Effect of internalized stigma on functional recovery in patients with schizophrenia

Does stigma leave its mark? The interplay between negative effects of perceived stigma with positive effect of self-esteem on long-term social functioning in schizophrenia

BACKGROUND

Individuals with schizophrenia commonly experience poor social functioning (SF), influenced by stigmatization and linked to low self-esteem. The intricate role of self-esteem in this context remains insufficiently explored. This study delves into the short and long-term impact of perceived stigma on SF, investigating the mediating or moderating effects of self-esteem and momentary fluctuations in self-esteem.

METHODS

Data were derived from a longitudinal cohort of individuals with schizophrenia and related disorders from the 2nd (T1) and 3rd (T2) waves. Perceived stigma and self-esteem were measured at T1 with self-report questionnaires. Self-esteem at T2 was measured with the experience sampling method. SF was measured at both time points. Multiple regression was applied to analyse the effect of perceived stigma and the role of (fluctuations in) self-esteem on SF.

RESULTS

Perceived stigma significantly correlated with SF in the short-term (β = -4.66, SE = 1.24, p < 0.001) and long-term (β = -3.77, SE = 0.51, p < 0.001). Once we analysed samples with self-esteem (N = 157), stigma was still associated with SF (β = -2.78, SE = 1.36, p = 0.043), but not when self-esteem was controlled for (β = -2.13, SE = 1.34, p < 0.100). Self-esteem significantly mediated stigma-SF relationship in T1 whereas in T2 it only significantly predicted SF (β = 2.17, SE = 0.70, p = 0.002). Fluctuations in self-esteem did not show mediating/moderating effects.

CONCLUSION

Perceived stigma significantly predicts poor SF both concurrently and, to some extent, over the long term. Moreover, self-esteem may serve as a buffer that mitigates the negative impact of perceived stigma. Early interventions aimed at reducing stigma and enhancing self-esteem through anti-stigma initiatives are essential for improving SF.

Medication Adherence and Functioning in Individuals With Bipolar Disorder Type I

PURPOSE

To determine the correlation between medication adherence and functioning in individuals with bipolar disorder (BD) and the predictors of functionality.

METHOD

This cross-sectional and correlational study was conducted with 145 individuals with BD type I. Data were collected using a Patient Information Form, the Medication Adherence Rating Scale, and Functioning Assessment Short Test.

RESULTS

Findings showed that most participants did not take medication as prescribed. Medication adherence was negatively correlated with functionality. Predictors of functionality were years of treatment, number of hospitalizations, working status, medication adherence, family history of mental illness, and history of suicide.

CONCLUSION

Medication nonadherence is a fundamental problem for individuals with BD. Nursing interventions to increase functionality and medication adherence among this at-risk group should be planned and implemented. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Examination of internalized stigma, quality of life, and happiness in patients with schizophrenia

BACKGROUND

Happiness in patients with schizophrenia is a neglected concept that needs to be developed. Determining the relationship between internalized stigma, quality of life, and happiness, which is important for the prognosis of schizophrenia, will reveal why it is necessary to focus on activities that will increase happiness in patients with schizophrenia.

AIM

This study aimed to compare the levels of internalized stigma, quality of life, and happiness in patients with schizophrenia.

METHODS

A descriptive and correlational research design was used. The research population consisted of patients who applied to the psychiatry outpatient clinic of a hospital in eastern Turkey during the research period and were diagnosed with schizophrenia according to the DSM-5 diagnostic criteria; 87 voluntary patients who agreed to participate in the study constituted the research sample. A personal information form, the Internalized Stigma of Mental Illness Scale (ISMI), the World Health Organization Quality-of-Life Scale (WHOQOL-BREF), and the Subjective Happiness Scale (SHS) were used for data collection.

RESULTS

According to the patients' ISMI, WHOQOL-BREF-TR, and SHS scores, patients perceived internalized stigma above the moderate level in all sub-dimensions. In general, their quality of life was moderate (the highest mean score was on the national environment domain and the lowest mean score was on the social domain); the mean SHS score was 13.02 ± 5.53. There was a strong and negative correlation between the mean SHS score and the total ISMI score and a strong and positive correlation between SHS and the physical, mental, social, and national environment domains of WHOQOL-BREF-TR.

