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Penas P, Uriarte JJ, Alvarez-Gonzalez A, Moreno-Calvete MC, Garay MA, Iraurgi I. The role of personal recovery and internalised stigma on the expression of symptomatology in severe mental disorders: Mediating and moderating effects. J Psychiatr Res 2024; 177:264-270. [PMID: 39053294 DOI: 10.1016/j.jpsychires.2024.07.020] [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: 03/06/2024] [Revised: 07/09/2024] [Accepted: 07/14/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Given the relevance of internalised stigma in people suffering from a mental disorder, in the present study, the possible mediating and moderating role of self-stigma in the relationship between personal recovery and symptomatology has been studied. METHOD 265 participants with severe mental disorder completed the following instruments: ISMI (self-stigma), REE (personal recovery) and HoNOS, CGI, GAF and EuroQol (symptomatology). RESULTS both the mediation and moderation analyses show significant results, which would indicate that internalised stigma has an effect on the relationship between personal recovery and symptomatology. Also, people with lower level of personal recovery and greater self-stigma have greater symptomatology than those who are in more advanced personal recovery processes and have a lower perception of internalised stigma. DISCUSSION the findings of this study suggest that self-stigma has an effect, and the improvement at personal recovery and symptomatology is accentuated when people with a severe mental disorder have a better management of internalised stigma. Therefore, it may be interesting to include this variable in recovery interventions.
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Affiliation(s)
- Patricia Penas
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Bizkaia, Spain.
| | - Jose Juan Uriarte
- Biobizkaia Health Research Institute, Osakidetza Basque Health Service, Bizkaia Mental Health Network, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | | | - María-Concepción Moreno-Calvete
- Biobizkaia Health Research Institute, Osakidetza Basque Health Service, Bizkaia Mental Health Network, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Maria Asuncion Garay
- Osakidetza Basque Health Service, Bizkaia Mental Health Network, C/ María Díaz de Haro, 58, 48010, Bilbao, Spain
| | - Ioseba Iraurgi
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Bizkaia, Spain
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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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Djordjevic M, Farhang S, Shirzadi M, Mousavi SB, Bruggeman R, Malek A, Mohagheghi A, Ranjbar F, Shafiee-Kandjani AR, Jongsma HE, Veling W. Self-stigma, religiosity, and perceived social support in people with recent-onset psychosis in the Islamic Republic of Iran: Associations with symptom severity and psychosocial functioning. Int J Soc Psychiatry 2024; 70:542-553. [PMID: 38312047 PMCID: PMC11067409 DOI: 10.1177/00207640231221090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
AIMS Most evidence on psychosocial factors in recent-onset psychosis comes from high-income countries in Europe, Australia, Canada and the USA, while these factors are likely to differ under varying sociocultural and economic circumstances. In this study, we aimed to investigate associations of self-stigma, religiosity and perceived social support with symptom severity and psychosocial functioning in an Iranian cohort of people with recent-onset psychosis (i.e. illness duration of <2 years). METHODS We used baseline data of 361 participants (N = 286 [74%] male, mean age = 34 years [Standard Deviation = 10.0]) from the Iranian Azeri Recent-onset Acute Phase Psychosis Survey (ARAS). We included assessments of self-stigma (Internalized Stigma of Mental Illness, ISMI), religiosity (based on Stark & Glock), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS), symptom severity (Positive And Negative Syndrome Scale, PANSS) and psychosocial functioning (clinician-rated Global Assessment of Functioning Scale, GAF, and self-reported World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0). Descriptive analyses were employed to characterize the study sample. Covariate-adjusted ordinal and multivariable linear regression analyses were performed to investigate cross-sectional associations of baseline ISMI, religiosity and MSPSS with concurrent PANSS, GAF and WHODAS 2.0. RESULTS Higher self-stigma was associated with poorer self-reported functioning (B = 0.375 [95% Confidence Interval (CI): 0.186, 0.564]) and more severe concurrent symptoms (B = 0.436 [95% CI: 0.275, 0.597]). Being more religious was associated with poorer clinician-rated functioning (OR = 0.967 [95% CI: 0.944, 0.991]), but with less severe symptoms (B = -0.258 [95% CI: -0.427, -0.088]). Stronger social support was associated with poorer clinician-rated (OR = 0.956 [95% CI: 0.935, 0.978]) and self-reported functioning (B = 0.337 [95% CI: 0.168, 0.507]). CONCLUSION This study shows that self-stigma, religiosity and perceived social support were associated with symptom severity and clinician-rated as well as self-reported psychosocial functioning in an Iranian cohort of people with recent-onset psychosis. The findings extend previous evidence on these psychosocial factors to one of the largest countries in the Middle East, and suggest that it may be worthwhile to develop strategies aimed at tackling stigma around psychosis and integrate the role of religiosity and social support in mental ill-health prevention and therapy.
