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Gonzales L, Saperstein AM, Jones N, Erlich MD, Medalia A. Perceived Stigma Toward Cognitive Impairment Among People With Schizophrenia. Psychiatr Serv 2024:appips20240106. [PMID: 39091170 DOI: 10.1176/appi.ps.20240106] [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: 08/04/2024]
Abstract
OBJECTIVE Stigma toward schizophrenia spectrum disorders is pervasive and negatively influences service access and delivery. Cognitive impairment associated with schizophrenia (CIAS) is common, but its association with stigma is unknown. In this study, the authors examined whether individuals with CIAS receiving cognitive remediation treatment report experiencing CIAS-related stigma and sought to establish associations between CIAS-related stigma and recovery-relevant outcomes. METHODS Data from 48 individuals with schizophrenia spectrum diagnoses were drawn from a larger study evaluating cognitive remediation. Participants completed measures of CIAS-related stigma, internalized mental illness stigma, self-perceived cognitive impairment, cognitive performance, and interviewer-rated quality of life. RESULTS CIAS-related stigma was commonly reported and significantly positively associated with internalized stigma and self-perceived cognitive impairment. CIAS-related stigma was also significantly negatively associated with motivation to engage in goal-directed behavior and daily activities. CONCLUSIONS CIAS-related stigma exists and warrants additional exploration with regard to implications for psychiatric service delivery.
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Affiliation(s)
- Lauren Gonzales
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
| | - Alice M Saperstein
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
| | - Nev Jones
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
| | - Matthew D Erlich
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
| | - Alice Medalia
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City, and New York State Office of Mental Health, Albany (Gonzales, Saperstein, Erlich, Medalia); School of Social Work, University of Pittsburgh, Pittsburgh (Jones)
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2
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Sum MY, Wong CTW, Chu ST, Li A, Lee AHT, Chen EYH, Chan SKW. Systematic review and meta-analysis of internalised stigma and stigma resistance in patients with psychosis: The impact of individualism-collectivism culture and other individual factors. Int J Soc Psychiatry 2024; 70:639-652. [PMID: 38279534 DOI: 10.1177/00207640231216924] [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: 01/28/2024]
Abstract
PURPOSE This study aimed to meta-analysis the level of internalised stigma experienced by individuals with psychosis worldwide, and the impact of cultural differences, economic status of the studied regions and duration of illness on their levels of internalised stigma. Clinical and individual level factors associated with internalised stigma and stigma resistance were also systematically reviewed. METHODS A systematic search of keywords on two scholarly databases were conducted. The individualism index of the countries or regions where the studies were conducted was retrieved from Hofstede's updated measurement of individualism. Economic status of regions was categorised based on their per capita gross national income. Meta-analysis and meta-regression were conducted using the 'metafor' package in R. Factors associated with internalised stigma and stigma resistance were also systematically consolidated. RESULTS Seventy-three articles were included in the meta-analysis and the pooled score of both internalised stigma and stigma resistance of individuals with psychosis were within the mild range (2.20 and 2.44, respectively). The meta-regression analysis found high collectivism culture is significantly related to a higher level of internalised stigma. Economic status was not significant. Thirty-five articles were included in the systematic review and clinical, psychological, psychosocial variables, cognition and sociodemographic factors were found to be associated with internalised stigma. CONCLUSION Internalised stigma in psychosis is ubiquitous worldwide and high collectivism culture may be related with high internalised stigma. With the presence of multiple individual factors related to internalised stigma, intervention programmes to reduce internalised stigma should consider focussing on both macro- and micro-level factors.
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Affiliation(s)
- Min Yi Sum
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Charmaine Tsz Wing Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Sin Ting Chu
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Angel Li
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Athena Hoi Ting Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
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3
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Styła R, Świtaj P. Time perspective and self-stigma in schizophrenia. J Ment Health 2024; 33:48-56. [PMID: 36883339 DOI: 10.1080/09638237.2023.2182413] [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: 02/15/2022] [Accepted: 01/19/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Time perspective (TP) offers a new understanding of human personality, postulating that there are individual differences in how our mind assigns our experiences to different time categories. This concept may shed new light on the role of personality traits in shaping vulnerability to the internalized stigma. AIM In this paper we propose a novel approach to clarifying the underpinning of self-stigma by empirically exploring its links with TP. METHOD We conducted a cross-sectional study among 86 patients with ICD-10 diagnoses of paranoid schizophrenia to validate the predictive role of TP for self-stigma. We used the Zimbardo Time Perspective Inventory (ZTPI), Internalized Stigma of Mental Illness scale (ISMI) and Brief Psychiatric Rating Scale (BPRS). RESULTS We found significant positive correlations of self-stigma with Past-Negative, Future-Negative and Present-Fatalistic TP categories and negative correlation with the Future-Positive category. The hierarchical regression analyses revealed that two TP categories and Deviation from the Balanced Time Perspective (DBTP) are significant predictors of self-stigma over and above sociodemographic and clinical control variables. Conclusion. The results of the study confirm the hypothesis that TP opens new possibilities to understand proneness or resistance to self-stigmatization, and this may provide a basis for novel approaches to anti-self-stigma interventions.
