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Dissanayake A, Dupuis A, Burton CL, Soreni N, Peters P, Gajaria A, Arnold PD, Schachar R, Crosbie J. Racial/Ethnic Disparities in Psychiatric Traits and Diagnoses within a Community-based Sample of Children and Youth: Disparités raciales/ethniques dans les traits et diagnostics psychiatriques au sein d'un échantillon communautaire d'enfants et de jeunes. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:415-427. [PMID: 38425291 PMCID: PMC11107440 DOI: 10.1177/07067437241233936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Racial/ethnic disparities in the prevalence of psychiatric disorders have been reported, but have not accounted for the prevalence of the traits that underlie these disorders. Examining rates of diagnoses in relation to traits may yield a clearer understanding of the degree to which racial/ethnic minority youth in Canada differ in their access to care. We sought to examine differences in self/parent-reported rates of diagnoses for obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders after adjusting for differences in trait levels between youth from three racial/ethnic groups: White, South Asian and East Asian. METHOD We collected parent or self-reported ratings of OCD, ADHD and anxiety traits and diagnoses for 6- to 17-year-olds from a Canadian general population sample (Spit for Science). We examined racial/ethnic differences in trait levels and the odds of reporting a diagnosis using mixed-effects linear models and logistic regression models. RESULTS East Asian (N = 1301) and South Asian (N = 730) youth reported significantly higher levels of OCD and anxiety traits than White youth (N = 6896). East Asian and South Asian youth had significantly lower odds of reporting a diagnosis for OCD (odds ratio [OR]East Asian = 0.08 [0.02, 0.41]; ORSouth Asian = 0.05 [0.00, 0.81]), ADHD (OREast Asian = 0.27 [0.16, 0.45]; ORSouth Asian = 0.09 [0.03, 0.30]) and anxiety (OREast Asian = 0.21 [0.11, 0.39]; ORSouth Asian = 0.12 [0.05, 0.32]) than White youth after accounting for psychiatric trait levels. CONCLUSIONS These results suggest a discrepancy between trait levels of OCD, ADHD and anxiety and rates of diagnoses for East Asian and South Asian youth. This discrepancy may be due to increased barriers for ethnically diverse youth to access mental health care. Efforts to understand and mitigate these barriers in Canada are needed.
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Affiliation(s)
- Andrew Dissanayake
- Department of Psychiatry, Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dupuis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christie L. Burton
- Department of Psychiatry, Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Noam Soreni
- Offord Center for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Pediatric OCD Consultation Clinic, Anxiety Treatment and Research Centre, St. Joseph’s Healthcare, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Paul Peters
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Amy Gajaria
- The Margaret and Wallace McCain Centre for Child Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Paul D. Arnold
- Mathison Centre for Mental Health Research and Education, Departments of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Russell Schachar
- Department of Psychiatry, Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, School of Graduate Studies, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Neurosciences and Mental Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Narula S, Pal A, Reddy MS, Mahajan SL. Research on clinical aspects of bipolar disorder: A review of Indian studies. Indian J Psychiatry 2024; 66:421-432. [PMID: 38919568 PMCID: PMC11195747 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_698_23] [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: 09/10/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 06/27/2024] Open
Abstract
Background Bipolar disorder is one of the severe mental disorders that are associated with significant morbidity of the patients. Despite advancements in our understanding about the disorder, it remains a challenging proposition to treat bipolar disorder, largely since the prophylactic treatment of the disorder requires assessment of complex clinical algorithms. The revisions of the classificatory systems have also changed the conceptualization of the disorder. In this background, we conducted a review of the Indian studies conducted on the clinical aspects of bipolar disorder. Methods A narrative review was conducted with focus on the literature published from India. The databases searched included PubMed, Scopus, and Google Scholar, and articles published over the last 15 years by Indian authors were included for this review. Results In our review, we could access a substantial volume of research published from India. We could identify studies that catered to most of the relevant themes in bipolar disorder including epidemiology, etiology, comorbidities, stigma, disability, clinical course, cognitive profile, pathways to care, and recovery. Conclusion The research trajectory was in line with the research conducted elsewhere in the world. However, certain dissimilarities in terms of focus could also be observed. The possible reason behind this deviation could be the difference in clinical need and unique challenges faced in the management and rehabilitation of patients in bipolar disorder in Indian scenario.
