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Santosa A, Sopamena Y, Visser M, Dadun D, Damayanti R, Yang L, Zweekhorst M, Peters R. Interdisciplinary perspectives on 'what matters most' in the cultural shaping of health-related stigma in Indonesia. BMJ Glob Health 2024; 9:e012394. [PMID: 39313252 PMCID: PMC11418500 DOI: 10.1136/bmjgh-2023-012394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/22/2024] [Indexed: 09/25/2024] Open
Abstract
Health-related stigma plays a significant role in the burden of various health conditions such as neglected tropical diseases and mental illnesses, and undermines successful health outcomes. Stigmatised individuals can face lifelong socioeconomic consequences because of their condition. It is broadly recognised that culturally salient factors interact with the way stigma is expressed in different local contexts. This study aimed to capture cultural capabilities that shape health-related stigma in Indonesia, using the 'what matters most' (WMM) stigma framework. In this qualitative research, 15 in-depth interviews with experts in the field of Indonesian culture and health studies were conducted, followed by a group discussion. Data were collected between April and September 2021, and analysed using thematic content analysis. The analysis shows that cultural values such as communal participation in local networks and the 'shame culture' shapes experiences of stigma in Indonesia. Moreover, the participants explained that achieving full standing in the Indonesian context meant contributing to the collective interest and maintaining the family reputation. Personhood is also related to socially defined gender roles. For example, community participation was often influenced by patriarchal values, which lead to differences in access to life opportunities, while recognition in the family was often connected to complying with gender roles. This study contributes to research on the cultural shaping of health-related stigma involving the WMM framework in the Indonesian context. Future research should focus on the perspectives of those who are affected by stigmatised conditions and on integrating these insights in the assessment and reduction of health-related stigma.
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Affiliation(s)
- Adibah Santosa
- Athena Institute, Faculty of Science, VU Amsterdam, Amsterdam, Netherlands
| | - Yoslien Sopamena
- Athena Institute, Faculty of Science, VU Amsterdam, Amsterdam, Netherlands
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Marlies Visser
- Athena Institute, Faculty of Science, VU Amsterdam, Amsterdam, Netherlands
| | - Dadun Dadun
- Center for Health Research, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Rita Damayanti
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Lawrence Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | | | - Ruth Peters
- Athena Institute, Faculty of Science, VU Amsterdam, Amsterdam, Netherlands
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Zilberstein T, Shomron B. The depiction of people with schizophrenia in news media: A cross-national analysis. Schizophr Res 2024; 274:171-177. [PMID: 39317120 DOI: 10.1016/j.schres.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Though people with schizophrenia have been habitually stigmatized in the media, the past two decades have seen a substantial rise in public awareness and anti-stigma intervention plans. AIMS In this comprehensive cross-national study, we examine the portrayal of people with schizophrenia in the news media across four countries: the U.S., the U.K., Russia, and Israel. METHODS We employed thematic content analysis to analyze 80 articles from four prominent middle-market and tabloid news media outlets. RESULTS Findings suggest people with schizophrenia were routinely depicted in the news media as violent and dangerous perpetrators who were typically young adult white males. CONCLUSIONS Though some differences existed between venues in different countries, this study suggests that despite the rise in public awareness and anti-stigma intervention plans, the media overall - regardless of country origin - mostly failed to deliver the desired anti-stigma results.
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Affiliation(s)
- Tanya Zilberstein
- Department of Communications Studies, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Department of Communication, Johannes Gutenberg University Mainz (JGU), Mainz, Germany.
| | - Baruch Shomron
- Department of Communications Studies, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Department of Communication, Johannes Gutenberg University Mainz (JGU), Mainz, Germany
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McDaid D, Vidyasagaran AL, Nasir M, Walker S, Wright J, Muliyala KP, Thekkumkara S, Huque R, Faisal MR, Benkalkar S, Kabir MA, Russell C, Siddiqi N. Understanding the costs and economic impact of mental disorders in South Asia: A systematic review. Asian J Psychiatr 2024; 102:104239. [PMID: 39332059 DOI: 10.1016/j.ajp.2024.104239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/11/2024] [Accepted: 09/05/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Mental disorders remain the most significant contributor to years lived with disability in South Asia, yet governmental health expenditure on mental health in South Asia remains very low with limited strategic policy development. To strengthen the case for action it is important to better understand the profound economic costs associated with poor mental health. METHODS We conducted a systematic review on the costs of all mental disorders, as well as intentional self-harm and suicide, in the World Bank South Asia Region. Ten global and South Asian databases as well as grey literature sources were searched. RESULTS 72 studies were identified, including 38 meeting high quality criteria for good reporting of costs. Of these, 27 covered India, five Pakistan, four Nepal and three Bangladesh and Sri Lanka. Most studies focused on depressive disorders (15), psychoses (14) and harmful alcohol use (7); knowledge of economic impacts for other conditions was limited. Profound economic impacts within and beyond health care systems were found. In 15 of 18 studies which included productivity losses to individuals and/or carers, these costs more than outweighed costs of health care. CONCLUSION Mental disorders represent a considerable economic burden, but existing estimates are conservative as they do not consider long-term impacts or the full range of conditions. Modelling studies could be employed covering longer time periods and more conditions. Clear distinctions should be reported between out-of-pocket and health system costs, as well as between mental health service-specific and physical health-related costs.
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Affiliation(s)
- David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | | | - Muhammed Nasir
- Department of Economics, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | | | | | | | | | | | - Claire Russell
- Metro North Hospital and Health Service, Queensland, Australia
| | - Najma Siddiqi
- Department of Health Sciences and Hull York Medical School (HYMS), York, UK; Bradford District Care NHS Foundation Trust (BDCFT), Bradford, UK
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Wallhagen MI, Kraemer JD, Saalim K, Adams ET, Stelmach RD, West JS, Chung JJW, Nyblade L. Development and Preliminary Validation of Stigma Measures for Care Partners of Persons Who Are d/Deaf or Hard of Hearing. Ear Hear 2024; 45:35S-41S. [PMID: 39294879 DOI: 10.1097/aud.0000000000001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
OBJECTIVES A great deal of literature documents the significant demands, both physical and psychosocial, that care partners experience when providing care to persons with a range of health conditions. There is, however, far less research available on care partners of adult persons who are d/Deaf or hard of hearing (d/DHH). In response to this gap, the authors developed measures of d/DHH stigma among care partners as part of the work of the Lancet Commission on Hearing Loss' Measures, Models, and Stigma Reduction Subgroup. The measures examined in this article are part of a larger set of parallel measures to enable comparison of stigma measurement across groups. DESIGN The present study describes the preliminary validation of five stigma scales specifically tailored for use to assess the prevalence and effect of stigma on the care partners of adult people who are d/DHH in the United States. Care partners in this context are defined broadly and can include spouses, partners, adult children, siblings, and friends of persons who are d/DHH. The scales describe the care partner's own assessment of how the person who is d/DHH experiences and perceives stigma as well as the care partner's own internalized, experienced, and perceived stigma as a result of their association with a person who is d/DHH. This latter set of three scales describes secondary stigma, or the stigma a person experiences related to their association with a member of a stigmatized group. Measures were developed through a process that included a literature review, Delphi groups with people who became d/DHH after they developed spoken language, cognitive interviews, and a pretest. An online, self-administered preliminary validation survey was conducted with 151 care partners. RESULTS Results support the internal reliability of each of the five stigma scales (ordinal α's all greater than 0.9) and that each scale is assessing a single factor. CONCLUSIONS Additional testing is needed to confirm the validity of these measures. After further validation, they can be used to assess the prevalence and effect of stigma on care partners of persons who are d/DHH and to evaluate the success of interventions developed to address stigma and its effects both on the care partner and the person who is d/DHH and receiving the care.
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Affiliation(s)
- Margaret I Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California, USA
| | - John D Kraemer
- Department of Health Management and Policy, Georgetown University, Washington, DC, USA
- International Development Group, RTI International, Research Triangle Park, North Carolina, USA
| | - Khalida Saalim
- International Development Group, RTI International, Research Triangle Park, North Carolina, USA
| | - Elizabeth Troutman Adams
- Social, Statistical, and Environmental Sciences Business Unit, RTI International, Research Triangle Park, North Carolina, USA
| | - Rachel D Stelmach
- International Development Group, RTI International, Research Triangle Park, North Carolina, USA
| | - Jessica S West
- Department of Head and Neck Surgery & Communication Sciences, Duke University Health System, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- Duke University Population Research Institute, Duke University, Durham, North Carolina, USA
| | - Jenny Jae Won Chung
- Department of Health Management and Policy, Georgetown University, Washington, DC, USA
| | - Laura Nyblade
- Social, Statistical, and Environmental Sciences Business Unit, RTI International, Research Triangle Park, North Carolina, USA
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Kochhar SS, Chadda RK, Sood M, Bhargava R. Knowledge of Mental Illness and Its Associations Among Caregivers of Patients With Schizophrenia. Cureus 2024; 16:e66448. [PMID: 39144411 PMCID: PMC11324005 DOI: 10.7759/cureus.66448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Schizophrenia is a severe mental illness that greatly impacts the real-world functioning of patients. In India, caregivers are primarily responsible for their patients and function as their support system, often taking treatment decisions on their behalf. However, they may have insufficient knowledge of the illness, which can have a negative impact on their roles as effective caregivers. The knowledge of schizophrenia and its associations among caregivers has received very little research attention. AIM To examine the knowledge of mental illness and its socio-demographic and psychosocial associations among caregivers of patients with schizophrenia. The objectives were to assess the knowledge of mental illness and its treatment in caregivers of patients with schizophrenia, to assess the socio-demographic and clinical associations of this knowledge, and to assess the caregivers' psychosocial variables associated with this knowledge. METHODOLOGY This cross-sectional observational data was taken from a larger study carried out between August 2018 and January 2021 at an urban tertiary care hospital in the capital city of India. One hundred fifty-eight patients with schizophrenia and their caregivers (n=158) were taken using purposive sampling. Knowledge of Mental Illness Scale was used to evaluate the knowledge and understanding of the illness and its treatment among caregivers. Caregivers coming to this institution in New Delhi were also assessed with respect to their demographic variables, caregiving experience, family functioning, coping strategies, available social support, psychological distress, quality of life, and spiritual, religious, and personal beliefs. The assessment also included demographic and clinical variables of the patients. RESULTS Caregivers possessed relatively greater knowledge regarding the medication being taken (52.5%), its side effects (38%), and the diagnosis (36.1%). However, their knowledge was poorer with respect to the meaning and implications of the diagnosis (21.5%) and the purpose of the medication (10.1%). In multivariate regression analysis of these five domains with socio-demographic, clinical, and psychosocial variables; the knowledge of the diagnosis was associated with a family history of psychiatric illness in a second-degree relative, the total duration of treatment, and stigma in caregivers. The meaning of the diagnosis was associated with the environmental domain of quality of life and positive symptoms of the patient. Knowledge of medication was associated with the number of patient hospitalizations, caregivers supervising medications, caregiver age, and the total duration of illness. Knowledge of the purpose of medication was associated with the total duration of illness and patient positive symptoms. Knowledge of medication side effects was associated with the roles domain of family functioning, positive caregiving experience, patient negative symptoms, and the acceptance/redefinition domain of coping. CONCLUSION A range of associations were examined in this study. Correct knowledge of schizophrenia is necessary to promote timely help-seeking, preventing a longer duration of untreated psychosis and a poor prognosis. In research, knowledge of illness is a construct with immense potential applicability. In patient care, this knowledge may help caregivers participate in treatment planning, improve patient functioning, and support their patients toward better functional outcomes.
