Perceived Stigma and Associated Factors among People with Schizophrenia at Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Institution Based Study

Examining the association between perceived stigma, its correlates, and restrictions in participation among persons with disabilities in Nepal: a cross-sectional study

BACKGROUND

Disability stigma in low- and middle-income countries is one of the most persistent and complex barriers limiting persons with disabilities (PwDs) from enjoying their rights and opportunities. Perceived stigma among PwDs and its impact on participation restriction is rarely assessed in Nepal.

OBJECTIVE

This study aimed to measure the extent of perceived stigma by PwDs, identify its relationships with specific demographic factors, and assess the impact on social participation.

METHODS

A cross-sectional survey was conducted between May and July 2022 among PwDs in Nepal, with a sample of 371. The Explanatory Model Interview Catalog (EMIC) stigma scale and P-scale suitable for people affected by stigmatized conditions were used, and the generated scores were analyzed. One-way ANOVA was performed to determine group differences for sociodemographic variables, and linear regression and correlational analysis were used to identify their association and measure the strength and direction of the relationship.

RESULTS

The mean stigma score was 16.9 (SD 13.8). 42% of respondents scored higher than the mean. The scores differed significantly by disability type, caste and ethnicity, education, occupation, and household wealth. Over 56% reported participation restriction, and 38% had severe/extreme restriction. Approximately 65% of participants with intellectual disabilities, 53% with multiple disabilities, and 48.5% of persons with severe or profound disabilities experienced severe or extreme restrictions. Perceived stigma had a positive correlation with Disability type (r = 0.17, P < 0.01) and negative correlations with Severity of disability (r= -0.15, P < 0.05), and Household wealth (r= -0.15, P < 0.01). Education was inversely associated with both stigma (r= -0.24, P < 0.01), and participation restriction (β= -9.34, P < 0.01). However, there was no association between stigma and participation restriction (β= -0.10, P > 0.05).

CONCLUSION

All participants exhibited stigma in general; however, the severity varied based on disability type, level of education, and sociocultural circumstances. A large proportion of participants reported facing a high degree of restrictions in participation; however, no association was detected between perceived stigma and participation restriction. A significant negative linear correlation was observed between education and participation restriction. Stigma reduction programs focusing on education and empowerment would be especially important for overcoming internalized stigma and increasing the participation of PwDs.

Difference in the risk of discrimination on psychological distress experienced by early wave infected and late wave infected COVID-19 survivors in Japan

The psychological distress experienced by coronavirus disease of 2019 (COVID-19) survivors after recovery from the illness is amplified by discrimination endured because of their infection status. However, the difference in the risk of facing discrimination and risk of experiencing psychological distress in the early and late waves of the COVID-19 pandemic remain unclear. This study aimed to investigate whether the risk of facing discrimination because of infection status was lower in the early or late waves and whether risk of discrimination on psychological distress was more serious in later, rather than earlier waves. We conducted two online surveys to collect data from survivors divided into two groups. The participants with scores of five or more on the Kessler Psychological Distress Scale were identified as having experienced psychological distress. The participants were identified as having experienced discrimination based on infection status if they had endured being blamed, some type of discrimination, or having themselves or their families maligned. The timing of infection was split into infected during early waves of the pandemic for 2021 participants and infected during later waves of the pandemic for 2022 participants. Modified Poisson regression analyses were performed using experiences of discrimination as criteria and timing of infection as predictors. Modified Poisson regression analyses were further performed using the presence of psychological distress as a criteria and experiences of discrimination and timing of infection as the criteria, in addition to interaction effect of these es. The data of 6010 participants who were infected in early waves and 5344 participants who were infected in later waves were analyzed. The risks of being blamed, some forms of discrimination, and participants and their families being maligned were significantly lower in the group who were infected in later waves than those infected in earlier waves. Experiences of discrimination were highly associated with psychological distress in those infected in later waves than those infected in earlier waves, while only being blamed showed a significant association. Risk of discrimination was found to be lower in those infected in later waves, whereas risk of discrimination on psychological distress was shown to be more serious in those infected in later waves. Therefore, we submit that it is more important to support COVID-19 survivors who face discrimination, than it is to attempt to decrease the current discriminatory climate caused by the COVID-19 pandemic.

Internalised stigma among people with mental illness in Africa, pooled effect estimates and subgroup analysis on each domain: systematic review and meta-analysis

BACKGROUND

Internalisation of stigma occurs when people with a stigmatised attribute, such as a mental illness, supress negative but accepted societal attitudes. However, as far as is known, there is no comprehensive picture of the prevalence of and factors associated with, internalised stigma among people living with mental illness in Africa. This systematic review and meta-analysis provide new knowledge by examining the evidence on the prevalence of internalised stigma and associated factors among people living with mental illness in Africa.

