1
|
Hall LM, Moussa-Tooks AB, Sheffield JM. Associations between social engagement, internalizing symptoms, and delusional ideation in the general population. Soc Psychiatry Psychiatr Epidemiol 2024; 59:989-1002. [PMID: 37624462 DOI: 10.1007/s00127-023-02540-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Delusions are a hallmark feature of psychotic disorders and lead to significant clinical and functional impairment. Internalizing symptoms-such as symptoms of depression, anxiety, and trauma exposure-are commonly cited to be related to delusions and delusional ideation and are often associated with deficits in social functioning. While emerging studies are investigating the impact of low social engagement on psychotic-like experiences, little work has examined the relationship between social engagement, internalizing symptoms, and delusional ideation, specifically. METHODS Using general population data from the Nathan Kline Institute-Rockland (NKI-Rockland) database (N = 526), we examined the relationships between self-reported delusional ideation, internalizing symptoms, and social engagement and tested four indirect effect models to understand how these factors interrelate. RESULTS Delusional ideation was significantly associated with both increased internalizing symptoms (r = 0.41, p < 0.001) and lower social engagement (r = - 0.14, p = 0.001). Within aspects of social engagement, perceived emotional support showed the strongest relationship with delusional ideation (r = - 0.17, p < 0.001). Lower social engagement was also significantly associated with increased internalizing symptoms (r = - 0.29, p < 0.001). Cross-sectional models suggest that internalizing symptoms have a significant indirect effect on the association between delusional ideation and social engagement. CONCLUSIONS These findings reveal that elevated delusional ideation in the general population is associated with lower social engagement. Elevated internalizing symptoms appear to play a critical role in reducing engagement, possibly exacerbating delusional thinking. Future work should examine the causal and temporal relationships between these factors.
Collapse
Affiliation(s)
- Lauren M Hall
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Suite 3057K, Nashville, TN, 37212, USA.
| | - Alexandra B Moussa-Tooks
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Suite 3057K, Nashville, TN, 37212, USA
| | - Julia M Sheffield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave S, Suite 3057K, Nashville, TN, 37212, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Seet V, Lee YY, Chua YC, Verma SK, Subramaniam M. Self-stigma and quality of life among people with psychosis: The protective role of religion. Early Interv Psychiatry 2024; 18:338-345. [PMID: 37726099 DOI: 10.1111/eip.13469] [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: 03/06/2023] [Revised: 08/12/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
AIM The quality of life in people with psychosis has been consistently demonstrated to be lower than those without, with self-stigma contributing greatly to this impairment. Hence, it is imperative to address this gap in order to facilitate recovery-oriented and other outcomes. This study investigates the potential of religiosity in moderating the effects of self-stigma on quality of life among those with psychosis. METHODS Adults with psychosis (n = 99) were recruited from the Early Psychosis Intervention Programme in Singapore from 2018 to 2021, and administered the self-report Religious Commitment Index, Internalized Stigma of Mental Illness scale, and Abbreviated World Health Organization Quality of Life instrument. Linear regression analyses were conducted and the interaction between self-stigma and religious commitment scores calculated to investigate the moderation effects of religiosity on the relationship between stigma and quality of life. RESULTS Preliminary regression analyses revealed a significant association between sex and psychological quality of life. After controlling for sex, religiosity was found to moderate the relationship between self-stigma and psychological quality of life. CONCLUSIONS The results of the study demonstrate the potential of religiosity in buffering the effects of self-stigma on quality of life. This reveals an area that can be easily targeted and addressed in treatment programs to improve outcomes beyond the clinical setting among people living with psychosis, to facilitate their recovery journey and beyond.