CONCLUSIONS

It was determined that the mean internal stigma score of the patients decreased and their mean quality of life score increased as their mean subjective happiness score increased. It is recommended clinical studies be carried out to increase happiness in patients with schizophrenia.

Role of Nutraceuticals in Treating Erectile Dysfunction via Inhibition of Phosphodiesterase-5 Enzyme: A Mini Review

Erectile Dysfunction (ED) is a prevalent sexual health condition affecting a significant portion of the male population worldwide. The conventional therapeutic approaches for ED often involve the use of pharmaceutical agents targeting the phosphodiesterase-5 (PDE5) enzyme. Currently, treatment with PDE-5 inhibitors is the standard approach for ED, and four PDE-5 inhibitors, namely sildenafil, vardenafil, tadalafil, and avanafil, are in use. However, these pharmaceutical interventions may be associated with adverse effects and limitations. As a result, there has been a growing interest in exploring alternative and complementary treatment options for ED, such as nutraceuticals, which are bioactive compounds derived from natural sources. Nutraceuticals, which include vitamins, minerals, herbs, and other dietary supplements, have gained popularity for their potential health benefits. Certain nutraceuticals have demonstrated the ability to modulate various physiological pathways, including those involved in erectile function. A notable mechanism of action is the inhibition of the PDE5 enzyme, which plays a pivotal role in the regulation of cGMP levels. By inhibiting PDE5, nutraceuticals can promote the accumulation of cGMP, leading to enhanced penile blood flow and improved erectile function. A comprehensive analysis of the literature showcases various nutraceutical agents, including plant-derived compounds like flavonoids, polyphenols, and amino acids which have exhibited PDE5 inhibitory effects. Mechanistic insights into their action involve modulation of NO release, cGMP elevation, and relaxation of penile smooth muscles, all critical factors for achieving and sustaining erections. This review focuses on elucidating the role of nutraceuticals in treating erectile dysfunction through the inhibition of the PDE5 enzyme.

Associations of internalized stigma with psychosocial functioning and quality of life in people with schizophrenia

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.

A correlational and cross-sectional study on the relationship between internalized stigma and religious coping in patients with schizophrenia

Self stigmatization, which occurs as a result of internalization of public stigma in severe mental illnesses, is a factor that impairs the mental well-being of individuals and their compliance with treatment. Data on exactly which factors are associated with internalized stigma are still insufficient. Our aim in this clinical study is to investigate the relationship between internalized stigma and religious coping in patients with schizophrenia. Sociodemographic Data Form, Religious Coping Scale, internalized stigma of mental illness (ISMI) Scale were applied to 147 schizophrenic patients who were followed up by the community mental health center and met the inclusion criteria. The results were analyzed with IBM SPSS 22 package program. Descriptive statistics, Mann-Whitney U test, Pearson Chi-Square, Fisher Exact test, Spearman correlation analysis and multiple linear regression analysis were applied. There was a negative correlation between positive and negative religious coping in patients with schizophrenia (r: -0.467, P < .001); a positive correlation between negative religious coping and social withdrawal (r: 0.711, P < .001) and perceived discrimination (r: 0.706, P < .001); negative correlation between positive religious coping and social withdrawal (r: -0.343, P < .001) and perceived discrimination (r: -0.302, P < .001). There was no significant relationship between other subdimensions of ISMI and religious coping scale. There was a significant negative correlation between ISMI total score and positive religious coping (r: -0.256, P: .002), a significant positive correlation with negative religious coping (r: 0.683, P < .001). Multiple linear regression analysis was applied to reveal the explanatory effect of age, duration of illness and religious coping on internalized stigma, and according to the model obtained (R = 0.729, R2 = 0.516, F = 32.071, P < .001), 51.6% of the change in the total score of the ISMI can be explained by this model. The significant relationship between positive and negative religious coping and internalized stigma in patients included in the study suggests that it may be beneficial to consider religious coping attitudes in addition to other interventions in the fight against stigma in severe mental illnesses such as schizophrenia.