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Affiliation(s)
- Sanimar S Kochhar
- Clinical Psychology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | | | - Mamta Sood
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Rachna Bhargava
- Clinical Psychology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Ong WJ, Goh CMJ, Tan GTH, Shahwan S, Subramaniam M. A qualitative enquiry on the impact of mental illness stigma on caregiving role and experiences in Singapore. Front Psychiatry 2024; 15:1417514. [PMID: 39041047 PMCID: PMC11262131 DOI: 10.3389/fpsyt.2024.1417514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/13/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction Given that mental illness stigma is a common occurrence amongst people with mental illness and caregivers (CGs) can be a potential victim of stigma themselves, there is a need to examine caregivers' perspective on the phenomenon. This study is part of a larger study which aims to qualitatively examine the concept of mental illness stigma amongst different stakeholders in Singapore. Methods Focus group discussions (FGDs) were conducted amongst 21 informal caregivers to explore the experience of stigma encountered by them and their care recipients, and how it may implicate their caregiving experience. Both inductive and deductive thematic analyses were employed to analyze the data. Results Three overarching themes of stigma encounters that may have implication on caregiving experience were identified: 1) Stigma within the family; 2) Structural stigma; and 3) Stigma by association. Experience of stigma within family (e.g., social exclusion and lack of understanding) limits the caregiving supports available to CGs. CGs also took up a mediating role between their care recipients and other family who may hold stigmatizing views. Witnessing their care recipients being subjected to structural disadvantages (e.g., employment, school, and mandatory conscription) can induce emotional stresses amongst CGs and motivate them to protest and seek redress on their behalf. Furthermore, encounters of stigma themselves (e.g., being judged or blamed for their loved one's condition) also led to feelings of guilt and self-blame amongst the CGs. Discussion These findings can aid the formulation of interventions in informing CGs on what to expect on their caregiving journey and supporting them in dealing with issues relating to stigma and highlight the importance of anti-stigma efforts in organizational settings such as schools, corporations, and government agencies.
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Affiliation(s)
- Wei Jie Ong
- Research Division, Institute of Mental Health, Singapore, Singapore
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Lohrasbi F, Maghsoudi J, Alavi M, Akbar M. Care Bermuda, families of the patients with chronic mental disorders in Iran surrounded by psychosocial problems and needs: a qualitative study. Ann Med Surg (Lond) 2024; 86:3357-3366. [PMID: 38846850 PMCID: PMC11152856 DOI: 10.1097/ms9.0000000000000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/28/2023] [Indexed: 06/09/2024] Open
Abstract
Background A mental disorder is characterized by a clinically significant impairment of cognition, emotion regulation, or behavior. As a result of the shift in care from medical centers and hospitals to home care, we now see a change in the treatment of patients with chronic mental disorders. Consequently, families have become the main support system in the progressive care of these patients, leading to psychological and social problems. The current qualitative study investigated the social and psychological health needs and problems of family caregivers of patients with chronic mental disorders in Iran's cultural and social context. Methods This was a content analysis qualitative study. The study was conducted in three psychiatric hospitals in Farabi, Noor, Modares. Purposive sampling was done and continued until data saturation. Semi-structured, face-to-face, and individual interviews were conducted with 49 participants (15 family caregivers of patients with CMD and 34 members of the mental health care team). Data analysis was done using the conventional content analysis method. Results Eight hundred seventy-five primary codes were obtained, which were classified into 10 subcategories and 3 main categories of 'health challenges of caregiver', 'confused concept of care' and "the need for a coherent support system. Conclusion In Iranian society, after the patient is discharged from the hospital or care center, family members will change their role to the most important caregivers of these patients. The psychological and social health of these caregivers is destroyed because of the problems they have in providing care for their patients and their needs, which are not met.
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Affiliation(s)
- Fateme Lohrasbi
- Mental Health Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences
| | - Jahangir Maghsoudi
- Nursing & midwifery care Research Center, Mental Health Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mousa Alavi
- Nursing & midwifery care Research Center, Mental Health Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Akbar
- Nursing & midwifery care Research Center, Mental Health Nursing Department, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Li Y, Qiu D, Wu Q, Ni A, Tang Z, Xiao S. Affiliate stigma and its association with family burden among family members of people living with schizophrenia in China. Schizophr Res 2024; 267:193-200. [PMID: 38569392 DOI: 10.1016/j.schres.2024.03.046] [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: 04/26/2023] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Understanding affiliate stigma and its impact on family of people living with schizophrenia (PLS) in China is important for culturally informed intervention. This study aims to describe the pattern of affiliate stigma of family members of PLS in China and investigated the association between affiliate stigma and family burden. METHODS PLS and their family members dwelling in community were randomly recruited from four cities across China and completed measures of affiliate stigma and family burden. Linear regression analyses were used to determine the association between affiliate stigma and family burden. RESULTS A total of 493 dyads of family member and PLS were include in this study. The mean affiliate stigma in family members was 2.21 (SD = 0.61). The vast majority of family members reported the feeling of inferiority, helpless and sad because of their family members' schizophrenia, but few family members refusing to communicate or contact with the PLS. The mean score of overall family burden was 22.25 (SD = 14.90), with 98 % of participants reported moderate or severe burden. A higher level of affiliate stigma was associated with more family burden (b = 7.837, 95CI: 5.240 to 8.747). Affiliate stigma was significantly associated with family daily activities, entertainment activities, family relationship, physical health and mental health of family members, but not family economic burden. CONCLUSION A higher level of affiliate stigma was associated with more family burden among family with PLS. Anti-stigma intervention of mental illness should be consider not only PLS but also their family members.
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Affiliation(s)
- Yilu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Qiu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiuyan Wu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Anyan Ni
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Zixuan Tang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Antonio G, Kwakye IN, Essel C. Experiences of relatives caring for psychiatric patients in the Greater Accra Region of Ghana. Br J Health Psychol 2024; 29:317-332. [PMID: 37844916 DOI: 10.1111/bjhp.12701] [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: 03/02/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The study aimed at examining the lived experiences of relatives caring for family members with mental illness in Ghana. METHODS Interpretative Phenomenological Analysis (IPA) was adopted to explore caregivers' in-depth experiences. Fifteen caregivers were purposefully selected from four hospitals within the Greater Accra Region of Ghana, and they were engaged in face-to-face interview sessions through the semi-structured guided interviews. Interviews were transcribed into text formats and analysed using the IPA approach. RESULTS Three superordinate themes and their respective sub-themes were identified. Theme 1: Being with the mentally ill (time consuming; financial burden; healer shopping); Theme 2: Psychosocial effect (stigmatization; stress and depression; changes in social/work life); Theme3: Coping resources (prayers/spirituality; psychological capital - ignoring, self-encouragement, acceptance, routinization; social/family support; reading). CONCLUSION It was recommended that healthcare professionals ought to prepare family members for the emotional challenges by providing them with constant therapeutic service to help reduce their emotional strain associated with the burden of care. Public education should be intensified for people to understand the need for accepting people with mental illness in order to reduce the issue of stigmatization. Again, government should institute policies through its agencies (Ministry of Health, Ghana Health Service) to assist the caregivers in the discharge of responsibilities. This could take the form of reducing cost of drugs, and establishing community mental health care to provide immediate support.
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Affiliation(s)
| | - Isaac Nyarko Kwakye
- Department of Built Environment, University of Environment and Sustainable Development, Somanya, Ghana
| | - Cynthia Essel
- Salvation Army Hospital/West End University College, Accra, Ghana
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Devkota HR, Poudel S, Shrestha MK, Oli RU, Rai NK, Poudel M, Banjara P, Malla C, Hazel YP, Dahal A, Gurung R. Examining the association between perceived stigma, its correlates, and restrictions in participation among persons with disabilities in Nepal: a cross-sectional study. BMC Public Health 2024; 24:1176. [PMID: 38671414 PMCID: PMC11046843 DOI: 10.1186/s12889-024-18682-9] [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: 07/27/2023] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Disability stigma in low- and middle-income countries is one of the most persistent and complex barriers limiting persons with disabilities (PwDs) from enjoying their rights and opportunities. Perceived stigma among PwDs and its impact on participation restriction is rarely assessed in Nepal. OBJECTIVE This study aimed to measure the extent of perceived stigma by PwDs, identify its relationships with specific demographic factors, and assess the impact on social participation. METHODS A cross-sectional survey was conducted between May and July 2022 among PwDs in Nepal, with a sample of 371. The Explanatory Model Interview Catalog (EMIC) stigma scale and P-scale suitable for people affected by stigmatized conditions were used, and the generated scores were analyzed. One-way ANOVA was performed to determine group differences for sociodemographic variables, and linear regression and correlational analysis were used to identify their association and measure the strength and direction of the relationship. RESULTS The mean stigma score was 16.9 (SD 13.8). 42% of respondents scored higher than the mean. The scores differed significantly by disability type, caste and ethnicity, education, occupation, and household wealth. Over 56% reported participation restriction, and 38% had severe/extreme restriction. Approximately 65% of participants with intellectual disabilities, 53% with multiple disabilities, and 48.5% of persons with severe or profound disabilities experienced severe or extreme restrictions. Perceived stigma had a positive correlation with Disability type (r = 0.17, P < 0.01) and negative correlations with Severity of disability (r= -0.15, P < 0.05), and Household wealth (r= -0.15, P < 0.01). Education was inversely associated with both stigma (r= -0.24, P < 0.01), and participation restriction (β= -9.34, P < 0.01). However, there was no association between stigma and participation restriction (β= -0.10, P > 0.05). CONCLUSION All participants exhibited stigma in general; however, the severity varied based on disability type, level of education, and sociocultural circumstances. A large proportion of participants reported facing a high degree of restrictions in participation; however, no association was detected between perceived stigma and participation restriction. A significant negative linear correlation was observed between education and participation restriction. Stigma reduction programs focusing on education and empowerment would be especially important for overcoming internalized stigma and increasing the participation of PwDs.
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Affiliation(s)
- Hridaya Raj Devkota
- Institute for Social and Environmental Research Nepal (ISER-N), Bharatpur-15, Chitwan, Nepal.
| | | | | | | | | | - Manish Poudel
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | | | | | | | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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Trani JF, Yen BJ, Duncan A, Bakhshi P, Palmo T, Jadhav S, Deshpande S. People with mental illness stigmatize mental illness less: A comparison study between a hospital-based sample of people with mental illness and a non-clinical general population sample in urban India. Transcult Psychiatry 2023; 60:954-972. [PMID: 37551092 DOI: 10.1177/13634615231179265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Evidence shows that stigma negatively influences the quality of life of persons with severe mental illness. Nonetheless, stigma towards mental illness is lower among persons with a lived experience of mental illness compared to the rest of the population. Understanding the association between stigma of mental illness and the mental status of individuals living in urban India and whether this association is moderated by demographic factors opens a new avenue for prevention of social exclusion. Persons diagnosed with schizophrenia, bipolar disorder, or severe unipolar depression (cases, n = 647) were recruited from among hospital patients in New Delhi between November 2011 and June 2012 and matched with non-psychiatric urban dwellers by age, sex, and location of residence (controls, n = 649). Propensity score matching with multivariable linear regression was used to test whether stigma towards mental illness, measured by a 13-item Stigma Questionnaire, differed between cases and controls. Cases reported significantly lower stigma scores than controls (b = -0.50, p < 0.0001). The strength of the association between mental illness and stigma was not affected after controlling for age, caste, sex, education, and employment status, while wealth marginally reduced the strength of the association. These findings suggest individuals with a lived experience of mental illness, in New Delhi, India, may be more tolerant towards mental illness and support the need to involve persons with lived experience in the development and implementation of health promotional campaigns and programs aimed at reducing stigma towards mental illness.
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Affiliation(s)
- Jean-Francois Trani
- Brown School and Institute of Public Health, Washington University in St Louis, USA
- National Pedagogical school Health and Solidarity, National Center for Arts and Crafts, France
| | - Bing-Jie Yen
- School of Public Health, Indiana University Bloomington, USA
| | - Alexis Duncan
- Brown School and Institute of Public Health, Washington University in St Louis, USA
| | - Parul Bakhshi
- School of Occupational Therapy, Medical School, Washington University in St Louis, USA
| | - Trinley Palmo
- Students health and wellness, University of Virginia, USA
| | | | - Smita Deshpande
- Department of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, PGIMER-Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Rao R, Majhi G, Rashmi A, Ponnuchamy L. What is associated with caregiver burden for adults with bipolar affective disorder: Illness severity or financial well being? Ind Psychiatry J 2023; 32:S86-S92. [PMID: 38370949 PMCID: PMC10871404 DOI: 10.4103/ipj.ipj_199_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/21/2023] [Accepted: 06/13/2023] [Indexed: 02/20/2024] Open
Abstract
Background Persons with bipolar affective disorder (BPAD) need long-term care and support. As most of the expenses for this are met personally by the caregivers, it will have financial implications for them. However, we do not know how much financial well-being is associated with the caregivers' burden as compared to the illness severity. Aim This study aimed to examine the association between financial well-being and illness severity with the caregivers' burden in the context of BPAD. Materials and Methods This study adopted a cross-sectional descriptive design. The first 50 consenting caregivers of persons with an International Classification of Diseases (ICD)-10 diagnosis of BPAD, who visited the National Institute of Mental Health and Neurosciences (NIMHANS) within 2019-2021, were included in the study. The patients were assessed on the Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF) for the severity of the symptoms and the current level of functioning, respectively. Caregivers were assessed on the Personal Finance Well-Being Scale. Results In this study, the majority of caregivers were males (62%), with a median, monthly household income of Rs. 24,000, and expenditure of Rs. 12,000. The median cost of medicine was Rs. 1000 per month. The majority (64%) of patients did not have any health insurance. A total of 28 (56%) caregivers reported the cost of damage due to illness behavior. It was found that the severity of illness and current level of functioning had a significant negative correlation with caregivers' burden. The financial well-being as reflected through income and health expenditure did not have a significant correlation with the caregivers' burden. Conclusions Caregivers of persons with BPAD meet the treatment expenditure out of their pocket. Though they have the financial burden, it is the illness severity and functioning capacities that are associated with caregivers' burden. These findings have implications for mental health care in persons with BPAD.