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Affiliation(s)
- Rafał Styła
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Piotr Świtaj
- First Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland
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Au-Yeung C, Penney D, Rae J, Carling H, Lassman L, Lepage M. The relationship between negative symptoms and MATRICS neurocognitive domains: A meta-analysis and systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110833. [PMID: 37482283 DOI: 10.1016/j.pnpbp.2023.110833] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Negative symptoms (NS) are a core symptom domain in schizophrenia spectrum disorders and are associated with poorer social and vocational functioning, and with increased likelihood and durations of hospital admission. NS are not well understood, limiting available interventions. However, numerous studies have reported associations between neurocognitive domains and NS severity. Thus, one promising area in understanding NS is in relation to neurocognition. Currently, the specificity of the relationship between NS and neurocognition is unknown, meaning that there is no consensus regarding which neurocognitive domain is most strongly associated with NS. There is a need to systematically examine the relationship between NS and various neurocognitive domains within study samples. METHODS A systematic search of Ovid PsycINFO, Ovid MEDLINE and Web of Science was performed for articles published since 2004 (year of MATRICS Consensus publication). Inclusion criteria were: 1) individuals with schizophrenia spectrum disorders, first episode psychosis or clinical high risk 2) assessed all six MATRICS neurocognitive domains (processing speed, attention, working memory, verbal learning & memory, visual learning & memory, reasoning & problem solving), 3) reported correlations between all six MATRICS neurocognitive domains and global NS. A three-level random effects hierarchical meta-analysis was performed to assess the relationship between NS (global, expressive, and experiential dimensions) and the six MATRICS neurocognitive domains. RESULTS 21 studies were included in the review (n = 3619). All MATRICS neurocognitive domains had small significant correlations with global NS (r = -0.16 to -0.20, p < 0.0001). This relationship was significantly moderated by diagnosis and the moderating effect of sex/ gender trended on significance. Analysis of a subset of the studies revealed that MATRICS neurocognitive domains also had small significant correlations with the two NS dimensions, expressive and experiential. Correlations were stronger with the expressive NS dimension. CONCLUSIONS This review is novel in assessing the relationship between multiple neurocognitive domains and NS within the same sample, by synthesizing close to two decades of research. Our results suggest that there is a non-specific relationship between neurocognition and NS, and that expressive NS may have a stronger relationship with neurocognitive functioning-based on the MATRICS classification of neurocognition and the neurocognitive assessments used in the included studies. This has implications on our understanding of NS and neurocognition, as well as their treatments. As we gain better understanding of the directionality of the NS-cognition relationship, it could suggest that NS, particularly in the expressive domain, could be improved by targeting cognition globally or that neurocognitive treatments could be more effective if NS are addressed first. Further implications of these results are discussed.
