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Sibley AL, Noar SM, Muessig KE, O'Shea NG, Paquette CE, Spears AG, Miller WC, Go VF. An Automated Text Messaging Intervention to Reduce Substance Use Self-Stigma (Project RESTART): Protocol for a Feasibility and Acceptability Pilot Study. JMIR Res Protoc 2024; 13:e59224. [PMID: 39121478 DOI: 10.2196/59224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/27/2024] [Accepted: 06/18/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Stigma is a barrier to treatment and harm reduction seeking in people who use drugs. Most stigma reduction interventions offer psychotherapy or psychoeducation in group-based clinical settings, failing to reach people who are not in treatment. SMS text messaging is an effective and acceptable modality for delivering health information to people who use drugs and may be a suitable conduit for providing information and advice to understand and cope with stigma. OBJECTIVE This paper presents the protocol for a study that aims to determine the feasibility, acceptability, and preliminary effectiveness of a 4-week automated SMS text message intervention to increase stigma resistance and reduce self-stigma in people who use drugs. METHODS We designed a novel automated SMS text message intervention to address the four personal-level constructs of stigma resistance: (1) not believing stigma and catching and challenging stigmatizing thoughts, (2) empowering oneself through learning about substance use and one's recovery, (3) maintaining one's recovery and proving stigma wrong, and (4) developing a meaningful identity and purpose apart from one's substance use. Theory-based messages were developed and pilot-tested in qualitative elicitation interviews with 22 people who use drugs, resulting in a library of 56 messages. In a single-group, within-subjects, community-based pilot trial, we will enroll 30 participants in the Resisting Stigma and Revaluating Your Thoughts (RESTART) intervention. Participants will receive 2 daily SMS text messages for 4 weeks. Implementation feasibility will be assessed through recruitment, enrollment, retention, and message delivery statistics. User feasibility and acceptability will be assessed at follow-up using 23 survey items informed by the Theoretical Framework of Acceptability. Primary effectiveness outcomes are changes in self-stigma (Substance Abuse Self-Stigma Scale) and stigma resistance (Stigma Resistance Scale) from baseline to follow-up measured via a self-administered survey. Secondary outcomes are changes in hope (Adult Dispositional Hope Scale) and self-esteem (Rosenberg Self-Esteem Scale). Feasibility and acceptability will be assessed with descriptive statistics; effectiveness outcomes will be assessed with paired 2-tailed t tests, and group differences will be explored using ANOVA. Overall, 12 participants will also be selected to complete acceptability interviews. RESULTS This pilot study was funded by the National Institute on Drug Abuse in April 2023 and received regulatory approval in January 2024 by the University of North Carolina-Chapel Hill Institutional Review Board. Recruitment and enrollment began in March 2024. Follow-up visits are expected to conclude by May 2024. Results will be disseminated in relevant peer-reviewed journals. CONCLUSIONS To the best of our knowledge, this is the first study to address substance use stigma via a self-help SMS text messaging program. Results will add to the nascent literature on stigma reduction in people who use drugs. This protocol may interest researchers who are considering text messaging to address psychosocial needs in hard-to-reach populations. TRIAL REGISTRATION ClinicalTrials.gov NCT06281548; https://clinicaltrials.gov/ct2/show/NCT06281548. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59224.
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Affiliation(s)
- Adams L Sibley
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Seth M Noar
- Hussman School of Journalism and Media, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn E Muessig
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Nisha G O'Shea
- Research Triangle Institute, Research Triangle Park, NC, United States
| | - Catherine E Paquette
- Department of Population Health Sciences, Duke University, Durham, NC, United States
| | | | - William C Miller
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Vivian F Go
- Department of Health Behavior, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
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Shi X, Sun X, Zhang C, Li Z. Individual stigma in people with severe mental illness: Associations with public stigma, psychological capital, cognitive appraisal and coping orientations. Compr Psychiatry 2024; 132:152474. [PMID: 38547572 DOI: 10.1016/j.comppsych.2024.152474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 03/16/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The reason why some people with severe mental illness (SMI) maintain positive self-identity, while some are affected by the stigmatized environment is unclear. AIMS To describe the status of individual stigma and explore the relationship between self-stigma, stigma resistance and related variables in people with SMI. METHODS A cross-sectional study was conducted from April 2021 to March 2022. The Chinese version of Internalized Stigma of Mental Illness Scale and Stigma Resistance Scale were used to assess individual stigma. Perceived public stigma, psychological capital, stigma stress appraisal and coping orientations were also measured by scales. Data was provided by 422 patients with schizophrenia or bipolar disorder, from one psychiatric hospital and four community healthcare centers in China. A structural equation model was applied for analysis. RESULTS The total mean scores of self-stigma and stigma resistance were (2.06 ± 0.65), and (3.95 ± 0.84). Perceived public stigma was the primary condition for constructing individual stigma, which indirectly affected self-stigma (β = 0.268) and stigma resistance (β = -0.145). Stigma stress appraisal mediated the transformation of public stigma into individual, which had direct and indirect effects on self-stigma (β = 0.417, 0.166), and an indirect effect on stigma resistance (β = -0.374). Secrecy positively affected self-stigma (β = 0.117), while positive coping positively affected stigma resistance (β = 0.380). Psychological capital significantly directly impacted individual stigma. CONCLUSIONS Findings highlighted how public stigma determines the degree to which patients with SMI deal with stigma stress appraisal, and how this influences individuals. Anti-stigma programs and interventions to improve individuals' psychological capital and coping capabilities should be emphasized.
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Affiliation(s)
- Xiuxiu Shi
- School of Nursing, Hangzhou Normal University, NO. 2318, Yuhangtang Rd, Yuhang District, Hangzhou, Zhejiang 311121, China.
| | - Xuhai Sun
- Psychiatry Department, Desheng Community Healthcare Centers, Xicheng District, Beijing 100035, China
| | - Chong Zhang
- Psychiatry Department, Tiancun Community Healthcare Centers, Haidian District, Beijing 100143, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, No 33 Ba Da Chu Road, Shijingshan District, Beijing 100144, China.
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Swistak MSc Z, Sookoo Ma S, Jewell PhD T. Integrating Subjective Recovery and Stigma Resistance in Individuals with Schizophrenia: A Narrative Review and Theoretical Integration. Issues Ment Health Nurs 2024; 45:537-551. [PMID: 38684074 DOI: 10.1080/01612840.2024.2341049] [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: 05/02/2024]
Abstract
Stigmatised attitudes are known to be associated with negative outcomes in schizophrenia, yet there is little focus on the role of stigma in the recovery process. Attempts to develop interventions to reduce self-stigma in schizophrenia have not been found effective. This paper presents a theoretical integration based on a narrative review of the literature. PsycINFO, Medline and Embase databases were searched up to the 11th December 2023. Studies were included if they were: i) empirical studies using qualitative, quantitative or mixed methods studies investigating mental health stigma; ii) included participants based in the United Kingdom, fluent in English, between the ages of 16 and 70, meeting criteria for a schizophrenia spectrum diagnosis. Fourteen studies were included. In Part 1, we propose a novel theoretical model derived from a synthesis of service-user perspectives on the relationship between stigma and schizophrenia. Stigmatised attitudes were commonly perceived to be caused by a lack of education and further exacerbated by disinformation primarily through the media and cultural communities. Stigma led to negative self-perceptions, negative emotional responses, social isolation and increased symptom severity, ultimately acting as a barrier to recovery. In Part 2, we identify several factors that ameliorate the impact of stigma and promote clinical and subjective recovery among service-users: education, empowerment, self-efficacy, self-acceptance, hope and social support. We argue that the notion of stigma resistance may be helpful in developing new interventions aimed at promoting recovery in individuals with schizophrenia. Wider implications are discussed and recommendations for future research and practice are explored.