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Affiliation(s)
- Rachita Rao
- Research Associate, Project Funded by Alzheimer's Association USA, Moving Pictures: Using Digital Media to Improve Dementia Care in India, NIMHANS, Bengaluru, Karnataka, India
| | - Gobinda Majhi
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - A. Rashmi
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Lingam Ponnuchamy
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
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Dimitriou L, Chiu M, Carson J. Flourishing, psychological distress and internalized stigma among parents of an adult son or daughter with schizophrenia. Int J Soc Psychiatry 2023; 69:1481-1489. [PMID: 37095719 PMCID: PMC10523824 DOI: 10.1177/00207640231166630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
BACKGROUND Parents of adults diagnosed with schizophrenia, have been reported to have higher levels of psychological distress than the general population, and parents whose offspring have other mental or physical illnesses. AIM This study examines the comparatively new construct of flourishing, and its relationship to internalized stigma and psychological distress. METHOD A cross-sectional survey was conducted between July 2021 and March 2022, with an international sample of 200 parents of adult sons or daughters diagnosed with schizophrenia. Participants completed a demographic questionnaire and three standardized inventories. These were the PERMA Profiler, which measures flourishing, the CORE-10, which measures psychological distress, and a new parental Internalized Stigma Scale. Sample characteristics of individuals of schizophrenia and their parents were examined using descriptive statistics, and the contributing factors affecting stigma were assessed through regression analysis. RESULTS The initial hypothesis that parents scoring high on internalized stigma, would have significantly higher levels of psychological distress and lower levels of flourishing, than parents with low-level internalized stigma, was confirmed. Overall, the flourishing levels were lower and psychological distress higher in these parents, than those of the general population. Regression analysis identified psychological distress and hopefulness as the two major predictors of flourishing, though in different directions. Interestingly, stigma did not determine flourishing, in spite of their close relationship. CONCLUSIONS Researchers have long been aware of internalized stigma in persons with schizophrenia. Yet this study is one of the few that linked it with parents of adults with schizophrenia and flourishing and psychological distress. Implications were discussed in the light of the findings.
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Affiliation(s)
| | - Marcus Chiu
- School of Health and Social Care, University of Bolton, Bolton, UK
| | - Jerome Carson
- School of Psychology, University of Bolton, Bolton, UK
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Aggarwal M, Chakrabarti AS, Chatterjee C. Movies, stigma and choice: Evidence from the pharmaceutical industry. HEALTH ECONOMICS 2023; 32:1019-1039. [PMID: 36727570 DOI: 10.1002/hec.4653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 10/22/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
Do movies reduce stigma, increasing healthcare product choices offered by firms? We provide causal evidence on this question in the context of Indian pharmaceutical markets. For unpacking these effects, we use an exogenous shock to the market due to the release of a Bollywood blockbuster movie - My Name is Khan (MNIK) where the protagonist, superstar Shahrukh Khan, suffers from Asperger's Syndrome (AS). Using a difference-in-differences design, we find a positive and statistically significant effect of MNIK (between 14% and 22% increase in variety sold and prescribed) on product differentiation and choices in the market for antipsychotic medicines used to clinically treat AS. Results are consistent using alternative controls, a placebo treatment-based test and with a variety of other robustness checks. Our findings document likely for the first-time, supply side responses to edutainment and suggests potential associated welfare effects in healthcare markets characterized by sticky demand. Implications for global health and public policy given worldwide concerns around a mental wellness epidemic with Covid-19 are discussed.
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Affiliation(s)
| | - Anindya S Chakrabarti
- Economics Area, IIM Ahmedabad, Ahmedabad, India, Science Policy Research Unit, Business School, University of Sussex, Brighton, UK
| | - Chirantan Chatterjee
- Science Policy Research Unit, Business School, University of Sussex, IIM Ahmedabad & Hoover Institution, Stanford University, Brighton, UK
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15
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Tari-Keresztes N, Armstrong N, Smith JA, Gupta H, Goding S, Endemann SA. "You Don't Get That from Professionals": A Consumer-Led Peer Recovery Program for Families and Friends of Individuals with Alcohol and Other Drugs Use Issues in Darwin. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085514. [PMID: 37107795 PMCID: PMC10138685 DOI: 10.3390/ijerph20085514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
While there has been a reduction in alcohol consumption among Australians aged 18 years and above, about 25% of people still drink above the recommended limit. The use of alcohol and other drugs is a substantial issue in the Northern Territory; however, there have been significant investments in alcohol reforms over the past few years. This paper reports on a pilot study that involved co-designing, implementing, and evaluating the Circles of Support consumer-led recovery and empowerment program for families and friends of individuals with alcohol and other drugs use issues. The evaluation comprised a mixed-methods approach; however, this article only presents the qualitative component (n = 7). Interview data were thematically analysed, and four main themes were identified: (1) the value of a peer-to-peer approach; (2) facing challenges and distress; (3) adopting self-care strategies; and (4) the development of valuable skills. Participants enjoyed the program content and learning. This involved self-care and communication strategies, boundary setting, service navigation, the concept of post-traumatic growth, the circles of control, and the stages of change model for families. Our findings strongly support the scaling up of the program in Darwin and other locations across the Northern Territory and future program adaptation for different vulnerable target audiences.
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Affiliation(s)
- Noemi Tari-Keresztes
- Rural and Remote Health, College of Medicine & Public Health, Flinders University, Casuarina, NT 0815, Australia
- Correspondence:
| | - Noelene Armstrong
- Northern Territory Lived Experience Network, Darwin, NT 0820, Australia
| | - James A. Smith
- Rural and Remote Health, College of Medicine & Public Health, Flinders University, Casuarina, NT 0815, Australia
| | - Himanshu Gupta
- Rural and Remote Health, College of Medicine & Public Health, Flinders University, Casuarina, NT 0815, Australia
| | - Sam Goding
- Northern Territory Lived Experience Network, Darwin, NT 0820, Australia
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16
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Nigussie K, Tesfaye D, Bete T, Asfaw H. Perceived stigma, common mental disorders and associated factors among primary caregivers of adult patients with mental illness attending at public hospitals, Harari regional state, Eastern Ethiopia: A multicenter cross-sectional study. Front Public Health 2023; 11:1024228. [PMID: 36935723 PMCID: PMC10017855 DOI: 10.3389/fpubh.2023.1024228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Background Giving care to someone who is experiencing mental distress is a difficult and challenging task that could be detrimental to the caregiver's overall quality of life. Numerous studies show that caregivers frequently experience mental distress and feel stigmatized. However, there is limited study done on this topic in our country. Objective To determine the magnitude and associated factors of perceived stigma and common mental disorder among primary caregivers of adults with mental illness in public hospitals at Harari regional state, Eastern Ethiopia, 2022. Methods A cross-sectional study design was conducted. A total of 419 participants were recruited by a systematic random sampling technique. The data was collected by using a face-to-face interview and by reviewing patients' charts. Perceived stigma and common mental disorder were assessed by Family Interview Schedule and Self-Reporting Questionnaire, respectively. Epi-data version 4.6.2 was used to enter data, and SPSS version 20 was used to analyze. Bivariable and multivariable logistic regression were performed. P-values < 0.05 were considered statistically significant. Result The magnitude of perceived stigma and common mental disorder were 42.5% (95% CI, 37.7-47.3) and 39.4% (95% CI, 34.8-44.0) respectively. Age of caregiver between 26 and 33 [AOR = 3.13, 95% CI: (1.71-8.93)], no formal education [AOR = 3.85, 95% CI: (1.81-8.15)], illness duration ≥7 years [AOR = 1.93, 95% CI: (1.04-3.57)], family history of mental illness [AOR = 1.92, 95% CI: (1.09-3.39)] and poor social support [AOR = 4.87, 95% CI: (3.74-12.71)] were significantly associated with perceived stigma. Being female [AOR = 1.92, 95% CI: (1.31-3.34)], having no formal education [AOR = 4.04, 95% CI: (2.15-10.01)], having a family history of mental illness [AOR = 2.26, 95% CI: (1.29-4.00)], having comorbid other illness [AOR = 2.13, 95% CI: (1.15-3.94)], and having poor social support [AOR = 4.58, 95% CI: (2.53-8.28)] were significantly associated with common mental disorder. Conclusion The magnitude of perceived stigma and common mental disorder was high among primary caregivers of patients with mental illness compared with other studies. Age of caregiver between 26 and 33, no formal education, duration of illness ≥7 years, family history of mental illness and poor social support were associated with perceived stigma and being female, no formal education, family history of mental illness, comorbid other illness and poor social support were associated with common mental disorder.
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Affiliation(s)
- Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | | | | | - Henock Asfaw
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
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17
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Gong JW, Luo D, Liu WJ, Zhang J, Chen ZR, Wang QY, Yang XY, Yang BX, Huang HS, Wang XQ. Challenges faced when living with schizophrenia in the community: A narrative inquiry. Int J Soc Psychiatry 2023; 69:420-429. [PMID: 35943191 DOI: 10.1177/00207640221109168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Schizophrenia is a chronic and severe mental disorder. People with schizophrenia have transferred from hospital-based care to community-based care with the support of mental health legal policies. Challenges faced in the community should be emphasized. Limited qualitative studies have explored the challenges of living with schizophrenia. AIMS To explore the challenges of people living with schizophrenia in the community. METHODS A narrative method was used, including semi-structured, face-to-face interviews. Thematic analysis approach was used to analyze data. RESULTS Ten clients and their family members participated in the study. Analysis revealed three main themes related to their challenges in the community: deficits in self-management of illness; insufficient community mental health care; and the influence of policy. These challenges prevent those with schizophrenia from effectively managing their illness, returning to a productive role in society, and improving their quality of life. CONCLUSIONS There are challenges in mental health rehabilitation and social reintegration of individuals with schizophrenia. There is a need for continuous community mental rehabilitation services, appropriate policy support, and the need to educate the public to reduce social bias and discrimination which allows individuals with schizophrenia to assume a productive role in the community.
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Affiliation(s)
| | - Dan Luo
- School of Nursing, Wuhan University, China
| | - Wen Jia Liu
- School of Nursing, Wuhan University, China.,University of Washington School of Nursing, Seattle, USA
| | - Juan Zhang
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zi Ru Chen
- School of Nursing, Wuhan University, China
| | - Qin-Yu Wang
- Department of Psychology, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Bing Xiang Yang
- School of Nursing, Wuhan University, China.,Department of Psychiatry, Renmin Hospital of Wuhan University, China.,Population and Health Research Center, Wuhan University, China
| | - Hai-Shan Huang
- Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Sharifi M, Younesi SJ, Foroughan M, Safi MH, Khanjani MS. The Challenges of Caring for an Adult Child with Schizophrenia in the Family: An Analysis of the Lived Experiences of Older Parents. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580221148867. [PMID: 36752143 PMCID: PMC9909083 DOI: 10.1177/00469580221148867] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The present study aimed to investigate the lived experiences of older parents regarding the challenges in caring for adult children with schizophrenia. The current study was conducted on 16 parental (mother or father) caregivers of adult children with schizophrenia using a descriptive phenomenological qualitative approach and Colaizzi's seven-step method. This study follows the Qualitative Research Checklist (COREQ). The findings showed that the parent caregivers' experiences could be classified into two main themes: "burden of care" and "Negative attitude and inefficient performance." The former consisted of three sub-themes including "disrupted social and family interactions," "helplessness and inefficient support," and "challenges of the healthcare system," while the latter had two sub-themes including "Negative attitude and inefficient performance of the caregivers" and "Negative attitude and inefficient performance of families and society." Older parents have to tolerate a significant burden of care due to their age and physical conditions. Improving the knowledge of specialists, the government's redoubled efforts in multifaceted support for patients and caregivers, creating an integrated team of specialists, and accepting and improving public attitudes against stigma and obvious discrimination in society as important priorities in improving the condition of caregivers and patients with schizophrenia were considered.