Collapse
Affiliation(s)
- Vanessa Seet
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Ying Ying Lee
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yi Chian Chua
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore, Singapore
| | - Swapna Kamal Verma
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore, Singapore
- Education Office, Duke-NUS Medical School, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| |
Collapse
|
4
|
Ehret BC, Titone MK, Carey CJ, Martinez A, Chalker SA, Granholm EL, Depp CA. Are all reasons for living made equally? Reasons for living and dysfunctional attitudes in psychotic disorders and bipolar I. Psychol Psychother 2023; 96:748-761. [PMID: 37039342 DOI: 10.1111/papt.12466] [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: 05/25/2022] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Persons with schizophrenia, schizoaffective, or bipolar I disorder are more likely to die by suicide compared to the general population. Dysfunctional attitudes have been shown to be significant predictors of cognitive vulnerability to depression, hopelessness, and poor problem-solving skills, which predict suicidal ideation. Dysfunctional attitudes are common in persons with schizophrenia spectrum disorders (SSDs) and bipolar I. The Reasons for Living Inventory (RFLI) examines distinct reasons for not dying by suicide. This study's objectives were to examine the relationship between the RFLI subscales and dysfunctional attitudes among persons with SSDs and bipolar I. We hypothesized significant positive correlations between two RFLI subscales (Fear of Suicide and Fear of Social Disapproval) and total score on the Dysfunctional Attitude Scale (DAS). We did not expect significant correlations between other subscales. DESIGN AND METHODS This correlational, cross-sectional study examined baseline scores on the RFLI and dysfunctional attitudes (DAS) among N = 102 outpatients with SSDs or bipolar I. RESULTS Significant positive correlations were observed between RFLI subscales Fear of Suicide and Fear of Social Disapproval and DAS total scores. No other significant relationships were observed. CONCLUSIONS Certain reasons for living (i.e. fear of suicide and social disapproval) may be associated with dysfunctional attitudes among persons with SSDs or bipolar I. These, in turn, may place these individuals at a greater risk for suicide by increasing their cognitive vulnerability. These findings may inform clinical treatment targets for persons with SSDs and bipolar I.
Collapse
Affiliation(s)
- Blaire C Ehret
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Madison K Titone
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin J Carey
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Alexandra Martinez
- Graduate School of Education and Psychology, Pepperdine University, Malibu, California, USA
| | - Samantha A Chalker
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Eric L Granholm
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin A Depp
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| |
Collapse
|
5
|
Chan KKS, Tsui JKC. Longitudinal impact of experienced discrimination on mental health among people with mental disorders. Psychiatry Res 2023; 322:115099. [PMID: 36848709 DOI: 10.1016/j.psychres.2023.115099] [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: 12/17/2022] [Revised: 01/29/2023] [Accepted: 02/05/2023] [Indexed: 02/09/2023]
Abstract
The present study examined the longitudinal impact of stigma on mental health among people with mental disorders. Specifically, this study tested whether higher levels of experienced discrimination would be longitudinally associated with lower levels of symptomatic remission, functional restoration, well-being, and life satisfaction and whether these associations would be mediated by higher levels of self-stigma content and process. A total of 202 people with mental disorders completed questionnaires at three time points (i.e., T1, T2, and T3) over two years. Path analyses showed that experienced discrimination at T1 was positively associated with self-stigma content and process at T2, which were, in turn, negatively associated with symptomatic remission, functional restoration, well-being, and life satisfaction at T3. Bootstrap analyses further revealed that experienced discrimination at T1 had indirect effects on symptomatic remission, functional restoration, well-being, and life satisfaction at T3 through self-stigma content and process at T2. This study shows that experienced discrimination may exacerbate self-stigma content and process and, in turn, impede recovery and wellness among people with mental disorders. Our findings highlight the importance of designing and implementing stigma and self-stigma reduction programs in order to enable people with mental disorders to attain mental illness recovery and positive mental health.