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Affiliation(s)
- Christy Au-Yeung
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Douglas Research Centre, Montréal, Québec, Canada
| | - Danielle Penney
- Douglas Research Centre, Montréal, Québec, Canada; Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Jesse Rae
- Douglas Research Centre, Montréal, Québec, Canada
| | - Hannah Carling
- Department of Psychology, McGill University, Montreal, Quebec, Canada; Douglas Research Centre, Montréal, Québec, Canada
| | - Libby Lassman
- Douglas Research Centre, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Martin Lepage
- Douglas Research Centre, Montréal, Québec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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Li Y, Xiao X, Zhou Y, Su X, Wang H. The mediating role of executive function in the relationship between self-stigma and self-injury or suicidal ideation among men who have sex with men living with HIV. Front Public Health 2023; 10:1066781. [PMID: 36699888 PMCID: PMC9869120 DOI: 10.3389/fpubh.2022.1066781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Men who have sex with men (MSM) living with HIV suffer from psychosocial pressures and marginalization as a result of being HIV-positive and belonging to a sexual minority group, and self-injury or suicidal ideation are prevalent among this group. Studies have found that both perceived self-stigma and altered executive function is related to self-injury or suicidal ideation. However, the combined contribution of self-stigma and executive function to self-injury or suicidal ideation remains unclear, especially in MSM living with HIV. Therefore, this study is conducted to explore the mechanism of self-injury or suicidal ideation by hypothesizing that executive function plays a mediating role in the relationship between self-stigma and self-injury or suicidal ideation. Methods We conducted a cross-sectional survey among 448 MSM living with HIV who were recruited in the HIV clinic of a tertiary general hospital in Changsha, China, from November 2021 to February 2022. A questionnaires survey was adopted to collect sociodemographic and disease-related information and data related to executive function (including working memory, inhibition, and task monitoring), self-stigma, and self-injury or suicidal ideation. Structural equation modeling and bootstrap testing were used to investigate the potential mediating role of executive function in the relationship between self-stigma and suicidal ideation. Results The participants were aged 18-76 years. Those who had ever had self-injury or suicidal ideation accounted for 32.8% of the total. A higher level of self-stigma and poorer executive function were associated with more frequent self-injury or suicidal ideation (p < 0.01). The mediation model analysis showed a good fit (x 2/df = 1.07, p = 0.381). The direct effect of self-stigma on self-injury or suicidal ideation (β = 0.346, p < 0.001) and the indirect effect of self-stigma via executive function (β = 0.132, p < 0.001) were significant, with the indirect effect accounting for 27.6% of the total effect. Conclusions This study demonstrates that executive function mediates the relationship between self-stigma and self-injury or suicidal ideation among MSM living with HIV. It suggests that future studies targeting enhancing executive function and decreasing self-stigma may reduce self-injury or suicidal ideation among MSM living with HIV.
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The clinical and psychosocial correlates of self-stigma among people with schizophrenia spectrum disorders across cultures: A systematic review and meta-analysis. Schizophr Res 2022; 248:64-78. [PMID: 35963056 DOI: 10.1016/j.schres.2022.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/29/2022] [Accepted: 08/01/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Individuals with schizophrenia spectrum disorders (SSD) are at heightened risk of experiencing self-stigma, and some cultures are more stigmatizing towards SSD than others. The first purpose of this review is to provide an estimate of the relationship between self-stigma and clinical and psychosocial outcomes. The second purpose is to examine how these relationships vary across cultures. METHOD Studies reporting correlations between self-stigma and outcome variable(s) were identified through electronic database searches from June 1, 2021, to January 2, 2022. Mean effect sizes were calculated using Fisher's r-to-Z-transformation. RESULTS Sixty-three articles (N = 8925, 22 countries) were included in the systematic review and fifty-three articles (N = 7756) were included in the meta-analysis. For the most studied clinical correlates, self-stigma had a moderate, positive correlation with depressive symptoms (r = 0.49, p < .001), a moderate, negative correlation with functioning (r = -0.39, p < .001), and a positive, small correlation with severity of psychotic symptoms (r = 0.29, p < .001), negative symptoms (r = 0.18, p < .001) and positive symptoms (r = 0.13, p = .01). For the most studied psychosocial correlates, self-stigma had a strong, negative correlation with quality of life (r = -0.52, p < .001) and self-esteem (r = -0.55, p < .001). The correlates of self-stigma were similar across cultures. DISCUSSION Self-stigma shows strong to small correlations with clinical and psychosocial variables similarly across cultures. More research is needed to examine underlying mechanisms to develop effective interventions.
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Thompson EC, Muhammad JN, Adimora AA, Chandran A, Cohen MH, Crockett KB, Goparaju L, Henderson E, Kempf MC, Konkle-Parker D, Kwait J, Mimiaga M, Ofotokun I, Rubin L, Sharma A, Teplin LA, Vance DE, Weiser SD, Weiss DJ, Wilson TE, Turan JM, Turan B. Internalized HIV-Related Stigma and Neurocognitive Functioning Among Women Living with HIV. AIDS Patient Care STDS 2022; 36:336-342. [PMID: 36099481 PMCID: PMC9810353 DOI: 10.1089/apc.2022.0041] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.