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Affiliation(s)
- Mehdi Sharifi
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,Department of Counseling, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyyed Jalal Younesi
- Department of Counseling, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,Seyyed Jalal Younesi, Department of Counseling, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Mahshid Foroughan
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hadi Safi
- Department of Psychology, Faculty of Humanities & Social Sciences, Ardakan University, Ardakan, Iran
| | - Mohammad Saeed Khanjani
- Department of Counseling, Faculty of Behavioral Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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19
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Wang Y, An S, Yang X, Zhang Z, Li S, Yao J, Chen Y, Deng H. Disease information disclosure among patients with mental illness and their family members in China. Front Psychiatry 2023; 13:1036568. [PMID: 36683996 PMCID: PMC9846142 DOI: 10.3389/fpsyt.2022.1036568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023] Open
Abstract
Objective The disclosure of mental illness is a first and crucial step in alleviating stigma and promoting mental recovery. However, at present, there is a lack of research on this subject in the Chinese context. Therefore, we conducted this survey among patients with mental illness and their family members and analyzed the influencing factors. Methods Questionnaires were distributed to qualified patients with mental illness and their family members, who were enrolled from the inpatient departments of two major mental health centers in China. Hierarchical linear regression analysis was used to evaluate the factors affecting the disclosure of disease information by patients with mental illness and their family members. Results A total of 153 patients and 159 family members were included. The percentages of patients and family members who intended to disclose disease information were 34.6 and 18.2%, respectively. Regarding the benefits of being out (BBO), marital status and the number of hospitalizations explained 13.1% of the variance, and stigma explained 4.3% of the variance. Regarding the reasons for staying in (RSI), marital status and family history of mental illness explained 14.4% of the variance, and stigma explained 14.8% of the variance. In the model predicting the influencing factors of family member disclosure, stigma was a predictor of both BBO and RSI, explaining 8.1 and 8.7% of the variance, respectively. Conclusion Both patients and their families were more reluctant than willing to disclose. Marital status, number of hospitalizations and family history of mental illness were all influencing factors of patients' intentions to disclose disease information. Stigma is closely related to disclosure intention and plays an important role in the disclosure intentions of patients and their families. This suggests that the disclosure of disease information is complex, and many factors need to be considered. Disclosure guidelines should be tailored to individuals.
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Affiliation(s)
- Yi Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- Sleep Medicine Center, The Third People’s Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Siyao An
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Xun Yang
- School of Public Affairs, Chongqing University, Chongqing, China
| | - Zhuoqiu Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Shuiying Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Jing Yao
- Sleep Medicine Center, The Third People’s Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Ying Chen
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Hope Recovery and Rehabilitation Center, Chengdu, China
| | - Hong Deng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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20
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Li XH, Deng SY, Zhang TM, Wang YZ, Wei DN, Wong IYL, Chan CLW, Ran MS. Affiliate stigma of mental illness in family caregivers of persons with mental illness in Hong Kong. Int J Soc Psychiatry 2022; 68:1698-1707. [PMID: 34791960 DOI: 10.1177/00207640211057723] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Affiliate stigma of family caregivers may severely influence family caregiving, early treatment, and recovery of people with mental illness (PMI), and it may be impacted by the knowledge of mental illness and contact with PMI. However, little is known about the correlation between affiliate stigma of family caregivers of PMI and contact in Hong Kong. AIMS This study aimed to investigate affiliate stigma and its influencing factors among family caregivers of PMI in Hong Kong. METHODS A total of 106 family caregivers in Hong Kong participated in the study. The measurements included affiliate stigma, contacts (quantity, quality, and level), knowledge, prejudice, and discriminatory behaviors. Multiple regression analyses were employed. RESULTS The mean score of affiliate stigma scale (ASS) in family caregivers was 2.17 (SD = 0.65). In regression analyses, the results showed that contact quantity and contact level were significantly associated with higher affiliate stigma and its cognitive domain, while contact quality (e.g. positive contact) were significantly associated with lower affiliate stigma and its all domains among family caregivers. The positive relationship between prejudicial attitudes and affiliate stigma was also found. CONCLUSIONS Affiliate stigma is severe among family caregivers of PMI in Hong Kong. The results of this study indicate that contact, especially positive contact, contributes to reducing affiliate stigma among family caregivers of PMI. The results of this study are important for development of health policy on reducing stigma in family caregivers of PMI. The effectiveness of Enhancing Contact Model (ECM) should be examined in future anti-stigma interventions.
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Affiliation(s)
- Xu-Hong Li
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Shu-Yu Deng
- Department of Social Work and Social Administration, University of Hong Kong, China
| | | | - Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Dan-Nuo Wei
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Irene Yin Ling Wong
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, USA
| | - Cecilia Lai-Wan Chan
- Department of Social Work and Social Administration, University of Hong Kong, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, China
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21
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Can Öz Y, Duran S, İncedere A. Requirements of caregivers of patients with schizophrenia: A qualitative study in Turkey. Arch Psychiatr Nurs 2022; 41:81-86. [PMID: 36428079 DOI: 10.1016/j.apnu.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/04/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
Abstract
Caregivers have different experiences and difficulties in the patient care process during which the role of providing care is fulfilled. Understanding the requirements of caregivers may help determine the content of the country-specific psychoeducation program needed. Caregivers of patients with schizophrenia want certain needs to be met while they provide care to these patients. This qualitative study aims to determine and analyze these needs. The researchers conducted face-to-face semi-structured interviews with 15 caregivers. Themes were Themes identified included determined as managing disease behavior, gaining independent living skills, managing social-educational problems, and psychosocial support needs of the family members. Mental health and psychiatric nurses should understand, accept, and protect the needs of caregivers. It is suggested that mental health and psychiatric nurses plan group training about the determined needs and provide support for caregiving family members.
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Affiliation(s)
- Yüksel Can Öz
- Kocaeli University, Faculty of Health Sciences, Department of Psychiatric Nursing, Kocaeli, Turkey.
| | - Songül Duran
- Izmir Demokrasi University, Health Services Vocational College, Care of Elderly Program, Izmir, Turkey
| | - Aysel İncedere
- Istanbul University-Cerrahpaşa, Graduate Education Institute Mental Health and Psychiatric Nursing PhD Student, İstanbul, Turkey
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22
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Naslund JA, Tyagi V, Khan A, Siddiqui S, Kakra Abhilashi M, Dhurve P, Mehta UM, Rozatkar A, Bhatia U, Vartak A, Torous J, Tugnawat D, Bhan A. Schizophrenia Assessment, Referral and Awareness Training for Health Auxiliaries (SARATHA): Protocol for a Mixed-Methods Pilot Study in Rural India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14936. [PMID: 36429654 PMCID: PMC9690971 DOI: 10.3390/ijerph192214936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/05/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Workforce shortages pose major obstacles to the timely detection and treatment of schizophrenia, particularly in low-income and middle-income countries. The SARATHA (Schizophrenia Assessment, Referral, and Awareness Training for Health Auxiliaries) project involves the systematic development, iterative refinement, and pilot testing of a digital program for training community health workers in the early detection and referral of schizophrenia in primary care settings in rural India. METHODS SARATHA is a three-phase study. Phase 1 involves consulting with experts and clinicians, and drawing from existing evidence to inform the development of a curriculum for training community health workers. Phase 2 consists of designing and digitizing the training content for delivery on a smartphone app. Design workshops and focus group discussions will be conducted to seek input from community health workers and service users living with schizophrenia to guide revisions and refinements to the program content. Lastly, Phase 3 entails piloting the training program with a target sample of 20 community health workers to assess feasibility and acceptability. Preliminary effectiveness will be explored, as measured by community health workers' changes in knowledge about schizophrenia and the program content after completing the training. DISCUSSION If successful, this digital training program will offer a potentially scalable approach for building capacity of frontline community health workers towards reducing delays in early detection of schizophrenia in primary care settings in rural India. This study can inform efforts to improve treatment outcomes for persons living with schizophrenia in low-resource settings.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | | | | | - Saher Siddiqui
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | | | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru 560029, India
| | - Abhijit Rozatkar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Bhopal 462026, India
| | - Urvita Bhatia
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford OX3 0BP, UK
- Sangath, Porvorim 403501, India
| | - Anil Vartak
- Schizophrenia Awareness Association, Pune 411041, India
| | - John Torous
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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23
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Rangaswamy T. Stigma and discrimination: Time for interventions. Indian J Psychiatry 2022; 64:537-539. [PMID: 36714676 PMCID: PMC9881710 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_743_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Thara Rangaswamy
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
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Wang M, Chen L, Tang J, Wei Y, Jin G, Lu X. Access to family resources by families living with schizophrenia: a qualitative study of primary care workers in urban Beijing, China. BMJ Open 2022; 12:e062675. [PMID: 36691176 PMCID: PMC9454069 DOI: 10.1136/bmjopen-2022-062675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study aims to investigate the access to family resources by families living with schizophrenia from the perspective of primary care workers in Beijing, and provide evidence for appropriate and effective family resource coordination in primary care. DESIGN Qualitative research using individual in-depth interviews to identify the access to family resources by families living with schizophrenia from the perspective of primary care workers. SETTING This study was conducted from September to December 2021 in six urban community health service centres (CHSCs) in Beijing, China. PARTICIPANTS 3 general practitioners and 10 mental health doctors selected by purposive sampling method from 6 CHSCs in urban Beijing were interviewed. RESULTS Five themes emerged from the insights of the primary care workers: most family resources are non-targeted for families living with schizophrenia, the publicity of family resources is difficult, burdensome application process of family resources, limited available community-based treatment options and stigma hindering effective communication between families and society. CONCLUSIONS It is necessary to simplify the application process of family resources and provide primary care workers with systematic training regarding family resources. More family resources and improved public attitudes should be promoted for patients with schizophrenia and their caregivers.
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Affiliation(s)
- Meirong Wang
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
- General Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lifen Chen
- Department of Education, Xuanwu Hospital, Beijing, China
| | - Juan Tang
- General Practice, Gong He Community Health Service Center, Beijing, China
| | - Yun Wei
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Guanghui Jin
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Xiaoqin Lu
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
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Kalayci E, Uzunaslan İ, Uzunaslan Ş. Caregiver burden experiences of caregivers of patients with schizophrenia: A qualitative inquiry. Int J Soc Psychiatry 2022; 69:543-550. [PMID: 35978546 DOI: 10.1177/00207640221114564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Parents of children with schizophrenia struggle with emotional, social, and economic burdens because they do not receive adequate support and experience difficulties. AIM To determine the caregiver burden experiences of parents who care for schizophrenic patients and to provide in-depth data on their feelings, thoughts, and opinions on this issue. METHODS In this study, the phenomenological method was used. In-depth interviews were conducted with 13 parents. Maxqda 2020 was used for the analysis of the research data. RESULTS In our qualitative study, it was concluded that caregivers were stigmatized by their environment, exposed to social isolation, and stigmatized themselves. It has been determined that the social isolation experienced by the parents negatively affects them economically, socially, and emotionally. CONCLUSION The results of this study were discussed within the framework of three themes: emotional burden, social burden, and economic burden experienced by caregivers.
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Analysis of family stigma and socioeconomic factors impact among caregivers of patients with early- and late-onset Alzheimer's disease and frontotemporal dementia. Sci Rep 2022; 12:12663. [PMID: 35879380 PMCID: PMC9314345 DOI: 10.1038/s41598-022-16400-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 07/08/2022] [Indexed: 11/28/2022] Open
Abstract
To the best of our knowledge, there are no research studies about socioeconomic factors, family stigma, and their psychological impact on early-onset dementia caregivers. We assessed the impact of family stigma and socioeconomic factors on psychological outcomes, quality of life (QoL), and caregiver burden among 150 caregivers of patients with early-onset Alzheimer’s disease due to E280A mutation in presenilin 1 (EOAD), frontotemporal dementia (FTD), and late-onset Alzheimer’s disease (LOAD). Caregivers of patients with EOAD presented a higher frequency of socioeconomic risk factors. Caregivers of FTD presented higher levels of family stigma and a higher prevalence of negative outcomes. We found family stigma to be a more suitable predictor of all outcomes. After adjusting for the type of dementia, dementia stage and behavioral changes, and caregiver age and education, family stigma was the most important factor associated with a higher risk of caregiver burden and a reduction in QoL in terms of energy fatigue and emotional wellbeing among early-onset dementia caregivers.