Collapse
Affiliation(s)
- Kevin Ka Shing Chan
- Department of Psychology, The Education University of Hong Kong, Hong Kong; Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong.
| | - Jack Ka Chun Tsui
- Department of Psychology, The Education University of Hong Kong, Hong Kong
| |
Collapse
|
6
|
Tao TJ, Hui CLM, Ho ECN, Hui PWM, Suen YN, Lee EHM, Chan SKW, Chang WC, Chen EYH. Correlates and predictors of perceived stigma and self-stigma in Chinese patients with psychosis. Early Interv Psychiatry 2022; 16:1075-1084. [PMID: 34913256 DOI: 10.1111/eip.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/07/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
AIMS In patients with psychosis, perceived stigma (i.e., beliefs about discriminative viewpoints held by the public) and self-stigma (i.e., internalization of such perceived stereotypes) could have devastating consequences. Knowledge about their correlates bears importance for understanding individual differences in stigma experiences, and further, given the social nature of stigma, Asians may show more distinctive features than Westerners. METHODS A total of 142 Chinese patients who originally enrolled into a randomized controlled trial during their first-episode psychosis were followed up at 10 years. We explored potential demographics, clinical and psychosocial correlates of perceived stigma and self-stigma. RESULTS Stepwise multiple regression analyses indicated that both perceived- and self-stigma were predicted by a more negative attitude to treatment, whereas differential factors including perceived recovery predicted perceived stigma, and quality of life and attention predicted self-stigma. CONCLUSIONS These results can help identify individuals susceptible to experiencing perceived- or self-stigma, highlighting the need to consider factors such as attitude towards treatment when designing anti-stigma strategies.
Collapse
Affiliation(s)
- Tiffany Junchen Tao
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Elise Chun Ning Ho
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Yi Nam Suen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, SAR, China
| |
Collapse
|
7
|
Dikeç G, Bilaç Ö, Kardelen C, Sapmaz ŞY, Kandemir H. Which factors affect internalized stigmatization in adolescents with mental disorders? JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 35:362-371. [PMID: 35962770 DOI: 10.1111/jcap.12391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this descriptive study was to determine the factors affecting internalized stigmatization of adolescents with mental disorders. METHOD The study data were collected in a university hospital between August 1, 2020 and July 30, 2021 (n = 123), using a Personal information form and the Internalized Stigmatization of Mental Illness-Adolescent Form (ISMI-AF). RESULTS Gender and the number of hospitalizations were determined to be independent variables with explanatory power in the ISMI-AF, and in the model created with these variables, it was determined that these variables explained 18% of the change in the total points of the ISMI-AF. CONCLUSIONS It could be recommended that psychosocial programs are developed with the aim of decreasing internalized stigmatization and increasing the psychological resilience of adolescents.
Collapse
Affiliation(s)
- Gül Dikeç
- Department of Nursing, Faculty of Health Sciences, Fenerbahce University, Istanbul, Turkey
| | - Öznur Bilaç
- Department of Child and Adolescent Psychiatry, Hafsa Sultan Medical School Hospital, Celal Bayar University, Manisa, Turkey
| | - Cansın Kardelen
- Department of Child and Adolescent Psychiatry, Hafsa Sultan Medical School Hospital, Celal Bayar University, Manisa, Turkey
| | - Şermin Yalın Sapmaz
- Department of Child and Adolescent Psychiatry, Hafsa Sultan Medical School Hospital, Celal Bayar University, Manisa, Turkey
| | - Hasan Kandemir
- Department of Child and Adolescent Psychiatry, Hafsa Sultan Medical School Hospital, Celal Bayar University, Manisa, Turkey
| |
Collapse
|
8
|
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: 90] [Impact Index Per Article: 30.0] [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.