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Affiliation(s)
- M Djordjevic
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - S Farhang
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - M Shirzadi
- Clinical Research Development Center, Imam Khomeini, Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical
Sciences, Kermanshah, Iran
| | - SB Mousavi
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - R Bruggeman
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - A Malek
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - A Mohagheghi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - F Ranjbar
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - AR Shafiee-Kandjani
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - HE Jongsma
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - W Veling
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
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4
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Tu CY, Liu WS, Huang WL. Associations of internalized stigma with psychosocial functioning and quality of life in people with schizophrenia. Int J Soc Psychiatry 2023; 69:1409-1419. [PMID: 37029497 DOI: 10.1177/00207640231164013] [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: 04/09/2023]
Abstract
BACKGROUND Schizophrenia is associated with poor functional recovery. Internalized stigma is one of the factors related to the functioning of individuals with schizophrenia. We aimed to investigate whether internalized stigma was associated with subjective and objective recovery-related outcomes after controlling for neurocognition and other important confounders in individuals with schizophrenia. METHOD We assessed the socio demographic background, psychopathology, neurocognition, internalized stigma, psychosocial functioning, and quality of life of 86 patients who had schizophrenia. Correlation analyses and multiple linear regression were used to investigate the association of internalized stigma and other variables with recovery-related outcomes. RESULTS We found that the negative symptom scores of the Positive and Negative Syndrome Scale but not internalized stigma was associated with psychosocial functioning as measured by the Personal and Social Performance global score. In contrast, internalized stigma was associated with the Psychological, Social relationships, and Environment scores of the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF). Depression was also associated with the Physical health, Psychological, and Social relationships sores of the WHOQOL-BREF. CONCLUSIONS While internalized stigma was associated with several domains of quality of life, it was not associated with clinician-rated psychosocial functioning. The effects of internalized stigma on the subjective and objective recovery-related outcomes of individuals with schizophrenia might be divergent.
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Affiliation(s)
- Chao-Ying Tu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wei-Shih Liu
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
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5
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Bridgwater M, Bachman P, Tervo-Clemmens B, Haas G, Hayes R, Luna B, Salisbury DF, Jalbrzikowski M. Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis. Psychol Med 2022; 52:1698-1709. [PMID: 33019960 PMCID: PMC8021611 DOI: 10.1017/s0033291720003463] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression - how age affects clinical presentation in first-episode psychosis - has not been thoroughly investigated. METHODS Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first-episode psychosis (N = 340, 12-40 years, 1-12 visits), collected at the University of Pittsburgh from 1990 to 2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on change in positive or negative symptom severity following baseline assessment and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development. RESULTS Perceptual positive symptom severity significantly decreased with increasing age (F = 7.0, p = 0.0007; q = 0.003) while non-perceptual positive symptom severity increased with age (F = 4.1, p = 0.01, q = 0.02). Anhedonia severity increased with increasing age (F = 6.7, p = 0.00035; q = 0.0003), while flat affect decreased in severity with increased age (F = 9.8, p = 0.002; q = 0.006). Findings remained significant when parental SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p > 0.25). Beginning at age 18, there was a statistically significant association between severity of non-perceptual and perceptual symptoms. This relationship increased in strength throughout adulthood. CONCLUSIONS These findings suggest that as maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced. Findings underscore how pathological brain-behavior relationships vary as a function of development.