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Ran MS, Wang YZ, Lu PY, Weng X, Zhang TM, Deng SY, Li M, Luo W, Wong IYL, Yang LH, Thornicroft G, Lu L. Effectiveness of enhancing contact model on reducing stigma of mental illness among family caregivers of persons with schizophrenia in rural China: A cluster randomized controlled trial. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 22:100419. [PMID: 35257121 PMCID: PMC8897707 DOI: 10.1016/j.lanwpc.2022.100419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Contact-based intervention has been documented and proved effective on reducing stigma of mental illness in high-income countries, but it is still unclear about the effectiveness of the contact-based intervention among family caregivers of persons with schizophrenia (FCPWS) in low- and middle-income countries including rural China. Methods We conducted a cluster randomized controlled trial in FCPWS in eight rural townships in Xinjin district of Chengdu city in Southwest China. The FCPWS in these townships were randomly allocated to the Enhancing Contact Model (ECM), Psychoeducational Family Intervention (PFI), or Treatment as Usual (TAU) group. FCPWS in three groups were provided specific interventions and follow-ups. By using a mixed-effect model, our goal was to examine the differences in affiliate self-stigma scale (ASSS) scores among three groups with the data collected at baseline (T0), post-intervention (T1), 3-month (T2), and 9-month (T3) follow-up timepoints, respectively. This trial is registered with ChiCTR, number ChiCTR2000039133. Findings In April 2019, 253 FCPWS from 8 townships were randomly assigned to receive either ECM (cluster=3, n=90), PFI (cluster=2, n=81), or TAU (cluster=3, n=82). Compared with participants in the TAU group, participants in the ECM group had statistically significantly lower ASSS scores at 9-month follow-up (estimated parameter [EP]= -5.51, 95% CI -10.27 to -0.74, p=0.02). There were no statistically significantly different ASSS scores at 9-month follow up between ECM and PFI groups. Compared with participants in the PFI group, younger (<60 years old), with higher monthly income and other caregiver (e.g., parent, sibling, child) participants in the ECM group had statistically significantly lower ASSS scores in the 3-month follow-up (EP = -5.66, 95% CI -10.13 to -1.19, p<0.01; EP = -7.82, 95% CI -11.87 to -3.78, p<0.001; EP = -6.79, 95% CI -10.69 to -2.90, p<0.001, respectively). Interpretation This first trial in rural China shows that ECM intervention, a new anti-stigma intervention model, is a promising method for reducing affiliate stigma among FCPWS. The ECM intervention is more effective and stable than the PFI on reducing affiliate stigma among FCPWS. Further research needs to explore whether a long-term intervention could produce a more positive anti-stigma outcome trajectory. Funding General Research Fund, University Grants Committee, Hong Kong SAR (GRF, Grant No. 17605618, 2018-2021, PI: Dr. M.S. Ran).
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Affiliation(s)
- Mao-Sheng Ran
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Corresponding author at: Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China.
| | - Yi-Zhou Wang
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Pei-Yi Lu
- Department of Political Science, Iowa State University, United States
| | - Xue Weng
- Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University at Zhuhai, Zhuhai, China
| | - Tian-Ming Zhang
- Department of Social Work, Shanghai University, Shanghai, China
| | - Shu-Yu Deng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Ming Li
- Chengdu Xinjin Second People's Hospital, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, China
| | - Irene Yin-Ling Wong
- School of Social Policy and Practice, University of Pennsylvania, United States
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, New York University, United States
- Department of Epidemiology, Columbia University, United States
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China
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Karaçar Y, Bademli K. Relationship between perceived social support and self stigma in caregivers of patients with schizophrenia. Int J Soc Psychiatry 2022; 68:670-680. [PMID: 33730905 DOI: 10.1177/00207640211001886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The study was conducted to determine the relationship between self-stigmatization and perceived social support in caregivers of schizophrenia with patient. METHODS A cross-sectional study design was used. The study sample consisted of 84 participants who cared for schizophrenic patients registered in a community mental health center. In the data collection, the 'Self-stigmatizing Scale for Families' and 'Multidimensional Perceived Social Support Scale' were used. The data were analyzed via frequency, mean, standard deviation, Cronbach's alpha analysis, linear regression, Pearson correlation analysis, independent samples t-test, and ANOVA test. RESULTS Self-stigmatization (32.48 ± 15.15) and perceived social support (44.36 ± 22.88) were found to be moderate in caregivers. Self-stigmatization was found to be higher in caregivers who do not work; have a spouse, mother, or father; have a disease; do not receive support from their family and have not received any education about schizophrenia (p < .05). It was determined that, with increasing age, perceived social support decreases, and the perception of social support increases in caregivers who are high school graduates, working, having children, have no illness, and are educated about schizophrenia (p < .05). It was determined that, as the level of perceived social support increases in caregivers, self-stigmatization decreases (p < .05). CONCLUSION It was determined that, as the perceived social support increases in caregivers, self-stigmatization decreases. We recommend providing informative support about schizophrenia, to increase hope and social-skill training, and to implement interventions that include caregivers in the fight against stigma.
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Affiliation(s)
- Yeliz Karaçar
- Department of Psychiatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Kerime Bademli
- Department of Psychiatric Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Patra BN, Patil V, Balhara YPS, Khandelwal SK. Self-stigma in patients with major depressive disorder: An exploratory study from India. Int J Soc Psychiatry 2022; 68:147-154. [PMID: 33243067 DOI: 10.1177/0020764020975811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND One of the barriers to effective care in patients with depression is stigma associated with having a mental disorder, which also acts as a barrier to recovery and increases the disability. AIMS To study the stigma and disabilities experienced by the patients with depressive disorders seeking treatment in a tertiary care hospital. METHODOLOGY Fifty patients diagnosed to have depressive disorder as per ICD-10 were recruited by convenient sampling. To measure the stigma, the Discrimination and Stigma Scale -12 was applied. The severity of depression was determined by applying Hamilton Depression Rating Scale (HAMD). The disability was calculated by using WHO Disability Assessment Schedule 2.0. RESULTS Fifty percentages of the participants reported unfair treatment and they experienced discrimination in at least one life domain. There was significant positive correlation between unfair treatment subscale of stigma and disability. Around one fourth of the participants reported to be treated unfairly by their own families. Seventy percent reported to have concealed their mental health problems, 54% have stopped themselves from having a close personal relationship and 32% didn't apply for work in anticipating discrimination. Experienced and anticipated discrimination were significantly associated with concealing the mental health problem. CONCLUSION Stigma due to having depression acts as a barrier to vocational & social integration and functional recovery. Concealment of the diagnosis of depression is itself barrier for help seeking and to receiving appropriate treatment. Small sample size and adopting the purposive sampling method are the limitations of the study.
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Affiliation(s)
- Bichitra Nanda Patra
- Department of Psychiatry & NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vaibhav Patil
- Department of Psychiatry & NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Yatan Pal Singh Balhara
- Department of Psychiatry & NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sudhir K Khandelwal
- Department of Psychiatry & NDDTC, All India Institute of Medical Sciences (AIIMS), New Delhi, India.,Presently at Holy Family Hospital, Okhla, New Delhi
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Richard-Lepouriel H, Aubry JM, Favre S. Is Coping with Stigma by Association Role-Specific for Different Family Members? A Qualitative Study with Bipolar Disorder Patients' Relatives. Community Ment Health J 2022; 58:179-192. [PMID: 33751291 PMCID: PMC8732906 DOI: 10.1007/s10597-021-00809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/23/2021] [Indexed: 12/01/2022]
Abstract
Trying to cope with stigma by association (SBA) often results in behaviors leading to social isolation and withdrawal. This study aimed at exploring the stigma-related experiences of family members of persons living with bipolar disorder (PW-BD). A semi-structured interview was conducted with relatives of PW-BD. Open-ended questions addressed three issues: awareness of public stigma of bipolar disorder, experiences of associative stigma, and ways of coping with experiences of SBA. Data were collected from a purposive sample of 21 family members. Experiences of SBA were specifically related to the different family roles. Parents had to deal with responsibility, partners with the choice of staying or not, and siblings with "a sort of duty." These specific prejudices enhanced specific coping strategies. This is the first study to highlight specific issues and coping from the perspective of family members. Based on these findings, specific targeted interventions could be developed.
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Affiliation(s)
- Hélène Richard-Lepouriel
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Rue de Lausanne 20, 1201, Geneva, Switzerland.
| | - Jean-Michel Aubry
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Rue de Lausanne 20, 1201, Geneva, Switzerland.,Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Sophie Favre
- Mood Disorder Unit, Psychiatric Specialties Service, Geneva University Hospital, Rue de Lausanne 20, 1201, Geneva, Switzerland
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31
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Salunkhe G, Böge K, Wilker T, Zieger A, Jena S, Mungee A, Ta TMT, Bajbouj M, Schomerus G, Hahn E. Perceived Course of Illness on the Desire for Social Distance From People Suffering From Symptoms of Schizophrenia in India. Front Psychiatry 2022; 13:891409. [PMID: 35722581 PMCID: PMC9204028 DOI: 10.3389/fpsyt.2022.891409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stigmatization of people with schizophrenia remains a highly relevant topic worldwide, particularly in low- and middle-income countries like India. It is crucial to identify the determinants of the desire for social distance as a proxy for discriminatory behavior in a socio-cultural context to indicate ways to reduce stigma. This study aims to explore whether the public perception of the perceived course of an illness concerning people with symptoms of schizophrenia has an impact on the desire for social distance. SUBJECTS AND METHODS Data collection took place in five cities in India. The sample (N = 447) was stratified for gender, age, and religion. Desire for social distance was sampled based on a self-reported questionnaire using unlabelled vignettes for schizophrenia. First, factor analysis was conducted to identify the main factors underlying the perception of the perceived course of the illness. Subsequently, a regression analysis was conducted to examine the impact of the perception of those prognostic factors on the desire for social distance. RESULTS Factor analysis revealed two independent factors of the perceived course of an illness: (1) life-long dependency on others and loss of social integration and functioning and (2) positive expectations toward treatment outcome. This second factor was significantly associated with a less desire for social distance toward persons with schizophrenia. CONCLUSION The desire for social distance toward people with schizophrenia reduces with the expectation of positive treatment outcomes which underlines the need to raise public mental health awareness and provide psychoeducation for affected people and their family members in India. Help-seeking behaviors can be promoted by directing those needing treatment toward locally available, affordable and credible community-based services rather than facility-based care. Strikingly, lifelong dependency and the inability to socially integrate do not increase the desire for social distance, reflecting the Indian nation's socio-relational values and insufficiency of public mental health services. This indicates the suitability of systemic therapy approaches in public mental healthcare services to support the family's involvement and family-based interventions in caregiving for mentally ill people across the lifespan.
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Affiliation(s)
- Gayatri Salunkhe
- Centre of Medicine and Society, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kerem Böge
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Tanja Wilker
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Aron Zieger
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Sunita Jena
- Public Health Department, Asian Institute of Public Health, Utkal University, Bhubhaneshwar, India
| | - Aditya Mungee
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Georg Schomerus
- Department of Psychiatry, Universitätsklinikum Leipzig, University of Leipzig, Leipzig, Germany
| | - Eric Hahn
- Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Minichil W, Getinet W, Kassew T. Prevalence of perceived stigma and associated factors among primary caregivers of children and adolescents with mental illness, Addis Ababa, Ethiopia: Cross-sectional study. PLoS One 2021; 16:e0261297. [PMID: 34928986 PMCID: PMC8687571 DOI: 10.1371/journal.pone.0261297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
Background Mental illness exposes persons to stigma and this stigma also affects family caregivers of persons with mental illness. The objective of the study was to assess the prevalence of perceived stigma and associated factors among primary caregivers of children and adolescents with mental illness, Addis Ababa, Ethiopia. Methods A cross-sectional study design and systematic random sampling technique were used to recruit 408 participants at St. Paul’s Hospital Millennium Medical College and Yekatit-12 Hospital Medical College, Addis Ababa, Ethiopia. We collected the data by face-to-face interview. Devaluation of Consumer Families Scale was used to measure perceived stigma. Patient Health Questionnaire-9 and Oslo-3 social support scale were the instruments used to assess the factors. Coded variables were entered into Epidata V.3.1 and exported to SPSS V.21 for analysis. Binary logistic regression was used for analysis. Result A total of 408 participants were interviewed, with a response rate of 96.5%. The magnitude of perceived stigma was 38.5% with 95% CI (33.6-43.1). Majority (68.6%) of the respondents were female. In the multivariate logistic regression, being mother (AOR = 2.8, 95% CI: 1.59, 4.91), absence of other caregiver (AOR = 2.0, 95% CI: 1.15, 3.49), poor social support (AOR = 3.9, 95% CI: 1.59, 6.13), and symptoms of depression (AOR = 2.9, 95% CI: 1.88, 3.65) were factors significantly associated with perceived stigma. Conclusion The prevalence of perceived stigma among primary caregivers of children and adolescents with mental illness was high. Being mother, absence of other caregiver, poor social support, and symptoms of depression were factors significantly associated with perceived stigma.
