Spearman correlation, and regression analysis to estimate direct and indirect effects using bootstrap analysis. RESULTS This research found that internalized stigma and caregiving burden can separately and sequentially mediate the relationship between severity of illness and distress. Moreover the mediation of internalized stigma plays the largest role among the multiple mediations. CONCLUSION The severity of illness, internalized stigma, and caregiving burden are significant factors of distress among family caregivers of persons living with schizophrenia. The future intervention studies which be designed aiming at the three factors may be beneficial for family caregivers of persons living with schizophrenia. IMPACT This research examined the psychosocial development of distress and indicated that interventions improving patients' symptoms and decreasing internalized stigma and caregiving burden can help to prevent or reduce distress among family caregivers.
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Affiliation(s)
- Ziyao Guan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yuwei Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Louisa Lam
- School of Nursing and Healthcare, Federation University Australia, Bewick, Vic, Australia
| | - Wendy Cross
- School of Nursing and Healthcare, Federation University Australia, Bewick, Vic, Australia
| | - James A Wiley
- Xiangya School of Nursing, Central South University, Changsha, China.,Family and Community Health and Institute of Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Chongmei Huang
- School of Nursing and Midwifery, Monash University, Clayton, Vic, Australia
| | - Xiaoling Bai
- Nursing Department, Guizhou Provincial People's Hospital, Guiyang, China
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China.,Hunan Women's Research Association, Changsha, PR China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China.,Hunan Women's Research Association, Changsha, PR China
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7
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Cleary M, West S, Hunt GE, McLean L, Kornhaber R. A Qualitative Systematic Review of Caregivers' Experiences of Caring for Family Diagnosed with Schizophrenia. Issues Ment Health Nurs 2020; 41:667-683. [PMID: 32255401 DOI: 10.1080/01612840.2019.1710012] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: To synthesise qualitative research that explored caregivers' experiences of caring for family diagnosed with schizophrenia.Methods: Electronic databases including PsycINFO, PubMed, CINAHL and Scopus were searched to identify relevant journal articles published from 2000 to March 2019. Quality was assessed and thematic synthesis of the qualitative research evidence undertaken. Papers were screened and independently appraised by two reviewers using The Critical Appraisal Skills Programme (CASP) for Qualitative Studies Checklist. The review was guided by Thomas and Harden's framework for thematic synthesis of qualitative research evidence.Results: The breadth of information across the 43 papers was noteworthy. Review of the findings noted that almost all of what was discussed fell into three broad themes: the 'feelings' of the caregiver towards their role, the patient and others, including the health system; the 'impacts' of the diagnosis and their caregiving role on the caregiver; and the 'needs' of the caregiver to improve the patient's quality of life and thereby the caregiver's quality of life. Within needs also came recommendations for future changes.Conclusion: Studies have shown that the caregiving process is a complex one, with both negative and positive emotional reactions, societal barriers, such as stigma and isolation, and unmet needs, such as timely, relevant and helpful information. Meeting the needs identified by caregivers has the capacity to address the impacts of the illness and caregiving and thereby reduce the negative feelings associated with the caregiver role.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, Australia
| | - Sancia West
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, Australia
| | - Glenn E Hunt
- Discipline of Psychiatry, Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, the University of Sydney, Australia.,Royal North Shore Hospital, Consultation-Liaison Psychiatry, St Leonards, Sydney, Australia.,Western Sydney Local Health District, Westmead Psychotherapy Program for Complex Traumatic Disorders, Parramatta, Australia
| | - Rachel Kornhaber
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, Australia
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Swami V, Vintila M, Goian C, Tudorel O, Bucur V. Mental Health Literacy of Maternal and Paternal Postnatal Depression in a Community Sample of Romanian Adults. ACTA ACUST UNITED AC 2020. [DOI: 10.1037/ipp0000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Postnatal depression affects a large proportion of Romanian parents, but no existing research has examined knowledge of postnatal depression in Romanian adults. To rectify this, we examined the ability of Romanian adults to correctly identify cases of maternal and paternal postnatal depression, as well as attitudes toward cases of postnatal depression. A total of 1,248 Romanian adults were presented with vignettes describing cases of maternal or paternal postnatal depression. Based on the vignettes, participants were asked to report if they thought anything was wrong with the targets and, if so, to describe what they thought was wrong. Participants also rated the targets on several attitudinal dimensions. Participants were more likely to indicate that something was wrong when the target was female (67.9%) compared with male (46.4%). Of those who believed something was wrong, 57.7% of participants correctly described the female target as experiencing postnatal depression, but only 37.1% did so for the male target. Women held significantly more positive attitudes toward the targets than men, particularly when the target was female. Mental health literacy of postnatal depression appears to be poor in Romanian adults compared with other national groups, especially in the case of paternal postnatal depression.
