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Chu RST, Ng CM, Chu SC, Lui TT, Lau FC, Chan SKW, Lee EHM, Hui CLM, Chen EYH, Lui SSY, Chang WC. Rate and correlates of self-stigma in adult patients with early psychosis. Front Psychiatry 2023; 14:1200568. [PMID: 37520240 PMCID: PMC10374014 DOI: 10.3389/fpsyt.2023.1200568] [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: 04/05/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Self-stigma impedes recovery process and is associated with poorer clinical and functional outcomes in people with psychotic disorders. However, there is limited research specifically examining self-stigma in the early stage of illness, and mixed findings were observed regarding factors associated with increased self-stigma. We aimed to investigate the rate and correlates of self-stigma in a cohort of adult patients with early psychosis using a comprehensive array of clinical, treatment and other illness-related variables. Methods A total of 101 Chinese adult early psychosis patients aged 26-55 years who had received three-year psychiatric treatment for first psychotic episode in Hong Kong and completed self-stigma assessment were included for the current investigation. A broad range of assessments encompassing socio-demographics, premorbid adjustment, onset and illness profiles, symptom severity, psychosocial functioning, treatment characteristics and medication side-effects were conducted. Results Twenty-eight (27.7%) patients had moderate-to-high levels of self-stigma. Univariate linear regression analyses showed that age at study entry, sex, educational level, age at psychosis onset, duration of untreated psychosis (DUP), insight level, global psychosocial functioning, and the use of second-generation antipsychotic were related to self-stigma levels. Final multivariable regression model revealed that female sex, younger age at entry, longer DUP and better insight were independently associated with higher levels of self-stigma. Conclusion More than one-fourth of early psychosis patients experienced significant self-stigma, highlighting an unmet need for early detection and intervention of self-stigma in the initial years of illness. Further investigation is warranted to clarify trajectories and predictors of self-stigma in the early illness course.
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Affiliation(s)
- Ryan Sai Ting Chu
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chung Mun Ng
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sheung Chit Chu
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tsz Ting Lui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Fu Chun Lau
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Christy Lai Ming Hui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Simon Sai Yu Lui
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Le PD, Choe K, Burrone MS, Bello I, Velasco P, Arratia T, Tal D, Mascayano F, Jorquera MJ, Schilling S, Ramírez J, Arancibia D, Fader K, Conover S, Susser E, Dixon L, Alvarado R, Yang LH, Cabassa LJ. Initial adaptation of the OnTrack coordinated specialty care model in Chile: An application of the Dynamic Adaptation Process. FRONTIERS IN HEALTH SERVICES 2022; 2:958743. [PMID: 36925802 PMCID: PMC10012675 DOI: 10.3389/frhs.2022.958743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/10/2022] [Indexed: 05/31/2023]
Abstract
Background In 2005, Chile became the first country in Latin America to guarantee universal free access for the diagnosis and treatment of schizophrenia. A cluster randomized control trial utilizing the Dynamic Adaptation Process framework is underway to adapt and test the OnTrack coordinated specialty care model to provide recovery-oriented, person-centered care by a multidisciplinary team for individuals with first episode psychosis (FEP) in Chile. Methods A qualitative formative research study was conducted to inform the initial adaptation of the OnTrack Chile (OTCH) program. We conducted key informant interviews (n = 17) with various stakeholders (policymakers; directors/managers of community mental health centers; mental health professionals) and focus group discussions (n = 6) with individuals with FEP and caregivers (n = 35 focus group participants total). Data was analyzed using thematic analysis, organized by participants' perspectives on the benefits, barriers, and recommendations for the key principles, multidisciplinary team, psychosocial components, and the training and supervision model of OnTrack. Results Participants expressed enthusiasm and support for OnTrack's recovery-oriented and person-centered principles of care. While many participants lauded the emphasis on shared decision-making and family involvement, some reported reticence, citing that it is culturally normative for patients and families to adopt a passive role in treatment. Peer specialists, and the family psychoeducation and support and supported education and employment components were perceived as aspects that could encourage the promotion of personhood and autonomy development. However, implementation challenges, including the prevailing biomedical approach, professional hierarchy, and the lack of infrastructure, human, and financial resources necessitate some modifications to these aspects. Some mental health professionals further conveyed reservations regarding the perceived hierarchical structure of the supervision model. Conclusion OnTrack represents a shift from a biomedical model to a valued, aspirational, person-centered and culturally responsive model that focuses on recovery, shared decision-making and psychosocial care. With the appropriate governmental and agency-level provision of resources and modifications to some of the program components, particularly regarding the shared decision-making framework, peer specialist, family engagement, and the training supervision model, OTCH could be a transformative program for a more comprehensive, evidence-based care for individuals with FEP in Chile.
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Affiliation(s)
- PhuongThao D. Le
- School of Global Public Health, New York University, New York, NY, United States
| | - Karen Choe
- School of Global Public Health, New York University, New York, NY, United States
| | | | - Iruma Bello
- New York State Psychiatric Institute, New York, NY, United States
| | - Paola Velasco
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Tamara Arratia
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
| | - Danielle Tal
- Department of Clinical Psychology, Teachers College Columbia University, New York, NY, United States
| | - Franco Mascayano
- New York State Psychiatric Institute, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - María José Jorquera
- Departamento de Atención Primaria y Salud Familiar, Universidad de Chile, Santiago, Chile
| | - Sara Schilling
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jorge Ramírez
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Diego Arancibia
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Kim Fader
- New York State Psychiatric Institute, New York, NY, United States
| | - Sarah Conover
- Silberman School of Social Work, Hunter College, New York, NY, United States
| | - Ezra Susser
- New York State Psychiatric Institute, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Lisa Dixon
- New York State Psychiatric Institute, New York, NY, United States
- Division of Behavioral Health Services and Policy Research & Center for Practice Innovations, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Rubén Alvarado
- Instituto de Ciencias de la Salud, Universidad de O'Higgins, Rancagua, Chile
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Lawrence H. Yang
- School of Global Public Health, New York University, New York, NY, United States
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Leopoldo J. Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, MO, United States
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