Collapse
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
| |
Collapse
|
9
|
Yu BCL, Chio FHN, Mak WWS, Corrigan PW, Chan KKY. Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clin Psychol Rev 2021; 87:102029. [PMID: 34058604 DOI: 10.1016/j.cpr.2021.102029] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of collectivism in the internalization process. Results of the meta-analytic structural equation modeling suggested that self-stigma is a significant mediator in the relationships between experienced stigma and perceived stigma with well-being and recovery variables (indirect effects = 0.02 to -0.16). Experienced and perceived stigma had significant direct effects on well-being and recovery variables (Bs = 0.07 to -0.21, p < 0.05), suggesting that both external (e.g., public stigma) and internal (i.e., self-stigma) influences of stigma work concurrently to affect recovery and well-being of people with mental illness. The results of the mixed effect three-level meta-analytic models showed that collectivism significantly moderated the relationship between experienced and perceived stigma with self-stigma (Bs = 0.06 to 0.11, p < 0.05). This implied that the more collectivistic a culture is, the stronger the correlation between experienced and perceived stigma with self-stigma. Implications to stigma reduction approaches were discussed.
Collapse
Affiliation(s)
- Ben C L Yu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Floria H N Chio
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, United States
| | - Kelly K Y Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| |
Collapse
|
10
|
Nhunzvi C, Langhaug L, Mavindidze E, Harding R, Galvaan R. Occupational justice and social inclusion among people living with HIV and people with mental illness: a scoping review. BMJ Open 2020; 10:e036916. [PMID: 32784258 PMCID: PMC7418773 DOI: 10.1136/bmjopen-2020-036916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore ways in which occupational justice and social inclusion are conceptualised, defined and operationalised in highly stigmatised and chronic conditions of mental illness and HIV. DESIGN This scoping review protocol followed Arksey and O'Malley's (2005) Scoping Review Framework. DATA SOURCES AND ELIGIBILITY The following databases were searched for the period January 1997 to January 2019: Medline via PubMed, Scopus, Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Africa-Wide Information, Humanities International Complete, Web of Science, PsychInfo, SocINDEX and grey literature.Eligible articles were primary studies, reviews or theoretical papers which conceptualised, defined and/or operationalised social inclusion or occupational justice in mental illness or HIV. STUDY APPRAISAL AND SYNTHESIS We undertook a three-part article screening process. Screening and data extraction were undertaken independently by two researchers. Arksey's framework and thematic analysis informed the collation and synthesis of included papers. RESULTS From 3352 records, we reviewed 139 full articles and retained 27 for this scoping review. Definitions of social inclusion and occupational justice in the domains of mental illness and HIV were heterogeneous and lacked definitional clarity. The two concepts were conceptualised as either processes or personal experiences, with key features of community participation, respect for human rights and establishment and maintenance of healthy relationships. Conceptual commonalities between social inclusion and occupational justice were premised on social justice. CONCLUSIONS To address lack of clarity, we propose further and concurrent exploration of these concepts, specifically with reference to persons with comorbid mental health disorders such as substance use disorders and HIV living in low-income countries. This should reflect contextual realities influencing community participation, respect for human rights and meaningful occupational participation. From this broadened understanding, quantitative measures should be applied to improve the standardisation of measurements for occupational justice and social inclusion in policy, research and practice.
Collapse
Affiliation(s)
- Clement Nhunzvi
- College of Health Sciences, Rehabilitation Department, University of Zimbabwe, Harare, Zimbabwe
| | - Lisa Langhaug
- Department of Psychiatry, College of Health Sciences, University of Zimbabwe, African Mental Health Research Initiative (AMARI), Harare, Zimbabwe
| | - Edwin Mavindidze
- Occupational Therapy, Ingutsheni Central Hospital, Bulawayo, Zimbabwe
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Roshan Galvaan
- Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
11
|
Hawthorne A, Fagan R, Leaver E, Baxter J, Logan P, Snowden A. Undergraduate nursing and midwifery student's attitudes to mental illness. Nurs Open 2020; 7:1118-1128. [PMID: 32587731 PMCID: PMC7308689 DOI: 10.1002/nop2.494] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/23/2019] [Accepted: 03/02/2020] [Indexed: 11/06/2022] Open
Abstract
Aim To explore levels of stigma in students of all fields of nursing and midwifery at different years and examine the impact of exposure to people with mental illness. Design A cross-sectional survey was used. Methods The Community Attitudes to Mental Illness questionnaire was administered to all branches of student nurses (adult health, mental health, child health and learning disability) and midwives in all three years in one Higher Education Institution (HEI) in Scotland. Results Mental health nursing students scored significantly better on all stigma subscales. Stigma worsened with a little professional exposure to people with mental illness but then improved with increasing exposure. Both personal exposure and professional exposure to people with mental illness change perceptions. The professional results follow a J-curve. Current plans for cross-field experience involving short or virtual placements during student nurse training are likely to worsen stigma rather than improve it.