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Affiliation(s)
- Zosia Swistak MSc
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- The Nightingale Hospital, London, UK
| | - Susan Sookoo Ma
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tom Jewell PhD
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Shi J, Chen Y, Jiang Y, Li Y, Wang W, Zhao H, Guo L, Liao Y, Zhang H, Gao C, McIntyre RS, Zhang WH, Han X, Lu C. Stigma and its associations with medication adherence in major depressive disorder. Psychiatry Res 2024; 331:115664. [PMID: 38070363 DOI: 10.1016/j.psychres.2023.115664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/02/2024]
Abstract
This study sought to evaluate internalized stigma (IS) and perceived stigma (PS), in persons (n = 522) living with major depressive disorder (MDD), with a view to analyzing the association of IS and PS with medication adherence in a cohort of participants with MDD in China. Perceived stigma is the awareness of societal negative views and attitudes towards depression, and IS is applying others' attitudes to oneself, both measured by the Depression Stigma Scale (DSS). Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). We observed that 76.0 % of participants reported IS and 84.5 % reported PS. Factors associated with increased IS included older age, marital status, disease history, and a higher baseline Patient Health Questionnaire-9 (PHQ-9). Higher education level, family income, and scores on the Connor-Davidson Resilience Scale (CD-RISC) were associated with lower levels of IS. Higher education levels, Childhood Trauma Questionnaire (CTQ) scores, and living with others were also associated with higher PS, while engagement in exercise and higher number of prior episodes were associated with lower PS. IS had a negative association with medication adherence, whereas PS did not significantly associate with adherence. In conclusion, a testable hypothesis is derived from our data that strategies targeting IS amongst persons with MDD may improve overall rates of adherence to antidepressant treatment, a necessary prelude to improving recovery.
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Affiliation(s)
- Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Yingchen Jiang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yanzhi Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Wanxin Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Hao Zhao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China
| | - Yuhua Liao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Caihong Gao
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Wei-Hong Zhang
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, No.7, Huaming Road, Shenzhen 518054, PR China.
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, 74 Zhongshan Rd 2, Guangzhou 510080, PR China; Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, 510080, PR China.
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Ahmed MM, John J. Perceptions of mental health services among the children who are in conflict with the law in Jammu and Kashmir. Glob Ment Health (Camb) 2023; 10:e81. [PMID: 38161739 PMCID: PMC10755411 DOI: 10.1017/gmh.2023.70] [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: 01/05/2023] [Revised: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 01/03/2024] Open
Abstract
Background: Due to the Jammu and Kashmir conflict, many teenagers are involved in disputes with the law. The conflict made generations suffer for decades. Such children made the mobs; being involved in life-threatening situations and the risk they confront develop psychiatric disorders. As a result of the various tense conditions when applied in multiple anti-social activities, aberrant children sent to correctional homes have to encounter numerous psychological disorders. Aim: The motive of the study is to explore the level of awareness, availability of services, stigma and obstacles to seeking assistance. Method: Due to the open-ended interview questions and a small sample size of 15 respondents, this study employed a qualitative methodology - a thematic analysis was done. Results: The findings revealed that, although the stigma is not publicly acknowledged, children who break the law and seek mental health services (MHS) are stigmatised. It was also shown that minor offenders fear that when they receive services provided by the staff of the observation home (OH), there will be a violation of their privacy and fear unforeseen repercussions. Conclusion: Collaborative action must proactively raise appropriate awareness to lessen the stigma linked with mental health problems, especially regarding MHS among these teenagers.
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Affiliation(s)
- Mohd Manshoor Ahmed
- Research Scholar, Department of Social Work, Central University of Kerala, Periye, Kerala
| | - Jilly John
- Assistant Professor, Department of Social Work, Central University of Kerala, Periye, Kerala
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Hunger JM, Brochu PM. Weight as a social identity: Theoretical and empirical advances. Body Image 2023; 46:103-107. [PMID: 37271032 DOI: 10.1016/j.bodyim.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Bannatyne AJ, Jones C, Craig BM, Jones D, Forrest K. A systematic review of mental health interventions to reduce self-stigma in medical students and doctors. Front Med (Lausanne) 2023; 10:1204274. [PMID: 37396888 PMCID: PMC10311217 DOI: 10.3389/fmed.2023.1204274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023] Open
Abstract
Background A growing body of literature has revealed that many medical students and doctors do not seek professional help for their mental health due to fear of stigma (both public- and self-stigma) and questioning of their clinical competency. The aim of this systematic review was to identify and evaluate direct and indirect interventions that address mental health stigma in medical students and/or doctors. We focused explicitly on studies that measured the impact on self-stigma outcomes. Method A systematic search of the following electronic databases was undertaken from inception to 13 July 2022: PubMed, Embase, PsycINFO, and CINAHL, together with manual searching of reference lists. Screening of titles, abstracts, and full texts of eligible studies, plus quality appraisal using the Mixed Methods Appraisal Tool, were independently conducted by multiple reviewers with disagreements resolved via discussion. Results From 4,018 citations, five publications met the inclusion criteria. None of the studies explicitly aimed to reduce self-stigmatisation, with the majority focusing on medical students. Most of the identified interventions focused on reducing professional stigma (i.e., stigma toward patients with mental illness) and measurement of self-stigma was incidentally collected via a subscale of the general stigma measure selected. Three studies found significant reductions in self-stigma following the delivered intervention. These studies were of moderate quality, had medical student samples, employed combined education and contact interventions, and used the same outcome measure. Discussion Intentional development and evaluation of interventions specifically designed to decrease self-stigma among doctors and medical students are needed, with further research required on the optimal components, format, length, and delivery of such interventions. Researchers delivering public/professional stigma reduction interventions should strongly consider measuring the impact of such interventions on self-stigma outcomes, using fit-for-purpose, psychometrically sound instruments.
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Affiliation(s)
- Amy Jean Bannatyne
- Medical Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Cindy Jones
- Medical Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Belinda M. Craig
- Medical Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Dominique Jones
- Medical Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Kirsty Forrest
- Medical Program, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- Gold Coast Health and Hospital Service, Gold Coast, QLD, Australia
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Han ZY, Chen Y, Chen YD, Sun GM, Dai XY, Yin YQ, Geng YQ. Latent characteristics and influencing factors of stigma in rheumatoid arthritis: A latent class analysis. Medicine (Baltimore) 2023; 102:e34006. [PMID: 37335640 DOI: 10.1097/md.0000000000034006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
To explore the latent classes of stigma in patients with rheumatoid arthritis, we analyzed the characteristics of the different categories. Adopting a convenient sampling method, socio-demographic and disease-related information from the outpatient clinics and wards of 3 tertiary care hospitals in China was collected. The Chinese version of the Internalized Stigma of Mental Illness scale-Rheumatoid Arthritis was used in this survey. Rheumatoid arthritis stigma was divided into 3 potential categories: Low Stigma-Strong Resistance (83, 41.5%), Medium Stigma-Strong Alienation (78, 39.0%), and High Stigma-Weak Resistance (39, 19.5%). Unordered multinomial logistic regression analysis showed that pain (OR = 1.540, P = .005; OR = 1.797, P < .001), elementary school education and below (OR = 4.051, P = .037), and duration of morning stiffness (OR = 0.267, P = .032) were risk factors for stigma, whereas family history was a protective factor against stigma (OR = 0.321, P = .046). Patients with longer morning stiffness, more severe pain, and less education have a greater risk of heavier stigma. Strong alienation is an early warning of heavy stigma. Resistance to stigma and family support can help patients overcome their psychological obstacles. More attention should be paid to constructing family centered support systems to help resist stigma.
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Affiliation(s)
- Zi-Yin Han
- Department of Nursing, Nanjing Medical University, Jiangning District, Nanjing, China
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yong Chen
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - You-Di Chen
- Department of Nursing, Bengbu Medical College, Bengbu, China
| | - Guo-Min Sun
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Xiao-Ying Dai
- Department of Rheumatology, The First Affiliated Hospital of Wannan Medical College, Wuhan, China
| | - Yue-Qin Yin
- Department of Rheumatology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, China
| | - Ya-Qin Geng
- Department of Nursing, Nanjing Medical University, Jiangning District, Nanjing, China
- Department of Rheumatology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
- Department of Nursing, Bengbu Medical College, Bengbu, China
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Aliche CJ, Ifeagwazi CM, Nwamarah JU, Okechukwu FO, Ngwu EC. Mediating roles of positive reappraisal and stigma resistance in the relationship between mindfulness and quality of life among stable schizophrenia patients. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Zhou N, Ren F, Shi G, Wang J. Understanding the Relationship Between Peer Support and Grief/Growth in Chinese Shidu Parents: The Roles of Internalized Stigma and Stigma Resistance. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231154844. [PMID: 36718655 DOI: 10.1177/00302228231154844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In China, families who have lost their only child are called shidu families. Support from similar others, or peer support, can help bereaved individuals adapt by reducing negative consequences and promoting positive changes. However, no research has examined the mechanism that mediates the effect of peer support on postloss adaptation. This article investigates the mediating roles of internalized stigma and stigma resistance in the relationship between peer support and grief/growth among Chinese shidu parents. In total, 208 shidu parents completed the required measurements. Structural equation modeling was used to analyze the data. The results showed that peer support was negatively related to grief symptoms and positively linked with posttraumatic growth by reducing internalized stigma. The mediating effect existed only for informational support. The mediating role of stigma resistance was not significant. These findings provide valuable information for the mechanism of peer support and promote the development of interventions.