The effect of interpersonal relations theory-based motivational interviews on functional remission and insight levels of patients with schizophrenia: A randomized controlled trial

BACKGROUND

Using therapeutic techniques and conducting motivational interviews in communication with patients with schizophrenia increases individuals' functional remission, insight, and motivation levels.

AIM

This single-blind, randomized controlled study examines the effect of Interpersonal Relations Theory-Based motivational interviews on functional remission and insight levels in patients with schizophrenia.

METHODS

The participants of this study were 40 patients with schizophrenia randomly assigned to either the experimental or control groups (20 in each group). The researchers carried out a 6-session Interpersonal Relations Theory-based motivational interview with the participants in the experimental group. Study data were collected using a demographic questionnaire, the Functional Remission of General Schizophrenia Scale (FROGS), and the Scale for Assessing the Three Components of Insight (SAI).

RESULTS

Social Functioning, Health and Treatment, Daily Living Skills, and SAI scores of the individuals in the intervention group were statistically higher than those in the control group (p < 0.05) in the post-intervention and follow-up measures. There was a positive and significant correlation between the post-intervention Social Functioning, Health and Treatment, Daily Life Skills, and total FROGS scores and the SAI score of the individuals in the intervention group (p < 0.05).

CONCLUSIONS

It was concluded that motivational interviews based on Interpersonal Relations Theory were effective in increasing the insights and functionality of patients with schizophrenia. Psychiatric nurses' practice of motivational interviews based on the therapeutic relationship is considered to increase the quality of care and satisfaction of patients with schizophrenia. It is recommended that this practice be used extensively in clinical practice.

Rate and correlates of self-stigma in adult patients with early psychosis

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.

The Mediating Role of Positive Thinking on the Relationship Between Depression and Functional Recovery in Community-Dwelling People With Schizophrenia

Functional recovery as a consumer-centered approach is critical to recovery for community-dwelling people with schizophrenia. The current study investigated the mediating role of positive thinking in the relationship between depression and functional recovery in community-dwelling people with schizophrenia in South Korea. Depression, positive thinking, and functional recovery measures were completed by 158 people with schizophrenia in the community with self-reported questionnaires. Depression had a significantly negative influence on functional recovery. Positive thinking fully mediated the relationship between depression and functional recovery. An effective intervention strategy for functional recovery in this population may reinforce positive thinking and depression management. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 44-52.].

Factors associated with personal recovery among psychiatric nursing home residents

WHAT IS KNOWN ABOUT THE SUBJECT?: Poor recovery will cause harm to the quality of life and well-being of residents and that the scope of influence includes the self, family and society. No study to date has investigated empowerment and the other multiple factors associated with personal recovery among psychiatric nursing home residents. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The factors associated with personal recovery are empowerment, social support and global functioning. This pioneer study contributes new evidence that personal recovery is mainly predicted by empowerment, social support and global function, with empowerment exhibiting the highest predictive value. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Strengthening empowerment in mental health nursing may contribute more to the personal recovery of psychiatric nursing home residents than improving global function or social support. Mental health professionals should shift to empowerment-oriented care to improve individuals' personal recovery, such as offering more opportunities to achieve autonomy, encouraging individuals' involvement in decision-making and promoting individuals' motivation for achieving their goals. ABSTRACT: Introduction Individuals diagnosed with mental illness have a need for recovery. No study to date has investigated empowerment and the other multiple factors associated with personal recovery among psychiatric nursing home residents. Aim The study aimed to identify the factors associated with personal recovery among psychiatric nursing home residents. Methods This was a cross-sectional study with convenience sampling. Participants were recruited from a psychiatric nursing home in Northern Taiwan between April and June 2018. Data were collected through self-reported, structured questionnaires with verified reliability and validity. Descriptive and hierarchical regression analyses were performed. The present study followed the STROBE guidelines. Results The study included 158 participants. The factors associated with recovery according to bivariate associations were religious belief, psychotic symptoms, global function, social support and empowerment. In the hierarchical regression, empowerment, social support and global function were the main predictive factors of recovery, with the explained variation reaching 40.8%. Empowerment exhibited the highest predictive value for the recovery. Implications for clinical practice Strengthening empowerment in mental health nursing may contribute more to the personal recovery of psychiatric nursing home residents than improving global function or social support.