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Affiliation(s)
- Sharon Narula
- Department of Psychiatry, Postgraduate Institute of Medical Educations and Research, Chandigarh, India
| | - Arghya Pal
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - MS Reddy
- Consultant Psychiatrist, ASHA Hospital, Hyderabad, Telangana, India
| | - Sudhir L. Mahajan
- Department of Psychiatry, Government Medical College and Hospital, Nagpur, Maharashtra, India
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Trani JF, Yen BJ, Duncan A, Bakhshi P, Palmo T, Jadhav S, Deshpande S. People with mental illness stigmatize mental illness less: A comparison study between a hospital-based sample of people with mental illness and a non-clinical general population sample in urban India. Transcult Psychiatry 2023; 60:954-972. [PMID: 37551092 DOI: 10.1177/13634615231179265] [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] [Indexed: 08/09/2023]
Abstract
Evidence shows that stigma negatively influences the quality of life of persons with severe mental illness. Nonetheless, stigma towards mental illness is lower among persons with a lived experience of mental illness compared to the rest of the population. Understanding the association between stigma of mental illness and the mental status of individuals living in urban India and whether this association is moderated by demographic factors opens a new avenue for prevention of social exclusion. Persons diagnosed with schizophrenia, bipolar disorder, or severe unipolar depression (cases, n = 647) were recruited from among hospital patients in New Delhi between November 2011 and June 2012 and matched with non-psychiatric urban dwellers by age, sex, and location of residence (controls, n = 649). Propensity score matching with multivariable linear regression was used to test whether stigma towards mental illness, measured by a 13-item Stigma Questionnaire, differed between cases and controls. Cases reported significantly lower stigma scores than controls (b = -0.50, p < 0.0001). The strength of the association between mental illness and stigma was not affected after controlling for age, caste, sex, education, and employment status, while wealth marginally reduced the strength of the association. These findings suggest individuals with a lived experience of mental illness, in New Delhi, India, may be more tolerant towards mental illness and support the need to involve persons with lived experience in the development and implementation of health promotional campaigns and programs aimed at reducing stigma towards mental illness.
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Affiliation(s)
- Jean-Francois Trani
- Brown School and Institute of Public Health, Washington University in St Louis, USA
- National Pedagogical school Health and Solidarity, National Center for Arts and Crafts, France
| | - Bing-Jie Yen
- School of Public Health, Indiana University Bloomington, USA
| | - Alexis Duncan
- Brown School and Institute of Public Health, Washington University in St Louis, USA
| | - Parul Bakhshi
- School of Occupational Therapy, Medical School, Washington University in St Louis, USA
| | - Trinley Palmo
- Students health and wellness, University of Virginia, USA
| | | | - Smita Deshpande
- Department of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, PGIMER-Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Mejri I, Ouali U, Gronholm PC, Zgueb Y, Ouertani A, Nacef F. "To fast or not to fast?" Ramadan and religiosity through the eyes of people with bipolar disorder: an exploratory study. Front Psychiatry 2023; 14:1270000. [PMID: 37908594 PMCID: PMC10613667 DOI: 10.3389/fpsyt.2023.1270000] [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: 07/31/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023] Open
Abstract
Background The month of Ramadan, due to its changes in social rhythms, can seriously affect the course of bipolar disorder (BD). Therefore, psychiatrists sometimes find it necessary to discourage Ramadan practices, especially fasting, although taking part in this practice can give a sense of belonging and accomplishment to patients. Research on this subject is limited. Aim The aim of the present work was to explore: (i) religious practices with special attention to Ramadan before and after the onset of BD, (ii) the perceptions and behaviors related to not fasting during Ramadan in patients with BD and their families' attitudes, (iii) religiosity and self-stigmatization and their relationships with religious practices, and (iv) the doctor-patient relationship around fasting. Methods We conducted a retrospective, cross-sectional and descriptive study in clinically stabilized patients with BD in a public mental hospital and in a private psychiatric practice in Tunis, Tunisia. Socio-demographic and clinical data, as well as data related to general religious practices and Ramadan practices were collected using a self-established questionnaire. We assessed (i) religiosity of the patients with the Duke University Religion Index and (ii) self-stigma using the Internalized Stigma of Mental Illness scale. Results Our sample consisted of 118 patients of whom 65.3% were fasting regularly before BD onset. More than half had stopped this practice following BD onset. Of the patients who did not fast, 16% felt guilty about this and 4.9% reported receiving negative remarks from their surroundings. High self-stigma scores were observed in 11% of the patients. Self-stigma was associated significantly with negative perception of not fasting, negative remarks regarding not fasting and taking both meals at regular times during Ramadan. The decision whether to fast or not was taken without seeking medical advice in 71.2% of the sample, and 16.9% of the sample reported that their psychiatrist had spontaneously approached the issue of Ramadan fasting. Conclusion Religiosity and more specifically the practice of Ramadan remains an important point that should be considered when treating patients with psychiatric problems. It seems necessary that healthcare professionals should integrate the positive and the negative side of fasting into their reflections. Our results remain exploratory and encourage further work on the subject.