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Affiliation(s)
- Ningning Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Fei Ren
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Guangyuan Shi
- Center for Psychological Development, Tsinghua University, Beijing, China
| | - Jianping Wang
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
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Shi X, Li Z. The Stigma Resistance Scale for people with mental illness: Transcultural adaption and validation of the Chinese version. Res Nurs Health 2022; 45:456-465. [DOI: 10.1002/nur.22233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Xiuxiu Shi
- School of Nursing Peking Union Medical College Beijing China
| | - Zheng Li
- School of Nursing Peking Union Medical College Beijing China
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Dubreucq J, Plasse J, Gabayet F, Faraldo M, Blanc O, Chereau I, Cervello S, Couhet G, Demily C, Guillard-Bouhet N, Gouache B, Jaafari N, Legrand G, Legros-Lafarge E, Pommier R, Quilès C, Straub D, Verdoux H, Vignaga F, Massoubre C, Franck N. Stigma resistance is associated with advanced stages of personal recovery in serious mental illness patients enrolled in psychiatric rehabilitation. Psychol Med 2022; 52:2155-2165. [PMID: 33196405 DOI: 10.1017/s0033291720004055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Stigma resistance (SR) is defined as one's ability to deflect or challenge stigmatizing beliefs. SR is positively associated with patient's outcomes in serious mental illness (SMI). SR appears as a promising target for psychiatric rehabilitation as it might facilitate personal recovery. OBJECTIVES The objectives of the present study are: (i) to assess the frequency of SR in a multicentric non-selected psychiatric rehabilitation SMI sample; (ii) to investigate the correlates of high SR. METHODS A total of 693 outpatients with SMI were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluation included standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, and personal recovery and a large cognitive battery. SR was measured using internalized stigma of mental illness - SR subscale. RESULTS Elevated SR was associated with a preserved executive functioning, a lower insight into illness and all recovery-related outcomes in the univariate analyses. In the multivariate analysis adjusted by age, gender and self-stigma, elevated SR was best predicted by the later stages of personal recovery [rebuilding; p = 0.004, OR = 2.89 (1.36-4.88); growth; p = 0.005, OR = 2.79 (1.30-4.43)). No moderating effects of age and education were found. CONCLUSION The present study has indicated the importance of addressing SR in patients enrolled in psychiatric rehabilitation. Recovery-oriented psychoeducation, metacognitive therapies and family interventions might improve SR and protect against insight-related depression. The effectiveness of psychiatric rehabilitation on SR and the potential mediating effects of changes in SR on treatment outcomes should be further investigated in longitudinal studies.
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Affiliation(s)
- J Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
- Réseau Handicap Psychique, Grenoble, France
| | - J Plasse
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
- Centre référent lyonnais de réhabilitation psychosociale CL3R, centre hospitalier Le Vinatier, Lyon, France
| | - F Gabayet
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
| | - M Faraldo
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
| | - O Blanc
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - I Chereau
- Fondation FondaMental, Créteil, France
- CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1, France
| | - S Cervello
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
- Centre référent lyonnais de réhabilitation psychosociale CL3R, centre hospitalier Le Vinatier, Lyon, France
| | - G Couhet
- Centre référent de réhabilitation psychosociale C2RP Nouvelle-Aquitaine Sud, Pôle de réhabilitation psychosociale, Centre de la Tour de Gassies, Bruges, France
| | - C Demily
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France
- Centre de référence maladies rares Génopsy, pôle ADIS, centre hospitalier Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
| | | | - B Gouache
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - N Jaafari
- CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France
| | - G Legrand
- Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, 63037 Clermont-Ferrand Cedex 1, France
| | - E Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France
| | - R Pommier
- REHALise, CHU de Saint-Etienne, France
| | - C Quilès
- Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux& Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - D Straub
- Centre de Réhabilitation Psychosociale, Centre Hospitalier de Roanne, France
| | - H Verdoux
- Centre référent de réhabilitation psychosociale C2RP Nouvelle Aquitaine Sud, Pôle universitaire de psychiatrie adulte, centre hospitalier Charles Perrens, Bordeaux& Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France
| | - F Vignaga
- Dispositif de Soins de Réhabilitation Psychosociale, Centre Psychothérapeutique de l'Ain, France
| | | | - N Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France
- Centre ressource de réhabilitation psychosociale et de remédiation cognitive, Hôpital Le Vinatier, UMR 5229, CNRS & Université Lyon 1, Université de Lyon, France
- Centre référent lyonnais de réhabilitation psychosociale CL3R, centre hospitalier Le Vinatier, Lyon, France
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Zamanian H, Amini-Tehrani M, Jalali Z, Daryaafzoon M, Ramezani F, Malek N, Adabimohazab M, Hozouri R, Rafiei Taghanaky F. Stigma and Quality of Life in Women With Breast Cancer: Mediation and Moderation Model of Social Support, Sense of Coherence, and Coping Strategies. Front Psychol 2022; 13:657992. [PMID: 35237203 PMCID: PMC8882621 DOI: 10.3389/fpsyg.2022.657992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/12/2022] [Indexed: 01/02/2023] Open
Abstract
Objectives The breast cancer stigma affects Health-related quality of life (HRQoL), while general resilience resources (GRRs), namely, sense of coherence (SOC), social support, and coping skills, are thought to alleviate this effect. The study aimed to explore the mediating/moderation role of GRRs in the relationship between stigma and HRQoL and its dimensions in Iranian patients with breast cancer. Methods In this cross-sectional study, Stigma Scale for Chronic Illness 8-item version (SSCI-8), SOC-13, Medical Outcome Survey- Social Support Scale (MOS-SSS), Brief COPE, and Functional Assessment of Cancer Therapy-Breast (FACT-B) were investigated in a convenience sample of Iranian women with confirmed non-metastatic breast cancer. Following the establishment of correlations using Pearson's correlation, single and parallel mediation analysis and moderation analysis were conducted to determine the extent to which each GRR might be impacted by stigma or decrease the adverse impact of stigma on HRQoL. Results An analysis of 221 women (response rate of 87.5%) with the mean age of 47.14 (9.13) showed that stigma was negatively correlated to all HRQoL's dimensions (r = -0.27∼0.51, p < 0.05), SOC (r = -0.26∼0.35, p < 0.01), social support (r = -0.23∼0.30, p < 0.01), and the bulk of coping skills. In the single mediation analysis, stigma affected all facets of SOC, all subscales of social support, and positive reframing, which partially reduced breast cancer HRQoL. Stigma affects general HRQoL through damaging meaningfulness, social support (except for tangible), and positive reframing. Meaningfulness was marked as the most impacted GRR in terms of all domains of HRQoL. In parallel mediation, reduced meaningfulness, total social support, and positive reframing were highlighted as the pathways of diminished breast cancer HRQoL. Moderation analysis indicated the higher levels of humor, behavioral disengagement, and use of instrumental support behaviors to be functional in protecting different dimensions of HRQoL, while the results were mixed for venting, especially in patients with mastectomy surgery. Conclusion While GRRs may be impacted by stigma, they exert a relatively small protective effect against the impact of stigma on HRQoL. This study provides some novel findings, but longitudinal studies are needed to further verify these before any causal conclusion or recommendations for health policy can be drawn.
