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Lespine LF, de Martène B, Zeltner B, Chenu B, Berbey CD, Rey R. Leo program, a short multi-family skill-based psychoeducational program for caregivers of relatives living with a severe mental disorder: a retrospective pilot study. Front Psychiatry 2024; 15:1374540. [PMID: 38784162 PMCID: PMC11112345 DOI: 10.3389/fpsyt.2024.1374540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Background Caring for a relative with a severe mental disorder (SMD) is associated with high levels of burden and poor physical and mental health. There is a dire need for family psychoeducational programs that can be provided as early as possible. This manuscript describes the pilot testing of "Leo" a motivational-based psychoeducational program for caregivers of individuals with a SMD. The Leo program aims to provide caregivers with skills to best support their relative and to adopt self-care behaviors. Methods We retrospectively analyzed medical records of caregivers who enrolled in a short, multi-family, skill-based psychoeducational program, consisting of eight 3-hour sessions over 8 weeks. Outcomes of interest included: i) adherence to the program, ii) satisfaction and perceived usefulness, and iii) pre-post changes in self-reported levels of depression (CES-D), burden (ZBI), and skills (10 Likert-scaled items). A network analysis was used to investigate the relationships between pre-post changes in self-evaluated skills and pre-post changes in burden and depression levels. Results Over the 91 enrolled participants, 87 (95.6%) completed the program attending at least 5/8 sessions, 80.5% attending all sessions. Seventy-six caregivers fulfilled the questionnaires at baseline and after the program, and were included in the analysis. Although there was no evidence for significant change in self-reported depression levels (Cohen's d=0.19, p=0.210), burden scores and all evaluated skills were improved post-intervention, with medium to strong effect size (Cohen's ds from 0.47 to 0.87; p<0.001). Network output indicated that increased self-evaluated competence in 5 skills were associated with a global improvement in caregivers' burden and/or depression scores. Post-intervention, 89.7% of caregivers were "very satisfied" and 82.1% found the program "extremely useful". Conclusion This pilot retrospective study shows high levels of satisfaction, perceived usefulness, and adherence to "Leo", a short, multi-family, skill-based psychoeducational program with promising results in improving caregivers' burden, self-evaluated competence in coping with caregiving demands and in self-care behaviors. This study provides preliminary insights into the mechanisms by which family psychoeducation might alleviate burden of care. A larger-scaled, controlled, randomized study with follow-up assessments is warranted to determine how burden, depression, and skills, as well as their inter-relationships, evolve over time.
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Affiliation(s)
- Louis-Ferdinand Lespine
- Center for Caregivers in Psychiatry of Lyon, Le Vinatier Hospital, Bron, France
- Division for Clinical Research and Innovation, Le Vinatier Hospital, Bron, France
| | | | - Blandine Zeltner
- School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France
| | | | | | - Romain Rey
- Center for Caregivers in Psychiatry of Lyon, Le Vinatier Hospital, Bron, France
- Fondation FondaMental, Créteil, France
- University Lyon 1, CNRS, INSERM, Lyon Neuroscience Research Center U1028 UMR5292, PSYR2, Bron, France
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Erdoğan Kaya A, Erdogan Akturk B. The Relationship Between Religious Coping and Internalized Stigma Among Patients With Bipolar Disorder. Cureus 2023; 15:e43511. [PMID: 37588131 PMCID: PMC10426246 DOI: 10.7759/cureus.43511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Stigmatization is a situation that results from the negative perspective of society toward individuals with certain mental and physical illnesses and has negative effects. It has been observed that there are not enough studies in the literature investigating the attitudes of individuals with mental illness to cope with lifelong difficulties such as stigma and especially their religious coping attitudes. However, there are many clinical studies on general psychology and religious coping with varying results. Our aim in this research is to reveal the association between religious coping and internal stigma among bipolar disorder patients. METHODS The religious coping scale and the Internalized Stigma in Mental Illness (ISMI) scale were administered to 79 patients with bipolar disorder. The obtained data were analyzed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). RESULTS Forty-two (53.1%) patients were female and 37 (46.9%) were male, the mean age was 43.41±12.57, and the mean follow-up period was 11.95±9.15 years. A positive correlation was found between negative religious coping and discrimination experience, alienation, and social withdrawal in bipolar disorder patients. A significant negative correlation was found between discrimination experience, alienation and social withdrawal, and positive religious coping. CONCLUSIONS The correlation of religious coping attitudes with discrimination experience, alienation, and social withdrawal makes us think that religious coping methods may be one of the issues to be considered when dealing with self-stigma in bipolar disorder patients. In addition, the relationship between religious coping and self-stigmatization in mental illnesses can add a new dimension to psychosocial approaches. It would be beneficial for authors interested in religion and social psychology to focus on more extensive research on this subject.