Predictors of Internalized Stigma in Patients with Schizophrenia in Northern Chile: A Longitudinal Study

The study aim was to longitudinally assess internalized stigma in a sample of patients from Northern Chile with a diagnosis of schizophrenia along with indicators of patient recovery, including quality of life, psychotic symptomatology, social cognition, premorbid adjustment, and years of untreated psychosis. The 10-year follow-up of stigma measures and predictors were assessed at public outpatient mental health centers in the city of Arica, Chile, during the months of March–July 2012. A total of 26 patients successfully completed the evaluation. The results revealed that, with the exception of the self-stigma subdimension, no clinically significant changes were seen in the trajectories of internalized stigma ratings between baseline and 10-year follow-up, underscoring the importance of assessing global components such as quality of life and premorbid adjustment during the process of internalizing stigma.

The effect of cognitive behavioral therapy-based psychoeducation on internalized stigma and functional remission in individuals diagnosed with schizophrenia

PURPOSE

The aim of this study is to determine the effect of cognitive behavioral therapy-based psychoeducation provided to individuals diagnosed with schizophrenia on internalized stigma and functional remission.

DESIGN AND METHODS

The study was conducted based on the quasi-experimental design with pretest-posttest control group with 100 individuals, who were diagnosed with schizophrenia, in a Community Mental Health Center between September 2020 and June 2021.

FINDINGS

It was determined that after the cognitive behavioral therapy-based psychoeducation, the internalized stigma level decreased and the functional remission level increased in the experimental group compared with the control group.

PRACTICE IMPLICATIONS

In the study, it was determined that the experimental and control groups had low levels of functional remission and high levels of internalized stigma before the cognitive behavioral therapy-based psychoeducation, and the functional remission levels increased and the internalized stigma levels decreased in the experimental group compared with the control group after the cognitive behavioral therapy-based psychoeducation.

Investigation of the relationship between the negative automatic thoughts of patients with schizophrenia and their levels of social functionality

AIM

This study was carried out to investigate the relationship between the negative automatic thoughts of patients with schizophrenia and their levels of social functionality.

DESIGN AND METHODS

This cross-sectional study was conducted 142 patients with schizophrenia. The data were collected using the Personal Information Form, Negative Automatic Thoughts Questionnaire (NATQ) and Social Functioning Assessment Scale (SFAS).

FINDINGS

There was a strong negative correlation between the mean scores obtained from the overall NATQ and SFAS. In addition, negative automatic thoughts of the patients with schizophrenia had a negative effect of 47.2% on their social functionality.

PRACTICE IMPLICATIONS

It was found that the patients had moderate levels negative automatic thoughts and social functionality; and that their negative automatic thoughts affected their social functionality negatively.

The clinical and psychosocial correlates of self-stigma among people with schizophrenia spectrum disorders across cultures: A systematic review and meta-analysis

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 &lt; .001), a moderate, negative correlation with functioning (r = -0.39, p &lt; .001), and a positive, small correlation with severity of psychotic symptoms (r = 0.29, p &lt; .001), negative symptoms (r = 0.18, p &lt; .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 &lt; .001) and self-esteem (r = -0.55, p &lt; .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.

The significant mediators between depression and mental health recovery among community-dwelling people with a diagnosed mental disorder

To investigate the mediating roles of community integration and positive thinking on the relationship between depression and mental health recovery among community dwelling people with mental disorders in South Korea. A cross-sectional, descriptive study was utilized. Data were collected from 167 community-dwelling people with mental disorders who did not use the day program at community mental health centers. Data were collected from November 20, 2018, to February 15, 2019. Both community integration and positive thinking were found to mediate the effects of depression on mental health recovery. The mediating effect of positive thinking was significantly greater than that of community integration. This study added evidence for a significant multiple mediating effect of community integration and positive thinking on the relationship between depression and mental health recovery in community-dwelling people with mental disorders. Although the consumer-centered recovery paradigm of people with mental health difficulties is of global importance, little research has been conducted on mental health recovery among community-dwelling people with mental disorders who do not use the day program at community mental health centers. It was found that community integration and positive thinking mediated the effects of depression on mental health recovery, with positive thinking mediating this relationship the most. Thus, these results suggest a specific direction of community mental health services to promote mental health recovery for people with mental disorders who do not have access to community mental health services.