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Affiliation(s)
- Hadi Zamanian
- Department of Health Education and Promotion, School of Health, Qom University of Medical Sciences, Qom, Iran.,Health Psychology and Behavior Medicine Research Group, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadali Amini-Tehrani
- Health Psychology and Behavior Medicine Research Group, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran
| | - Zahra Jalali
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mona Daryaafzoon
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Fatemeh Ramezani
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Negin Malek
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Maede Adabimohazab
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Roghayeh Hozouri
- Department of Psychology, Karaj Branch, Islamic Azad University, Karaj, Iran
| | - Fereshteh Rafiei Taghanaky
- Health Psychology and Behavior Medicine Research Group, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
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14
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Pinho ES, Souza ACS, Moreira ACGC, Nogueira LEFL, Limongi AMES, Silva NDS, Sousa JM. Mental health assistance: identification of nursing diagnoses in a community mental health service. Rev Bras Enferm 2021; 75:e20201175. [PMID: 34614098 DOI: 10.1590/0034-7167-2020-1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to map and identify nursing diagnoses targeted at night care users in a Psychosocial Care Center according to NANDA-I Taxonomy. METHOD this is a descriptive-exploratory study, of documentary research type of 319 records in medical records. It was held in a Psychosocial Care Center III in Goiás, from 2014-2018. Nursing diagnoses and records were extracted with non-standardized language. RESULTS 813 records of nursing diagnoses identified in 53 different titles, in 10 domains, were identified. The most frequent diagnosis was risk for self-extermination. The domain with the highest number of diagnostic records was activity/rest. There was a predominance of diagnoses focused on the problem. FINAL CONSIDERATIONS mapping contributes to the planning of evidence-based nursing interventions and to the strengthening of professional identity in mental health. It is evident the need for practices that go beyond the symptoms in a preventive perspective, with a view to comprehensiveness.
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15
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Unpacking stigma: Meta-analyses of correlates and moderators of personal stigma in psychosis. Clin Psychol Rev 2021; 89:102077. [PMID: 34563943 DOI: 10.1016/j.cpr.2021.102077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 06/18/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022]
Abstract
Personal stigma entails perceived, experienced and internalised stigmatisation. Mental Health stigma has been widely researched across a range of countries and a meta-analysis of their associations and moderators in psychosis is timely. Meta-analyses were conducted examining the correlates and moderators of personal stigma in terms of: (1) demographic variables (2) illness related variables (3) symptoms/negative outcomes, and (4) aspects of wellbeing. Associations were obtained from a total of 216 records. Several demographic factors including age, economic status, employment, and rural residence had small associations with aspects of personal stigma (r's = 0.12 to -0.13). Personal stigma aspects were inversely related to medication adherence (r's = -0.20, -0.21), and positively associated with insight and number of hospitalisations (r's = 0.09-0.19). Most symptoms were positively associated with personal stigma (r's = 0.10-0.43), whereas inverse relations with wellbeing variables were identified (r's = -0.13 to -0.54). Moderator effects emerged including that of cultural setting and sex, age and education level, highlighting the role of cultural and demographic factors in shaping personal stigma aspects in psychosis. The present study also highlights the importance of recognizing the negative effect of actual stigma and discrimination experiences; particularly its detrimental impact on self-image and its complex role in shaping the internalisation of societal stigma.
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16
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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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17
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Brener L, Broady T, Cama E, Hopwood M, Byrne J, Treloar C. Positive effects of community attachment on internalised stigma and wellbeing among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103323. [PMID: 34146790 DOI: 10.1016/j.drugpo.2021.103323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Internalised stigma experienced by people who inject drugs (PWID) is known to have negative health consequences. Research has explored factors that may protect or buffer individuals from the negative consequences of internalised stigma. Community attachment, or perceived connection to a community of like people, can have numerous health-related benefits. However, this relationship may be complex for PWID; being part of a social network of PWID may provide opportunity for more frequent drug use and equipment sharing. This study investigated the relationships between community attachment, internalised stigma, and wellbeing among PWID, while also addressing potential health risks associated with PWID community attachment. METHODS PWID (n=603) were recruited through nine peer-based drug user organisations across Australia with assistance from the peak consumer organisation. Participants completed a survey measuring community attachment, internalised stigma, personal wellbeing, injecting frequency, and equipment sharing. RESULTS Greater attachment to a PWID community was associated with lower internalised stigma, but also with sharing of injecting equipment and increased frequency of injecting behaviour. The relationship between community attachment and personal wellbeing was mediated by internalised stigma, however this was only the case for PWID who reported no sharing of injecting equipment. CONCLUSIONS This research highlights the significance of community attachment for PWID while also noting the complexity of this relationship and the potential negative consequences. It is important to view networks of PWID communities as sources of positive social capital, where norms about health behaviours and harm reduction can be promoted and which can buffer community members from the harms associated with stigma.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW, Sydney, Australia.
| | - Timothy Broady
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League (AIVL), Canberra, ACT, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
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18
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Hegedüs A, Burr C, Pfluger V, Sieg D, Nienaber A, Schulz M. Peer support worker training: Results of the evaluation of the Experienced Involvement training programme in Switzerland and Germany. Int J Ment Health Nurs 2021; 30:451-460. [PMID: 33118298 DOI: 10.1111/inm.12805] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/26/2023]
Abstract
The 'Experienced Involvement' (EX-IN) training programme prepares and certifies individuals who have experienced mental health problems to work as peer support workers and to support others challenged by similar conditions. We aimed to assess the impact of the EX-IN training on hope, self-efficacy, introspection, stigma resistance, personal recovery, health-related quality of life and employment in participants. Data was collected using standardized assessment instruments before the training started (t1) and upon course completion (t2). Data from 103 participants who participated in both measurement times were included into data analysis. Participants significantly improved their recovery, stigma resistance and introspection during the EX-IN training. In addition, a significant higher proportion of participants were employed at t2. Participants whose last inpatient stay was 0-1 year before the start of the EX-IN training showed significantly lower levels of stigma resistance, and self-efficacy at t1 than participants with two or more years since the last inpatient stay. There were no significant changes in mean values over time, or in the mean values at t2 between the two groups. EX-IN training has a positive influence on the handling of stigma, on one's recovery path and introspection. This indicates that EX-IN training has a therapeutic effect on the participants. EX-IN training seems to meet the challenges of peer support work. Therefore, the training can be recommended as preparation for working as a peer support worker as well as an intervention to improve one´s recovery process.
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Affiliation(s)
- Anna Hegedüs
- Research Institute, Careum School of Health, Zurich, Switzerland.,International Graduate Academy (InGrA), "Participation as Goal of Nursing and Therapy", Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Christian Burr
- Departement of Clinical Nursing Science, University Psychiatric Services, Bern, Switzerland
| | - Viviane Pfluger
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Daniel Sieg
- Diaconia University of Applied Sciences, Bielefeld, Germany
| | - André Nienaber
- University of Applied Sciences Münster, Münster, Germany
| | - Michael Schulz
- LWL-Clinic Gütersloh, Gütersloh, Germany.,Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle-Wittenberg, Germany
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19
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Schwarzbold ML, Kern RS, Novacek DM, McGovern JE, Catalano LT, Green MF. Self-stigma in psychotic disorders: Clinical, cognitive, and functional correlates in a diverse sample. Schizophr Res 2021; 228:145-150. [PMID: 33444932 PMCID: PMC7987768 DOI: 10.1016/j.schres.2020.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
Self-stigma in mental illness is linked to negative clinical and functional outcomes, but little is known about its correlates specifically in psychotic disorders. Here we investigated the role of clinical symptoms, cognition, and vocational status as correlates of self-stigma in 98 individuals with psychotic disorders (36 Black American, 32 White Hispanic, 11 White Non-Hispanic, 11 Asian American). A principal component analysis of the Internalized Stigma of Mental Illness scale yielded three components: Experiential Stigma, Stereotype Endorsement, and Stigma Resistance. Higher Experiential Stigma was associated with greater severity of affective symptoms and lower vocational status. Higher Stigma Resistance was associated with higher social and non-social cognition, and higher vocational status. Stereotype Endorsement did not significantly correlate with any predictor variable. Linear regression models showed that 13% of the variance in Experiential Stigma was explained by affective symptoms and vocational status, and 20% of the variance in Stigma Resistance was explained by non-social cognition and vocational status. These findings provide new information about the correlates of self-stigma in an ethnically and racially diverse psychotic disorder sample. Such information may lead to a better understanding of self-stigma mechanisms in this population.