Collapse
Affiliation(s)
- Angela Hawthorne
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
- Rapid Response Team, Royal Edinbugh HospitalEdinburghUK
| | - Ross Fagan
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
- South East Recovery HubSouth Neighbourhood Office (West Wing)EdinburghUK
| | - Elspeth Leaver
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
- HMP AddiewellAddiewellUK
| | - Jessica Baxter
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
- Huntlyburn WardBorders General HospitalMelroseUK
| | - Pamela Logan
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Austyn Snowden
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| |
Collapse
|
12
|
Wright A, Fowler D, Greenwood K. Influences on functional outcome and subjective recovery in individuals with and without First Episode Psychosis: A metacognitive model. Psychiatry Res 2020; 284:112643. [PMID: 31718807 DOI: 10.1016/j.psychres.2019.112643] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/22/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022]
Abstract
Models of functional and subjective recovery in psychosis suggest that the path between neurocognition and functioning is mediated by cognitive processes, which may include metacognition, considered 'thinking about thinking'. Metacognition has several components: metacognitive ability, experience and efficiency, connected by metacognitive monitoring and metacognitive control processes; akin to executive control processes. This study aimed to explore whether metacognitive components are fragmented, how individuals with FEP perform on the metacognitive scores compared to healthy control participants, and whether metacognitive components are associated with functioning and, for FEP only, subjective recovery. 62 individuals with FEP and 73 matched healthy controls completed measures of metacognition, functional capacity, functional outcome, and subjective recovery; covariates: IQ and symptoms. Factor analysis, to assess loading of metacognitive items onto separate factors, demonstrated that metacognitive ability, experience, efficiency and monitoring were separate components, with limited association. Metacognitive ability and metacognitive control process were reduced in FEP sample, but metacognitive experience and monitoring process were higher in FEP. Metacognitive ability predicted functional capacity, functional outcome and subjective recovery. Metacognitive experience predicted functional capacity. This is the first study to assess key metacognitive components within a large model and consider the distinct contributions to both functional and subjective recovery.
Collapse
Affiliation(s)
- Abigail Wright
- Center of Excellence for Psychosocial & Systemic Research, Massachusetts General Hospital; University of Sussex, School of Psychology.