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Affiliation(s)
- Miranda Bridgwater
- Department of Psychology, University of Maryland, Baltimore County, Maryland, USA
| | - Peter Bachman
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Gretchen Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- VISN4 MIRECC at VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Rebecca Hayes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dean F Salisbury
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maria Jalbrzikowski
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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6
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DeTore NR, Balogun-Mwangi O, Tepper M, Cather C, Russinova Z, Lanca M, Mueser KT. The interrelationships of motivation, positive symptoms, stigma, and role functioning in early psychosis. Early Interv Psychiatry 2022; 16:736-743. [PMID: 34431230 DOI: 10.1111/eip.13213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/23/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022]
Abstract
AIM Avolition, or the lack of motivation, has consistently been shown to be a significant predictor of poor psychosocial outcome, with decreased overall motivation as the single strongest predictor of poor work or school outcome in first episode psychosis. This study aimed to better understand the ways in which motivation impacts work and school functioning. This study first examined the factors related to motivation in people recovering from a recent onset of psychosis, then explored the unique interrelationships between positive symptoms, stigma, and motivation and how they influence role functioning. METHODS A total of 40 participants with early psychosis were recruited for this cross-sectional design study; with a mean of 14.5 months of treatment prior to study assessment. RESULTS Neither experienced nor internalized stigma were related to motivation in this sample, but internalized stigma was related to work and school functioning. Positive symptoms were significantly inversely related to both work and school functioning and motivation, with mediation analyses showing that motivation significantly mediates the relationship between positive symptoms and role functioning. CONCLUSION This relationship may shed light on the link between motivational deficits and work and school outcomes early in the course of psychosis, an area of critical importance for early intervention.
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Affiliation(s)
- Nicole R DeTore
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA
| | | | - Miriam Tepper
- Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Corinne Cather
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zlatka Russinova
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA
| | - Margaret Lanca
- Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA.,Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
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7
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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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8
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Phalen P, Millman Z, Rouhakhtar PR, Andorko N, Reeves G, Schiffman J. Categorical versus dimensional models of early psychosis. Early Interv Psychiatry 2022; 16:42-50. [PMID: 33559329 PMCID: PMC8349380 DOI: 10.1111/eip.13128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
AIM Early psychosis is typically operationalized as a categorical construct by dividing people into one of three diagnostic statuses: low-risk, clinical high-risk, and first episode psychosis. We empirically assess whether an alternative dimensional approach focused on observed symptom severity may be more desirable for clinical and research purposes. METHODS Participants were 152 help-seeking youths ages 12-22 years old. Structured interview for psychosis risk syndromes interviews were used to obtain dimensional psychosis symptom severity ratings, and to classify participants by categorical psychosis risk status. Twenty-five participants were classified as having a diagnosable psychotic disorder, 52 participants as clinical high-risk, and 75 participants as help-seeking controls. We assessed the relation between categorical and dimensional measurements of psychosis severity, and then compared categorical versus dimensional psychosis severity in their ability to predict social and role functioning. RESULTS On average, dimensional psychosis symptom severity increased along with categorical risk status (help-seeking control < clinical high-risk < diagnosable psychotic disorder). There was, however, considerable overlap between categories, with people at clinical high-risk being particularly hard to distinguish from people with diagnosable psychotic disorders on the basis of symptom severity. Dimensional symptom severity was more predictive of functioning than categorical risk status. CONCLUSIONS Categorical risk status and psychosis symptom severity are related but not interchangeable, and dimensional models of psychosis may be more predictive of functional outcomes. Adopting a dimensional rather than categorical approach to the psychosis risk spectrum may facilitate better predictive models and a richer theoretical understanding of early psychosis.
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Affiliation(s)
- Peter Phalen
- VA Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA.,Division of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zachary Millman
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA.,Center of Excellence in Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicole Andorko
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA
| | - Gloria Reeves
- Division of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA.,Psychological Science, University of California, Irvine, California, USA
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9
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Dubreucq J, Plasse J, Franck N. Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences. Schizophr Bull 2021; 47:1261-1287. [PMID: 33459793 PMCID: PMC8563656 DOI: 10.1093/schbul/sbaa181] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma-including from mental health providers-predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy.