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Affiliation(s)
- Woredaw Minichil
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Wondale Getinet
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Monnapula-Mazabane P, Petersen I. Mental health stigma experiences among caregivers and service users in South Africa: a qualitative investigation. CURRENT PSYCHOLOGY 2021; 42:9427-9439. [PMID: 34465971 PMCID: PMC8396139 DOI: 10.1007/s12144-021-02236-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/06/2022]
Abstract
The study aimed to understand the nature and context of mental health stigma among people living with a mental health condition and the subsequent effect on their caregivers. Semi-structured qualitative face to face interviews were conducted by trained mental healthcare professionals with mental health service users (n = 26) and caregivers (n = 24) in private rooms at a tertiary health facility, where service users were admitted. Following transcription and translation, data was analysed using framework analysis. There was limited knowledge about their mental health diagnosis by service users and generally low mental health literacy among service users and caregivers. Mental health service users reported experiences of stigma from their own families and communities. Caregivers reported withholding the patient’s diagnosis from the community for fear of being stigmatised, and this fear of stigma carries the risk of negatively affecting care treatment-seeking. Limited mental health knowledge, coupled with a high prevalence of perceived family and community stigma among caregivers and service users, impedes the capacity of caregivers to effectively cope in supporting their family members living with mental illness. There is a need for interventions to provide psychoeducation, reduce community stigma, and support coping strategies for caregivers and people with mental health conditions.
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Affiliation(s)
- Portia Monnapula-Mazabane
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
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Asher L, Birhanu R, Baheretibeb Y, Fekadu A. "Medical treatments are also part of God's gift": Holy water attendants' perspectives on a collaboration between spiritual and psychiatric treatment for mental illness in Ethiopia. Transcult Psychiatry 2021; 58:585-599. [PMID: 34034571 DOI: 10.1177/13634615211015082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Ethiopia, traditional and spiritual treatments, such as holy water, are used by people with mental disorders instead of, or alongside, psychiatric services. Collaborations between traditional and psychiatric providers may increase access to evidence-based treatments and address human rights abuses. This study aimed to explore the perspectives of holy water attendants on a novel collaboration between holy water and psychiatric care, at St Mary's Clinic, Entoto, Ethiopia, and to characterize the users of this service. Semi-structured interviews were conducted with 14 holy water attendants, who run group houses for holy water residents and are paid by family members. A thematic analysis was conducted. Socio-demographic and clinical data were extracted from the records of all service users who had attended the clinic. A total of 174 individuals have attended the clinic in the three years since it opened. The majority were diagnosed with schizophrenia. Holy water attendants provide a partial gatekeeping role to psychiatric care, selecting which of their clients they think will benefit and, for these individuals, facilitating attendance to the clinic and antipsychotic medication adherence. Psychiatric care was felt to be compatible with holy water by some, but not all, attendants. However, family members often had the "final say" in individuals attending the clinic, in some cases putting up strong resistance to using psychiatric care. A novel collaboration is acceptable to some holy water attendants and may increase access to psychiatric care amongst people with mental illness living at a holy water site in Ethiopia.
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Affiliation(s)
- Laura Asher
- University of Nottingham, School of Medicine, Academic Unit of Population and Lifespan Sciences, Nottingham, UK
| | - Ribka Birhanu
- Addis Ababa University, College of Health Sciences, Department of Psychiatry, Addis Ababa, Ethiopia
| | - Yonas Baheretibeb
- Addis Ababa University, College of Health Sciences, Department of Psychiatry, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, Department of Psychiatry, Addis Ababa, Ethiopia
- Addis Ababa University, College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa, Ethiopia
- Brighton and Sussex Medical School, Global Health & Infection Department, Brighton, UK
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Sarkar NDP, Bardaji A, Baingana FK, Rivera JM, Criel B, Bunders-Aelen J, Grietens KP. Intra-household Variation in Pathways to Care for Epilepsy and Mental Disorders in Eastern Uganda. Front Public Health 2021; 9:583667. [PMID: 34381746 PMCID: PMC8350049 DOI: 10.3389/fpubh.2021.583667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 06/14/2021] [Indexed: 11/22/2022] Open
Abstract
Integrating mental, neurological, and substance use (MNS) health care into the public health system has become a global priority, with mental health, and well-being now being part of the Sustainable Development Goals. In the aim to provide good quality care for MNS disorders, understanding patients' pathways to care is key. This qualitative study explores the pathways to care of patients attending an outpatient mental health clinic of a district hospital in eastern rural Uganda, from the perspectives of their caregivers. Twenty seven in-depth interviews were conducted with caregivers of MNS patients visiting the clinic, with a focus on four case-presentations. Data analysis consisted of thematic and emergent content analyses using NVivo 11. Results across all interviews highlight that chosen help-seeking itineraries were largely pluralistic, combining and alternating between traditional healing practices, and biomedical care, regardless of the specific MNS disorder. Intra-household differences in care seeking pathways—e.g., where one patient received traditional help or no care at all, while the other received biomedical care—depended on caregivers' perceived contextual illness narrative for each patient, in combination with a variety of other factors. If interpreted as a form of bewitchment, traditional medicine and healing was often the first form of care sought, while the mental health clinic was seen as a recourse to “free” care. Patients, especially younger children, who showed visible improvements once stabilized on psychotropic medication was a source of motivation for caregivers to continue with biomedical care at the mental health clinic. However, stock-outs of the free psychotropic medication at the clinic led to dissatisfaction with services due to out-of-pocket expenses and precipitated returning to alternative therapy choices. This article showcases the importance of understanding the complex and varied combinations of individual, cultural, socioeconomic and structural factors that may affect caregivers' choices of pathways to care for patients with MNS disorders in eastern rural Uganda. These cumulative complex processes and context-specific help-seeking behaviors, which ultimately impact patient treatment and MNS health outcomes, need to be first acknowledged, understood and taken into account if we are to promote more inclusive, effective and integrated public mental health systems globally.
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Affiliation(s)
- Nandini D P Sarkar
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,ISGlobal, Hospital Clinic - University of Barcelona, Barcelona, Spain
| | - Azucena Bardaji
- ISGlobal, Hospital Clinic - University of Barcelona, Barcelona, Spain
| | - Florence K Baingana
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan Muela Rivera
- PASS Suisse, Neuchatel, Switzerland.,Medical Anthropology Research Centre (MARC) at Departament d'Antropologia, Filosofia i Treball Social, Universidad Rovira i Virgili, Tarragona, Spain
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joske Bunders-Aelen
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Qi L, Zhou Y, Wang R, Wang Y, Liu Y, Zeng L. Perceived quality of primary healthcare services and its association with institutional trust among caregivers of persons diagnosed with a severe mental illness in China. J Psychiatr Ment Health Nurs 2021; 28:394-408. [PMID: 32881201 DOI: 10.1111/jpm.12687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/08/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Low utilization of the family-oriented community rehabilitation services is a threatening challenge facing low- and middle- income countries. Family caregiver's trust in community healthcare providers is the precondition of service utilization and is shaped by their perceived quality of primary healthcare services from previous experience. Most of the studies concerning the relationship between perceived quality and institutional trust were conducted in western countries, resulting in limited attention paid to conditions in non-western countries. Which aspect of quality predicts institutional trust in China has not been studied yet. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE In China's context, institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Significant rural-urban disparity was observed: among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief; institutional trust was only associated with worry relief in urban respondents. WHAT ARE THE IMPLICATIONS FOR PRACTICE Mental health nurses training or working with community healthcare workers may improve their technical and communicative competence. Priorities may differ between rural and urban areas. Mental health nurses or community healthcare workers may provide more family-oriented psycho-education to rural families, and more emotional support to urban families. Wider public anti-stigma initiatives are needed to reduce the affiliated stigma of families of persons diagnosed with a severe mental illness. ABSTRACT Introduction Prior studies suggested that caregiver's trust in community healthcare providers is the precondition of the utilization of community-based rehabilitation services and is shaped by their perceived quality of primary healthcare services. Nevertheless, the research conducted in non-western countries is scarce, and which aspect of quality is associated with institutional trust in China has not been studied. Aim To explore the association between perceived quality of primary healthcare services and institutional trust in China's context. Methods This cross-sectional study was conducted with 796 family caregivers from Eastern, Central and Western China between August 2018 and October 2019. Perceived quality of primary healthcare services was measured by technical competence, communication, worry relief and risk of privacy leak. Results Institutional trust was generally associated with communication, worry relief and risk of privacy leak, but not with technical competence. Among rural respondents, institutional trust was associated with technical competence, communication and risk of privacy leak, but not with worry relief. Contrary finding was observed in urban respondents. Discussion and implications for practice With rural-urban disparity considered, strategies such as improving the technical and communicative competence of community healthcare workers, providing family-oriented psycho-education and emotional support, and promoting public anti-stigma initiatives may be worth consideration.
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Affiliation(s)
- Ling Qi
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | | | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Yang Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yifeng Liu
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
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Amoako YA, Ackam N, Omuojine JP, Oppong MN, Owusu-Ansah AG, Abass MK, Amofa G, Ofori E, Frimpong M, Bailey F, Molyneux DH, Phillips RO. Caregiver burden in Buruli ulcer disease: Evidence from Ghana. PLoS Negl Trop Dis 2021; 15:e0009454. [PMID: 34061828 PMCID: PMC8195390 DOI: 10.1371/journal.pntd.0009454] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/11/2021] [Accepted: 05/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Buruli ulcer disease (BUD) results in disabilities and deformities in the absence of early medical intervention. The extensive role of caregiving in BUD is widely acknowledged, however, associated caregiver burden is poorly understood. In this paper we assessed the burden which caregivers experience when supporting patients with BUD in Ghana. METHOD/ PRINCIPAL FINDINGS This qualitative study was conducted in 3 districts in Ghana between August and October 2019. 13 semi-structured interviews were conducted on caregivers of BUD patients in the local language of Twi. Data was translated into English, coded into broad themes, and direct content analysis approach was used to analyse results. The results show the caregivers face financial, psychological and health issues as a consequence of their caregiving role. CONCLUSION/ SIGNIFICANCE This study found significant caregiver burden on family members. It also highlighted the psychological burden caregivers experience and the limited knowledge of the disease within endemic communities. Further research is needed to quantify the caregiver burden of BUD at different economic levels in order to better understand the impact of possible caregiver interventions on patient outcomes.
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Affiliation(s)
- Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
- * E-mail:
| | - Nancy Ackam
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abena Gyawu Owusu-Ansah
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | - Michael Frimpong
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Freddie Bailey
- Department of Tropical Disease Biology, Pembroke Place, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David Hurst Molyneux
- Department of Tropical Disease Biology, Pembroke Place, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
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38
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Pal A, Saxena V, Avinash P. Stigma in Bipolar Affective Disorder: A Systematic Quantitative Literature Review of Indian Studies. Indian J Psychol Med 2021; 43:187-194. [PMID: 34345093 PMCID: PMC8287384 DOI: 10.1177/0253717621996618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Bipolar affective disorder (BPAD) is one of the most common severe mental illnesses that cause morbidity. Stigma can negatively influence the disease experience in patients with BPAD. Significant differences are observed in the attributes of stigma across the various sociocultural milieus. The current review was thus conducted to compile the evidence regarding the burden and correlates of various forms of stigma in BPAD in India. METHODS An exhaustive literature review was conducted in PubMed, MedIND, and Google Scholar to identify Indian studies conducted on stigma in BPAD. The broad themes in various forms of stigma were identified (qualitative analysis). Quantitative analysis of measures of stigma was done, calculating the effect size in BPAD and comparator groups (schizophrenia and anxiety disorders) using standardized mean difference. RESULTS Overall, 12 studies could be identified for qualitative analysis, and 5 were used for quantitative analysis. Overall, the current evidence points out that the stigma in BPAD is less than that in schizophrenia but more than that in anxiety disorders. Internalized stigma in BPAD is correlated with poor self-esteem, reduced community participation, and low quality of life. Caregivers of patients with BPAD also experience significant stigma. CONCLUSIONS The review shows that stigma in BPAD is substantial. It also draws attention to the fact that the research regarding stigma in BPAD is lagging behind. This review also provides a platform to develop an intervention in the Indian scenario, where further research should be carried out.