METHODS

Using the population, intervention, comparison, outcome, and type of study (PICOT) approach, PubMed, Scopus, MEDLINE, PsycINFO, CINAHL, ScienceDirect, and Google Scholar were searched using a structured search comprising terms associated with mental health, mental illness, internalised stigma, and a list of all African countries. To evaluate paper quality, the Joanna Briggs Institute Quality Appraisal Checklist was used. Subgroup analysis with country and diagnosis was tested using a random-effect model, and bias was checked using a funnel plot and an inspection of Egger's regression test. A p-value, OR and 95% CI was used to demonstrate an association.

RESULTS

The pooled prevalence of internalised stigma was 29.05% (25.42,32.68: I2 = 59.0%, p ≤ 0.001). In the subgroup analysis by country, Ethiopia had the highest prevalence of internalised stigma at 31.80(27.76,35.84: I2 = 25.6%, p ≤ 0.208), followed by Egypt at 31.26(13.15,49.36: I2 = 81.6%, p ≤ 0.02), and Nigeria at 24.31(17.94,30.67: I2 = 62.8%, p ≤ 0.02). Based on domains of internalised stigma, pooled prevalence was stigma resistance: 37.07%, alienation: 35.85%, experience of discrimination: 31.61%, social withdrawal: 30.81% and stereotype: 26.10%. Experiencing psychotic symptoms (1.42(0.45,2.38)), single marital status (2.78(1.49,4.06)), suicidal ideation (2.32(1.14,3.49)), drug nonadherence (1.5(-0.84,4.00)), poor social support (6.69(3.53,9.85)), being unemployed (2.68(1.71,3.65)), and being unable to read and write (3.56(2.26,4.85)) were identified as risk factors for internalised stigma.

CONCLUSIONS

Internalised stigma is common among people suffering from mental illnesses in Africa. This review determined that 29% of the sample population had elevated internalised stigma scores, and there were variations by country. People experiencing mental illness who have a single marital status, suicidal behaviours, poor social support, unemployed and have poor literacy levels were at a higher risk of internalised stigma. The finding points to populations that require support to address internalised stigma and improve the mental health outcomes.

Prevalence of internalized stigma in patients with psychiatric illness in Abha, Southern Region, Saudi Arabia

BACKGROUND

Mental stigma occurs when patients with various mental disorders are labeled by their disorders. Little is known about the burden of mental stigma on patients with mental disorders. The aim of this study was to evaluate the incidence of mental stigma on patients with psychiatric disorder in Saudi Arabia.

MATERIALS AND METHODS

This cross-sectional study was conducted among previously diagnosed patients with any psychiatric disorder attending King Khalid Hospital, Abha, Saudi Arabia. The patients were interviewed with a sociodemographic questionnaire and a validated Arabic version of the Internalized Stigma of Mental Illness (ISMI-29) scale. Chi-square test and t-test were used to assess the association between various demographic characteristics and presence of stigma.

RESULTS

The study included 489 patients with different psychiatric disorders. The mean age of the participants was 32.8 years and 54.6% were females. About 39% participants showed no to minimal internalized stigma, 37.4% of total sample had mild stigma, 20% had moderate stigma, and 3.7% had severe stigma. A signficantly higher proportion (71.4%) of widowed patients had stigma (P = 0.032).

CONCLUSION

Self-stigma is prevalent among patients with psychiatric disorders in Abha, Saudi Arabia, but lower than the prevalence in developing countries. Marital status has a significant impact on the prevalence and severity of the self-stigma of patients. There is a need for awareness program to reduce self-stigma. Psychiatric institutions should also focus on promotion of patients' social life and increase patient's awareness of certain issues that could prevent stigma.

Stigmatized Attitude toward Mental Illness among the Caregivers of Patients with Psychiatric Illness

Background: Stigma is a trait, belief, or disgrace where a mentally ill person is socially defamed in certain manners. Stigma can cause great psychological distress among the caregivers of patients with psychiatric illness.

Aim: The study was aimed to assess the level of stigmatized attitude toward mental illness among the caregivers.

Materials and Methods: A cross-sectional study design was used to collect data among 210 caregivers of patients with psychiatric illness who were recruited using purposive sampling technique. Baseline proforma and stigmatizing attitude scale were used to collect the data.

Results: The findings depicted the mean age of the caregiver was 44 years. More than half number of subjects (54.3%) were females. Majority (90.44%) of the caregivers had moderate, whereas 3.33% had low stigmatizing attitude with the mean ± standard deviation was 52.77 ± 9.91. Chi-squared test showed no significant association between stigmatized attitude score and selected demographic variables.