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Affiliation(s)
- Marcelo L. Schwarzbold
- Department of Clinical Medicine, Federal University of Santa Catarina, Florianópolis, Brazil,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Robert S. Kern
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Derek M. Novacek
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Jessica E. McGovern
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Lauren T. Catalano
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Michael F. Green
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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20
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Taylor LE, Antshel KM. Factors Associated with Parental Treatment Attitudes and Information-Seeking Behaviors for Childhood ADHD. J Atten Disord 2021; 25:607-617. [PMID: 30623746 DOI: 10.1177/1087054718821734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Despite the association between childhood ADHD and long-term negative outcomes, there is a significant delay to treatment and a low rate of lifetime treatment contact for individuals with ADHD. Method: The current study examined (a) variables associated with parental treatment-seeking attitudes and information-seeking behaviors and (b) the relationship between these attitudes and behaviors in 87 non-treatment-seeking parents whose children had elevated ADHD symptoms. Results: Regressions indicated that attitudes toward ADHD treatment were associated with ADHD knowledge and misconceptions (ps < .01), susceptibility to ADHD stigma (p < .001), and satisfaction with past providers (ps < .01). Experience with past providers was significantly associated with information-seeking behavior (ps < .01). Conclusion: Parental knowledge of ADHD, low levels of stigma, and positive experiences with past providers were the strongest predictors of positive attitudes about ADHD treatment. Experience with past providers was the only factor related to treatment-seeking behavior. These results offer avenues to decreasing barriers to treatment in pediatric ADHD.
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21
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Conneely M, McNamee P, Gupta V, Richardson J, Priebe S, Jones JM, Giacco D. Understanding Identity Changes in Psychosis: A Systematic Review and Narrative Synthesis. Schizophr Bull 2020; 47:309-322. [PMID: 32989443 PMCID: PMC7965068 DOI: 10.1093/schbul/sbaa124] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Experiencing psychosis can be associated with changes in how people see themselves as individuals and in relation to others (ie, changes in their identity). However, identity changes receive little attention in treatment, possibly due to a lack of clarity or consensus around what identity change means in people with psychosis. We aimed to create a conceptual framework synthesizing how identity changes are understood in the psychosis literature. METHODS Electronic databases were searched up to April 2020. Studies about identity changes among people with psychotic disorders were analyzed using narrative synthesis by a collaborative review team, including researchers from different disciplines, clinicians, and people who have experienced psychosis. RESULTS Of 10 389 studies screened, 59 were eligible. Identity changes are understood in 5 ways as (1) characteristics of psychosis, (2) consequences of altered cognitive functioning, (3) consequences of internalized stigma, (4) consequences of lost roles and relationships, and (5) reflections of personal growth. These 5 understandings are not mutually exclusive. Across a heterogeneous literature, identity changes were mostly framed in terms of loss. CONCLUSIONS Our conceptual framework, comprising 5 understandings, highlights the complexity of studying identity changes and suggests important implications for practice and research. For clinicians, this framework can inform new therapeutic approaches where the experience and impact of identity changes are acknowledged and addressed as part of treatment. For researchers, the conceptual framework offers a way of locating their understandings of identity changes when undertaking research in this area.
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Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,To whom correspondence should be addressed; Unit for Social and Community Psychiatry, Newham Centre for Mental Health, London E13 8SP, UK; tel: +44 020 7540 4380 (ext.: 2308), fax: +44 020 7540 4380, e-mail:
| | - Philip McNamee
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Veenu Gupta
- Department of Primary Care and Mental health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - John Richardson
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK
| | - Janelle M Jones
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, WHO Collaboration Centre, Queen Mary University of London, London, UK,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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22
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Facial-expression recognition: An emergent approach to the measurement of tourist satisfaction through emotions. TELEMATICS AND INFORMATICS 2020. [DOI: 10.1016/j.tele.2020.101404] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Stigma Resistance and Its Associated Factors among Patients with Mood Disorder at St. Paul's Hospital and Millennium Medical College, Addis Ababa, Ethiopia, 2019. PSYCHIATRY JOURNAL 2020; 2020:7429567. [PMID: 32566638 PMCID: PMC7301189 DOI: 10.1155/2020/7429567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
Background Stigma resistance is described as the capacity to counteract or remain unaffected by the stigma of mental illness. Patients who have high stigma resistance have shown good treatment outcome, so working on this issue is crucial since little is known about the stigma resistance level among patients with mood disorders. Objectives To determine the magnitude and determinant factors of stigma resistance among patients with mood disorder attending at St. Paul's Hospital. Methods A cross-sectional study design was conducted on 238 study samples, and systematic random sampling was used to get the study participants. Internalized Stigma of Mental Illness Scale was used to measure stigma resistance. Data was entered using EpiData 3.1 and exported to the Statistical Package for Social Science 22.0 for analysis. Linear regression analysis (P < 0.05) was used to identify a significant association between the outcome and predictor variable. Results Out of 238 study samples, 235 patients took part with a 99% response rate. The overall percentage of stigma resistance was 49.5%. Low educational status (B = −1.465, 95% CI (-2.796, -0.134), P ≤ 0.031), disability (B = −0.064, 95% CI (-0.102, -0.026), P ≤ 0.001), nonadherence due to stigma (B = −1.365, 95% CI (-2.151, -0.580), P ≤ 0.001), duration of treatment (B = 0.091, 95% CI (0.042, 0.141), P ≤ 0.001), internalized stigma (B = −2.948, 95% CI (-3.642, -2.254), P ≤ 0.001), and self-esteem (B = 1.859, 95% CI (0.812, 2.906), P ≤ 0.001) were significantly associated with stigma resistance. Conclusion This study found that only half of the patients had stigma resistance. Low educational status, high self-stigma, low self-esteem, disability, and short duration of treatment were negatively associated with stigma resistance, so working on those modifiable identified factors with focal stakeholders will be crucial to promote the stigma resistance level of patients with mood disorder.
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Demoulin S, Nguyen N, Chevallereau T, Fontesse S, Bastart J, Stinglhamber F, Maurage P. Examining the role of fundamental psychological needs in the development of metadehumanization: A multi-population approach. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2020; 60:196-221. [PMID: 32346901 DOI: 10.1111/bjso.12380] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/11/2020] [Indexed: 11/28/2022]
Abstract
In the present paper, we investigate dehumanization processes from a victim perspective. We propose that dehumanization experiences, that is metadehumanization, arise from people's feelings that their fundamental human needs are thwarted and that such experiences influence their emotions, self-esteem, and coping strategies. Our model is put at test in three contexts involving different types of dehumanization victims: Women (Study 1a, N = 349), patients with severe alcohol use disorder (Study 1b, N = 120), and employees in organizations (Study 1c, N = 347). Our integrated model of metadehumanization, which considers both its antecedents and consequences, proved stable across contexts and populations and therefore helps building bridges between different psychological disciplines in which dehumanization occurs.
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Affiliation(s)
| | - Nathan Nguyen
- Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | | | | | | | - Pierre Maurage
- Université Catholique de Louvain, Louvain-la-Neuve, Belgium
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Milačić‐Vidojević I, Čolić M, Tošković O, Dragojević N. People with physical disability in Serbia: Relationship between internalized stigma, experienced and anticipated discrimination, and empowerment. Scand J Psychol 2019; 61:290-296. [DOI: 10.1111/sjop.12603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ivona Milačić‐Vidojević
- Faculty of Special Education and Rehabilitation University of Belgrade Visokog Stevana 2 11 000 Belgrade Serbia
| | - Marija Čolić
- Faculty of Special Education and Rehabilitation University of Belgrade Visokog Stevana 2 11 000 Belgrade Serbia
- Special Education Department University of Hawaii at Manoa 1776 University Avenue Honolulu HI 96822
| | - Oliver Tošković
- Faculty of Philosophy University of Belgrade Čika Ljubina 18‐20 Belgrade 11000 Serbia
| | - Nada Dragojević
- Faculty of Special Education and Rehabilitation University of Belgrade Visokog Stevana 2 11 000 Belgrade Serbia
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Changes in Stigma Experience Among Mental Health Service Users over Time: A Qualitative Study with Focus Groups. Community Ment Health J 2019; 55:1389-1394. [PMID: 31309384 DOI: 10.1007/s10597-019-00442-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
Public expenditure on mental health education has grown exponentially in the past two decades. A qualitative study using focus groups was used to explore whether the experience of stigma among 22 mental health service users improved over time. We identified five major themes on changes in social stigma, perceived stigma, and stigma coping. Stigmatizing and discriminatory experiences were still common in workplace, healthcare system, and relational aspects but some participants perceived that there were reductions in social stigma. Participants believed that media portrayal and celebrity effect were important in fostering greater acceptance toward people with mental illness and the importance of family support and stigma resistance for minimizing the harmful impacts of stigma. The findings are important in the future design of public educational and stigma reduction programs.