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Affiliation(s)
- Imen Mejri
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Uta Ouali
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Petra C. Gronholm
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Yosra Zgueb
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Fethi Nacef
- Department Psychiatry A, Razi Hospital La Manouba, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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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, 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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Ellouze S, Jenhani R, Bougacha D, Turki M, Aloulou J, Ghachem R. [Self-stigma and functioning in patients with bipolar disorder]. L'ENCEPHALE 2023; 49:34-40. [PMID: 36253184 DOI: 10.1016/j.encep.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 01/19/2023]
Abstract
Self-stigma of people with bipolar disorder is an underestimated problem, with serious consequences in terms of clinical severity and social and professional functioning. OBJECTIVES This study aimed to evaluate self-stigma in patients with bipolar disorder, to identify socio-demographic and clinical factors associated with it and to analyze the links between self-stigma and functioning in this population. METHODS We conducted a cross-sectional, descriptive and analytic study including 61 patients with bipolar disorder meeting criteria of remission. We used the internalized stigma of mental illness (ISMI) to investigate self-stigma, and the functioning assessment short test (FAST) to assess functioning. RESULTS The mean age of patients was 43.4 years. The sex ratio was 2.4. Half of the patients were single or divorced (50 %). They had secondary or university education in 69 % of cases and were professionally inactive in 59 % of cases. The socioeconomic level was low or medium in 92 % of cases. A personal judicial record was found in 16 % of patients, a suicide attempt in 41 % of cases. Most patients in our series had bipolar I disorder (92 %). The mean age at onset of the disease was 23.5 years, with a mean duration of disease progression of 20 years. Patients were hospitalized an average of 5.9 times. Most patients (90 %) exhibited psychotic features during their mood relapses. The mean duration of the last remission was 27.9 months. Patients had regular follow-ups at our consultations in 87 % of cases. Among the patients included in the study, 8 % were on long-acting neuroleptics. The mean score on the internalized stigma of mental illness was 2.36±0.56. More than half of our patients (59 %) were self-stigmatized. Discrimination and alienation were found in 51 % of cases, followed by resistance to stigmatization (43 %) and assimilation of stereotypes (41 %). Regarding functioning, a global impairment was noted in more than two thirds of patients (71 %). An alteration in professional functioning was found in 82 % of cases and in cognitive functioning in 69 % of cases. Disruption of the financial sphere concerned 43 % of the patients, and the relational sphere 41 % of them. Autonomy was altered in 41 % of patients. Analysis of the relationships between self-stigma and characteristics of the study population revealed statistically significant associations between higher self-stigma scores and single or divorced status, low socio-economic level and judicial record. In terms of clinical parameters, the mean self-stigma score was significantly associated with a higher total number of thymic episodes and hospitalizations, a longer cumulative duration of hospitalizations and a shorter duration of the last remission. In addition, the mean self-stigma score was associated with significantly more impaired functioning. CONCLUSIONS Our study underlines the need to work towards the implementation of management modalities aimed at combating the self-stigmatization of patients with bipolar disorder and mitigating its negative consequences during the course of the disease.