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Affiliation(s)
- Viren Swami
- Division of Psychology and Sport Science, Anglia Ruskin University, and Centre for Psychological Medicine, Perdana University
| | - Mona Vintila
- Department of Psychology, West University of Timișoara
| | - Cosmin Goian
- Department of Social Work, West University of Timișoara
| | | | - Venera Bucur
- Department of Social Work, West University of Timișoara
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9
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Guan Z, Huang C, Wiley JA, Sun M, Bai X, Tang S. Internalized stigma and its correlates among family caregivers of patients diagnosed with schizophrenia in Changsha, Hunan, China. J Psychiatr Ment Health Nurs 2020; 27:224-236. [PMID: 31639239 DOI: 10.1111/jpm.12571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 01/30/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity. Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. ABSTRACT: Introduction Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support.
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Affiliation(s)
- Ziyao Guan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chongmei Huang
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - James A Wiley
- Xiangya School of Nursing, Central South University, Changsha, China.,Department of Family and Community Health and Institute of Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoling Bai
- Nursing Department, Guizhou Provincial People's Hospital, Guiyang, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China
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10
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Yanos PT, DeLuca JS, Salyers MP, Fischer MW, Song J, Caro J. Cross-sectional and prospective correlates of associative stigma among mental health service providers. Psychiatr Rehabil J 2020; 43:85-90. [PMID: 31246075 PMCID: PMC6933106 DOI: 10.1037/prj0000378] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Preliminary research has suggested that mental health clinicians who work with people with severe mental illness may experience associative stigma, and the Clinician Associative Stigma Scale (CASS; Yanos, Vayshenker, DeLuca, & O'Connor, 2017) was recently developed and tested in a cross-sectional, online sample to examine this construct. The purpose of the present study was to further investigate the CASS's psychometric properties, examining associations with measures of burnout, job satisfaction, and "turnover intention" with service providers in a setting directly working with people with severe mental illness (i.e., a community mental health center). Furthermore, we examined these associations over a 6-month period to assess predictive validity of the measure. METHOD Participants were 68 providers working in a large community mental health center in a midwestern city. Participants completed the CASS as well as measures of burnout, job satisfaction, and turnover intention at 2 points in time (baseline and 6 months later). RESULTS The CASS significantly predicted burnout (emotional exhaustion and personal accomplishment) and job satisfaction when examined cross-sectionally, even after controlling for demographic characteristics. Longitudinal analyses showed that increased associative stigma was associated with increased burnout and lower job satisfaction over time. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Associative stigma may have negative consequences for mental health service providers, as well as the consumers they serve, and the CASS appears to be a useful tool to study this phenomenon. Associative stigma may be an appropriate target for interventions designed to reduce burnout among mental health providers. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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11
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Yin M, Li Z, Zhou C. Experience of stigma among family members of people with severe mental illness: A qualitative systematic review. Int J Ment Health Nurs 2020; 29:141-160. [PMID: 31648408 DOI: 10.1111/inm.12668] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Abstract
Family members of people with severe mental illness are subjected to stigmatization, and a better understanding of their experience of stigma is important for developing anti-stigma interventions to reduce the related adverse consequences. This review aimed to systematically identify, evaluate, and synthesize existing findings from qualitative studies regarding the experience of stigma among family members of people with severe mental illness. A systematic literature search for primary studies was conducted in PubMed, EMBASE, Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, ProQuest Dissertations and Theses (PQDT), SinoMed (China), Chinese Citation Database (CNKI), and Wanfang Data (China) until March 2019. Findings from the included qualitative studies were extracted and aggregated using meta-synthesis, guided by the Joanna Briggs Methodology for Qualitative Systematic Reviews. The results revealed that family members experienced stigma and suffered from various negative consequences related to it. Five major categories were identified in 20 studies: 'negative public images of mental illness', 'structural discrimination against mental illness', 'stigma encountered in everyday life', 'psychological distress associated with stigmatization', and 'coping with stigma'. The study contributes to our understanding of the stigma experienced by family members of people with severe mental illness. It is suggested that culturally appropriate multi-level interventions targeting the general public, health professionals, communities, and family members need to be developed to reduce the harmful influence of associated family stigma.