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Affiliation(s)
- Emma C. Thompson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Josh N. Muhammad
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adoara A. Adimora
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aruna Chandran
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mardge H. Cohen
- Chicago Women's Interagency HIV Study, Chicago, Illinois, USA
| | - Kaylee B. Crockett
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lakshmi Goparaju
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Emmett Henderson
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mirjam-Colette Kempf
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deborah Konkle-Parker
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennafer Kwait
- Whitman-Walker Institute, Washington, District of Columbia, USA
| | - Matthew Mimiaga
- School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Igho Ofotokun
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Leah Rubin
- School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anjala Sharma
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Linda A. Teplin
- School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David E. Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sheri D. Weiser
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Deborah J. Weiss
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tracey E. Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Janet M. Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bulent Turan
- Department of Psychology, Koc University, Istanbul, Turkey
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Barlati S, Morena D, Nibbio G, Cacciani P, Corsini P, Mosca A, Deste G, Accardo V, Turrina C, Valsecchi P, Vita A. Internalized stigma among people with schizophrenia: Relationship with socio-demographic, clinical and medication-related features. Schizophr Res 2022; 243:364-371. [PMID: 34183209 DOI: 10.1016/j.schres.2021.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with schizophrenia are at high risk of suffering from stigma and internalizing it. Recently, a better understanding of the stigma process has shifted the attention from public stigma to self-stigma, which is deeply debilitating. This study aimed to assess factors associated to self-stigma by evaluating socio-demographic, clinical and treatment-related variables in a group of subjects diagnosed with schizophrenia and to identify predictors of high internalized stigma. METHODS Ninety-four inpatients accessing rehabilitative centers with a diagnosis of schizophrenia were included in this cross-sectional study. Measures included both patient-rated scales, assessing internalized stigma, attitude toward medications, side effects experience and subjective well-being, and clinician-rated scales, assessing schizophrenia symptoms and global clinical severity and antipsychotic-related side effects. RESULTS Twenty-one patients (22.3%) showed high internalized stigma while 73 (77.7%) did not. Patients experiencing more medication adverse effects and worse subjective well-being were more likely to suffer from internalized stigma according to a logistic regression analysis. Extrapyramidal, psychic and some autonomic reactions also emerged as individual predictors of self-stigma in a separate regression analysis. CONCLUSIONS Self-stigma and subjective medication side effects perception represent a relevant issue in patients' life and should be carefully taken into account in clinical practice.
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Affiliation(s)
- Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | | | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Cacciani
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Paola Corsini
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Mosca
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Vivian Accardo
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Cesare Turrina
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Valsecchi
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Schwarzbold ML, Kern RS, Novacek DM, McGovern JE, Catalano LT, Green MF. Self-stigma in psychotic disorders: Clinical, cognitive, and functional correlates in a diverse sample. Schizophr Res 2021; 228:145-150. [PMID: 33444932 PMCID: PMC7987768 DOI: 10.1016/j.schres.2020.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
Self-stigma in mental illness is linked to negative clinical and functional outcomes, but little is known about its correlates specifically in psychotic disorders. Here we investigated the role of clinical symptoms, cognition, and vocational status as correlates of self-stigma in 98 individuals with psychotic disorders (36 Black American, 32 White Hispanic, 11 White Non-Hispanic, 11 Asian American). A principal component analysis of the Internalized Stigma of Mental Illness scale yielded three components: Experiential Stigma, Stereotype Endorsement, and Stigma Resistance. Higher Experiential Stigma was associated with greater severity of affective symptoms and lower vocational status. Higher Stigma Resistance was associated with higher social and non-social cognition, and higher vocational status. Stereotype Endorsement did not significantly correlate with any predictor variable. Linear regression models showed that 13% of the variance in Experiential Stigma was explained by affective symptoms and vocational status, and 20% of the variance in Stigma Resistance was explained by non-social cognition and vocational status. These findings provide new information about the correlates of self-stigma in an ethnically and racially diverse psychotic disorder sample. Such information may lead to a better understanding of self-stigma mechanisms in this population.