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Affiliation(s)
- S Ellouze
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie.
| | - R Jenhani
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
| | - D Bougacha
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
| | - M Turki
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie
| | - J Aloulou
- Service de psychiatrie B, CHU de Hèdi Chaker de Sfax, Sfax 3000, Tunisie
| | - R Ghachem
- Service de psychiatrie B, hôpital Razi, La Mannouba, Tunisie
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Self-stigma among clients of outpatient psychiatric clinics: A cross-sectional survey. PLoS One 2022; 17:e0269465. [PMID: 35776719 PMCID: PMC9249178 DOI: 10.1371/journal.pone.0269465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
Self-stigma is common among people with mental disorders. A large body of research has examined associations between self-stigma and sociodemographic, clinical and psychosocial factors but the results are still conflicting. The aim of this study was to describe self-stigma among persons with affective and psychotic disorders and identify sociodemographic and clinical factors associated with experiences of self-stigma. A cross-sectional survey was performed with Finnish clients (N = 898) at 16 psychiatric clinics using self-reported questionnaires. The data were analyzed using descriptive statistics and with one-way and multi-way analysis of variance (ANOVA). The results showed that clients in community settings experience self-stigma (a total mean SSMIS-SF score of 74.8 [SD 22.3]). Having a diagnosis of an affective disorder, having a long history of mental disorder (>16 years) and the severity of depressive symptoms were the key factors associated with experiences of self-stigma. Clients living in community settings should be assessed regularly for depressive symptoms of mental disorders, and interventions should be conducted, especially at an early stage of the illness, to reduce self-stigma. Factors associated with self-stigma should be taken into account in the future development of interventions to reduce stigma.
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Morán-Kneer J, Ríos U, Costa-Cordella S, Barría C, Carvajal V, Valenzuela K, Wasserman D. Childhood Trauma and Social Cognition in participants with Bipolar Disorder: The Moderating Role of Attachment. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Patra BN, Patil V, Balhara YPS, Khandelwal SK. Self-stigma in patients with major depressive disorder: An exploratory study from India. Int J Soc Psychiatry 2022; 68:147-154. [PMID: 33243067 DOI: 10.1177/0020764020975811] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND One of the barriers to effective care in patients with depression is stigma associated with having a mental disorder, which also acts as a barrier to recovery and increases the disability. AIMS To study the stigma and disabilities experienced by the patients with depressive disorders seeking treatment in a tertiary care hospital. METHODOLOGY Fifty patients diagnosed to have depressive disorder as per ICD-10 were recruited by convenient sampling. To measure the stigma, the Discrimination and Stigma Scale -12 was applied. The severity of depression was determined by applying Hamilton Depression Rating Scale (HAMD). The disability was calculated by using WHO Disability Assessment Schedule 2.0. RESULTS Fifty percentages of the participants reported unfair treatment and they experienced discrimination in at least one life domain. There was significant positive correlation between unfair treatment subscale of stigma and disability. Around one fourth of the participants reported to be treated unfairly by their own families. Seventy percent reported to have concealed their mental health problems, 54% have stopped themselves from having a close personal relationship and 32% didn't apply for work in anticipating discrimination. Experienced and anticipated discrimination were significantly associated with concealing the mental health problem. CONCLUSION Stigma due to having depression acts as a barrier to vocational & social integration and functional recovery. Concealment of the diagnosis of depression is itself barrier for help seeking and to receiving appropriate treatment. Small sample size and adopting the purposive sampling method are the limitations of the study.