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Affiliation(s)
- Julien Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France
- Centre référent de réhabilitation psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
- Fondation FondaMental, Créteil, France
| | - Julien Plasse
- Réseau Handicap Psychique, Grenoble, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation cognitive, Centre Hospitalier Le Vinatier, Bron, France
| | - Nicolas Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation cognitive, Centre Hospitalier Le Vinatier, Bron, France
- Pôle Centre Rive Gauche, Centre Hospitalier Le Vinatier, Bron, France
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10
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Dubreucq J, Faraldo M, Abbes M, Ycart B, Richard-Lepouriel H, Favre S, Jermann F, Attal J, Bakri M, Cohen T, Cervello C, Chereau I, Cognard C, De Clercq M, Douasbin A, Giordana JY, Giraud-Baro E, Guillard-Bouhet N, Legros-Lafarge E, Polosan M, Pouchon A, Rolland M, Rainteau N, Roussel C, Wangermez C, Yanos PT, Lysaker PH, Franck N. Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial. Trials 2021; 22:124. [PMID: 33557924 PMCID: PMC7869198 DOI: 10.1186/s13063-021-05067-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning. Methods This is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery. Discussion NECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice. Trial registration ClinicalTrials.gov NCT03972735. Trial registration date 31 May 2019.
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Affiliation(s)
- J Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France. .,Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France. .,Fondation FondaMental, Créteil, France. .,Réseau Handicap Psychique, Grenoble, France.
| | - M Faraldo
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - M Abbes
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - B Ycart
- Laboratoire Jean Kuntzmann, CNRS UMR 5224, Université Grenoble-Alpes, Grenoble, France
| | - H Richard-Lepouriel
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - S Favre
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - F Jermann
- Department of Psychiatry, Mood disorders Unit, Geneva University Hospital, 20bis rue de Lausanne, CH-1201, Geneva, Switzerland
| | - J Attal
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - M Bakri
- Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - T Cohen
- Centre Référent de Réhabilitation Psychosociale et de Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, 1 place du Conseil National de la Résistance, 38400 Saint Martin d'Hères, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - C Cervello
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
| | - I Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69 63003, Clermont-Ferrand Cedex 1, France
| | - C Cognard
- Unité Ariane de rehabilitation psychosociale, EPSM, Caen, France
| | - M De Clercq
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 chemin des bois des Fornets, 74800, La Roche sur Foron, France
| | - A Douasbin
- Unité Ariane de rehabilitation psychosociale, EPSM, Caen, France
| | - J Y Giordana
- Centre Hospitalier Sainte Marie de Nice, 87 Avenue Joseph Raybaud, 06100, Nice, France
| | - E Giraud-Baro
- Clinique du Dauphiné- Groupe Sinoué, 252 Route de Saint-Nizier, 38180, Seyssins, France
| | | | - E Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges C2RL, CH Esquirol, Limoges, France
| | - M Polosan
- Centre Expert Troubles Bipolaires, Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, CS10217, F-38043, Grenoble, France
| | - A Pouchon
- Centre Expert Troubles Bipolaires, Service Universitaire de Psychiatrie, CHU de Grenoble et des Alpes, CS10217, F-38043, Grenoble, France
| | - M Rolland
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
| | - N Rainteau
- Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm, 1061, Montpellier, France
| | - C Roussel
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 chemin des bois des Fornets, 74800, La Roche sur Foron, France
| | - C Wangermez
- CREATIV & URC Pierre Deniker, CH Laborit, Poitiers, France
| | - P T Yanos
- John Jay College of Criminal Justice, City University of New York, New York, USA
| | - P H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, USA
| | - N Franck
- Centre de Neurosciences Cognitive, UMR 5229, CNRS & Université Lyon 1, Lyon, France.,Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier, Bron, France.,Centre Référent Lyonnais de Réhabilitation Psychosociale et de Remédiation Cognitive (CL3R), Centre Hospitalier Le Vinatier, Bron, France
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11