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Affiliation(s)
- Marcelo L. Schwarzbold
- Department of Clinical Medicine, Federal University of Santa Catarina, Florianópolis, Brazil,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Robert S. Kern
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Derek M. Novacek
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Jessica E. McGovern
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Lauren T. Catalano
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Michael F. Green
- Desert Pacific Mental Illness Research, Education and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
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Chiang YS, Chang YC, Liu YP, Tzeng WC. Quality of life in patients with comorbid serious mental illness and chronic diseases: A structural equation model. J Adv Nurs 2020; 77:1271-1283. [PMID: 33230880 DOI: 10.1111/jan.14663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 11/04/2020] [Indexed: 11/28/2022]
Abstract
AIMS To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases. DESIGN Descriptive, cross-sectional study design. METHODS In total, 204 patients with serious mental illness were recruited from two hospitals. Self-reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 - January 2019. The structural equation model was applied to examine the associations among the study variables. RESULTS Internalized stigma (β = -0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = -0.207, p = .002) and psychiatric symptoms (β = -0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life. CONCLUSION The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population. IMPACT Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases.
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Affiliation(s)
- Yu-Shuang Chiang
- Department of Nursing, Tri-Service General Hospital Beitou Branch, Taipei City, Taiwan.,School of Nursing, National Defense Medical Center, Taipei City, Taiwan
| | - Yue-Cune Chang
- Department of Mathematics, Tamkang University, New Taipei City, Taiwan
| | - Yia-Ping Liu
- Department of Psychiatry, Cheng-Hsin General Hospital, Taipei City, Taiwan.,Laboratory of Cognitive Neuroscience, Departments of Physiology and Psychiatry, National Defense Medical Center, Taipei City, Taiwan
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan
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11
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Schnell T, Moritz S. Less self-stigmatization and more empowerment in patients with schizophrenia and comorbid cannabis use disorder compared to non-comorbid schizophrenia. Schizophr Res 2020; 222:523-524. [PMID: 32507374 DOI: 10.1016/j.schres.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/18/2020] [Accepted: 05/06/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Thomas Schnell
- Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457 Hamburg, Germany.
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
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12
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Lopez D, Altamirano O, Weisman de Mamani A. The association between perceived racial discrimination and subclinical symptoms of psychosis. J Ment Health 2020; 31:14-21. [PMID: 32662709 DOI: 10.1080/09638237.2020.1793120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Schizophrenia is one of the most disabling disorders with the poorest outcomes. Cross-cultural research indicates an association between perceived racial discrimination and depression, anxiety, general psychological distress, and psychotic-spectrum disorders. Studies also find that coping moderates the relationship between discrimination and depression. Assessing subclinical symptoms may be useful in prevention efforts. AIMS The study aims to (1) assess if perceived racial discrimination is associated with psychosis subclinical symptoms among a non-clinical sample and (2) examine the role of maladaptive coping and depression, anxiety, and stress. METHODS The sample consisted of 261 ethnic minority undergraduate students. A structural equation model using a subclinical psychosis latent variable within a moderated mediation model assessed relationships between racial discrimination, maladaptive coping, depression, anxiety, and stress, and subclinical psychosis. RESULTS Perceived racial discrimination was associated with greater subclinical symptoms of psychosis through increased depression, anxiety, and stress at greater levels of maladaptive coping. CONCLUSIONS Knowing risk factors that can be targeted, such as perceived discrimination and maladaptive coping, may have implications for vulnerable populations.
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Affiliation(s)
- Daisy Lopez
- Psychology Department, University of Miami, Miami, FL, USA
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Abstract
Aims and methodSchizophrenia is a psychotic disorder that is stereotypically stigmatised as untreatable and associated with violence. Several authorities have suggested that changing the name, for example to psychosis, would reduce such stigmatisation. We aimed to compare attitudes to schizophrenia and psychosis on Twitter to see if psychosis was associated with less negative attitudes. Tweets containing the terms 'schizophrenia', 'schizophrenic', 'psychosis' or 'psychotic' were collected on www.twitter.com and were captured with NCapture. On NVivo, tweets were coded into categories based on user type, tweet content, attitude and stigma type by two independent raters. We compared the content and attitudes of tweets referring to schizophrenia/schizophrenic and psychosis/psychotic. RESULTS: A total of 1120 tweets referring to schizophrenia/schizophrenic and 1080 referring to psychosis/psychotic were identified over two 7-day periods; 424 original tweets for schizophrenia and 416 original tweets for psychosis were included in the analysis. Psychosis was significantly more commonly included in tweets expressing negative attitudes (n=131, 31.5%) than schizophrenia (n=41, 9.7%) (χ² = 237.03, P < 0.0001). Of the personal opinions or dyadic interactions, 125 (53.4%) in the psychosis data set were stigmatising, compared with 33 (24.6%) of those in the schizophrenia set (χ² = 44.65, P < 0.0001).Clinical implicationsThe terms psychosis/psychotic are associated with a significantly higher number of tweets with negative content than schizophrenia/schizophrenic. Together with other evidence, this suggests that changing the name of schizophrenia to psychosis will not reduce negative attitudes toward the condition.Declaration of interestS.L. has received personal fees from Otsuka and Sunovion, and personal and research fees from Janssen.