Conclusion: It is vital that awareness programs and antistigma campaign can be initiated in the community settings, with the help of interdisciplinary coordination and collaboration of the health care members to eradicate the stigmatizing attitude among the caregivers.

Adapting the Health Stigma and Discrimination Framework to understand the association between stigma and sleep deficiency: A systematic review

OBJECTIVE

Sleep deficiency and sleep disorders disproportionally affect socially disadvantaged and marginalized individuals and groups. Recent evidence suggests that stigma, a social process characterized by labeling, stereotyping, and prejudice, is associated with sleep characteristics.

PURPOSE

Guided by the Health Stigma and Discrimination Framework, the purpose of this systematic review is to describe associations between dimensions of stigma and sleep deficiency and to identify future directions for research.

METHODS

We searched the OVIDPsycINFO, OVIDEMASE, OVIDMEDLINE, and CINAHL databases for empirical research studies that reported relationships between the 3 dimensions of stigma-internalized, perceived, and anticipated-and characteristics of sleep deficiency-duration, continuity/efficiency, timing, alertness/sleepiness, quality, and disorders.

RESULTS

Of 1717 articles, 15 met our inclusion criteria. The most frequently assessed dimensions of stigma were internalized and perceived stigma. Characteristics of sleep deficiency were measured by self-report and included sleep quality, duration, trouble sleeping, and insomnia symptoms. We found consistent evidence that stigma, whether internalized, perceived, or anticipated, is associated with self-reported characteristics of sleep deficiency.

CONCLUSIONS

This evidence base can be further strengthened with prospective studies that incorporate both multidimensional measures of stigma and objective measures of sleep characteristics. We outline research implications that can clarify underlying mechanisms and more precisely define the relationships between stigma and sleep and inform interventions to address stigma, improve sleep, and reduce the health inequities that disproportionately affect individuals from socially disadvantaged and marginalized groups.

The magnitude and correlates of internalized stigma among people with mental illness attending the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

Introduction

Internalized stigma is an ongoing process of psychological assimilation of the community labels towards mental illness, in which people with mental illness (PWMI) gradually lose their current positive belief and confidence in themselves and their future wishes. It affects the treatment and help-seeking behavior which leads to poor drug adherence, social marginalization, unemployment, socio-economic devastation, and poor quality of life for PWMI. Therefore, the current study aimed to determine the magnitude and correlates of high internalized stigma among People with Mental Illness (PWMI) attending the outpatient department of Amanuel mental specialized hospital, Addis Ababa, Ethiopia.

Methods

Institution based cross-sectional study was conducted from March 03 to March 28, 2019. A consecutive sampling technique was used to select an estimated 406 study participants. Internalized stigma was assessed using a 29 Item Internalized Stigma of Mental Illness (ISMI-29) tool. Data were entered and analyzed using SPSS 22 software. A Binary logistic regression model was fitted to identify correlates of internalized stigma. An adjusted odds ratio (AOR) with a 95% confidence interval was computed to determine the strength of association and the level of significance was declared with a p-value <0.05.

Result

Of the total study participants, 388 respondents agreed to participate in the study giving a response rate of 96%. The magnitude of high internalized stigma among the study participants was 61.3% (95% CI: 58.2, 64.4). Poor social support (AOR = 1.973; 95%CI = 1.189, 3.27) and being unemployed (AOR = 2.87, 95% CI = 1.192–6.931) were significant correlates of high internalized stigma among PWMI.

Conclusion

Overall, around three in five PWMI experienced high internalized stigma. Poor social support and being unemployed were significant correlates of high internalized stigma. Large scale community-based study supplemented by qualitative design is highly recommended to identify additional correlates of internalized stigma and understand perspectives of PWMI.

TB related stigma and gender disparity among unaffected population in central Kerala, a survey

BACKGROUND

TB continues to ravage high burden countries despite aggressive TB control measures. Poverty and adverse socioeconomic and cultural factors play a significant role in stigmatization, causing delayed health care seeking, non-compliance to treatment and spread of disease in the community. Women are more vulnerable to stigmatization, posing the risk of gender inequality in health care. The objectives of this study were to ascertain the degree of stigmatization and gender disparity in TB related stigma in the community.

METHODS

Study was conducted among TB unaffected persons, using consecutive sampling from bystanders of patients attending the hospital for diseases other than TB. Closed structured questionnaire was used for measuring socio-demographic, knowledge and stigma variables. Stigma scoring was done using TB vignette.

RESULTS

Majority subjects (119 males and 102 females) were from rural area and low socioeconomic status; more than 60% of males and females having college education. