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So YK, Chan CY, Fung SC, Lui TT, Lau FC, Chan KW, Lee HM, Lui SY, Hui LM, Chen E, Chang WC. Rates and correlates of medication non-adherence behaviors and attitudes in adult patients with early psychosis. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1215-1225. [PMID: 37833425 DOI: 10.1007/s00127-023-02563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Literature on antipsychotic medication adherence in early psychosis primarily assessed adherence behaviors and focused on young patients. There is a paucity of research investigating negative medication attitude and its determinants in the early illness course, particularly in older-aged sample. We aimed to examine prevalence and correlates of medication non-adherence behaviors and negative medication attitudes separately in adult patients with early psychosis. METHODS One hundred ninety-nine Chinese early psychosis patients aged 26-55 years who had received three-year treatment for first psychotic episode in Hong Kong were examined. Assessments encompassing socio-demographics, premorbid adjustment, clinical and treatment profiles, self-stigma and therapeutic alliance were conducted. Patients were evaluated with Medication Compliance Questionnaire, which is a modified Chinese-translated version of Medication Adherence Rating Scale and includes items measuring adherence behaviors and attitudes towards medications. RESULTS Rates of medication non-adherence and negative attitude towards medications were 38.7% and 50.8%, respectively. Multivariate regression analysis showed that more severe positive symptoms, greater self-stigma and negative medication attitude were independently associated with medication non-adherence. Negative attitude towards medications was significantly associated with younger age, higher educational attainment, diagnosis of other psychotic disorders, poorer insight, greater self-stigma and less satisfaction with communication with healthcare staff, which represented an index reflecting suboptimal therapeutic alliance. CONCLUSION Antipsychotic non-adherence and negative medication attitudes are frequently observed in adult early psychosis patients. Our findings indicate that poor insight, elevated self-stigma and suboptimal therapeutic alliance may constitute potential treatment targets for promoting medication adherence and rectifying negative medication attitudes in the early illness stage.
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Affiliation(s)
- Yuen Kiu So
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ching Yui Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Shi Cheng Fung
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Tsz Ting Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Fu Chun Lau
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kit Wa Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ho Ming Lee
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Sai Yu Lui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Lai Ming Hui
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Eric Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
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2
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Karabulut B, Uslu E. Schizophrenia and medication adherence: Associated factors. Arch Psychiatr Nurs 2024; 49:47-54. [PMID: 38734454 DOI: 10.1016/j.apnu.2024.01.015] [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: 07/29/2023] [Revised: 09/07/2023] [Accepted: 01/23/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Schizophrenia is a chronic condition that requiring maintenance treatment with antipsychotic medication. Medication adherence is essential to improve the symptoms of this health problem reduce relapses and readmissions and achieve treatment goals. The rate of challenges associated with medication adherence in schizophrenia is reported to be 26.5-85.1 %. PURPOSE This study was conducted to determine factors associated with medication adherence in individuals diagnosed with schizophrenia. METHODS A descriptive correlational research design was used. The study was completed with a total of 162 participants diagnosed with schizophrenia, between February-June 2021, at a Community Mental Health Center. Regression analysis (Model: enter and stepwise) was used to determine associated factors. RESULTS The mean medication adherence score of individual diagnosed with schizophrenia indicated that more than half of the participants (52 %) had poor medication adherence. In individual diagnosed with schizophrenia, medication attitudes, level of internalized stigma, the status of regular attendance to appointments, belief in recovery, and using medicines as prescribed were complicating factors for medication adherence (p < 0.05). CONCLUSIONS Medication adherence in individuals with diagnosed schizophrenia may be multifactorial. Mental health professionals should consider associated factors and implement a personalized treatment plan in this direction for strengthening adherence to medication treatment.
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Affiliation(s)
| | - Esra Uslu
- Department of Psychiatric Nursing, Eskis(ş)ehir Osmangazi University, Eskis(ş)ehir, Turkey; Eskis(ş)ehir Osmangazi University, Faculty of Health Sciences, 26040 Odunpazarı, Eskis(ş)ehir, Turkey.