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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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Karter JM. An Ecological Model for Conceptual Competence in Psychiatric Diagnosis. JOURNAL OF HUMANISTIC PSYCHOLOGY 2019. [DOI: 10.1177/0022167819852488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Biancarelli DL, Biello KB, Childs E, Drainoni M, Salhaney P, Edeza A, Mimiaga MJ, Saitz R, Bazzi AR. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug Alcohol Depend 2019; 198:80-86. [PMID: 30884432 PMCID: PMC6521691 DOI: 10.1016/j.drugalcdep.2019.01.037] [Citation(s) in RCA: 281] [Impact Index Per Article: 56.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND People who inject drugs (PWID) have limited engagement in healthcare services and report frequent experiences of stigma and mistreatment when accessing services. This paper explores the impact of stigma against injection drug use on healthcare utilization among PWID in the U.S. Northeast. METHODS We recruited PWID through community-based organizations (CBOs; e.g., syringe service programs). Participants completed brief surveys and semi-structured interviews lasting approximately 45 min exploring HIV risk behaviors and prevention needs. Thematic analysis examined the emergent topic of stigma experiences in relation to healthcare utilization. RESULTS Among 33 PWID (55% male; age range 24-62 years; 67% White; 24% Latino), most used heroin (94%) and injected at least daily (60%). Experiences of dehumanization in healthcare settings were common, with many participants perceiving that they had been treated unfairly or discriminated against due to their injection drug use. As participants anticipated this type of stigma from healthcare providers, they developed strategies to avoid it, including delaying presenting for healthcare, not disclosing drug use, downplaying pain, and seeking care elsewhere. In contrast to large institutional healthcare settings, participants described non-stigmatizing environments within CBOs, where they experienced greater acceptance, mutual respect, and stronger connections with staff. CONCLUSIONS Stigma against injection drug use carries important implications for PWID health. Increased provider training on addiction as a medical disorder could improve PWID healthcare experiences, and integrating health services into organizations frequented by PWID could increase utilization of health services by this population.
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Affiliation(s)
- Dea L Biancarelli
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, United States.
| | - Katie B Biello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States; Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States; The Fenway Institute, Fenway Health, Boston, MA, United States.
| | - Ellen Childs
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States.
| | - M Drainoni
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States; Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, United States; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.
| | - Peter Salhaney
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States.
| | - Alberto Edeza
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States.
| | - Matthew J Mimiaga
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, United States; Departments of Behavioral and Social Health Sciences and Epidemiology, Brown University School of Public Health, Providence, RI, United States; The Fenway Institute, Fenway Health, Boston, MA, United States; Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, United States.
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States; Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States.
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States.
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J D, N F. Neural and cognitive correlates of stigma and social rejection in individuals with Serious Mental Illness (SMI): A systematic review of the literature. Psychiatry Res 2019; 274:146-158. [PMID: 30784783 DOI: 10.1016/j.psychres.2019.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/09/2019] [Accepted: 02/09/2019] [Indexed: 12/15/2022]
Abstract
Stigma and self-stigma are major issues for people with Serious Mental Illness (SMI). This review's aims were to determine the cognitive and neural processes underlying the effects of stigma and social rejection in people with SMI. A stepwise systematic literature review (PRISMA) was conducted by searching PubMed, Medline and Web of Science using the following keywords: "cyberball" OR "stereotype threat" OR "implicit association test" AND "mental illness". The articles included met the following criteria: (a) reporting on social rejection, stigma or self-stigma (b) diagnosis of SMI (c) available data on the underlying mechanisms. Our search on July 31th 2018 found in 955 articles on PubMed and 3,362 on Web of Science. Hypersensitivity to acute social rejection was found and associated with more self-related negative emotions and more dysfunctional emotion regulation strategies. People with SMI under-performed in cognitive tasks when confronted with stigma. Stigma resistance was described with its neural correlates. Psychiatric symptoms, duration of illness and baseline non-specific distress influenced the response to acute social rejection or stigma. The samples, methods, and reported outcomes were heterogeneous and difficult to compare. Future studies should investigate the associations between self-stigma and responses to acute and chronic social rejection.
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Affiliation(s)
- Dubreucq J
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France; Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, Grenoble, 38400 Saint Martin d'Hères, France; Fondation FondaMental, Créteil, France.
| | - Franck N
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, France; Réseau Handicap Psychique, Grenoble, France; Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, France; Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, France
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O'Connor LK, Yanos PT, Firmin RL. Correlates and moderators of stigma resistance among people with severe mental illness. Psychiatry Res 2018; 270:198-204. [PMID: 30265887 PMCID: PMC6292775 DOI: 10.1016/j.psychres.2018.09.040] [Citation(s) in RCA: 14] [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: 03/18/2018] [Revised: 08/12/2018] [Accepted: 09/18/2018] [Indexed: 01/28/2023]
Abstract
Research on factors associated with stigma resistance among people with severe mental illness remains relatively scant. This study aimed to (1) replicate previous findings linking stigma resistance with variables associated with recovery; (2) explore associations between stigma resistance and coping strategies and psychiatric symptoms; (3) compare these associations among individuals with different levels of self-stigma; and (4) examine whether race, age and education moderate these relationships. Analyses of a sample (n = 353) and sub-sample (n = 177) of persons with severe mental illness examined associations between stigma resistance and self-stigma, functional and clinical outcomes, and the moderating impact of age, race, and education on these relationships. Stigma resistance was significantly negatively associated with self-stigma and positively associated with social functioning, self-esteem, problem-centered coping, and symptoms of hostility-excitement, but not other types of symptoms. Race significantly moderated the relationship between stigma resistance and self-stigma, age significantly moderated the relationships between hopelessness and both stigma resistance and self-stigma, and education significantly moderated the relationship between stigma resistance and social functioning. Findings suggest that social circumstances impact the benefit of stigma resistance in complex ways; future work should aim to understand how these experiences impact stigma resistance to inform intervention development.
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Affiliation(s)
- Lauren K O'Connor
- Department of Psychology, John Jay College of Criminal Justice, 524 West 59th St., New York, NY 10019, USA; Department of Psychology, City University of New York, Graduate Center, New York, NY, USA.
| | - Philip T Yanos
- Department of Psychology, John Jay College of Criminal Justice, 524 West 59th St., New York, NY 10019, USA; Department of Psychology, City University of New York, Graduate Center, New York, NY, USA
| | - Ruth L Firmin
- Department of Psychiatry and Human Behavior, Brown University/Alpert Medical School, Providence, RI, USA
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Masuch TV, Bea M, Alm B, Deibler P, Sobanski E. Internalized stigma, anticipated discrimination and perceived public stigma in adults with ADHD. ACTA ACUST UNITED AC 2018; 11:211-220. [DOI: 10.1007/s12402-018-0274-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/09/2018] [Indexed: 12/19/2022]
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Yılmaz E, Kavak F. Effects of Mindfulness-Based Psychoeducation on the Internalized Stigmatization Level of Patients With Schizophrenia. Clin Nurs Res 2018; 29:496-503. [PMID: 30215273 DOI: 10.1177/1054773818797871] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The aim of this study was to determine the effects of mindfulness-based psychoeducation on internalized stigma in patients with schizophrenia. The patients were recruited from the community mental health centers. This quasiexperimental study was conducted using pretests and posttests with a control group. The participants were 69 patients with schizophrenia; 34 were part of the experimental group and 35 were part of the control group. The patients in the experimental group participated 2 days a week for 6 weeks in a total of 12 sessions which were given in the form of face-to-face group training. The difference between the scale mean posttest scores of the patients in the experimental and control groups was found to be statistically significant (p < .05). In the intragroup comparisons, a significant difference was found between the stigma mean scores in the experimental group (p < .05). It was concluded that mindfulness-based psychoeducation was effective in reducing stigma in patients with schizophrenia.