| | - David Fowler
- University of Sussex, School of Psychology; Sussex Partnership NHS Foundation Trust
| | - Kathryn Greenwood
- University of Sussex, School of Psychology; Sussex Partnership NHS Foundation Trust
| |
Collapse
|
13
|
Gardner A, Cotton S, O'Donoghue B, Killackey E, Norton P, Filia K. Group differences in social inclusion between young adults aged 18 to 25 with serious mental illness and same-aged peers from the general community. Int J Soc Psychiatry 2019; 65:631-642. [PMID: 31402736 DOI: 10.1177/0020764019868749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS Young adults with serious mental illness (SMI) are thought to be socially excluded. However, psychometric measures of social inclusion have not been employed to examine group differences relative to peers from the general community. The aim of this study was to employ such a measure to determine differences in social inclusion between young adults with SMI and peers from the general community. METHODS A cross-sectional hierarchical logistic regression was conducted to identify which dimensions and individual indicators from the Filia Social Inclusion Measure (F-SIM) discriminated between n = 152 young adults aged 18-25 from the general community (M = 21.36, SD = 2.16) and n = 159 young adults aged 18-25 with SMI (M = 21.13, SD = 2.21). RESULTS Group membership was accounted for by Interpersonal Connections (Nagelkerke R2 = .32), Vocational & Financial Security (Nagelkerke R2 = .32) and Healthy Independent Lifestyle (Nagelkerke R2 = .08) dimensions of the F-SIM. Relative to young adults from the general community, those with SMI were five times less likely to feel they had friends who would call on them in a crisis, odds ratio (OR) = .19 (95%CI = .04, .53), p = .04, almost five times more likely to live with their parents, OR = 4.79 (95%CI = 1.98,11.15), p = .004, almost four times less likely to have worked/studied any time over the past 12 months, OR = .27 (95%CI = .11,.64), p < .001, and three-and-a-half times more likely to report unstable accommodation, OR = 3.58 (95%CI = 1.14, 11.15), p = .03. CONCLUSION Young adults with SMI are socially excluded relative to peers from the general community in terms of interpersonal connections, vocational engagement, autonomy/independence and housing stability. In addition to the well-established focus on vocational engagement, interventions to improve social inclusion in this population must promote reciprocity within social relationships and healthy autonomy/independence (including stable housing).
Collapse
Affiliation(s)
- Andrew Gardner
- 1 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,2 School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Sue Cotton
- 1 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,3 Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Brian O'Donoghue
- 1 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,3 Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eóin Killackey
- 1 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,3 Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Peter Norton
- 2 School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Kate Filia
- 1 Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,3 Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
14
|
Wright AC, Davies G, Fowler D, Greenwood K. Three-Year Follow-Up Study Exploring Metacognition and Function in Individuals With First Episode Psychosis. Front Psychiatry 2019; 10:182. [PMID: 31031648 PMCID: PMC6473558 DOI: 10.3389/fpsyt.2019.00182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/13/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction: Research has demonstrated that functional outcome in psychosis is predicted by factors such as neurocognition, functional capacity, symptoms and, more recently, metacognition. Metacognitive ability has been demonstrated to mediate between neurocognition and functional outcome in First Episode Psychosis (FEP). Whether metacognition also predicts longer-term recovery in first episode psychosis is unknown. This study assessed whether neurocognition, functional capacity and metacognitive ability in FEP predicted functional outcome three years later. Methods: Eighty individuals with First Episode Psychosis were re-contacted after an average 3 years (range: 26-45 month follow-up) from baseline. Twenty-six participants (33%) completed completed measures of neurocognition, metacognition, functional capacity, functional outcome (hours spent in structured activity per week) and psychopathology at baseline and at follow-up. Results: Individual regression analyses demonstrated neurocognition, functional capacity, and metacognitive ability at baseline significantly predicted functional outcome at three years. However, when baseline functional outcome was controlled, only metacognitive ability was a significant predictor of change in functional outcome from baseline to follow-up, p < 0.001. This model explained 72% (adjusted r 2 = 0.69) of the variance in functional outcome at follow-up. Negative symptoms did not change the model. Discussion: This study demonstrated that better metacognitive ability significantly predicted improvement in functioning in FEP across a 3-year period. This highlights the potential value of clinical interventions that focus on improving metacognitive ability at first point of illness to maximize recovery.