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Pribadi T, Lin ECL, Chen PS, Lee SK, Fitryasari R, Chen CH. Factors associated with internalized stigma for Indonesian individuals diagnosed with schizophrenia in a community setting. J Psychiatr Ment Health Nurs 2020; 27:584-594. [PMID: 32009270 DOI: 10.1111/jpm.12611] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/25/2020] [Accepted: 01/30/2020] [Indexed: 01/01/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Internalized stigma in people diagnosed with mental illness has several negative outcomes; however, it remains unclear in an Indonesian context. The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of the existing stigma against mental illness and deficiencies in the country's mental healthcare services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To the best of our knowledge, this is the first study to examine the level of internalized stigma and related factors among Indonesians diagnosed with schizophrenia. Almost one-third of the subjects had moderate-to-severe levels of internalized stigma, among which discrimination was the strongest type. Specifically, younger and unemployed people with more psychotic symptoms had higher levels of internalized stigma. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The provision of adequate pharmacological and psychosocial treatments to help people manage their psychotic symptoms is extremely important to ameliorate stigma. Vocational rehabilitation and employment support for unemployed people may potentially reduce their internalized stigma and promote recovery. ABSTRACT: Introduction The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of societal stigma associated with mental illness and deficiencies in the country's mental healthcare services. Knowledge about internalized stigma among people diagnosed with schizophrenia in lower middle-income Muslim countries is also scarce. Aim To identify the level of internalized stigma and related factors among people diagnosed with schizophrenia in Indonesia. Method A cross-sectional survey was conducted with a purposive sample of 300 people diagnosed with schizophrenia from an urban Indonesian psychiatric hospital. Results Almost one-third of the subjects had moderate-to-severe levels of internalized stigma, among which discrimination was the strongest type. Younger age, unemployment status and having psychotic symptoms significantly increased the risk of internalized stigma when analysed in a multivariable ordinal logistic regression. Discussion The present study firstly identified the high levels of internalized stigma among Indonesian individuals diagnosed with schizophrenia. Implications for practice Mental health nurses are suggested to provide early anti-stigma illness management and family psychoeducation interventions to people diagnosed with schizophrenia and their family caregivers, helping them to develop an optimistic understanding about the concept of schizophrenia and mitigating the negative consequences of public and internalized stigma.
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Affiliation(s)
- Teguh Pribadi
- Faculty of Medicine, Nursing and Health Sciences, Malahayati University, Lampung, Indonesia
| | - Esther C-L Lin
- Department of Nursing, College of Medicine, National Cheng Kung University (NCKU) and Hospital, Tainan City, Taiwan
| | - Po-See Chen
- Department of Psychiatry, College of Medicine, National Cheng Kung University (NCKU) and Hospital, Tainan City, Taiwan
| | - Shih-Kai Lee
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Tsaotun Township, Nantou County, Taiwan
| | - Reziki Fitryasari
- Lecturer of Faculty of Nursing, Airlangga University, Surayaba, Indonesia
| | - Chih-Hsuan Chen
- Special Education Center, National Taitung University, Taitung City, Taiwan
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12
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Yanos PT, DeLuca JS, Roe D, Lysaker PH. The impact of illness identity on recovery from severe mental illness: A review of the evidence. Psychiatry Res 2020; 288:112950. [PMID: 32361335 DOI: 10.1016/j.psychres.2020.112950] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 01/13/2023]
Abstract
The "Illness Identity" model proposed that self-stigma impacts hope and self-esteem and subsequently leads to a cascade of negative effects on outcomes related to recovery among people diagnosed with severe mental illnesses. The purpose of the present review is to take stock of research support for the model. The citation index SCOPUS was reviewed for all papers published in peer-reviewed journals in English between 2010 and 2019 citing one of the initial 3 articles discussing the model: 111 studies met inclusion criteria and were reviewed. The most frequently tested, and supported, aspects of the model were relationships between self-stigma and self-esteem, hope, psychiatric symptoms and social relationships. Least frequently studied areas were relationships with suicide, avoidant coping, treatment adherence and vocational functioning, although they were supported in the majority of studies. The "insight paradox" was also tested in a relatively small number of studies, with mixed results. Findings were robust to geographic location of study, method, and subpopulation studied. Findings indicate that a large body of research has tested, and largely supported, the various components of the Illness Identity model, although some components need further investigation and there is a need for more comprehensive tests of the model.