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Affiliation(s)
- Ayşe Erdoğan Kaya
- Psychiatry, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, TUR
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Favre S, Richard-Lepouriel H. Self-stigma and bipolar disorder: A systematic review and best-evidence synthesis. J Affect Disord 2023; 335:273-288. [PMID: 37207946 DOI: 10.1016/j.jad.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Bipolar disorder is a severe and chronic mental illness characterized by recurrent major depressive episodes and mania or hypomania. In addition to the burden of the disease and its consequences, self-stigma can impact people with bipolar disorder. This review investigates the current state of research in self-stigma in bipolar disorder. METHODS An electronic search was carried out until February 2022. Three academic databases were systematically searched, and best-evidence synthesis was made. RESULTS Sixty-six articles were related to self-stigma in bipolar disorder. Seven key themes were extracted from these studies: 1/ Comparison of self-stigma in bipolar disorder and other mental illnesses, 2/ Sociocultural context and self-stigma, 3/ Correlates and predictors of self-stigma, 4/ Consequences of self-stigma, 5/ Treatments and self-stigma, 6/ Management of self-stigma, and 7/ Self-stigma and recovery in bipolar disorder. LIMITATIONS Firstly, a meta-analysis could not be performed due to the heterogeneity of the studies. Secondly, limiting the search to self-stigma has excluded other forms of stigma that also have an impact. Thirdly, the under-reporting of negative or nonsignificant results due to publication bias and unpublished studies might have limited the accuracy of this reviews' synthesis. CONCLUSION Research on self-stigma in persons with bipolar disorder has been the focused on different aspects, and interventions to reduce self-stigmatization have been developed, but evidence of their effectiveness is still sparse. Clinicians need to be attentive to self-stigma, its assessment, and its empowerment in their daily clinical practice. Future work is required to establish valid strategies to fight self-stigma.
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Affiliation(s)
- Sophie Favre
- Mood disorder unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Mood disorder unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
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Latifian M, Raheb G, Abdi K, Alikhani R. The bipolar patients' family experiences of the outcomes of encountering stigma in Tehran: A qualitative study. Int J Soc Psychiatry 2023; 69:503-511. [PMID: 35876132 DOI: 10.1177/00207640221113748] [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
INTRODUCTION Nowadays, the most common psychological-social pressure to which bipolar patients' families are exposed is stigma. Therefore, the present study was conducted to delve into the bipolar patients' family experiences of the outcomes of encountering stigma. METHOD The study was of qualitative type. Purposive sampling was used to select the participants from the persons suffering from bipolar disorder and their families. Twenty seven of the participants were interviewed. The main data collection instrument was semi-structured interview with open questions. Additionally, the collected data were analyzed via inductive content analysis method. The accuracy and validity of the study rooted in four factors: credibility, transferability, verifiability, and reliability. RESULTS Data analysis led to 1,326 primary codes, which were further categorized into five main categories as the main outcomes of encountering stigma (social deprivation, emotional and sentimental excitement, objective and behavioral reflections, family solidarity threat, and separation from society) and 21 sub-categories. CONCLUSION Given then irreparable outcomes of stigma for bipolar patients' family, it is necessary to take it into consideration. It is recommended to use media and also hygienic-treatment centers to educate different levels of society as to appropriate treatment with these patients and their families.
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Affiliation(s)
- Maryam Latifian
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ghoncheh Raheb
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kianoush Abdi
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Rosa Alikhani
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Latifian M, Abdi K, Raheb G, Islam SMS, Alikhani R. Stigma in people living with bipolar disorder and their families: a systematic review. Int J Bipolar Disord 2023; 11:9. [PMID: 36805368 PMCID: PMC9941403 DOI: 10.1186/s40345-023-00290-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Stigma affects different life aspects in people living with bipolar disorder and their families. This study aimed to examining the experience of stigma and evaluating predictors, consequences and strategies to combat stigma in people with bipolar disorder and their families. METHODS We conducted a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) in 2022. We extensively reviewed six online databases (PubMed, Scopus, Medline, EMBASE, Web of Science and Google Scholar). Articles published in the English language about stigma in people living with bipolar disorders and their families were included. RESULTS A total of 42,763 articles were retrieved, of which 40 articles from 14 countries were included in this study (n = 7417 participants). Of the 40 articles, 29 adopted quantitative methods (72.5%), two used mixed-methods (5%), eight used qualitative (20%) methods, and one was a case series (2.5%). The results of the studies were categorized into four themes: 1. Stigma experienced by people living with bipolar disorders and their families, 2. Predictors of stigma in people living with bipolar disorders and their families, 3. Consequences of stigma in people living with bipolar disorders and their families, 4. Effective interventions and strategies to reduce stigma in people living with bipolar disorders and their families. CONCLUSION The results of this study might be useful to design psychiatric cognitive interventions to reduce stigma in people living with bipolar disorders and their families and designing community-based interventions to normalize bipolar disorder at the community level.
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Affiliation(s)
- Maryam Latifian
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kianoush Abdi
- Department of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Ghoncheh Raheb
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sheikh Mohammed Shariful Islam
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Rosa Alikhani
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Latifian M, Raheb G, Abdi K, Alikhani R, Shariful Islam SM. The effectiveness of psychoeducation in improving attitudes towards psychological disorders and internalized stigma in the family members of bipolar patients: A quasi‐experimental study. Psych J 2022; 12:272-279. [PMID: 36504366 DOI: 10.1002/pchj.621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022]
Abstract
Family members of bipolar patients experience stigma following being labeled by others, which can disrupt their routine lives and result in social isolation. This study aims to evaluate the effectiveness of psychoeducation in improving the attitudes of bipolar patients' family members towards psychological disorders and internalized stigma. The present study is a quasi-experimental study with a pre- and post-test follow-up design, in which 74 individuals were selected by convenience sampling among families who had a member with a bipolar disorder who was referred to the largest psychiatric hospital in Iran in 2021. The participants were randomly divided into the experimental and control groups (n = 37 per group). The members of the experimental group then underwent eight 90-min sessions of psychoeducation. The control group also received psychoeducation at the end of the study. The results of analysis of covariance showed that psychoeducation reduced internalized stigma in the family members of bipolar patients and increased their positive attitudes towards psychological disorders compared with the control group (p < .01). On this basis, psychoeducation can be useful to reduce the internalized stigma of family members of bipolar patients and to increase their positive attitudes towards psychological disorders.
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Affiliation(s)
- Maryam Latifian
- Department of Social Work University of Social Welfare and Rehabilitation Sciences Tehran Iran
| | - Ghoncheh Raheb
- Psychosis Research Center University of Social Welfare and Rehabilitation Sciences Tehran Iran
| | - Kianoush Abdi
- Department of Rehabilitation Management University of Social Welfare and Rehabilitation Sciences Tehran Iran
| | - Rosa Alikhani
- Psychosis Research Center University of Social Welfare and Rehabilitation Sciences Tehran Iran
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences Deakin University Melbourne Australia
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Latifian M, Raheb G, Uddin R, Abdi K, Alikhani R. The process of stigma experience in the families of people living with bipolar disorder: a grounded theory study. BMC Psychol 2022; 10:282. [PMID: 36447295 PMCID: PMC9706820 DOI: 10.1186/s40359-022-00999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND One of the most challenging issues faced by families of people living with bipolar disorder is stigma. This study was conducted to explain the process of stigma experience in the families of people living with bipolar disorder using the grounded theory method. METHODS Data for this study were collected through semi-structured interviews with participants in Razi Psychiatric Hospital in Tehran, Iran, via purposive sampling and field notetaking. The dependability, conformability, and transferability measures were included to support the data accuracy and robustness, and MAXQDA 2020 software was used to facilitate data coding. The Strauss-Corbin method was used to analyse the data. RESULTS A total of 20 family members of people living with bipolar disorder, four people living with bipolar disorder, and three mental health professionals participated in this study. The analysis of participants' experiences led to identifying 64 subcategories, 21 categories, and six main concepts, including social deprivation, being labelled, cultural deficiency and lack of awareness, economic challenges, forced acceptance of the existing situation, and social isolation. CONCLUSION Families of people living with bipolar disorder experience social deprivation, social isolation, and social rejection, which have irreparable consequences for them. Overcoming stigma in these families should be a priority of policymakers and planners in the field of psychosocial health.
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Affiliation(s)
- Maryam Latifian
- grid.472458.80000 0004 0612 774XDepartment of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ghoncheh Raheb
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Riaz Uddin
- grid.1021.20000 0001 0526 7079Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Kianoush Abdi
- grid.472458.80000 0004 0612 774XDepartment of Rehabilitation Management, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Rosa Alikhani
- grid.472458.80000 0004 0612 774XPsychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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González-Sanguino C, Muñoz M. Predictors of Implicit and Explicit Internalized Stigma in a Sample With Different Mental Illness Diagnoses. J Nerv Ment Dis 2022; 210:665-671. [PMID: 35344973 DOI: 10.1097/nmd.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This research aimed to study implicit and explicit internalized stigma and its relationship with other variables in a sample of people with distinct mental illness diagnoses ( N = 160). Descriptive analysis, mean differences, correlations, and stepwise regression models were conducted. Implicit and explicit internalized stigma was found throughout the sample with differences depending on certain sociodemographic variables. Regression models revealed symptomatology, physical environment, personality traits, references to mental illness, and the time taken to seek professional help as predictors of explicit internalized stigma. At the implicit level, only self-esteem was found as a predictor explaining a low percentage of the variance. The results obtained underline the differences between implicit and explicit stigma, suggesting different relevant variables for interventions focused on prevention and internalized stigma reduction.
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Affiliation(s)
- Clara González-Sanguino
- Department of Clinical Psychology, School of Psychology, University Complutense of Madrid, Campus de Somosaguas, Madrid, Spain
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Heinström J, Nikou S, Sormunen E. Hide and seek – the role of personality, sense of coherence and experiential information in hidden information needs. JOURNAL OF DOCUMENTATION 2021. [DOI: 10.1108/jd-06-2021-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe aim of this study is to assess the impact of personality traits and sense of coherence (SOC) on concealing information needs out of shame. The study also investigates the link between concealed information needs and the use of experiential information for psychological wellbeing.Design/methodology/approachA Partial Least Square ‐ Structural Equation Modelling (PLS-SEM) approach is used to assess and analyse the proposed conceptual model, which is based on the responses of 412 upper secondary school students.FindingsThe findings reveal that personality traits not only have direct significant effects on concealing information needs but that their effects are also mediated by SOC. The positive relationship between concealed information needs and the use of experiential information is confirmed in the study.Originality/valueThis study is the first to show that personality and SOC influence concealing information needs. Two pathways are found. Firstly, negative emotionality and a low SOC lead to a heightened sense of shame. Secondly, introversion induces a more guarded behaviour. The study, moreover, quantitatively demonstrates a link between concealed information needs and the use of experiential information for psychological wellbeing.
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Dubreucq J, Plasse J, Franck N. Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences. Schizophr Bull 2021; 47:1261-1287. [PMID: 33459793 PMCID: PMC8563656 DOI: 10.1093/schbul/sbaa181] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma-including from mental health providers-predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy.
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Affiliation(s)
- Julien Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
| | - Julien Plasse
- Réseau Handicap Psychique, Grenoble, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation cognitive, Centre Hospitalier Le Vinatier, Bron, France
| | - Nicolas Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation cognitive, Centre Hospitalier Le Vinatier, Bron, France
- Pôle Centre Rive Gauche, Centre Hospitalier Le Vinatier, Bron, France
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Čolić M, Dababnah S, Milačić-Vidojević I. A model of internalized stigma in parents of individuals with disabilities. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:924-932. [PMID: 36568618 PMCID: PMC9788690 DOI: 10.1080/20473869.2021.1924032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/26/2021] [Accepted: 04/26/2021] [Indexed: 06/17/2023]
Abstract
Background: Stigma has negative impacts on both individuals with disabilities and their caregivers, including poor mental health and social isolation. In the present study, we aimed to test a model of stigma internalization among parents of individuals with disabilities, as this process in not yet completely understood. Aim: Specifically, we explored effects of experienced stigma and neuroticism on affiliate stigma and examined whether perceived stigma and self-blame are mediators in a stigma internalization model. Methods: We recruited 82 parents of individuals with disabilities in Serbia over the course of six months. Parents were asked about perceived stigma, experienced stigma, affiliate stigma, self-blame, and they completed an assessment of personality traits. Results: Both experienced stigma and neuroticism were positively correlated with affiliate stigma. In addition, perceived stigma was a mediator between these variables: parents who experienced stigma more and had higher neuroticism scores reported higher degrees of perceived stigma, which in turn positively affected affiliate stigma. Self-blame was not a significant mediator in the tested model. Conclusion: We conclude stigma internalization among parents of individuals with disabilities is a complex process, involving experienced stigma, neuroticism, and perceived stigma. Interventions should include multiple paths to adequately support parents to combat stigma.
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Affiliation(s)
- Marija Čolić
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Sarah Dababnah
- School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA
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Özkesici Kurt B, İnan Doğan E, Özdemir M, Alpsoy E. Internalized stigma: One of the main factors responsible for the psychosocial burden of melasma? J Cosmet Dermatol 2020; 20:1182-1187. [PMID: 32981229 DOI: 10.1111/jocd.13697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Internalized stigma is the acceptance of negative stereotypes about the disease created by society and withdrawing self from society with emotions such as worthlessness and shame. AIMS This study aimed to investigate the internalized stigma state of patients with melasma, and to identify the factors affecting the internalized stigma. METHODS A total of 55 melasma patients were included. The sociodemographic and clinical characteristics of the patients were recorded. Melasma Severity Index, the Turkish version of the Melasma Quality of Life Scale (MelasQoL-TR), and Internalized Stigma Scale (ISS) were used. Besides, patients answered the Perceived Health Status (PHS) and the General Health Questionnaire 12 scales (GHQ-12) surveys. RESULTS The mean ISS total score was found as 49.49 ± 13.15. Cronbach's alpha coefficient for the whole scale was calculated as 0.92 for melasma patients. There was a significant correlation between the ISS total score and MelasQoL-TR (r = 0.608, P < .001). Besides, statistically significant positive correlations were also found between the overall scores of ISS and GHQ-12 (r = 0.578, P < .001). Linear regression analysis revealed that the most important determinant of internalized stigma was MelasQoL-TR (β = 0.313, P < .001). CONCLUSIONS This study demonstrates that patients with melasma internalize the negative stereotype judgments of the society about the disease. High levels of internalized stigma are related to poor quality of life and psychological illnesses. Therefore, internalized stigma may be one of the main factors responsible for the psychosocial burden of melasma.
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Affiliation(s)
- Birgül Özkesici Kurt
- Clinic of Dermatology, Adıyaman University Training and Research Hospital, Adıyaman, Turkey
| | - Esra İnan Doğan
- Department of Dermatology and Venereology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey
| | - Mikail Özdemir
- Osmaniye Community Health Center, Tuberculosis Dispensary, Osmaniye, Turkey
| | - Erkan Alpsoy
- Department of Dermatology and Venereolaogy, Akdeniz University Faculty of Medicine, Antalya, Turkey
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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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Stiles BM, Fish AF, Vandermause R, Malik A. Identifying the Complexity of Diagnosing Bipolar Disorder: A Focused Ethnography. Issues Ment Health Nurs 2019; 40:812-818. [PMID: 31246151 DOI: 10.1080/01612840.2019.1615584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To identify and describe the complexity of diagnosing bipolar disorder, including the diagnostic process and patient experiences of being newly diagnosed with bipolar disorder. Design: A mixed-methods focused ethnography was conducted, grounded in a post-positivist foundation. Methods: Medical records (n = 100) of patients whose diagnosis had been switched to bipolar disorder were examined. Six weeks post-hospitalization, ten outpatients with the diagnosis of bipolar disorder underwent an in-depth interview. Findings: Four diagnostic processes were identified during the retrospective record review. Two patterns and five themes were identified from the interviews. The first pattern, living with undiagnosed bipolar disorder, demonstrated common experiences of distinguishing impulsive moods and behavior, suffering life challenges, and seeking relief. The second pattern, acclimating to a new diagnosis of bipolar disorder, demonstrated participants' ways of understanding the diagnosis and reconciling the diagnosis. Patterns in the interviews corroborated data from the record review. Conclusions: The rendering of an appropriate diagnosis is key. Many participants' lives were significantly improved when diagnosis was made, and treatment recommendations for bipolar disorder (BPD) were initiated. These findings offer clinicians and researchers new ways to think about the complexity of the diagnosis of BPD including contrasting decision-making outcomes along a screening, diagnosis, and treatment continuum, as well as using the diagnostic event to instigate meaningful life change in the patient.
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Affiliation(s)
- Brandie M Stiles
- Jonas Veterans Healthcare Scholar, Centerpointe Hospital , St. Louis , MO , USA
| | - Anne F Fish
- University of Missouri-St. Louis , St. Louis , MO , USA
| | | | - Azfar Malik
- Centerpointe Hospital , St. Louis , MO , USA
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Shi Y, Shao Y, Li H, Wang S, Ying J, Zhang M, Li Y, Xing Z, Sun J. Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2019; 26:49-61. [PMID: 30472763 DOI: 10.1111/jpm.12505] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A growing body of qualitative and quantitative research has investigated the experiences of affiliated stigma for family members of PWMI. Some findings are contradictory and have not been considered systematically. WHAT DOES THE PAPER ADDS TO EXISTING KNOWLEDGE?: Family caregivers of PWMI may encounter affiliate stigma, but no systematic review or meta-analysis has been conducted to evaluate affiliate stigma among them. We identified eight variables significantly related to affiliate stigma among caregivers of PWMI. The findings can be used to help clinical practice to develop health promotion and prevention strategies. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Affiliate stigma was prevalent among the family caregivers of PWMI and is important for clinicians to consider. Health-focused interventions for family caregivers can mediate the impact of affiliated stigma through provision of social support by practitioners, such as respite care based on the "Senses Framework," self-help groups and online support program. And the caregivers of PWMI might benefit from further support (e.g., psychoeducation) to improve their knowledge about mental illness. ABSTRACT: Introduction Many studies have investigated the correlates of affiliate stigma among family caregivers of people with mental illness (PWMI). Thus far, no systematic review or meta-analysis has been conducted to synthesize these results. Aims/Question This review aims to identify the correlates of affiliate stigma among family caregivers of PWMI. Method We searched four databases including PubMed, PsycINFO, EMBASE and Web of Science for studies that investigated the association of affiliate sigma with socio-demographic, psychosocial and disease-related factors. Results Twenty-two studies including 3,381 participants met the inclusion criteria. Eighteen variables were included for the meta-analysis. For disease-related characteristics, only "disease attribution" and "care time/day" were associated with affiliate stigma. For psychosocial characteristics, "support from others," "burden," "depression," "stress," "distress" and "face concern" were related to affiliate stigma. Discussion This review is the first to assess the association of affiliate stigma with other characteristics of interest. However, the findings are limited due to a very small number of studies. Researchers should conduct in-depth study in this area and improve the quality of the literature. Implications for practice Health-focused interventions for family caregivers such as respite care, self-help groups, online support program and psychosocial education can mediate the impact of affiliated stigma.
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Affiliation(s)
- Ying Shi
- School of Nursing, Jilin University, Changchun, China.,School of Nursing, Hubei University of Medicine, Shiyan, Hubei, China
| | - Yanping Shao
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Huanhuan Li
- School of Nursing, Jilin University, Changchun, China
| | - Shouqi Wang
- School of Nursing, Jilin University, Changchun, China
| | - Jie Ying
- School of Nursing, Jilin University, Changchun, China
| | - Meiling Zhang
- School of Nursing, Jilin University, Changchun, China
| | - Yuan Li
- School of Nursing, Jilin University, Changchun, China
| | | | - Jiao Sun
- School of Nursing, Jilin University, Changchun, China
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Stiles BM, Fish AF, Vandermause R, Malik AM. The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder: An Integrative Review [Formula: see text]. J Am Psychiatr Nurses Assoc 2018; 24:415-425. [PMID: 29952230 DOI: 10.1177/1078390318784360] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. OBJECTIVE The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. DESIGN An integrative review was conducted using standard criteria for evaluating research articles. RESULTS Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. CONCLUSIONS Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.
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Affiliation(s)
- Brandie M Stiles
- 1 Brandie M. Stiles, PhD, MSN, PMHNP-BC, University of Missouri-St. Louis, St. Louis, MO, USA; Centerpointe Hospital, St. Louis, MO, USA
| | - Anne F Fish
- 2 Anne F. Fish, PhD, RN, FAHA, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Roxanne Vandermause
- 3 Roxanne Vandermause, PhD, RN, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Azfar M Malik
- 4 Azfar M. Malik, MD, MBA, Centerpointe Hospital, St. Louis, MO, USA
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Pal A, Sharan P, Chadda RK. Internalized stigma and its impact in Indian outpatients with bipolar disorder. Psychiatry Res 2017; 258:158-165. [PMID: 29028582 DOI: 10.1016/j.psychres.2017.09.087] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/30/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Abstract
Patients with many psychiatric disorders have considerable internalized stigma. The current study intended to examine the level and impact of internalized stigma in patients with bipolar affective disorder (BPAD). 60 patients with BPAD, 33 patients with schizophrenia and 30 patients with anxiety disorders were compared on Internalized Stigma of Mental Illness scale and The Stigma Scale. The patients with BPAD were assessed using Rosenberg Self-Esteem Scale (RSES), Participation scale (PS) and World Health Organization Quality Of Life - Brief Version - Hindi (WHOQOL-bref). Significant differences were found in all domains of self-stigma measures among the three groups. Using appropriate covariates, it was found that the differences were significant and independent of the effect of the covariates. In patients of BPAD, stigma and its domains were significantly correlated with the measures on monthly income, education, socio-occupational functioning, RSES, PS and WHOQOL-bref. Patients with BPAD experience substantial stigma, which was intermediate between that experienced by patients with schizophrenia (higher) and that experienced by patients with anxiety disorder (lower). Internalized stigma has significant impact on self-esteem, socio-occupational participation and functioning, and quality of life in patients with BPAD. Small sample size, sample of convenience, and cross-sectional design, limit the generalizability of the results.