Collapse
Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom.,Center of Excellence for Psychosocial and Systemic Research, Massachusetts General Hospital, Boston, MA, United States
| | - Geoff Davies
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| |
Collapse
|
15
|
Hofer A, Post F, Pardeller S, Frajo-Apor B, Hoertnagl CM, Kemmler G, Fleischhacker WW. Self-stigma versus stigma resistance in schizophrenia: Associations with resilience, premorbid adjustment, and clinical symptoms. Psychiatry Res 2019; 271:396-401. [PMID: 30530057 DOI: 10.1016/j.psychres.2018.12.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Self-stigma is regarded as a barrier to recovery from schizophrenia and the identification of factors protecting from its development may help identify vulnerable patients and subsequently, implement effective preventive and therapeutic interventions. Hence, this study aimed to assess whether resilience, premorbid adjustment, and psychopathology might differently impact self-stigma and stigma resistance among 54 regular attendees of a specialized outpatient clinic. There was no significant association between sociodemographic variables and self-stigma/stigma resistance, while resilience was negatively correlated with self-stigma and positively correlated with stigma resistance. In addition, we detected a negative correlation between self-stigma and both academic and social functioning during late adolescence. Most residual symptoms correlated with self-stigma, while no association was found between stigma resistance and psychopathology, except for depressed symptoms. These data provide evidence that future self-stigma reduction interventions may consider to focus on the improvement of resilience in order to promote schizophrenia patients' stigma resistance. In addition, the improvement of depressive symptoms as well as interventions focusing on the strengthening of social adjustment during the prodromal phase may be effective in preventing self-stigma.
Collapse
Affiliation(s)
- Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria.
| | - Fabienne Post
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Silvia Pardeller
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Christine M Hoertnagl
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| |
Collapse
|
16
|
Mazzi F, Baccari F, Mungai F, Ciambellini M, Brescancin L, Starace F. Effectiveness of a social inclusion program in people with non-affective psychosis. BMC Psychiatry 2018; 18:179. [PMID: 29879925 PMCID: PMC5992655 DOI: 10.1186/s12888-018-1728-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/04/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND People with psychotic illness suffer from reduced quality of life and often from an insufficient level of social inclusion. These variables are associated with several negative outcomes, such as higher neuro-cognitive deficits, negative symptoms, internalised stigma, increased cardiovascular risk and, most importantly, excess mortality. To date, only a minority of social interventions in psychosis have been investigated. Since 2011, the Department of Mental Health and Substance Abuse in Modena introduced the "Social Point" program, which provides social inclusion interventions to promote active social participation for patients suffering from severe mental illness. The aim of this study was to assess whether a social inclusion intervention is associated with better outcomes in terms of personal and social recovery, with particular reference to the areas of social functioning and activity, and subjective dimensions such as self-esteem, self-stigma and perceived quality of life. METHODS A cross-sectional design was adopted to compare 30 subjects, selected at the completion of "Social Point" program, with a group of subjects, matched for socio-demographic and clinical features, selected from a wait list for "Social Point". All subjects were evaluated by means of instruments assessing: level of disability, level of functioning, severity of psychopathology, self-esteem, internalised stigma and quality of life. RESULTS Overall, the results of the study suggest that social inclusion interventions may be effective in people suffering from non-affective psychosis. A dose-effect relationship was also found between higher number of activities per patient and better outcomes within both social and psychopathological domains. However, due to the cross-sectional design of the study no definitive causality can be inferred. CONCLUSION Psychosocial interventions promoting social inclusion are likely to represent an effective approach to improve personal and social recovery.
Collapse
Affiliation(s)
- Fausto Mazzi
- 0000 0004 1756 2640grid.476047.6Department of Mental Health and Drug Abuse, AUSL Modena, Viale L Muratori 201, 41124 Modena, Italy
| | - Flavia Baccari
- 0000 0004 1756 2640grid.476047.6Department of Mental Health and Drug Abuse, AUSL Modena, Viale L Muratori 201, 41124 Modena, Italy
| | - Francesco Mungai
- Department of Mental Health and Drug Abuse, AUSL Modena, Viale L Muratori 201, 41124, Modena, Italy.
| | | | - Lisa Brescancin
- Social Point Modena – Centro Servizi Volontariato, Modena, Italy
| | - Fabrizio Starace
- 0000 0004 1756 2640grid.476047.6Department of Mental Health and Drug Abuse, AUSL Modena, Viale L Muratori 201, 41124 Modena, Italy
| |
Collapse
|