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Affiliation(s)
- Philip T Yanos
- John Jay College of Criminal Justice and the Graduate Center, City University of New York, 524 W. 59th St., New York 10019, NY, United States.
| | - Joseph S DeLuca
- John Jay College of Criminal Justice and the Graduate Center, City University of New York, 524 W. 59th St., New York 10019, NY, United States
| | | | - Paul H Lysaker
- Richard L Roudebush VA Medical Center, Indianapolis, IN, United States; Indiana University School of Medicine, IN, United States
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13
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Dubreucq J, Gabayet F, Ycart B, Faraldo M, Melis F, Lucas T, Arnaud B, Bacconnier M, Bakri M, Cambier G, Carmona F, Chereau I, Challe T, Morel S, Pires S, Roussel C, Lamy P, Legrand G, Pages E, Pommier R, Rey R, Souchet Y, Llorca PM, Massoubre C. Improving social function with real-world social-cognitive remediation in schizophrenia: Results from the RemedRugby quasi-experimental trial. Eur Psychiatry 2020; 63:e41. [PMID: 32349835 PMCID: PMC7355162 DOI: 10.1192/j.eurpsy.2020.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. Functional capacity (FC) has been identified as a key outcome to improve real-world functioning in schizophrenia. FC is influenced by cognitive impairments, negative symptoms, self-stigma and reduced physical activity (PA). Psychosocial interventions targeting FC are still under-developed. Methods. we conducted a quasi-experimental study evaluating the effects of an exercise-enriched integrated social cognitive remediation (SCR) intervention (RemedRugby [RR]) compared with an active control group practicing Touch Rugby (TR). To our knowledge, this is the first trial to date evaluating the effectiveness of such a program provided in a real-life environment. Results. Eighty-seven people with schizophrenia were included and allocated to either the RR group (n = 57) or the TR group (n = 30) according to the routine clinical practice of the recruiting center. Outcomes were evaluated at baseline and post-treatment in both groups and after 6 months of follow-up in the RR group using standardized scales for symptom severity, social functioning, self-stigma, and a large cognitive battery. After treatment we observed moderate to large improvements in social function (Personal and Social Performance Scale [PSP], p < 0.001, d = 1.255), symptom severity (Positive and Negative Syndrome Scale [PANSS] negative, p < 0.001, d = 0.827; PANSS GP, p < 0.001, d = 0.991; PANSS positive, p = 0.009, d = 0.594), verbal abstraction (p = 0.008, d = 0.554), aggression bias (p = 0.008, d = 0.627), and self-stigma (stereotype endorsement, p = 0.019, d = 0.495; discrimination experiences, p = 0.047; d = 0.389) that were specific to the RR group and were not observed in participants playing only TR. Effects were persistent over time and even larger between post-treatment and follow-up. Conclusions. Exercise-enriched integrated SCR appears promising to improve real-life functioning in schizophrenia. Future research should investigate the potential effects of this intervention on neuroplasticity and physical fitness.