Factors Influencing Compliance with Public Health Directives and Support for Government's Actions Against COVID-19: A Nigerian Case Study

Because COVID-19 is a novel viral pandemic, there is a dearth of research in the body of evidence that explore factors that can influence compliance with public health recommendations and Nigerian government's actions to prevent the spread of COVID-19. Hence, this study's aim is to address this gap to help inform policymakers and the actions of public health leaders in Nigeria. The study included a sample of 336 adult Nigerians who responded to an online Qualtrics survey. Descriptive and linear regression analyses were conducted to determine the predictors of compliance with COVID-19 public health directives and support for government's action against COVID-19 spread. Perceived risk of stigmatization, perceived threat of COVID-19, town/city, gender, and confidence in government's ability to curb the spread and impact of COVID-19 were found to be significantly associated with compliance with COVID-19 public-health directives, and support for governments action against COVID-19. Given Nigeria's weak health system and high level of poverty, there is need to ensure the public health responses to the pandemic are effective and contextually relevant. Nigerians and other concerned global health stakeholders will benefit from research that provides more information on issues of non-compliance with COVID-19 public health directives and government actions.

Mediating effects of self-stigma and depression on the association between autistic symptoms and recovery in patients with schizophrenia-spectrum disorders: a cross-sectional study

BACKGROUND

Several studies have indicated that self-stigma is associated with depressive symptoms and could be a barrier to recovery in patients with schizophrenia-spectrum disorders. More recently, an association between autistic symptoms and self-stigma was found in schizophrenia-spectrum patients. This study aimed to investigate the association between self-stigma, autistic and depressive symptoms, and recovery in patients with schizophrenia.

METHODS

In total, 105 participants were evaluated using the Autism Spectrum Quotient, the Internalized Stigma of Mental Illness Scale, the Quick Inventory of Depressive Symptomatology, and the Recovery Assessment Scale to investigate autistic symptoms, self-stigma, depressive symptoms, and recovery, respectively. The relationship between self-stigma, autistic symptoms, depressive symptoms, and recovery was assessed using structural equation modeling analysis.

RESULTS

Impaired attention switching, one symptom of autism, was found to positively affect stereotype endorsement, which negatively influenced recovery through depressive symptoms. Moreover, problems with communication skills negatively affected recovery through depressive symptoms. Concerning self-stigma, stereotype endorsement and perceived discrimination had a negative effect on recovery through depressive symptoms, whereas stigma resistance had a direct negative effect on recovery.

CONCLUSIONS

This study may provide meaningful insight into the psychological structure of recovery and could inform effective interventions for patients with schizophrenia-spectrum disorders. This was a cross-sectionally designed study; therefore, further longitudinal studies are needed to identify the causal relationships between self-stigma, autistic and depressive symptoms, and recovery.

Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences

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.

Reliability and Validity of the Chinese Version of the Scale for Assessing the Stigma of Mental Illness in Nursing

Background: The prevalence of mental illness continues to increase in China, but research on stigma is still in its infancy, and there are even fewer studies on stigma among nurses. A comprehensive, effective and reliable tool is needed to assess stigma in nursing so that it can be reduced or eliminated to improve nursing quality. This study aimed to translate a 20-item scale for assessing the stigma of mental illness in nursing into Chinese and evaluate its reliability and validity. Methods: An improved Brislin translation model was used to translate the nursing mental illness stigma assessment scale into Chinese. Content and face validity were determined by a panel of experts. A convenience sample of 501 nursing students was chosen. Confirmatory factor analysis, concurrent validity and known group comparison were used to evaluate the scale's structural validity. The reliability was evaluated based on the internal consistency reliability and 2-week retest reliability. Results: The content validity index was 0.90. Confirmatory factor analysis showed that this study supported the three-factor model. The moderate correlation between the Chinese version of the Scale for Assessing the Stigma of Mental Illness in Nursing and the Perceived Devaluation Discrimination Scale suggested acceptable concurrent validity. Cronbach's α (0.863) and the retest coefficient (0.839) were indicative of internal consistency. Conclusion: The Chinese version of the Scale for Assessing the Stigma of Mental Illness in Nursing has acceptable concurrent validity, marginal factor validity, and satisfactory reliability in China. Therefore, the three-factor structure of the Chinese scale should be considered. Relevance to Clinical Practice: The Chinese version of the Scale for Assessing the Stigma of Mental Illness in Nursing can be used to understand the degree of mental illness stigma in nursing.