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Griffiths S, Mitchison D, Murray SB, Mond JM, Bastian BB. How might eating disorders stigmatization worsen eating disorders symptom severity? Evaluation of a stigma internalization model. Int J Eat Disord 2018; 51:1010-1014. [PMID: 30055009 DOI: 10.1002/eat.22932] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/18/2018] [Accepted: 07/08/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Eating disorders stigmatization is common and is associated with greater eating disorders symptom severity. This study sought to elucidate stigma internalization as a potential mechanism underlying this association. Two central aspects of stigma internalization were focused on: alienation and social withdrawal. METHOD A cross-national sample of individuals with self-reported eating disorders (N = 260) completed measures of eating disorders stigmatization, symptom severity, alienation, and social withdrawal. RESULTS The model evidenced excellent fit. Eating disorders stigmatization directly predicted both alienation and social withdrawal, which, in turn, directly predicted symptom severity. Indirect effect analyses indicated that greater eating disorders stigmatization ultimately predicted greater symptom severity via alienation and social withdrawal. Moreover, social withdrawal mediated the association of alienation with symptom severity. Fitting a direct pathway from eating disorder stigmatization to symptom severity did not improve model fit. DISCUSSION Our model provides a potentially useful account of the mechanisms by which eating disorders stigmatization might worsen eating disorder symptom severity. Specifically, the stigma internalization processes of alienation and social withdrawal may be important factors linking stigmatization with symptom severity. The findings have implications for clinicians attempting to help individuals with eating disorders to monitor and modify their responses to eating disorders stigmatization.
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Affiliation(s)
- Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Mitchison
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Jonathan M Mond
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Brock B Bastian
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Jackson-Best F, Edwards N. Stigma and intersectionality: a systematic review of systematic reviews across HIV/AIDS, mental illness, and physical disability. BMC Public Health 2018; 18:919. [PMID: 30049270 PMCID: PMC6062983 DOI: 10.1186/s12889-018-5861-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/17/2018] [Indexed: 01/12/2023] Open
Abstract
Background Stigma across HIV/AIDS, mental illness, and physical disability can be co-occurring and may interact with other forms of stigma related to social identities like race, gender, and sexuality. Stigma is especially problematic for people living with these conditions because it can create barriers to accessing necessary social and structural supports, which can intensify their experiences with stigma. This review aims to contribute to the knowledge on stigma by advancing a cross-analysis of HIV/AIDS, mental illness, and physical disability stigma, and exploring whether and how intersectionality frameworks have been used in the systematic reviews of stigma. Methods A search of the literature was conducted to identify systematic reviews which investigated stigma for HIV/AIDS, mental illness and/or physical disability. The electronic databases MEDLINE, CINAHL, EMBASE, COCHRANE, and PsycINFO were searched for reviews published between 2005 and 2017. Data were extracted from eligible reviews on: type of systematic review and number of primary studies included in the review, study design study population(s), type(s) of stigma addressed, and destigmatizing interventions used. A keyword search was also done using the terms “intersectionality”, “intersectional”, and “intersection”; related definitions and descriptions were extracted. Matrices were used to compare the characteristics of reviews and their application of intersectional approaches across the three health conditions. Results Ninety-eight reviews met the inclusion criteria. The majority (99%) of reviews examined only one of the health conditions. Just three reviews focused on physical disability. Most reviews (94%) reported a predominance of behavioural rather than structural interventions targeting stigma in the primary studies. Only 17% of reviews used the concept and/or approach of intersectionality; all but one of these reviews examined HIV/AIDS. Conclusions The lack of systematic reviews comparing stigma across mental illness, HIV/AIDS, and physical disability indicates the need for more cross-comparative analyses among these conditions. The integration of intersectional approaches would deepen interrogations of co-occurring social identities and stigma.
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Affiliation(s)
| | - Nancy Edwards
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 1 Stewart Street, Room 205, Ottawa, ON, K1N 7M9, Canada
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Luther L, Firmin RL, Lysaker PH, Minor KS, Salyers MP. A meta-analytic review of self-reported, clinician-rated, and performance-based motivation measures in schizophrenia: Are we measuring the same "stuff"? Clin Psychol Rev 2018; 61:24-37. [PMID: 29751942 DOI: 10.1016/j.cpr.2018.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 03/27/2018] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
An array of self-reported, clinician-rated, and performance-based measures has been used to assess motivation in schizophrenia; however, the convergent validity evidence for these motivation assessment methods is mixed. The current study is a series of meta-analyses that summarize the relationships between methods of motivation measurement in 45 studies of people with schizophrenia. The overall mean effect size between self-reported and clinician-rated motivation measures (r = 0.27, k = 33) was significant, positive, and approaching medium in magnitude, and the overall effect size between performance-based and clinician-rated motivation measures (r = 0.21, k = 11) was positive, significant, and small in magnitude. The overall mean effect size between self-reported and performance-based motivation measures was negligible and non-significant (r = -0.001, k = 2), but this meta-analysis was underpowered. Findings suggest modest convergent validity between clinician-rated and both self-reported and performance-based motivation measures, but additional work is needed to clarify the convergent validity between self-reported and performance-based measures. Further, there is likely more variability than similarity in the underlying construct that is being assessed across the three methods, particularly between the performance-based and other motivation measurement types. These motivation assessment methods should not be used interchangeably, and measures should be more precisely described as the specific motivational construct or domain they are capturing.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University at Indianapolis (IUPUI), 402 N. Blackford St., Indianapolis, IN 46202, United States.
| | - Ruth L Firmin
- Indiana University-Purdue University at Indianapolis (IUPUI), 402 N. Blackford St., Indianapolis, IN 46202, United States
| | - Paul H Lysaker
- Indiana University School of Medicine, 340 W 10th St #6200, Indianapolis, IN 46202, United States; Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN 46202, United States
| | - Kyle S Minor
- Indiana University-Purdue University at Indianapolis (IUPUI), 402 N. Blackford St., Indianapolis, IN 46202, United States
| | - Michelle P Salyers
- Indiana University-Purdue University at Indianapolis (IUPUI), 402 N. Blackford St., Indianapolis, IN 46202, United States
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Feldhaus T, Falke S, von Gruchalla L, Maisch B, Uhlmann C, Bock E, Lencer R. The impact of self-stigmatization on medication attitude in schizophrenia patients. Psychiatry Res 2018; 261:391-399. [PMID: 29353769 DOI: 10.1016/j.psychres.2018.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/18/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
Negative attitudes towards medication in schizophrenia patients are one major factor contributing to non-adherence behavior. Besides, self-stigmatization represents another frequent and important obstacle in patients suffering from psychotic disorders. Here, we investigated possible associations between medication adherence attitude and the extent of self-stigmatization, while also exploring factors related to self-stigmatization. Sociodemographic characteristics, clinical variables, medication attitude and self-stigmatization were assessed among 81 subjects with schizophrenia or schizoaffective disorder. The cross-sectional data was then analyzed by multivariate analyses. A more positive attitude towards medication was predicted by better insight into illness, lower degree of self-stigmatization and good subjective knowledge about medication (adjusted R2 = 0.23). Furthermore, a higher level of self-stigmatization was associated with lower subjective wellbeing, more severe depressive symptoms and male gender (adjusted R2 = 0.58). Other clinical variables had no additional predictive value for medication adherence attitude or the extent of self-stigmatization. Our findings support the notion that self-stigmatization is an influential factor on medication attitude that should therefore be appreciated in clinical practice. Besides this, special emphasis should be taken on depressive symptoms and reduced wellbeing, especially in male patients, to lower the extent of self-stigmatization.
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Affiliation(s)
- Tobias Feldhaus
- Department of Psychiatry and Psychotherapy, University Hospital of Muenster, Muenster, Germany
| | - Sebastian Falke
- Department of Psychiatry and Psychotherapy, University Hospital of Muenster, Muenster, Germany
| | - Lara von Gruchalla
- Department of Psychiatry and Psychotherapy, University Hospital of Muenster, Muenster, Germany
| | | | - Christina Uhlmann
- Department of Psychiatry and Psychotherapy, University Hospital of Muenster, Muenster, Germany
| | - Eva Bock
- Department of Psychiatry and Psychotherapy, University Hospital of Muenster, Muenster, Germany
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University Hospital of Muenster, Muenster, Germany.