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Affiliation(s)
- Julien Dubreucq
- Centre de Neurosciences Cognitive, UMR 5229, CNRS and Université Lyon 1, Lyon, France.,Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France.,Réseau Handicap Psychique, Grenoble, France
| | - Franck Gabayet
- Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - Bernard Ycart
- Laboratoire Jean Kuntzmann, CNRS UMR 5224, Université Grenoble-Alpes, Grenoble, France
| | - Megane Faraldo
- Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France.,Fondation FondaMental, Créteil, France
| | - Fanny Melis
- Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - Thierry Lucas
- Centre Référent de Réhabilitation Psychosociale et de Remédiation cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble, France
| | - Benjamin Arnaud
- Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, Clermont-Ferrand Cedex 1 63037, France
| | - Mickael Bacconnier
- Centre Médical La Teppe, 25 Avenue de la Bouterne, CS 9721, Tain-l'Hermitage Cedex 26602, France.,Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - Motassem Bakri
- Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - Gentiane Cambier
- Centre Hospitalier de la Savoie, 89 avenue de Bassens, Bassens73000, France
| | | | - Isabelle Chereau
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, Clermont-Ferrand Cedex 1 63003, France
| | - Titaua Challe
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 Chemin des Bois des Fornets, La Roche sur Foron 74800, France
| | - Sophie Morel
- Centre de Réhabilitation Psychosociale et de Remédiation Cognitive (C2R), CH Drôme Vivarais, Montéléger, France
| | - Sylvie Pires
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, Clermont-Ferrand Cedex 1 63003, France
| | - Celine Roussel
- Centre Départemental de Réhabilitation Psychosociale des Glières, 219 Chemin des Bois des Fornets, La Roche sur Foron 74800, France
| | - Philippe Lamy
- REHALise, CHU de Saint-Etienne, Saint-Etienne, France
| | - Guillaume Legrand
- Centre Hospitalier Sainte Marie de Clermont Ferrand, 33 rue Gabriel Péri, CS 9912, Clermont-Ferrand Cedex 1 63037, France
| | - Emmanuelle Pages
- Centre Hospitalier de la Savoie, 89 avenue de Bassens, Bassens73000, France
| | | | - Romain Rey
- Fondation FondaMental, Créteil, France.,Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39, 95 bd Pinel, Bron Cedex69678, France
| | - Yohan Souchet
- Fondation FondaMental, Créteil, France.,Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39, 95 bd Pinel, Bron Cedex69678, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,CMP B, CHU, EA 7280 Faculté de Médecine, Université d'Auvergne, BP 69, Clermont-Ferrand Cedex 1 63003, France
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14
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Tong P, Bu P, Yang Y, Dong L, Sun T, Shi Y. Group cognitive behavioural therapy can reduce stigma and improve treatment compliance in major depressive disorder patients. Early Interv Psychiatry 2020; 14:172-178. [PMID: 31264787 PMCID: PMC7065070 DOI: 10.1111/eip.12841] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/11/2019] [Accepted: 06/02/2019] [Indexed: 11/30/2022]
Abstract
AIM The stigma of mental disorders and poor treatment compliance can deprive patients with major depressive disorder (MDD) of receiving standard treatment. This study aimed to clarify whether MDD patients' stigma and treatment non-compliance issues can be mitigated using group cognitive behavioural therapy (GCBT). METHODS Eighty-eight participants with first-episode MDD were randomly divided into GCBT groups (GCBTs) and control groups (Cs). The Hamilton Rating Scale for Depression (HRSD-24), Morisky Medication Adherence Scale (MMAS-8™) and Stigma Scale (SS) were used to evaluate the therapeutic effect on all participants before and after receiving GCBT. Data were assessed at baseline and post-treatment. RESULTS At the baseline, there were no significant differences (in terms of the demographic data of the participants and the scores on HRSD-24, MMAS-8™ and SS) between the two groups. After 8 weeks of GCBT, there were significant differences in HRSD-24 (P < .01), MMAS-8™ (P < .01), SS (P < .01), treatment compliance (P < .01) and therapeutic effect evaluation based on rate of deduction (P < .05) between the two groups. CONCLUSION GCBT can reduce patients' sense of stigma, improve treatment compliance, effectively alleviate depressive symptoms and promote the recovery of MDD patients.