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Affiliation(s)
- Bichitra Nanda Patra
- Department of Psychiatry & NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vaibhav Patil
- Department of Psychiatry & NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry & NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sudhir K Khandelwal
- Department of Psychiatry & NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi, India.,Presently at Holy Family Hospital, Okhla, New Delhi
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de Filippis R, Menculini G, D'Angelo M, Carbone EA, Tortorella A, De Fazio P, Steardo L. Internalized-stigma and dissociative experiences in bipolar disorder. Front Psychiatry 2022; 13:953621. [PMID: 35966460 PMCID: PMC9372275 DOI: 10.3389/fpsyt.2022.953621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Dissociative symptoms have been recently related to bipolar disorder (BD) symptomatology. Moreover, the disease burden carries on a share of perceived self-stigma that amplifies the BD impairment. Internalized stigma and dissociative symptoms often seem overlapping, leading toward common outcomes, with reduced treatment seeking and poor adherence. We hypothesize a potential relationship between dissociation and self-stigma in patients suffering from BD. MATERIALS AND METHODS In this cross-sectional study we enrolled a total of 120 adult clinically stable BD outpatients. All participants completed the Internalized Stigma of Mental Illness (ISMI), Dissociative Experiences Scale-II (DES-II), and Manchester Short Assessment of Quality of Life (MANSA). RESULTS Average age and age at BD (BD-I n = 66, 55%; BD-II n = 54, 45%) onset were 46.14 (±4.23), and 27.45 (±10.35) years, with mean disease duration of 18.56 (±13.08) years. Most participants were female (n = 71; 59.2%) and 40 (33%) of them experienced lifetime abuse, with an average of 1.05 (±0.78) suicide attempts. DES scores (mean 31.8, ±21.6) correlated with ISMI total-score, with significant association with spikes in Alienation (13.1, SD±3.1) (p < 0.001) and Stereotype (13.8, SD±3.9) (p < 0.001). Linear regression analysis has shown a significant association between DES total score and alienation (p < 0.001), stereotype (p < 0.001) and MANSA total-score (p < 0.001). DISCUSSION For the first time, our data suggests that self-stigma is associated to dissociative symptoms, reducing overall quality of life in BD. The early identification of at-risk patients with previous lifetime abuse and high perceived stigma could lead the way for an ever more precise tailoring of treatment management.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Martina D'Angelo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Farias CDA, de Azevedo Cardoso T, Campos Mondin T, Dias de Mattos Souza L, Silva RAD, Kapczinski F, Jansen K, Magalhães PVS. Early illness progression in mood disorders: A population-based longitudinal study. Psychiatry Res 2021; 306:114225. [PMID: 34627111 DOI: 10.1016/j.psychres.2021.114225] [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: 02/01/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
This study is aimed at assessing changes in functioning among young people from the general population with bipolar disorder and major depressive disorder over a period of five years. Specifically, we hypothesized that significant illness progression would take place during euthymia over time in bipolar disorder. We conducted a longitudinal study with 231 people, assessed at baseline and again at a five-year follow-up. A structured clinical interview was used to diagnose participants with mood disorders. A control group without mood disorders was also included. Functioning was assessed with the Functioning Assessment Short Test, and linear mixed models were used to analyze the effect of psychopathology on change in functioning. Mood disorders were associated with significant functional impairment, but functioning significantly improved in both groups over the 5-year follow-up period. Depressive episodes, however, were associated with worse functioning at follow-up, independently of depression severity. In contrast to our initial hypothesis, we found a worsening of functioning in a five-year period associated only with depressive episodes. This suggests that interventions focused on the prevention of mood episodes early in the course of illness may be particularly promising to reduce adverse functioning outcomes.
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Affiliation(s)
- Clarisse de Azambuja Farias
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, RS, Brazil.
| | - Taiane de Azevedo Cardoso
- Universidade Católica de Pelotas, Graduate Program in Health and Behavior, Pelotas, RS, Brazil; McMaster University, Department of Psychiatry and Behavioral Neurosciences, Hamilton, Ontario, Canada
| | - Thaise Campos Mondin
- Universidade Católica de Pelotas, Graduate Program in Health and Behavior, Pelotas, RS, Brazil
| | | | | | - Flavio Kapczinski
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, RS, Brazil; McMaster University, Department of Psychiatry and Behavioral Neurosciences, Hamilton, Ontario, Canada
| | - Karen Jansen
- Universidade Católica de Pelotas, Graduate Program in Health and Behavior, Pelotas, RS, Brazil
| | - Pedro V S Magalhães
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, RS, Brazil.
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13
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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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14
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Ghosal S, Mallik N, Acharya R, Dasgupta G, Mondal DK, Pal A. Medication adherence in bipolar disorder: Exploring the role of predominant polarity. Int J Psychiatry Med 2021:912174211030163. [PMID: 34196229 DOI: 10.1177/00912174211030163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Medication non-adherence is one important reason behind sub-optimal outcome from treatment of bipolar affective disorder (BPAD). Though various reasons behind medication non-adherence have been identified, little is known about the medication adherence patterns across various predominant polarities (PP) in BPAD. METHODS 100 euthymic patients of BPAD were purposively recruited and the PP were determined. Subsequently, Morisky Medication adherence scale (MMAS); Global Assessment of Functioning (GAF); Oslo Social Support Scale and World Health Organization Quality of Life scale- Brief version (WHOQOL-Bref) were administered. Analysis of covariance (ANCOVA) was done to estimate the difference of scores of MMAS after adjusting for any potential confounders. RESULTS Overall, 44 patients with manic PP (MPP), 17 with depressive PP (DPP) and 39 with indeterminate PP (IPP) were recruited. It was found that patients who presented with DPP showed significantly higher medication adherence as compared to MPP. CONCLUSION Knowledge of PP of a patient of BPAD can be useful in anticipating medication adherence and treatment outcome. The major limitations included non-probability sampling, cross-sectional design and limited generalizability of the results.