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Affiliation(s)
- Min Yin
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Chenxi Zhou
- School of Nursing, Peking Union Medical College, Beijing, China
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12
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Liu N, Zhang J. Experiences of caregivers of family member with schizophrenia in China: A qualitative study. Perspect Psychiatr Care 2020; 56:201-212. [PMID: 31241181 DOI: 10.1111/ppc.12412] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/25/2019] [Accepted: 06/01/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To explore the experience of caregivers of family members with schizophrenia. DESIGN AND METHODS A qualitative approach was adopted to examine the experience of caregivers of people with schizophrenia. The researcher conducted semi-structured interviews with 16 participants recruited through purposive sampling. FINDINGS The change findings encompassed five major themes: (a) loss of personal life, (b) mixed emotions, (c) changes in family relationships, (d) the need for professional support and help, and (e) coping strategies. PRACTICE IMPLICATIONS Clinicians, including nurses, must be aware of the cultural importance of mental illness, particularly the widespread cultural beliefs and patterns of help-seeking behaviors, to provide culturally sensitive health care and develop empirical strategies for helping both these caregivers and their dependents.
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Affiliation(s)
- Nan Liu
- Nursing College of Huzhou University, Huzhou, People's Republic of China
| | - JianGuo Zhang
- Yangzhou Wutaishan Hospital, YangZhou, People's Republic of China
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Krupchanka D, Chrtková D, Vítková M, Munzel D, Čihařová M, Růžičková T, Winkler P, Janoušková M, Albanese E, Sartorius N. Experience of stigma and discrimination in families of persons with schizophrenia in the Czech Republic. Soc Sci Med 2018; 212:129-135. [DOI: 10.1016/j.socscimed.2018.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/20/2018] [Accepted: 07/08/2018] [Indexed: 11/16/2022]
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14
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Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings. Lancet Psychiatry 2018; 5:747-764. [PMID: 29680468 DOI: 10.1016/s2215-0366(18)30095-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/23/2022]
Abstract
Receiving a mental health diagnosis can be pivotal for service users, and it has been described in both positive and negative terms. What influences service-user experience of the diagnostic process is unclear; consequently, clinicians report uncertainty regarding best practice. This Review aims to understand and inform diagnostic practice through a comprehensive synthesis of qualitative data on views and experiences from key stakeholders (service users, clinicians, carers, and family). We searched five databases and identified 78 papers for inclusion, originating from 13 countries and including 2228 participants. Eligible papers were assessed for quality, and data were coded and then developed into themes, which generated a model representing factors to consider for clinicians conveying, and individuals receiving, mental health diagnoses. Themes included disclosure, information provision, collaboration, timing, stigma, and functional value of diagnosis for recovery. Variations between different stakeholders and clinical contexts are explored. Findings support an individualised, collaborative, and holistic approach to mental health diagnosis.