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Affiliation(s)
- Ping Tong
- Department of Clinical Psychology, Clinical Medical College of Yangzhou University, Yangzhou, People's Republic of China.,Department of Integrated Traditional Chinese and Western Medicine, Medical College of Yangzhou University, Yangzhou, People's Republic of China
| | - Ping Bu
- Department of Clinical Psychology, Clinical Medical College of Yangzhou University, Yangzhou, People's Republic of China.,Department of Integrated Traditional Chinese and Western Medicine, Medical College of Yangzhou University, Yangzhou, People's Republic of China
| | - Yang Yang
- Department of Clinical Psychology, Clinical Medical College of Yangzhou University, Yangzhou, People's Republic of China
| | - Liping Dong
- Department of Clinical Psychology, Clinical Medical College of Yangzhou University, Yangzhou, People's Republic of China
| | - Ting Sun
- Department of Clinical Psychology, Clinical Medical College of Yangzhou University, Yangzhou, People's Republic of China
| | - Yuanhong Shi
- Department of Clinical Psychology, Clinical Medical College of Yangzhou University, Yangzhou, People's Republic of China
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15
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Mueser KT, DeTore NR, Kredlow MA, Bourgeois ML, Penn DL, Hintz K. Clinical and demographic correlates of stigma in first-episode psychosis: the impact of duration of untreated psychosis. Acta Psychiatr Scand 2020; 141:157-166. [PMID: 31557309 PMCID: PMC6980158 DOI: 10.1111/acps.13102] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the relationships between perceived stigma and duration of untreated psychosis (DUP), demographic characteristics, and clinical and psychosocial functioning in persons with a first episode of psychosis (FEP). METHOD A total of 399 participants with FEP presenting for treatment at 34 sites in 21 states throughout the United States were evaluated using standardized instruments to assess diagnosis, symptoms, psychosocial functioning, perceived stigma, wellbeing, and subjective recovery. RESULTS Perceived stigma was correlated with a range of demographic and clinical variables, including DUP, symptoms, psychosocial functioning, and subjective experience. After controlling for symptom severity, perceived stigma was related to longer DUP, schizoaffective disorder diagnosis, more severe depression, and lower wellbeing and recovery. The associations between stigma and depression, wellbeing, and recovery were stronger in individuals with long than short DUP, suggesting the effects of stigma on psychological functioning may be cumulative over the period of untreated psychosis. CONCLUSION The findings suggest that independent of symptom severity, perceived stigma may contribute to delay in seeking treatment for FEP, and this delay may amplify the deleterious effects of stigma on psychological functioning. The results point to the importance of reducing DUP and validating interventions targeting the psychological effects of stigma in people with FEP.
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Affiliation(s)
- Kim T. Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA.,Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Nicole R. DeTore
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA
| | | | | | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Kathryn Hintz
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA
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16
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O'Connor LK, Yanos PT, Firmin RL. Correlates and moderators of stigma resistance among people with severe mental illness. Psychiatry Res 2018; 270:198-204. [PMID: 30265887 PMCID: PMC6292775 DOI: 10.1016/j.psychres.2018.09.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 08/12/2018] [Accepted: 09/18/2018] [Indexed: 01/28/2023]
Abstract
Research on factors associated with stigma resistance among people with severe mental illness remains relatively scant. This study aimed to (1) replicate previous findings linking stigma resistance with variables associated with recovery; (2) explore associations between stigma resistance and coping strategies and psychiatric symptoms; (3) compare these associations among individuals with different levels of self-stigma; and (4) examine whether race, age and education moderate these relationships. Analyses of a sample (n = 353) and sub-sample (n = 177) of persons with severe mental illness examined associations between stigma resistance and self-stigma, functional and clinical outcomes, and the moderating impact of age, race, and education on these relationships. Stigma resistance was significantly negatively associated with self-stigma and positively associated with social functioning, self-esteem, problem-centered coping, and symptoms of hostility-excitement, but not other types of symptoms. Race significantly moderated the relationship between stigma resistance and self-stigma, age significantly moderated the relationships between hopelessness and both stigma resistance and self-stigma, and education significantly moderated the relationship between stigma resistance and social functioning. Findings suggest that social circumstances impact the benefit of stigma resistance in complex ways; future work should aim to understand how these experiences impact stigma resistance to inform intervention development.
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Affiliation(s)
- Lauren K O'Connor
- Department of Psychology, John Jay College of Criminal Justice, 524 West 59th St., New York, NY 10019, USA; Department of Psychology, City University of New York, Graduate Center, New York, NY, USA.
| | - Philip T Yanos
- Department of Psychology, John Jay College of Criminal Justice, 524 West 59th St., New York, NY 10019, USA; Department of Psychology, City University of New York, Graduate Center, New York, NY, USA
| | - Ruth L Firmin
- Department of Psychiatry and Human Behavior, Brown University/Alpert Medical School, Providence, RI, USA
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