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Buck B, Hester N. “Just Like Someone Without Mental Illness, Only More So”: Normalizing Beliefs and their Buffering Effects on Psychiatric Symptoms. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018. [DOI: 10.1521/jscp.2018.37.1.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Self-stigma leads sufferers of psychiatric conditions to experience reduced self-efficacy and self-esteem as well as avoid treatment, employment, and social opportunities. There is a dearth of research on the mechanisms underlying individuals' ability to resist stigmatizing beliefs; furthermore, research has revealed limitations in current popular approaches to de-stigmatization, such as emphasizing the biological and genetic characteristics of symptoms. We propose normalization—the understanding of psychiatric phenomena as varying degrees of normative, understandable, and common experiences—as a cross-diagnostic protective factor against self-stigma. We recruited a sample of 137 online study participants to pilot an assessment of normalization, predicting that normalizing beliefs about psychiatric symptoms would positively influence quality of life, especially for those who report personal experience of symptoms. We found evidence for this prediction: belief that psychiatric symptoms were relatively common, buffered the negative effect of people's own psychiatric symptoms on quality of life. Cross-diagnostic symptom normalization may function as a protective factor against the negative effects of psychiatric symptoms and associated stigma.
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Affiliation(s)
- Benjamin Buck
- University of North Carolina at Chapel Hill
- Puget Sound VA Healthcare System, Seattle Division
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Firmin RL, Lysaker PH, McGrew JH, Minor KS, Luther L, Salyers MP. The Stigma Resistance Scale: A multi-sample validation of a new instrument to assess mental illness stigma resistance. Psychiatry Res 2017; 258:37-43. [PMID: 28985551 DOI: 10.1016/j.psychres.2017.09.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 09/17/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Abstract
Although associated with key recovery outcomes, stigma resistance remains under-studied largely due to limitations of existing measures. This study developed and validated a new measure of stigma resistance. Preliminary items, derived from qualitative interviews of people with lived experience, were pilot tested online with people self-reporting a mental illness diagnosis (n = 489). Best performing items were selected, and the refined measure was administered to an independent sample of people with mental illness at two state mental health consumer recovery conferences (n = 202). Confirmatory factor analyses (CFA) guided by theory were used to test item fit, correlations between the refined stigma resistance measure and theoretically relevant measures were examined for validity, and test-retest correlations of a subsample were examined for stability. CFA demonstrated strong fit for a 5-factor model. The final 20-item measure demonstrated good internal consistency for each of the 5 subscales, adequate test-retest reliability at 3 weeks, and strong construct validity (i.e., positive associations with quality of life, recovery, and self-efficacy, and negative associations with overall symptoms, defeatist beliefs, and self-stigma). The new measure offers a more reliable and nuanced assessment of stigma resistance. It may afford greater personalization of interventions targeting stigma resistance.
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Affiliation(s)
- Ruth L Firmin
- University of California, Los Angeles, Los Angeles, CA, USA.
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John H McGrew
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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40
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Lau YW, Picco L, Pang S, Jeyagurunathan A, Satghare P, Chong SA, Subramaniam M. Stigma resistance and its association with internalised stigma and psychosocial outcomes among psychiatric outpatients. Psychiatry Res 2017; 257:72-78. [PMID: 28734239 DOI: 10.1016/j.psychres.2017.07.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/31/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
Abstract
Studies have suggested that stigma resistance plays an important role in the recovery from mental illness. However, there has been limited research in Asian countries that has examined the benefits of stigma resistance among the mentally ill in Asian populations. Hence, this study aimed to assess the prevalence of stigma resistance and establish the socio-demographic correlates of stigma resistance, as well as its association with internalised stigma and psychosocial outcomes among a multi-ethnic population of 280 outpatients with obsessive compulsive disorder (OCD), schizophrenia, depressive disorders and anxiety disorders in Singapore. Prevalence of stigma resistance measured using the Stigma Resistance subscale of the Internalised Stigma of Mental Illness Scale was 82.9%. ANOVA and logistic regressions were conducted and results revealed that: (i) Stigma resistance was positively associated with being separated/divorced/widowed but negatively associated with depression diagnosis; (ii) Psychosocial outcomes such as self-esteem and psychological health were positively associated with stigma resistance; and (iii) Internalised stigma was negatively associated with stigma resistance. Moving forward, treatments could emphasize on improving the self-esteem and psychological health of patients to increase their stigma resistance for counteracting effects of public and internalised stigma.
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Affiliation(s)
- Ying Wen Lau
- Research Division, Institute of Mental Health, Singapore.
| | - Louisa Picco
- Research Division, Institute of Mental Health, Singapore
| | - Shirlene Pang
- Research Division, Institute of Mental Health, Singapore
| | | | | | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
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41
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Kao YC, Lien YJ, Chang HA, Tzeng NS, Yeh CB, Loh CH. Stigma Resistance in Stable Schizophrenia: The Relative Contributions of Stereotype Endorsement, Self-Reflection, Self-Esteem, and Coping Styles. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:735-744. [PMID: 28884606 PMCID: PMC5638194 DOI: 10.1177/0706743717730827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Stigma resistance (SR) has recently emerged as a prominent aspect of research on recovery from schizophrenia, partly because studies have suggested that the development of stigma-resisting beliefs may help individuals lead a fulfilling life and recover from their mental illness. The present study assessed the relationship between personal SR ability and prediction variables such as self-stigma, self-esteem, self-reflection, coping styles, and psychotic symptomatology. METHOD We performed an exploratory cross-sectional study of 170 community-dwelling patients with schizophrenia. Self-stigma, self-esteem, self-reflection, coping skills, and SR were assessed through self-report. Psychotic symptom severity was rated by the interviewers. Factors showing significant association in univariate analyses were included in a stepwise backward regression model. RESULTS Stepwise regressions revealed that acceptance of stereotypes of mental illness, self-esteem, self-reflection, and only 2 adaptive coping strategies (positive reinterpretation and religious coping) were significant predictors of SR. The prediction model accounted for 27.1% of the variance in the SR subscale score in our sample. CONCLUSIONS Greater reflective capacity, greater self-esteem, greater preferences for positive reinterpretation and religious coping, and fewer endorsements of the stereotypes of mental illness may be key factors that relate to higher levels of SR. These factors are potentially modifiable in tailored interventions, and such modification may produce considerable improvements in the SR of the investigated population. This study has implications for psychosocial rehabilitation and emerging views of recovery from mental illness.
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Affiliation(s)
- Yu-Chen Kao
- 1 Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan.,2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Yin-Ju Lien
- 3 Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsin-An Chang
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Chin-Bin Yeh
- 2 Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,4 Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- 5 School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Vrbova K, Prasko J, Holubova M, Kamaradova D, Ociskova M, Marackova M, Latalova K, Grambal A, Slepecky M, Zatkova M. Self-stigma and schizophrenia: a cross-sectional study. Neuropsychiatr Dis Treat 2016; 12:3011-3020. [PMID: 27920538 PMCID: PMC5127434 DOI: 10.2147/ndt.s120298] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the degree of self-stigma in schizophrenia and its association with clinical and demographic factors. PATIENTS AND METHODS A total of 197 outpatients (54.3% females) diagnosed with schizophrenia spectrum disorders (schizophrenia, schizoaffective disorder, delusional disorder) according to International Classification of Diseases - tenth edition participated in the study. The mean age of the patients was 40.10±11.49 years. All individuals completed the Internalized Stigma of Mental Illness (ISMI) scale and a demographic questionnaire. The disorder severity was assessed by both a psychiatrist (the objective version of Clinical Global Impression - severity scale [objCGI-S]) and the patients (the subjective version of Clinical Global Impression - severity scale [subjCGI-S]). Treatment with antipsychotics stabilized the patients. RESULTS The overall level of self-stigma measured by the total score of the ISMI was 63.32±13.59. The total score of the ISMI positively correlated with the severity of the disorder measured by the objCGI-S and subjCGI-S. In addition, self-stigma positively correlated with the treatment duration and the number of psychiatric hospitalizations. The backward stepwise regression was applied to identify the most significant factors connected to self-stigma. The regression analysis identified the following regressors as the most relevant to self-stigma: the number of previous psychiatric hospitalizations, the severity of the disorder rated by a psychiatrist, and the difference between the objective rating and the subjective rating of the severity of the disorder. CONCLUSION Outpatients with schizophrenia spectrum disorders, who have undergone a higher number of psychiatric hospitalizations, who dispose of a higher severity of the disorder and show a higher discrepancy between their rating of the severity and the psychiatric rating, showed a greater degree of self-stigma. The management of self-stigma in patients with schizophrenia should be implemented in the routine care.
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Affiliation(s)
- Kristyna Vrbova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc
| | - Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc; Department of Psychiatry, Hospital Liberec, Liberec, Czech Republic
| | - Dana Kamaradova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc
| | - Marketa Marackova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc
| | - Ales Grambal
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic
| | - Marta Zatkova
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic
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