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Affiliation(s)
- Arghya Pal
- Department of Psychiatry, Medical College and Hospital, Kolkata, India.
| | - Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Rakesh Kumar Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
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Alpsoy E, Polat M, FettahlıoGlu-Karaman B, Karadag AS, Kartal-Durmazlar P, YalCın B, Emre S, Didar-Balcı D, Bilgic-Temel A, Arca E, Koca R, Gunduz K, Borlu M, Ergun T, Dogruk-Kacar S, Cordan-Yazici A, Dursun P, BilgiC O, Gunes-Bilgili S, Sendur N, Baysal O, Halil-Yavuz I, Yagcioglu G, Yilmaz E, Kavuzlu U, Senol Y. Internalized stigma in psoriasis: A multicenter study. J Dermatol 2017; 44:885-891. [PMID: 28407292 DOI: 10.1111/1346-8138.13841] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/13/2017] [Indexed: 11/30/2022]
Abstract
Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.
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Affiliation(s)
- Erkan Alpsoy
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mualla Polat
- Department of Dermatology and Venereology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey
| | | | - Ayse Serap Karadag
- Department of Dermatology and Venereology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Pelin Kartal-Durmazlar
- Department of Dermatology and Venereology, Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, Ankara, Turkey
| | - Basak YalCın
- Department of Dermatology and Venereology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Selma Emre
- Department of Dermatology and Venereology, Yildirim Beyazit University Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Didem Didar-Balcı
- Department of Dermatology and Venereology, Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Asli Bilgic-Temel
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ercan Arca
- Department of Dermatology and Venereology, Gulhane School of Medicine, Ankara, Turkey
| | - Rafet Koca
- Department of Dermatology and Venereology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Kamer Gunduz
- Department of Dermatology and Venereology, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Murat Borlu
- Department of Dermatology and Venereology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Tulin Ergun
- Department of Dermatology and Venereology, Marmara University School of Medicine, Istanbul, Turkey
| | - Seval Dogruk-Kacar
- Department of Dermatology and Venereology, Afyon Kocatepe University School of Medicine, Afyon, Turkey
| | - Ayca Cordan-Yazici
- Department of Dermatology and Venereology, School of Medicine, Mersin University, Mersin, Turkey
| | - Pınar Dursun
- Department of Dermatology and Venereology, Mersin State Hospital, Mersin, Turkey
| | - Ozlem BilgiC
- Department of Dermatology and Venereology, Selcuk University School of Medicine, Konya, Turkey
| | - Serap Gunes-Bilgili
- Department of Dermatology and Venereology, School of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Neslihan Sendur
- Department of Dermatology and Venereology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Ozge Baysal
- Department of Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ibrahim Halil-Yavuz
- Department of Dermatology and Venereology, School of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Gizem Yagcioglu
- Department of Dermatology and Venereology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Ertan Yilmaz
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ufuk Kavuzlu
- Department of Dermatology and Venereology, School of Medicine, Mersin University, Mersin, Turkey
| | - Yesim Senol
- Department of Medical Education, Akdeniz University School of Medicine, Antalya, Turkey
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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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Papagiannaki A, Shinebourne P. The contribution of creative art therapies to promoting mental health: Using Interpretative Phenomenological Analysis to study therapists’ understandings of working with self-stigmatisation. ARTS IN PSYCHOTHERAPY 2016. [DOI: 10.1016/j.aip.2016.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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