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Affiliation(s)
- Arghya Pal
- Dept. of Psychiatry, All India
Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Vrinda Saxena
- Dept. of Psychiatry, Himalayan
Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun,
Uttarakhand, India
| | - Priyaranjan Avinash
- Dept. of Psychiatry, Himalayan
Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun,
Uttarakhand, India
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39
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Monnapula-Mazabane P, Babatunde GB, Petersen I. Current strategies in the reduction of stigma among caregivers of patients with mental illness: a scoping review. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/00812463211001530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mental healthcare and wellness are a global concern and have increasingly become an essential service and priority from a human rights perspective. However, negative attitudes towards mental health, such as stigmatisation and discrimination from communities and family members, continue to pose challenges for deinstitutionalisation and home care of mentally ill persons. This study aimed to review the literature on the content and implementation methods of stigma reduction interventions for family/community caregivers of patients with mental illness to inform the development of an anti-stigma intervention for such caregivers in low- and middle-income countries like South Africa. A scoping literature review was conducted of English language studies published from 2008 to 2019 in peer-reviewed journals, using established guidelines for the study objectives. Primary interventions targeting caregivers of mental health patients were searched from PsycINFO, ScienceDirect, CINAHL, and Medline. In total, nine full-text articles were extracted for inclusion in the review, indicating a scarcity of literature on anti-stigma interventions aimed at primary caregivers of mental health patients. Interventions varied in terms of educational content, duration, delivery methods, and sample sizes. Intervention delivery was primarily through face-to-face, telephone, and online methods. Anti-stigma interventions for caregivers of patients with mental illness are varied and show positive short-term impacts on mental health stigma reduction among family caregivers. The evolution of health systems is a feasible approach towards integrating learning and trials that are needed to assess long-term impacts.
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Affiliation(s)
| | - Gbotemi B Babatunde
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Inge Petersen
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
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Sreeraj VS, Holla B, Ithal D, Nadella RK, Mahadevan J, Balachander S, Ali F, Sheth S, Narayanaswamy JC, Venkatasubramanian G, John JP, Varghese M, Benegal V, Jain S, Reddy YJ, Viswanath B. Psychiatric symptoms and syndromes transcending diagnostic boundaries in Indian multiplex families: The cohort of ADBS study. Psychiatry Res 2021; 296:113647. [PMID: 33429328 DOI: 10.1016/j.psychres.2020.113647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/11/2020] [Indexed: 02/06/2023]
Abstract
Syndromes of schizophrenia, bipolar disorder, obsessive-compulsive disorder, substance use disorders and Alzheimer's dementia are highly heritable. About 10-20% of subjects have another affected first degree relative (FDR), and thus represent a 'greater' genetic susceptibility. We screened 3583 families to identify 481 families with multiple affected members, assessed 1406 individuals in person, and collected information systematically about other relatives. Within the selected families, a third of all FDRs were affected with serious mental illness. Although similar diagnoses aggregated within families, 62% of the families also had members with other syndromes. Moreover, 15% of affected individuals met criteria for co-occurrence of two or more syndromes, across their lifetime. Using dimensional assessments, we detected a range of symptom clusters in both affected and unaffected individuals, and across diagnostic categories. Our findings suggest that in multiplex families, there is considerable heterogeneity of clinical syndromes, as well as sub-threshold symptoms. These families would help provide an opportunity for further research using both genetic analyses and biomarkers.
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Affiliation(s)
- Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Dhruva Ithal
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Furkhan Ali
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Sweta Sheth
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - John P John
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
| | -
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bengaluru, India.
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Reupert A, Gladstone B, Helena Hine R, Yates S, McGaw V, Charles G, Drost L, Foster K. Stigma in relation to families living with parental mental illness: An integrative review. Int J Ment Health Nurs 2021; 30:6-26. [PMID: 33283387 DOI: 10.1111/inm.12820] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 01/23/2023]
Abstract
Stigma is a pervasive social mechanism with negative ramifications for people who experience mental illness. Less is known about the stigma experiences of families where a parent has a mental illness. This review aims to identify and synthesize evidence on the concept of stigma and stigma-related experiences and outcomes reported by parents and children living with parental mental illness. An integrative review method was employed, with PRISMA (Preferred Reporting Items of Systematic Review and Meta-Analyses) guidelines to search and select literature and extract and analyse data. This approach allows for inclusion of theoretical and empirical literature and for concept definition. Fifty-eight papers, mostly from the USA, Australia, and the UK, met the inclusion criteria. Stigma was primarily conceptualized in families as a marked difference that was negatively appraised, and which could be internalized. Some articles examined how underpinning assumptions could shape the behaviour of individuals and groups and be embedded within social institutions and structures. For parents, mental illness stigma was interconnected with stigma relating to perceived violations of social and cultural norms related to parenting. Children's experience of stigma resulted in bullying, embarrassment, guilt and social isolation, and efforts to conceal their parent's mental illness. One outcome was that stigma prevented children and parents from seeking much needed supports. Public health policies and campaigns that focus exclusively on promoting open disclosure of mental illness to foster community education outcomes are unlikely to be effective without additional strategies aimed at preventing and redressing the structural impacts of stigma for all family members.
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Affiliation(s)
- Andrea Reupert
- Professional Psychology Programs in Education, Krongold Clinic, Faculty of Education, Monash University, Melbourne, Victoria, Australia
| | - Brenda Gladstone
- Centre for Critical Qualitative Health Research, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Rochelle Helena Hine
- South West Healthcare, Warrnambool, Australia.,School of Rural Health, Monash University, Warragul, Australia
| | - Scott Yates
- School of Applied Social Sciences, De Montfort University, Leicester, UK
| | - Violette McGaw
- Faculty of Education, Monash University, Wellington Road, Clayton, 3800, Australia
| | - Grant Charles
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada
| | - Louisa Drost
- University Centre for Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kim Foster
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,North Western Mental Health, Melbourne, Victoria, Australia
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Guan Z, Wang Y, Lam L, Cross W, Wiley JA, Huang C, Bai X, Sun M, Tang S. Severity of illness and distress in caregivers of patients with schizophrenia: Do internalized stigma and caregiving burden mediate the relationship? J Adv Nurs 2020; 77:1258-1270. [PMID: 33231315 DOI: 10.1111/jan.14648] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 09/25/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022]
Abstract
AIMS To test a multiple mediation model of internalized stigma and caregiving burden in the relationship between severity of illness and distress among family caregivers of persons living with schizophrenia. DESIGN This is a cross-sectional study. METHODS Data were collected from a consecutive sample of 344 Chinese family caregivers of persons living with schizophrenia between April-August 2018. Instruments used in this research included the Clinical Global Impression-Severity of Illness, the Internalized Stigma of Mental Illness Scale, the Caregiver Burden Inventory, and the Distress Thermometer. Data analysis was conducted using descriptive statistics, the Spearman correlation, and regression analysis to estimate direct and indirect effects using bootstrap analysis. RESULTS This research found that internalized stigma and caregiving burden can separately and sequentially mediate the relationship between severity of illness and distress. Moreover the mediation of internalized stigma plays the largest role among the multiple mediations. CONCLUSION The severity of illness, internalized stigma, and caregiving burden are significant factors of distress among family caregivers of persons living with schizophrenia. The future intervention studies which be designed aiming at the three factors may be beneficial for family caregivers of persons living with schizophrenia. IMPACT This research examined the psychosocial development of distress and indicated that interventions improving patients' symptoms and decreasing internalized stigma and caregiving burden can help to prevent or reduce distress among family caregivers.
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Affiliation(s)
- Ziyao Guan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yuwei Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Louisa Lam
- School of Nursing and Healthcare, Federation University Australia, Bewick, Vic, Australia
| | - Wendy Cross
- School of Nursing and Healthcare, Federation University Australia, Bewick, Vic, Australia
| | - James A Wiley
- Xiangya School of Nursing, Central South University, Changsha, China.,Family and Community Health and Institute of Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Chongmei Huang
- School of Nursing and Midwifery, Monash University, Clayton, Vic, Australia
| | - Xiaoling Bai
- Nursing Department, Guizhou Provincial People's Hospital, Guiyang, China
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China.,Hunan Women's Research Association, Changsha, PR China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China.,Hunan Women's Research Association, Changsha, PR China
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Ebrahim OS, Al-Attar GST, Gabra RH, Osman DMM. Stigma and burden of mental illness and their correlates among family caregivers of mentally ill patients. J Egypt Public Health Assoc 2020; 95:31. [PMID: 33164132 PMCID: PMC7649189 DOI: 10.1186/s42506-020-00059-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
Background and objectives Family caregivers play a curial role in supporting and caring for their mentally ill relatives. Their struggle for facing stigma and shouldering caregiving burden is marginalized, undervalued, and invisible to medical services. This study assessed the stigma and burden of mental illnesses, and their correlates among family caregivers of mentally ill patients. Methods A cross-sectional study design was used to collect data from 425 main family caregivers of mentally ill patients at Assiut University Hospital. A structured interview questionnaire was designed to collect socio-demographic data of both patients and their caregivers. Stigma scale for caregivers of people with mental illness (CPMI) was used to assess the affiliate stigma, while the associative stigma was assessed by the explanatory model interview catalogue stigma scale (EMIC-Stigma scale). The caregivers’ burden was assessed using Zarit burden Interview, and Modified Attitude toward Mental Illness Questionnaire was used to assess caregivers’ knowledge and attitude towards mental illness. Results Bipolar disorder (48%) and schizophrenia/other related psychotic disorders (42.8%) were the most common mental illnesses among the study patients. The mean scores of CPMI total scale, EMIC-Stigma scale, and Zarit Burden scale were 56.80 ± 7.99, 13.81 ± 5.42, and 55.20 ± 9.82, respectively. The significant correlates for affiliate stigma were being parents of patients (ß = 4.529, p < 0.001), having higher associate stigma (ß = 0.793, p < 0.001), and aggressive behavior of mentally ill patients (ß = 1.343, p = 0.038). The significant correlates for associate stigma of the study caregivers were being caregivers’ relatives other than parents (ß = 1.815, p = 0.006), having high affiliate stigma (ß = 0.431, p < 0.001), having poor knowledge and negative attitude towards mental illness (ß = − 0.158, p = 0.002), and aggressive behavior of mentally ill relatives (ß = 1.332, p = 0.005). The correlates for the high burden were being male (ß = 3.638, p = 0.006), non-educated caregiver (ß = 1.864, p = 0.045), having high affiliate stigma (ß = 0.467, p < 0.001), having high associative stigma (ß = 0.409, p < 0.001), having poor knowledge and negative attitude toward mental illness (ß = − 0.221, p = 0.021), seeking traditional healers and non-psychiatrist’s care from the start (ß = 2.378, p = 0.018), and caring after young mentally ill relatives (ß = − 0.136, p = 0.003). Conclusion The studied caregivers suffered from stigma and a high level of burden. Psycho-educational programs directed toward family caregivers are highly recommended.
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Affiliation(s)
- Omnya S Ebrahim
- Department of Community, Occupational and Environmental Medicine, Faculty of Medicine, Helwan University, Helwan, Egypt.
| | - Ghada S T Al-Attar
- Department of Public Health & Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Romany H Gabra
- Department of Neuropsychiatry, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Doaa M M Osman
- Department of Public Health & Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
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Abstract
BACKGROUND Caregivers have different experiences in the patient care process during which the role of providing care is fulfilled. AIM The aim of this study was to provide data on the feelings, thoughts and experiences of the caregivers of patients with schizophrenia. METHOD In this study, the phenomenological method was used. RESULTS The results of this study revealed the following themes: meaning of schizophrenia, the meaning of being caregiver, life before being caregiver, feeling of patients' relatives, difficult areas while providing care, coping situations and metaphors produced by the caregivers. CONCLUSION The results obtained from the study revealed that the caregivers of patients with schizophrenia need information about the mental illness and have a higher emotional burden. PRACTICE IMPLICATIONS Nurses should listen to caregivers' experiences, inquire about the experience of caregivers regarding patient care and advise caregivers on how to take care of their patients.