Elucidating the relationship between internalized stigma, cognitive insight, illness severity, and functioning in patients with schizophrenia using a path analysis approach

BACKGROUND

There is a paucity of studies examining the interrelationship between internalized stigma, cognitive insight, illness severity, and functioning.

AIMS

This study examined the dynamics of the relationship between these factors using a path modelling approach.

METHODS

Two hundred and seven patients with schizophrenia spectrum disorders were recruited in this cross-sectional study. Patients were assessed on internalized stigma, cognitive insight (including its two domains, self-reflectiveness and self-certainty), illness severity and functioning. Path analysis was used to test the hypothesized model for the interrelationship between the variables.

RESULTS

A direct positive association was observed between self-certainty and internalized stigma. This was also observed via the paths running through illness severity and functioning. Self-reflectiveness was only associated with self-certainty in the model. The residual variance of internalized stigma in the path model was relatively high.

CONCLUSION

Our findings highlight that self-certainty is associated with internalized stigma along with illness severity and functioning in individuals with schizophrenia. Therefore, interventions on reduction of internalized stigma may benefit from a multipronged approach targeting self-certainty, illness severity and functioning. The relatively high residual variance of internalized stigma in the model highlights the need for further research to provide better understanding on the mechanisms underlying internalized stigma.

The fight against stigma: Multilevel stigma interventions in schizophrenia patients

Background: Stigma is one of the main factors causing pasung (physical restraint or confinement in Indonesian terms) in schizophrenia patients. It is the main obstacle to reducing the number of pasung throughout the world. Thus, there is a need for appropriate interventions to reduce stigma in schizophrenia patients who go through pasung. This study aims to identify multilevel stigma interventions in people with schizophrenia who go through pasung (physical restraint and confinement). It can be applied and adapted to various cultural contexts.

Design and Methods: Quasi-experimental research with pretest and post-test analysis consists of 82 people with schizophrenia who go through pasung. Respondents were divided into the intervention group and the control group. A multilevel stigma intervention was given to the intervention group for three months.

Results: There was a significant difference in the average stigma score in the control group (moderate category stigma) and the intervention group (mild category stigma) after multilevel stigma intervention (p-value = 0.04). The average stigma score of schizophrenia patients in the intervention group decreased by 8.2%, while the average stigma score in the control group increase of 20.4%.

Conclusions: Multilevel stigma interventions are effective in reducing stigma in people with schizophrenia who go through pasung. We underline that multilevel stigma interventions through collaboration from various parties can provide great opportunities in stigma reduction programs in people with schizophrenia who go through pasung.

Major depression, sleep, hostility and body mass index are associated with impaired quality of life in schizophrenia. Results from the FACE-SZ cohort

BACKGROUND

Impaired Quality of life (QoL) in schizophrenia has been mostly associated with psychotic and mood symptomatology, insight and functioning so far.

AIMS

QoL levels remain unsatisfactory due to other factors we aim to explore.

METHOD

We have explored sleep quality with the Pittsburgh Sleep Quality Index, hostility with the Buss&Perry questionnaire, major depression with the Positive and Negative Syndrome Scale depressive factor, functioning with the Global Assessment of Functioning scale and weight gain with body mass index in addition to other classical QoL-associated factors.

RESULTS

559 patients (mean age=31 (SD 9) years, 74% male sex) were included in the national FACE-SZ cohort. Impaired QoL has been significantly associated with respectively major depression, impaired sleep quality, increased hostility, impaired functioning and impaired insight independently of age, sex, treatments, tobacco smoking and body mass index. Major depression was associated with impaired psychological and physical well-being, and impaired self-esteem. Impaired sleep quality has been associated with impaired psychological and physical well-being and sentimental life. Hostility has been associated with impaired psychological well-being and self-esteem, impaired friends' relationships and impaired autonomy. Weight was associated with impaired physical well-being. Tobacco smoking was associated with higher level of friends' relationships.