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Yıldız M, İncedere A, Kiras F, Abut FB, Kırcalı A, İpçi K. Development of Self-Stigma Inventory for Families of the patients with schizophrenia (SSI-F): validity and reliability study. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1480858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Mustafa Yıldız
- Department of Psychiatry, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Aysel İncedere
- Department of Psychosocial Rehabilitation, Kocaeli University Institute of Health Science, Kocaeli, Turkey
| | - Fatma Kiras
- Department of Psychiatry, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Fatma Betül Abut
- Department of Psychology, Kocaeli University Faculty of Art and Sciences, Kocaeli, Turkey
| | - Ayşe Kırcalı
- Department of Psychosocial Rehabilitation, Kocaeli University Institute of Health Science, Kocaeli, Turkey
| | - Kübra İpçi
- Department of Psychosocial Rehabilitation, Kocaeli University Institute of Health Science, Kocaeli, Turkey
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Wong YLI, Kong D, Tu L, Frasso R. "My bitterness is deeper than the ocean": understanding internalized stigma from the perspectives of persons with schizophrenia and their family caregivers. Int J Ment Health Syst 2018; 12:14. [PMID: 29636792 PMCID: PMC5883360 DOI: 10.1186/s13033-018-0192-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/26/2018] [Indexed: 01/29/2023] Open
Abstract
Background It is estimated that 8 million of the Chinese adult population had a diagnosis of schizophrenia. Stigma associated with mental illness, which is pervasive in the Chinese cultural context, impacts both persons with schizophrenia and their family caregivers. However, a review of the literature found a dearth of research that explored internalized stigma from the perspectives of both patients and their caregivers. Methods We integrated data from standardized scales and narratives from semi-structured interviews obtained from eight family-dyads. Interview narratives about stigma were analyzed using directed content analysis and compared with responses from Chinese versions of the Internalized Stigma of Mental Illness Scale and Affiliated Stigma Scale. Scores from the two scales and number of text fragments were compared to identify consistency of responses using the two methods. Profiles from three family-dyads were analyzed to highlight the interactive aspect of stigma in a dyadic relationship. Results Our analyses suggested that persons with schizophrenia and their caregivers both internalized negative valuation from their social networks and reduced engagement in the community. Participants with schizophrenia expressed a sense of shame and inferiority, spoke about being a burden to their family, and expressed self-disappointment as a result of having a psychiatric diagnosis. Caregivers expressed high level of emotional distress because of mental illness in the family. Family dyads varied in the extent that internalized stigma were experienced by patients and caregivers. Conclusions Family plays a central role in caring for persons with mental illness in China. Given the increasingly community-based nature of mental health services delivery, understanding internalized stigma as a family unit is important to guide the development of cultural-informed treatments. This pilot study provides a method that can be used to collect data that take into consideration the cultural nuances of Chinese societies. Electronic supplementary material The online version of this article (10.1186/s13033-018-0192-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yin-Ling Irene Wong
- 1School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104-6214 USA
| | - Dexia Kong
- 1School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104-6214 USA
| | - Lufei Tu
- 1School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104-6214 USA
| | - Rosemary Frasso
- 2College of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, PA 19107 USA
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Krupchanka D, Khalifeh H, Abdulmalik J, Ardila-Gómez S, Armiya'u AY, Banjac V, Baranov A, Bezborodovs N, Brecic P, Čavajda Z, de Girolamo G, Denisenko M, Dickens HA, Dujmovic J, Ergovic Novotny D, Fedotov I, Fernández MA, Frankova I, Gasparovic M, Giurgi-Oncu C, Grahovac T, James BO, Jomli R, Kekin I, Knez R, Lanfredi M, Lassman F, Mehta N, Nacef F, Nawka A, Nemirovsky M, Ola BA, Oshodi YO, Ouali U, Peharda T, Razic Pavicic A, Rojnic Kuzman M, Roventa C, Shamenov R, Smirnova D, Smoljanic D, Spikina A, Thornicroft A, Tomicevic M, Vidovic D, Williams P, Yakovleva Y, Zhabenko O, Zhilyaeva T, Zivkovic M, Thornicroft G, Sartorius N. Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries. Soc Psychiatry Psychiatr Epidemiol 2017; 52:989-1003. [PMID: 28285452 DOI: 10.1007/s00127-017-1366-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 02/16/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. METHODS This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models. RESULTS A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. CONCLUSION Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.