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Affiliation(s)
- Sutanuka Ghosal
- Department of Psychiatry, Institute of Post-Graduate Medical Education & Research, Kolkata, India
| | - Nitu Mallik
- Department of Psychiatry, College of Medicine & JNM Hospital, Kalyani, India
| | | | - Gargi Dasgupta
- Department of Psychiatry, Medical College and Hospital, Kolkata, India
| | - Dilip Kumar Mondal
- Department of Psychiatry, R. G. Kar Medical College and Hospital, Kolkata, India
| | - Arghya Pal
- Department of Psychiatry, All India Institute of Medical Sciences, Raebareli, India
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15
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González-Sanguino C, Castellanos MÁ, González-Domínguez S, Muñoz M. Talking about mental illness, professional help, self-esteem and health. A structural equation model of implicit and explicit internalized stigma. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01930-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Pal A, Saxena V, Avinash P. Stigma in Bipolar Affective Disorder: A Systematic Quantitative Literature Review of Indian Studies. Indian J Psychol Med 2021; 43:187-194. [PMID: 34345093 PMCID: PMC8287384 DOI: 10.1177/0253717621996618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Bipolar affective disorder (BPAD) is one of the most common severe mental illnesses that cause morbidity. Stigma can negatively influence the disease experience in patients with BPAD. Significant differences are observed in the attributes of stigma across the various sociocultural milieus. The current review was thus conducted to compile the evidence regarding the burden and correlates of various forms of stigma in BPAD in India. METHODS An exhaustive literature review was conducted in PubMed, MedIND, and Google Scholar to identify Indian studies conducted on stigma in BPAD. The broad themes in various forms of stigma were identified (qualitative analysis). Quantitative analysis of measures of stigma was done, calculating the effect size in BPAD and comparator groups (schizophrenia and anxiety disorders) using standardized mean difference. RESULTS Overall, 12 studies could be identified for qualitative analysis, and 5 were used for quantitative analysis. Overall, the current evidence points out that the stigma in BPAD is less than that in schizophrenia but more than that in anxiety disorders. Internalized stigma in BPAD is correlated with poor self-esteem, reduced community participation, and low quality of life. Caregivers of patients with BPAD also experience significant stigma. CONCLUSIONS The review shows that stigma in BPAD is substantial. It also draws attention to the fact that the research regarding stigma in BPAD is lagging behind. This review also provides a platform to develop an intervention in the Indian scenario, where further research should be carried out.
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Affiliation(s)
- Arghya Pal
- Dept. of Psychiatry, All India
Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Vrinda Saxena
- Dept. of Psychiatry, Himalayan
Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun,
Uttarakhand, India
| | - Priyaranjan Avinash
- Dept. of Psychiatry, Himalayan
Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun,
Uttarakhand, India
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17
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Wright L, Lari L, Iazzetta S, Saettoni M, Gragnani A. Differential diagnosis of borderline personality disorder and bipolar disorder: Self-concept, identity and self-esteem. Clin Psychol Psychother 2021; 29:26-61. [PMID: 33811707 DOI: 10.1002/cpp.2591] [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: 05/27/2020] [Revised: 11/28/2020] [Accepted: 03/26/2021] [Indexed: 01/04/2023]
Abstract
Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi-structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self-concept and self-esteem may help distinguish the two disorders, when they are not co-morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well-documented identity diffusion, and the self-concept appears predominantly negative; shifts in self-concept and self-esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self-concept and self-esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.