CONCLUSIONS

Major depression, sleep, hostility, and weight gain have been identified as potential targets to improve QoL in schizophrenia and should be implemented in the recommendations for good practice to optimize schizophrenia care.

The impact of illness identity on recovery from severe mental illness: A review of the evidence

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.

Association Between Autistic Symptoms and Self-Stigma in Patients with Schizophrenia Spectrum Disorders

PURPOSE

Self-stigma negatively influences self-esteem, quality of life, self-efficacy, treatment adherence, and recovery in psychiatric patients. By revealing personality traits that influence self-stigma, we can gain useful knowledge for the management of self-stigma. A previous meta-analysis indicated that patients with schizophrenia have higher scores on the Autism-Spectrum Quotient (AQ) than healthy controls. However, the relationship between autistic symptoms and self-stigma in patients with schizophrenia spectrum disorders remains unclear. Therefore, the present study aimed to reveal the association between autistic symptoms and self-stigma in patients with schizophrenia spectrum disorders.

PATIENTS AND METHODS

We recruited 127 patients with schizophrenia spectrum disorders (schizophrenia, schizoaffective disorder, and delusional disorder). We assessed participants' self-stigma and autistic symptoms using the Internalized Stigma for Mental Illness (ISMI) scale and the Autism-Spectrum Quotient (AQ), respectively. The differences in the scores of ISMI and AQ according to patient characteristics were investigated. Multiple regression analysis controlling for age and gender was performed to determine the relationship between the total scores on the AQ and IMSI scale.

RESULTS

Female patients showed a higher level of self-stigma than males. Unmarried patients showed a significantly higher score on the AQ than married patients. Multiple regression analysis adjusted for age and gender indicated that the total score on AQ might be a predictor of the overall rating on ISMI in patients with schizophrenia spectrum disorders.

CONCLUSION

This study is the first to reveal the association between autistic symptoms and self-stigma in patients with schizophrenia spectrum disorders. Our results highlight the importance of considering autistic symptoms in the assessment and management of self-stigma in patients with schizophrenia spectrum disorders.

The relationship between internalized stigma and loneliness in patients with schizophrenia

PURPOSE

The study was conducted for the purpose of determining the relationship between internalized stigma and loneliness in patients with schizophrenia.

DESIGN AND METHODS

The population of this correlational-descriptive study consisted of a total of 200 in patients with schizophrenia. The data were collected using "Form of Descriptive Characteristics", "Internalized Stigma of Mental Illness Inventory (ISMI)", and "UCLA Loneliness Scale".

FINDINGS

It was determined that the loneliness level of the patients who participated in the study was 57.20 ± 10.38 and level of of internalized stigma was 79.65 ± 13.48. There was a statistically positive and strong correlation between loneliness and internalized stigma total mean scores of the patients (P = 0.001, r = 0.854).

PRACTISE IMPLICATIONS

It was found that the schizophrenic patients had high levels of internalized stigma and loneliness.

Efficacy of a combined intervention program for the reduction of internalized stigma in people with severe mental illness

BACKGROUND

Internalized stigma (IS) is a key factor in the recovery, quality of life and functioning of people with severe mental illness (SMI), and effective intervention programs are needed to reduce IS in all its dimensions. The aim of this report was to design and evaluate the effectiveness of a new psychological intervention group program for the reduction of IS in people with SMI.

METHODS

A 9-session hands-on intervention program was designed with a group format in which different therapeutic techniques were combined. To evaluate the effectiveness of the program, 80 people with SMI and high levels of IS were selected and randomly assigned to one of two groups: program (n = 41, experimental group) or conventional treatment (n = 39, control group).

RESULTS

Mixed analysis of variance showed improvements in total IS and all of its dimensions (cognitive, emotional and behavioral) (p ≤ 0.01) and in depressive symptomatology (p = 0.01) in the experimental group after the treatment phase.

CONCLUSION

The results indicate that the program effectively reduces IS and its dimensions as well as other relevant associated variables in a sample of people with SMI.