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3
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Dai N, Huang B, Gao T, Zheng Y, Shi C, Pu C, Yu X. Initial attitudes toward a drug predict medication adherence in first-episode patients with schizophrenia: a 1-year prospective study in China. BMC Psychiatry 2023; 23:907. [PMID: 38053101 PMCID: PMC10696849 DOI: 10.1186/s12888-023-05419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients' attitudes toward medication have been shown to be a predictor of nonadherence to antipsychotic treatment. However, most previous studies that explored this relationship used a cross-sectional design. It is important to explore the association of attitudes toward drugs with discontinuation at different time points during antipsychotic treatment. In this study, we investigated the association of attitudes toward drugs (measured by the Drug Attitude Inventory (DAI-10)) with adherence at seven time points (baseline, 4 weeks, 8 weeks, 12 weeks, 26 weeks, 39 weeks, and 52 weeks) during 1 year of treatment. Factors that were potentially associated with attitudes toward drugs at the time point of interest were also studied. METHODS Demographic characteristics, psychopathology, social functioning, and attitudes toward drugs (measured by the DAI-10) were collected at baseline, 4 weeks, 8 weeks, 12 weeks, 26 weeks, 39 weeks and 52 weeks. The association of attitudes toward drugs (measured by DAI-10) with adherence at the seven time points was calculated using the Mann‒Whitney U test. The optimal cutoff point for the DAI-10 was then determined using receiver operating characteristic (ROC) analysis. Cox regression analysis was conducted to further investigate the association of DAI-10 scores with discontinuation, controlling for potential confounding variables. We used multiple regression analysis to identify the factors associated with DAI-10 scores. RESULTS Among the six time points, only baseline DAI-10 total scores were significantly different between the completed and discontinued groups (p = 0.004). Female sex and a baseline DAI-10 total score greater than - 1 were found to be independent protective factors against discontinuation of antipsychotic drug treatments during the 1-year follow-up. At baseline, the severity of the disease (CGI-s) and insight regarding the disease were shown to be associated with DAI-10 total scores. CONCLUSION Attitudes toward antipsychotic drugs at baseline were shown to play a crucial role in predicting treatment discontinuation. TRIAL REGISTRATION The data were collected from a clinical trial and the clinical trials.gov ID of the study is NCT01057849.
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Affiliation(s)
- Nan Dai
- Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, Yunnan, China
| | - Bingjie Huang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China
| | - Tianqi Gao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China
| | - Yue Zheng
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China
| | - Chengcheng Pu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China.
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), 51 Huayuan North Road, Beijing, China.
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4
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Fond G, Vidal M, Joseph M, Etchecopar-Etchart D, Solmi M, Yon DK, Correll CU, Boyer L. Self-stigma in schizophrenia: a systematic review and meta-analysis of 37 studies from 25 high- and low-to-middle income countries. Mol Psychiatry 2023; 28:1920-1931. [PMID: 36890299 DOI: 10.1038/s41380-023-02003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/25/2023] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
In schizophrenia, it is currently thought that stigma experience is increased by psychotic and depressive symptomatology, exposure to stigma at the workplace, and that self-stigma levels vary across countries without knowing the factors explaining these variations. The aim of the present meta-analysis was to synthetize the data of observational studies comprehensively exploring multiple self-stigma dimensions and associated factors. A systematic literature search without language or time restrictions was conducted in Medline, Google Scholar, and Web of Science for studies, last 09/2021. Eligible studies that included ≥80% of patients diagnosed with schizophrenia-spectrum disorders and used a validated scale measuring self-stigma dimensions were meta-analysed using random-effects models, followed by subgroup and meta-regression analyses. Study registration: PROSPERO CRD42020185030. Overall, 37 studies (n = 7717) from 25 countries (5 continents) published between 2007 and 2020 were included, with 20 studies conducted in high-income countries. These studies used two scales with total scores ranging 1-4. The mean estimate of perceived stigma was 2.76 [95% confidence interval (CI) = 2.60-2.94], experienced stigma 2.29 [95% CI = 2.18, 2.41], alienation 2.40 [95% CI = 2.29, 2.52], stereotype endorsement 2.14 [95% CI = 2.03, 2.27], social withdrawal 2.28 [95% CI = 2.17, 2.39] and stigma resistance 2.53 [95% CI = 2.43, 2.63]). Self-stigma levels did not reduce over time. Living outside urban areas, low-income, singleness, unemployment, high antipsychotic dose and low functioning were associated with different stigma dimensions. Some stigma dimensions were lower in studies carried out in Europe compared to other regions. Most studies published since 2007 report that self-stigma is a particular concern for a specific subgroup of patients. This subgroup is characterized by unemployment, high antipsychotic dose and low functioning. We identified important other missing factors that should be explored to improve the effectiveness of public policies and personalized interventions to reduce self-stigma. Importantly, classical illness severity indices (psychotic severity, age at illness onset, illness duration) and sociodemographic variables (age, sex and education) were not associated with self-stigma, moderating previous findings.
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Affiliation(s)
- Guillaume Fond
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France.
- FondaMental Foundation, Creteil, France.
| | - Martin Vidal
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | - Morgane Joseph
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France
| | - Damien Etchecopar-Etchart
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Marco Solmi
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, University of Ottawa, Ontario, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ontario, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa Ottawa Ontario, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
| | - Laurent Boyer
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
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5
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Tao TJ, Hui CLM, Ho ECN, Hui PWM, Suen YN, Lee EHM, Chan SKW, Chang WC, Chen EYH. Correlates and predictors of perceived stigma and self-stigma in Chinese patients with psychosis. Early Interv Psychiatry 2022; 16:1075-1084. [PMID: 34913256 DOI: 10.1111/eip.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/07/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
AIMS In patients with psychosis, perceived stigma (i.e., beliefs about discriminative viewpoints held by the public) and self-stigma (i.e., internalization of such perceived stereotypes) could have devastating consequences. Knowledge about their correlates bears importance for understanding individual differences in stigma experiences, and further, given the social nature of stigma, Asians may show more distinctive features than Westerners. METHODS A total of 142 Chinese patients who originally enrolled into a randomized controlled trial during their first-episode psychosis were followed up at 10 years. We explored potential demographics, clinical and psychosocial correlates of perceived stigma and self-stigma. RESULTS Stepwise multiple regression analyses indicated that both perceived- and self-stigma were predicted by a more negative attitude to treatment, whereas differential factors including perceived recovery predicted perceived stigma, and quality of life and attention predicted self-stigma. CONCLUSIONS These results can help identify individuals susceptible to experiencing perceived- or self-stigma, highlighting the need to consider factors such as attitude towards treatment when designing anti-stigma strategies.
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Affiliation(s)
- Tiffany Junchen Tao
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Elise Chun Ning Ho
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Yi Nam Suen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China
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6
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Nebhinani N, Pareek V, Choudhary S, Tripathi S, Singh P, Kumar M. Pathways of care and attitudes toward psychotropics in patients with depressive disorders and psychotic disorders. J Neurosci Rural Pract 2022; 13:785-790. [PMID: 36743762 PMCID: PMC9893934 DOI: 10.25259/jnrp-2021-11-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Delay in institution of appropriate mental healthcare is closely linked with attitudes, stigma, and availability of services, which further directs the help seeking pathways. This study was aimed to assess the pathway of care and attitudes toward psychotropic medications among patients with depressive disorder and psychotic disorders. Materials and Methods Eighty outpatients with depressive disorder and 40 patients with psychotic disorder were assessed in a tertiary care center for pathways to care and attitude toward psychotropics through Attitude toward Psychotropic Medications Questionnaire and Drug attitude inventory-10. Results The psychiatrist remained the most common first treatment contact (46% in depression and 62% in psychosis). Greater number of patients in psychotic disorder group had first treatment contact with faith healers or exorcist (17.5%), compared to depressive disorder (6.2%). Patients in depressive group had more favorable attitude toward psychotropics compared to psychosis group. Majority of patients had favorable attitude toward psychotropic medications, but they also had substantial misconceptions about side effects, utility, and need of taking lesser than prescribed doses. Conclusions Although majority of patients had favorable attitude, they also had substantial misconceptions about medications. These issues need to be addressed for better delivery of comprehensive mental healthcare.
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Affiliation(s)
- Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Vrinda Pareek
- Department of Psychiatry, Government Medical College, Vadodara, Gujarat, India
| | - Swati Choudhary
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Swapnil Tripathi
- Department of Medicine, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Prerna Singh
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Manish Kumar
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
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7
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Nyanyiwa S, Peters K, Murphy G. A scoping review: Treatment attitudes and adherence for adults with schizophrenia. J Clin Nurs 2022; 31:3060-3075. [PMID: 35043496 DOI: 10.1111/jocn.16219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/22/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVES This scoping review presents an exploration of literature on the relationship between treatment attitudes and adherence in adults experiencing schizophrenia. BACKGROUND Strategies to address adherence and improve treatment outcomes are described in literature. However, adherence remains a challenge for people experiencing mental illness in practice. Transformational frameworks, evidence-based practice and patient-centred approaches have been established and implemented but non-adherence incidence rates continue to rise among people with schizophrenia. Moreover, the relationship between treatment attitudes and adherence in adults diagnosed with schizophrenia remains unclear. DESIGN A scoping review using the framework offered by Implementation Science, 5, 2010, 1. The PRISMA-ScR checklist was used to ensure integrity of the review. METHODS Four databases PsychINFO, Medline, Cochrane and CINAHL databases were searched for literature along with the reference lists of eligible sources. Original research, peer-reviewed articles published between 2010 and 2020 in English language were included. Articles were included if study participants were adults with a diagnosis of schizophrenia or related psychosis. Methodological quality was evaluated using a quality assessment checklist, the Critical Appraisal Skills Programme tool. RESULTS Ten articles were included in the study. Five main themes about treatment adherence emerged from the literature: (i) severity of symptoms, (ii) side effects, (iii) beliefs and attitudes, (iv) insight and (v) support and relationships. CONCLUSIONS This scoping review concluded that attitude influenced adherence to medication in people with schizophrenia. The five main themes reported directly influenced attitude, impacting on treatment adherence in people experiencing schizophrenia. This review makes recommendations for a person-centred and recovery framework that aims to improve adherence. RELEVANCE TO CLINICAL PRACTICE Nurses in all healthcare settings could use evidence-based strategies to enhance treatment adherence in people with a range of physical and mental health conditions.
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Affiliation(s)
- Simehlani Nyanyiwa
- School of Nursing & Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kath Peters
- School of Nursing & Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
| | - Gillian Murphy
- School of Nursing & Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
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8
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Yu BCL, Chio FHN, Mak WWS, Corrigan PW, Chan KKY. Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clin Psychol Rev 2021; 87:102029. [PMID: 34058604 DOI: 10.1016/j.cpr.2021.102029] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of collectivism in the internalization process. Results of the meta-analytic structural equation modeling suggested that self-stigma is a significant mediator in the relationships between experienced stigma and perceived stigma with well-being and recovery variables (indirect effects = 0.02 to -0.16). Experienced and perceived stigma had significant direct effects on well-being and recovery variables (Bs = 0.07 to -0.21, p < 0.05), suggesting that both external (e.g., public stigma) and internal (i.e., self-stigma) influences of stigma work concurrently to affect recovery and well-being of people with mental illness. The results of the mixed effect three-level meta-analytic models showed that collectivism significantly moderated the relationship between experienced and perceived stigma with self-stigma (Bs = 0.06 to 0.11, p < 0.05). This implied that the more collectivistic a culture is, the stronger the correlation between experienced and perceived stigma with self-stigma. Implications to stigma reduction approaches were discussed.
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Affiliation(s)
- Ben C L Yu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Floria H N Chio
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, United States
| | - Kelly K Y Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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9
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Brandl EJ, Dietrich N, Mell N, Winkler JG, Gutwinski S, Bretz HJ, Schouler-Ocak M. Attitudes towards psychopharmacology and psychotherapy in psychiatric patients with and without migration background. BMC Psychiatry 2020; 20:176. [PMID: 32303265 PMCID: PMC7164188 DOI: 10.1186/s12888-020-02585-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sociodemographic factors, attitude towards treatment and acculturation may be important factors influencing the decision of immigrants to seek and maintain psychiatric treatment. A better understanding of these factors may significantly improve treatment adherence and outcome in these patients. Therefore, we investigated factors associated the attitude towards psychotherapy and medication in a sample of psychiatric outpatients with and without migration background. METHODS N = 381 patients in a psychiatric outpatient unit offering specialized treatment for migrants were included in this study. Attitude towards psychotherapy was assessed using the Questionnaire on Attitudes Toward Psychotherapeutic Treatment, attitude towards medication with the Drug Attitude Inventory-10. Acculturation, symptom load and sociodemographic variables were assessed in a general questionnaire. Statistical analyses included analyses of covariance and hierarchical regression. RESULTS Patients of Turkish and Eastern European origin reported a significantly more positive attitude towards medication than patients without migration background. When controlling for sociodemographic and clinical variables, we did not observe any significant differences in attitude towards psychotherapy. Acculturation neither influenced the attitude towards psychotherapy nor towards medication. CONCLUSION Our study indicates that sociodemographic and clinical factors may be more relevant for patients´ attitudes towards treatment than acculturation. Considering these factors in psychiatric treatment of patients with migration background may improve treatment outcome and adherence.
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Affiliation(s)
- Eva J. Brandl
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Nora Dietrich
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Nicoleta Mell
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Johanna G. Winkler
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Stefan Gutwinski
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - H. Joachim Bretz
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Meryam Schouler-Ocak
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
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Alexová A, Kågström A, Winkler P, Kondrátová L, Janoušková M. Correlates of internalized stigma levels in people with psychosis in the Czech Republic. Int J Soc Psychiatry 2019; 65:347-353. [PMID: 31113271 DOI: 10.1177/0020764019850204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Internalized stigma negatively affects lives and prognosis of individuals with psychosis. AIM This study aimed to identify correlates of internalized stigma among individuals with psychosis in a sample of community care users in the Czech Republic. METHODS A cross-sectional study was conducted among 133 community service users with psychosis. A shortened version of the Internalized Stigma of Mental Illness (ISMI-10) scale was used alongside the 5-level EQ-5D version (EQ-5D-5L), assessing health-related quality of life. Descriptive and linear regression analyses were performed in order to determine levels of internalized stigma and its correlates. RESULTS High levels of internalized stigma were reported in 25% of participants. Lower internalized stigma levels were associated with better self-reported health status and being married, and higher internalized stigma with a longer period of time since initial contact with psychiatric care. CONCLUSION Lower internalized stigma levels are associated with better self-reported health-related quality of life. In addition, clients having used psychiatric care for longer periods of time reported significantly higher internalized stigma levels. Therefore, authors suggest self-stigma reduction interventions based in a community setting with an emphasis on targeting clients with chronic psychosis.
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Affiliation(s)
- Aneta Alexová
- 1 National Institute of Mental Health, Klecany, Czech Republic.,2 Faculty of Social Sciences, Charles University, Prague, Czech Republic
| | - Anna Kågström
- 1 National Institute of Mental Health, Klecany, Czech Republic
| | - Petr Winkler
- 1 National Institute of Mental Health, Klecany, Czech Republic.,3 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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