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Affiliation(s)
- Kerime Bademli
- Psychiatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Neslihan Lök
- Psychiatric Nursing Department, Faculty of Nursing, Selcuk University, Konya, Turkey
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45
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Cleary M, West S, Hunt GE, McLean L, Kornhaber R. A Qualitative Systematic Review of Caregivers' Experiences of Caring for Family Diagnosed with Schizophrenia. Issues Ment Health Nurs 2020; 41:667-683. [PMID: 32255401 DOI: 10.1080/01612840.2019.1710012] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: To synthesise qualitative research that explored caregivers' experiences of caring for family diagnosed with schizophrenia.Methods: Electronic databases including PsycINFO, PubMed, CINAHL and Scopus were searched to identify relevant journal articles published from 2000 to March 2019. Quality was assessed and thematic synthesis of the qualitative research evidence undertaken. Papers were screened and independently appraised by two reviewers using The Critical Appraisal Skills Programme (CASP) for Qualitative Studies Checklist. The review was guided by Thomas and Harden's framework for thematic synthesis of qualitative research evidence.Results: The breadth of information across the 43 papers was noteworthy. Review of the findings noted that almost all of what was discussed fell into three broad themes: the 'feelings' of the caregiver towards their role, the patient and others, including the health system; the 'impacts' of the diagnosis and their caregiving role on the caregiver; and the 'needs' of the caregiver to improve the patient's quality of life and thereby the caregiver's quality of life. Within needs also came recommendations for future changes.Conclusion: Studies have shown that the caregiving process is a complex one, with both negative and positive emotional reactions, societal barriers, such as stigma and isolation, and unmet needs, such as timely, relevant and helpful information. Meeting the needs identified by caregivers has the capacity to address the impacts of the illness and caregiving and thereby reduce the negative feelings associated with the caregiver role.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, Australia
| | - Sancia West
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, Australia
| | - Glenn E Hunt
- Discipline of Psychiatry, Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, the University of Sydney, Australia.,Royal North Shore Hospital, Consultation-Liaison Psychiatry, St Leonards, Sydney, Australia.,Western Sydney Local Health District, Westmead Psychotherapy Program for Complex Traumatic Disorders, Parramatta, Australia
| | - Rachel Kornhaber
- School of Nursing, College of Health and Medicine, University of Tasmania, Sydney, Australia
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Yu Y, Liu ZW, Li TX, Li YL, Xiao SY, Tebes JK. Test of the stress process model of family caregivers of people living with schizophrenia in China. Soc Sci Med 2020; 259:113113. [PMID: 32646627 DOI: 10.1016/j.socscimed.2020.113113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022]
Abstract
Across the world, people living with schizophrenia (PLS) are often cared for by family caregivers. This is especially true in China where community-based systems of care for PLS are underdeveloped. Thus, family caregivers of PLS may experience emotional distress and burden in the absence of community-based services. Pearlin (1990) proposed a highly influential model for understanding the stress process and its relationship to health and wellbeing. Although the model has been examined worldwide, it has yet to be studied in China for caregivers of PLS. In the present study, we use Pearlin's stress process model to examine the mediating effect of perceived caregiver burden, family functioning, and caregivers' positive feelings about caregiving on PLS global functioning and caregiver depressive symptoms. We also examine whether the model differs for parent and spouse caregivers. A total of 327 primary family caregivers of PLS in Hunan province, China, were assessed cross-sectionally using culturally-validated measures. Bootstrap methods with Hayes's PROCESS Macro were used to test multiple mediation models of global functioning scores of PLS and caregiver depressive symptoms. In this first study of the stress process model of family caregivers of PLS in China, the results generally support the model. Caregiver perceived burden, family functioning, and positive caregiver feelings about caregiving all mediate the relationship between PLS global functioning and caregiver depression, with perceived caregiver burden having the strongest indirect effect. Analyses also show that the stress process differs between parent and spouse caregivers, with perceived caregiver burden a mediator for both groups but family functioning only a mediator for parent depressive symptoms. We discuss implications of these findings for extending the stress process model cross-culturally; suggest hypotheses for future research to examine parent and spouse differences; and discuss fruitful directions for intervention.
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Affiliation(s)
- Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan, 410008, China; Division of Prevention & Community Research, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA.
| | - Zi-Wei Liu
- Department of Preventive Medicine, School of Medicine, Hunan Normal University, Tongzipo Road 172, Changsha, Hunan, 410008, China.
| | - Tong-Xin Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan, 410008, China.
| | - Yi-Lu Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan, 410008, China
| | - Shui-Yuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Upper Mayuanlin Road 238, Changsha, Hunan, 410008, China.
| | - Jacob Kraemer Tebes
- Division of Prevention & Community Research, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA.
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Guan Z, Huang C, Wiley JA, Sun M, Bai X, Tang S. Internalized stigma and its correlates among family caregivers of patients diagnosed with schizophrenia in Changsha, Hunan, China. J Psychiatr Ment Health Nurs 2020; 27:224-236. [PMID: 31639239 DOI: 10.1111/jpm.12571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 01/30/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Schizophrenia is a severe and highly stigmatized mental illness. High internalized stigma affects FGs' quality of life and caregiving capacity. Worldwide studies aimed at internalized stigma among patients diagnosed with mental illness or their FGs have reported significant stigma and some correlates, but studies involving FGs that focus on a specific mental illness (e.g. schizophrenia) and report the impact of potential psychosocial variables (e.g. coping and hope) on internalized stigma are limited. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Internalized stigma was common among Chinese FGs of patients diagnosed with schizophrenia and half of them presented at a mild level. Internalized stigma was negatively associated with hope and positively associated with passive coping. FGs, who live with patients, have difficulty supervising medication, or care for a male relative has higher internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Regarding informative support, interventions (e.g. enhancing mental health literacy programs and cognitive therapies) to provide knowledge about schizophrenia, the skills to manage patients' adherence to medications, the benefits of treatment and the possibilities of rehabilitation are necessary for FGs. Regarding psychosocial processes, effective interventions (e.g. group psychoeducation and group social skills training) aimed to enhance hope, social support and coping styles towards internalized stigma should be implemented among FGs. Both informative support and psychosocial interventions used to decrease FGs' internalized stigma can be delivered by healthcare providers or by peer caregivers. ABSTRACT: Introduction Internalized stigma is prevalent among patients diagnosed with schizophrenia. Their family caregivers (FGs) also suffer from internalized stigma, but limited studies have addressed the issue. Aim The aim of this study was to determine the severity of internalized stigma and its correlates among FGs of patients diagnosed with schizophrenia in Changsha, Hunan, China. Methods A consecutive sample of 299 FGs was recruited at the psychiatric outpatient department of a tertiary hospital in Changsha. This study explored the relationships between internalized stigma and potential factors. Results Nearly 50% of the FGs perceived mild internalized stigma, 24% of the FGs reported moderate level, and 6% had a severe level. Internalized stigma was associated with patients' characteristics (severity of illness) and FGs' characteristics (hope, social support, passive coping, age, education background, residence with the patient, caring for a male or a young patient and difficulty in supervising medication). Discussion and implications for practice Informative and psychosocial interventions based on education and contact for FGs such as enhancing mental health literacy programs, cognitive therapies and group psychoeducation can provide FGs with a better understanding of schizophrenia and to promote hope, active coping and social support.
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Affiliation(s)
- Ziyao Guan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chongmei Huang
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - James A Wiley
- Xiangya School of Nursing, Central South University, Changsha, China.,Department of Family and Community Health and Institute of Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Mei Sun
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoling Bai
- Nursing Department, Guizhou Provincial People's Hospital, Guiyang, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China
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Yin M, Li Z, Zhou C. Experience of stigma among family members of people with severe mental illness: A qualitative systematic review. Int J Ment Health Nurs 2020; 29:141-160. [PMID: 31648408 DOI: 10.1111/inm.12668] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/23/2019] [Accepted: 09/30/2019] [Indexed: 11/28/2022]
Abstract
Family members of people with severe mental illness are subjected to stigmatization, and a better understanding of their experience of stigma is important for developing anti-stigma interventions to reduce the related adverse consequences. This review aimed to systematically identify, evaluate, and synthesize existing findings from qualitative studies regarding the experience of stigma among family members of people with severe mental illness. A systematic literature search for primary studies was conducted in PubMed, EMBASE, Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, ProQuest Dissertations and Theses (PQDT), SinoMed (China), Chinese Citation Database (CNKI), and Wanfang Data (China) until March 2019. Findings from the included qualitative studies were extracted and aggregated using meta-synthesis, guided by the Joanna Briggs Methodology for Qualitative Systematic Reviews. The results revealed that family members experienced stigma and suffered from various negative consequences related to it. Five major categories were identified in 20 studies: 'negative public images of mental illness', 'structural discrimination against mental illness', 'stigma encountered in everyday life', 'psychological distress associated with stigmatization', and 'coping with stigma'. The study contributes to our understanding of the stigma experienced by family members of people with severe mental illness. It is suggested that culturally appropriate multi-level interventions targeting the general public, health professionals, communities, and family members need to be developed to reduce the harmful influence of associated family stigma.
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Affiliation(s)
- Min Yin
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Chenxi Zhou
- School of Nursing, Peking Union Medical College, Beijing, China
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Abstract
People of BAMME (Black, Asian, Minority, and Migrant ethnic) heritage in the UK experience various anomalies when engaging with mental health services. Typically concentrated at secondary and secure levels of care, these discrepant experiences interact with a reticence to uptake mental health support at the primary care level. Official, national anti-stigma campaigns often reproduce messages that do not connect with BAMME communities, raising questions about how best to challenge stigma in this context. This research paper describes a case study of an alternative means to address stigma, drawing from a dramatic comedy performance, Plant Fetish, written and performed by an artist who carries a diagnosis of complex post-traumatic stress disorder (Complex PTSD). The study comprised of an individual interview with the artist, audience feedback, and a group discussion conducted after the show. Data were subject to interpretative phenomenological analysis. Findings are discussed in relation to the importance of using creativity to increase public awareness of mental health and inform efforts to reduce stigma. We conclude that such approaches show promise and merit further exploration in a context of growing discursive interest in mental health amidst acknowledged deficiencies of contemporary anti-stigma efforts, especially as they apply to BAMME people, their families, and their communities.
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Marutani T, Chhim S, Nishio A, Nosaki A, Fuse-Nagase Y. Quality of life and its social determinants for patients with schizophrenia and family caregivers in Cambodia. PLoS One 2020; 15:e0229643. [PMID: 32130240 PMCID: PMC7055908 DOI: 10.1371/journal.pone.0229643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022] Open
Abstract
Due to inadequate human and financial resource support, the development of mental health services in Cambodia has been undertaken by various non-governmental organizations (NGOs). Schizophrenia is the most common functional psychotic disorder, causing severe and chronic symptoms, and the programs provided by the NGOs should have enhanced the quality of life (QoL) of patients and their caregivers; however, epidemiological research, which is a driving force behind the recognition of mental health as a global public health concern, is lacking for schizophrenia in Cambodia. This study therefore aimed to create QoL evaluation questionnaires available in Khmer (the Cambodian language) for patients with schizophrenia and family caregivers, and to identify the social determinants and predictors of their QoL. This cross-sectional study recruited 59 patients and 59 caregivers attending three clinics operated by two NGOs: the Transcultural Psychosocial Organization (TPO) Cambodia and the Supporters for Mental Health (SUMH) Cambodia. We conducted linguistic validation of the Schizophrenia Quality of Life Questionnaire 18-item version (S-QoL 18) and the Schizophrenia Caregiver Questionnaire (SCQ), then analyzed correlations between the QoL dimensions and socio-demographic factors. The main findings of this study were as follows: 1) the newly created Khmer versions of S-QoL 18 and SCQ are relatively good psychometric tools that are suitable for research to identify patients’ and caregivers’ needs to improve their QoL; and 2) engaging in paid work or being of the post-Khmer Rouge generation results in higher QoL for patients, but having low household economic status or being affected by chronic disease leads to lower QoL for family caregivers. These findings are useful for enabling community mental health professionals and aid organizations to create programs to lessen the patient and caregiver burden in Cambodia. Further research is necessary to develop practical projects that will improve patients’ and caregivers’ QoL in various clinical settings in Cambodia.
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Affiliation(s)
- Toshiyuki Marutani
- Health Support Center, Tokyo Institute of Technology, Yokohama, Japan
- Supporters for Mental Health, Tokyo, Japan
- * E-mail:
| | - Sotheara Chhim
- Transcultural Psychosocial organization Cambodia, Phnom Penh, Cambodia
| | - Akihiro Nishio
- Supporters for Mental Health, Tokyo, Japan
- Health Administration Center, Gifu University, Gifu, Japan
| | - Akiko Nosaki
- Supporters for Mental Health, Tokyo, Japan
- Psychiatric and Mental Health Nursing, Graduate School of Nursing, Chiba University, Chiba, Japan
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