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Affiliation(s)
- Livia Wright
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy
| | - Lisa Lari
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy
| | | | - Marco Saettoni
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti, ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti, ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy.,Scuola di Psicoterapia Cognitiva SRL, Rome, Italy
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18
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Post F, Buchta M, Kemmler G, Pardeller S, Frajo-Apor B, Hofer A. Resilience Predicts Self-Stigma and Stigma Resistance in Stabilized Patients With Bipolar I Disorder. Front Psychiatry 2021; 12:678807. [PMID: 34093288 PMCID: PMC8176112 DOI: 10.3389/fpsyt.2021.678807] [Citation(s) in RCA: 4] [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: 03/10/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
The identification of factors that prevent self-stigma and on the other hand promote stigma resistance are of importance in the long-term management of bipolar disorder. Accordingly, the aim of the current study was to investigate the association of factors deemed relevant in this context, i.e., resilience, premorbid functioning, and residual mood symptoms, with self-stigma/stigma resistance. Sixty patients diagnosed with bipolar I disorder were recruited from a specialized outpatient clinic. Self-stigma and stigma resistance were measured by the Internalized Stigma of Mental Illness (ISMI) Scale. The presence and severity of symptoms were assessed by the Montgomery-Asberg Depression Rating Scale (MADRS) and the Young Mania Rating Scale (YMRS). Resilience and premorbid functioning were measured by the Resilience Scale (RS-25) and the Premorbid Adjustment Scale (PAS), respectively. Resilience correlated negatively with self-stigma and positively with stigma resistance and was a predictor for self-stigma/stigma resistance in multiple linear regression analysis. Residual depressive symptoms correlated positively with self-stigma and negatively with stigma resistance. There were no significant correlations between sociodemographic variables, premorbid functioning as well as residual manic symptoms and self-stigma/stigma resistance. The findings of this study implicate that resilience may be considered as an important component of self-stigma reduction interventions.
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Affiliation(s)
- Fabienne Post
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Melanie Buchta
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
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19
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Gomes DRAS, Zanetti ACG, Miasso AI, Castro FFS, Vedana KGG. Internalized Stigma in People With Mood Disorders: Predictors and Associated Factors. J Nerv Ment Dis 2021; 209:54-58. [PMID: 33093358 DOI: 10.1097/nmd.0000000000001257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To analyze the predictors of internalized stigma among people with mood disorders, we conducted an analytical observational cross-sectional study with 108 people with mood disorders in a public service setting in Sao Paulo, Brazil. We applied a sociodemographic and clinical questionnaire, the Internalized Stigma of Mental Illness Scale, the Medication Adherence Scale, the Brief Psychiatric Rating Scale-Anchored, and the Herth Hope Index. We analyzed the data using descriptive statistics, average comparison tests, a correlation test, and multiple linear regression. Internalized stigma was associated with symptomatology, history of aggressive behavior, psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to psychotropic medications, and unemployment. The predictors of internalized stigma were unemployment, more psychiatric symptoms, history of previous suicide attempts, and less hope. Clinical interventions and investigations for stigma reduction and psychosocial rehabilitation should incorporate the factors associated with self-stigma (aggressive behavior, history of psychiatric hospitalizations, suicide attempts, hopelessness, nonadherence to medication, and unemployment).
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20
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Yanos PT, DeLuca JS, Roe D, Lysaker PH. The impact of illness identity on recovery from severe mental illness: A review of the evidence. Psychiatry Res 2020; 288:112950. [PMID: 32361335 DOI: 10.1016/j.psychres.2020.112950] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 01/13/2023]
Abstract
The "Illness Identity" model proposed that self-stigma impacts hope and self-esteem and subsequently leads to a cascade of negative effects on outcomes related to recovery among people diagnosed with severe mental illnesses. The purpose of the present review is to take stock of research support for the model. The citation index SCOPUS was reviewed for all papers published in peer-reviewed journals in English between 2010 and 2019 citing one of the initial 3 articles discussing the model: 111 studies met inclusion criteria and were reviewed. The most frequently tested, and supported, aspects of the model were relationships between self-stigma and self-esteem, hope, psychiatric symptoms and social relationships. Least frequently studied areas were relationships with suicide, avoidant coping, treatment adherence and vocational functioning, although they were supported in the majority of studies. The "insight paradox" was also tested in a relatively small number of studies, with mixed results. Findings were robust to geographic location of study, method, and subpopulation studied. Findings indicate that a large body of research has tested, and largely supported, the various components of the Illness Identity model, although some components need further investigation and there is a need for more comprehensive tests of the model.