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Affiliation(s)
- Dzmitry Krupchanka
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic. .,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Hind Khalifeh
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Sara Ardila-Gómez
- Research Institute, School of Psychology, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Visnja Banjac
- Clinic of Psychiatry, University Clinical Center of the Republic of Srpska, Banjaluka, Bosnia and Herzegovina
| | | | | | | | - Zoran Čavajda
- Department of Acute and Biological Psychiatry, Clinical Hospital Centre Osijek, Osijek, Croatia
| | - Giovanni de Girolamo
- Unit of Psychiatric Epidemiology and Evaluation, Saint John of God Clinical Research Centre, Brescia, Italy
| | - Maria Denisenko
- Mental Health Clinic No1, Nizhny Novgorod, Russian Federation
| | | | | | | | - Ilya Fedotov
- Ryazan State Medical University, Ryazan, Russian Federation
| | - Marina A Fernández
- Research Institute, School of Psychology, University of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Catalina Giurgi-Oncu
- ″Victor Babes" University of Medicine and Pharmacy of Timisoara, Timisoara, Romania
| | | | - Bawo O James
- Federal Neuro-Psychiatric Hospital, Benin City, Nigeria
| | - Rabaa Jomli
- Department of Psychiatry "A" at Razi Hospital, Manouba, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Ivana Kekin
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Rajna Knez
- University Hospital Center Rijeka, Rijeka, Croatia
| | - Mariangela Lanfredi
- Unit of Psychiatry, Saint John of God Clinical Research Centre, Brescia, Italy
| | | | | | - Fethi Nacef
- Department of Psychiatry "A" at Razi Hospital, Manouba, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Alexander Nawka
- Institute of Neuropsychiatric Care (INEP), Prague, Czech Republic
| | | | | | - Yewande O Oshodi
- Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Uta Ouali
- Department of Psychiatry "A" at Razi Hospital, Manouba, Tunisia.,Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | | | | | - Martina Rojnic Kuzman
- University Hospital Centre Zagreb, Zagreb, Croatia.,Zagreb School of Medicine, Zagreb, Croatia
| | | | | | - Daria Smirnova
- Department of Psychiatry, Samara State Medical University, Samara, Russian Federation
| | | | - Anna Spikina
- Medical University Named After I.I. Mechnikov, Saint Petersburg, Russian Federation
| | - Amalia Thornicroft
- Occupational Therapy Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marko Tomicevic
- Neuropsychiatric Hospital "Dr. Ivan Barbot", Popovaca, Croatia
| | | | - Paul Williams
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Yulia Yakovleva
- Saint Petersburg Bekhterev Psychoneurological Research Institute, Saint Petersburg, Russian Federation
| | - Olena Zhabenko
- Railway Clinical Hospital #1 Station Kyiv, Kyiv, Ukraine
| | - Tatiana Zhilyaeva
- Department of Psychiatry and Medical Psychology, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russian Federation
| | - Maja Zivkovic
- University Psychiatric Hospital Vrapce, Zagreb, Croatia
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneve, Switzerland
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Krupchanka D, Kruk N, Sartorius N, Davey S, Winkler P, Murray J. Experience of stigma in the public life of relatives of people diagnosed with schizophrenia in the Republic of Belarus. Soc Psychiatry Psychiatr Epidemiol 2017; 52:493-501. [PMID: 28251244 DOI: 10.1007/s00127-017-1365-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Mental health-related stigma affects people with mental disorders and their families. We aimed to investigate the experience of stigma among relatives of patients with schizophrenia in Belarus and formulate recommendations for anti-stigma interventions. METHODS We conducted and thematically analysed 20 interviews with relatives of people diagnosed with schizophrenia. Experience of discrimination, strategies to cope with it, and requests for interventions were examined. RESULTS A number of themes related to the experience of stigma in the public life of relatives of people with schizophrenia were elicited in relation to: (1) mental health care (difficulties in contacting mental health professionals; in getting appropriate information; lack of alternatives to hospital treatment; absence of appropriate long-term care services); (2) employment of people living with schizophrenia and (3) contact with the police. Analysis of the strategies used to overcome difficulties revealed resignation and passive acceptance, self-reliance, and emotional containment during crises. Despite the passivity and scepticism in expressing needs, participants suggested a number of interventions that could reduce the burden of stigma. CONCLUSIONS With respect to the public domain of life, substantial stigma and discrimination perceived by families of people living with schizophrenia in Belarus is associated with structural issues of the country's mental health care system. To reduce the stigma-related burden, action must be taken to: (1) educate and support families and (2) deal with structural issues, by reorganising mental health services to better meet the needs of the families of people diagnosed with schizophrenia, and by including them in decision making at all levels.
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Affiliation(s)
- Dzmitry Krupchanka
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic. .,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Nina Kruk
- Department of Medical Psychology and Psychotherapy, Grodno State Medical University, Grodno, Belarus
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneve, Switzerland
| | - Silvia Davey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Winkler
- Department of Social Psychiatry, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanna Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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