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Affiliation(s)
- Giorgianna L Passerello
- Edinburgh Medical School, College of Medicine and Veterinary Medicine,University of Edinburgh,UK
| | - James E Hazelwood
- Edinburgh Medical School, College of Medicine and Veterinary Medicine,University of Edinburgh,UK
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14
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Grover S, Sahoo S, Nehra R. A comparative study of childhood/adolescent and adult onset schizophrenia: does the neurocognitive and psychosocial outcome differ? Asian J Psychiatr 2019; 43:160-169. [PMID: 31176081 DOI: 10.1016/j.ajp.2019.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/21/2019] [Accepted: 05/17/2019] [Indexed: 01/31/2023]
Abstract
AIMS & OBJECTIVES The present study aimed to evaluate the neurocognitive functioning and psychosocial outcome (in terms of social functioning, disability and internalized stigma) in patients with schizophrenia with childhood/adolescent onset (age of onset ≤18 years) and adult onset (>18years) schizophrenia and to evaluate the effect of neurocognitive impairment on the outcome variables in patients with youth and adult onset schizophrenia. METHODOLOGY 34 patients with youth onset schizophrenia (Group-I) and 56 patients with adult onset schizophrenia (Group-II), who were currently in clinical remission were assessed on a comprehensive neurocognitive battery,Positive and Negative syndrome Scale (PANSS), Global Assessment of Functioning Scale (GAF), Indian Disability Evaluation and Assessment Scale (IDEAS),Social and Occupational Functioning Assessment Scale (SOFS) and Internalised Stigma of Mental Illness Scale (ISMIS). RESULTS On neurocognitive domains (after adjusting for co-variates) significant differences were noted between the two groups in terms of processing speed (TMT-A; I > II; p-value -0.009), verbal fluency (COWA;I < II;p-value-0.001) and cognitive flexibility (TMT-B; I > II; p -0.031). Compared to patients with adult onset schizophrenia, patients with childhood & adolescent onset schizophrenia had significantly higher PANSS negative score, higher disability in all domains of IDEAS, poorer socio-occupational functioning, low global functioning and reported more stigma in the domains of alienation and discrimination.In patients with childhood & adolescent onset schizophrenia, higher deficits in the processing speed and verbal fluency were associated with significantly lower socio-occupational functioning and higher disability; higher executive dysfunction was associated with higher internalized stigma. Among patients with adult onset schizophrenia, higher disability was related to executive dysfunction only and higher stigma was associated with poor cognitive processing, selective attention and poor executive functioning. CONCLUSIONS The present study suggests that compared to adult onset schizophrenia, patients with childhood & adolescent onset schizophrenia have more deficits in neurocognition, have higher level of disability, poorer socio-occupational functioning and have higher level of self-stigma.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, PGIMER, 160012, Chandigarh, India.
| | | | - Ritu Nehra
- Department of Psychiatry, PGIMER, 160012, Chandigarh, India
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15
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Hofer A, Post F, Pardeller S, Frajo-Apor B, Hoertnagl CM, Kemmler G, Fleischhacker WW. Self-stigma versus stigma resistance in schizophrenia: Associations with resilience, premorbid adjustment, and clinical symptoms. Psychiatry Res 2019; 271:396-401. [PMID: 30530057 DOI: 10.1016/j.psychres.2018.12.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Self-stigma is regarded as a barrier to recovery from schizophrenia and the identification of factors protecting from its development may help identify vulnerable patients and subsequently, implement effective preventive and therapeutic interventions. Hence, this study aimed to assess whether resilience, premorbid adjustment, and psychopathology might differently impact self-stigma and stigma resistance among 54 regular attendees of a specialized outpatient clinic. There was no significant association between sociodemographic variables and self-stigma/stigma resistance, while resilience was negatively correlated with self-stigma and positively correlated with stigma resistance. In addition, we detected a negative correlation between self-stigma and both academic and social functioning during late adolescence. Most residual symptoms correlated with self-stigma, while no association was found between stigma resistance and psychopathology, except for depressed symptoms. These data provide evidence that future self-stigma reduction interventions may consider to focus on the improvement of resilience in order to promote schizophrenia patients' stigma resistance. In addition, the improvement of depressive symptoms as well as interventions focusing on the strengthening of social adjustment during the prodromal phase may be effective in preventing self-stigma.