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Affiliation(s)
- Philip T Yanos
- John Jay College of Criminal Justice and the Graduate Center, City University of New York, 524 W. 59th St., New York 10019, NY, United States.
| | - Joseph S DeLuca
- John Jay College of Criminal Justice and the Graduate Center, City University of New York, 524 W. 59th St., New York 10019, NY, United States
| | | | - Paul H Lysaker
- Richard L Roudebush VA Medical Center, Indianapolis, IN, United States; Indiana University School of Medicine, IN, United States
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21
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Buchman-Wildbaum T, Richman MJ, Váradi E, Schmelowszky Á, Griffiths MD, Demetrovics Z, Urbán R. Perceived loss among people living with mental disorders: Validation of the personal loss from mental illness scale. Compr Psychiatry 2020; 96:152146. [PMID: 31726289 DOI: 10.1016/j.comppsych.2019.152146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 10/05/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The development of mental illness often leads to pervasive losses in different areas of people's lives. However, previous research has tended to focus on the loss experienced by families while the examination of the loss experienced by individuals who are themselves coping with mental illness has been neglected. The present study tested the factor structure of the Hungarian version of the Personal Loss from Mental Illness (PLMI) scale, and analyzed its associations with age, gender, previous hospitalizations, marital status, loneliness, grief, and quality of life. METHODS Mentally ill patients (N = 200) with different diagnoses were recruited from a mental health center in Hungary, and completed self-report questionnaires. Confirmatory factor analysis (CFA) with covariates was conducted. RESULTS CFA analyses rejected the previous four-factor structure and suggested a single factor structure to be superior. Higher loss perception was predicted by higher loneliness, grief, and lower quality of life. Patients with mood disorders reported higher loss as compared to patients with other psychiatric diagnoses. CONCLUSIONS The present study stresses the magnitude of loss and raises the need to examine further the role of loss in coping and recovery. Asking patients about their feelings in clinical practice is of high importance.
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Affiliation(s)
- Tzipi Buchman-Wildbaum
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Mara J Richman
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Enikő Váradi
- XVI District Center for Mental Health Care, Budapest, Hungary; Integrated Day care Center for Psychiatric Patients, Cogito Foundation, Budapest, Hungary
| | | | - Mark D Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Róbert Urbán
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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22
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Park K, MinHwa L, Seo M. The impact of self-stigma on self-esteem among persons with different mental disorders. Int J Soc Psychiatry 2019; 65:558-565. [PMID: 31373252 DOI: 10.1177/0020764019867352] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study assumes that just as public stigma differs depending on types of mental disorder, so too does self-stigma. AIMS This study aims to compare self-stigma among persons with schizophrenia, alcohol use disorder and gambling disorder, and thereby analyze the effects of self-stigma on their self-esteem. METHODS A total of 321 Korean adults involved in community mental services for schizophrenia (N = 116), alcohol use disorder (N = 102) and gambling disorder (N = 103) were surveyed (Mage = 40.74, standard deviation (SD) = 10.10, 83.8% male, 16.2% female). Participants were questioned on self-stigma and self-esteem. One-way analysis of variance (ANOVA) was used to compare the self-stigma by mental disorder type. Furthermore, in order to analyze the effects of self-stigma on self-esteem with subjects' age and educational background controlled, hierarchical regression analysis was used. RESULTS The self-stigma of gambling disorder group was highest not only in overall self-stigma but also some of its subscales - alienation, stereotype endorsement and stigma resistance - followed by alcohol use disorder group and schizophrenia group. In all three groups, self-stigma had a negative effect on self-esteem, while stigma resistance of subscales was the most important predictor. In addition to stigma resistance, alienation was a predictor in the schizophrenia group, alienation and social withdrawal in the alcohol use disorder group and social withdrawal was a significant predictor in the gambling disorder group. Therefore, the predictors of self-esteem differed depending on the type of mental disorder. CONCLUSION Based on these results, we suggest cognitive-behavioral intervention to raise subject awareness of the unjust social stigma and boost self-advocacy to resist the stigma.
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Affiliation(s)
- Keunwoo Park
- Gyeongsang National University, Jinju, Republic of Korea
| | - Lee MinHwa
- Gyeongsang National University, Jinju, Republic of Korea
| | - Mikyung Seo
- Gyeongsang National University, Jinju, Republic of Korea
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