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Affiliation(s)
- Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria.
| | - Fabienne Post
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Silvia Pardeller
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Christine M Hoertnagl
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
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16
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Chuang SP, Wu JYW, Wang CS. Self-perception of mental illness, and subjective and objective cognitive functioning in people with schizophrenia. Neuropsychiatr Dis Treat 2019; 15:967-976. [PMID: 31118637 PMCID: PMC6499497 DOI: 10.2147/ndt.s193239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/05/2019] [Indexed: 11/23/2022] Open
Abstract
Background: People with schizophrenia may have a negative self-perception of mental illness. However, the relationship between the self-perception of illness and subjective and objective cognitive functioning remains unclear. Method: Thirty-seven people with schizophrenia were enrolled in the study group. All subjects completed self-reported self-perception of mental illness questionnaires (Birchwood Insight Scale [BIS], Internalized Stigma of Mental Illness [ISMI]), subjective cognitive functioning (Scale to Investigate Cognition in Schizophrenia [SSTICS]) and objective cognitive functioning (Luria Nebraska Neuropsychological Battery [LNNB]). Results: Spearman's rank analysis showed that awareness of illness (domain of insight) was positively associated with most domains of SSTICS and ISMI. Total insight was positively correlated with alienation (domain of ISMI). Need for treatment (domain of insight) was negatively correlated with stigma resistance (domain of ISMI). Awareness of symptoms (domain of insight) and total insight were negatively associated with receptive speech and arithmetic (LNNB subtest), respectively. ISMI was positively correlated with most domains of SSTICS, but not with LNNB. The group with good insight had higher scores in attention (domain of SSTICS) and total SSTICS and alienation, stereotype endorsement, social withdrawal (domains of ISMI) and total ISMI than the group with poor insight. The group with mild to moderate internalized stigma had higher scores in explicit memory, attention, language, praxia (domains of SSTICS) and total SSTICS than the group with no internalized stigma. Conclusion: We identified that awareness of illness (domain of insight), internalized stigma were significantly associated with most domains of SSTICS, but not with LNNB. Total insight and awareness of symptoms (domain of insight) were significantly associated with receptive speech and arithmetic (LNNB subtest), respectively. Schizophrenia with higher insight or more internalized stigma reported more subjective cognitive impairment. Future studies with larger samples involving follow up are necessary to verify our findings and extend the applicability.
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Affiliation(s)
- Shu Ping Chuang
- Department of Psychiatry, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Jo Yung Wei Wu
- Department of Counseling and Guidance, National University of Tainan, Tainan, Taiwan.,Good-Day Psychology Clinic, Tainan, Taiwan
| | - Chien Shu Wang
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
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Fleury MJ, Grenier G, Bamvita JM. Comparing Perceived Adequacy of Help Received Among Different Classes of Individuals with Severe Mental Disorders at Five-Year Follow-Up: A Longitudinal Cluster Analysis. Community Ment Health J 2018; 54:540-554. [PMID: 29134396 DOI: 10.1007/s10597-017-0181-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
This study developed a typology describing change in the perceived adequacy of help received among 204 individuals with severe mental disorders, 5 years after transfer to the community following a major mental health reform in Quebec (Canada). Participant typologies were constructed using a two-step cluster analysis. There were significant differences between T0 and T2 for perceived adequacy of help received and other independent variables, including seriousness of needs, help from services or relatives, and care continuity. Five classes emerged from the analysis. Perceived adequacy of help received at T2 increased for Class 1, mainly comprised of older women with mood disorders. Overall, greater care continuity and levels of help from services and relatives related to higher perceived AHR. Changes in perceived adequacy of help received resulting from several combinations of associated variables indicate that MH service delivery should respond to specific profiles and determinants.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute, Montreal, QC, H4H 1R3, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute, Montreal, QC, H4H 1R3, Canada
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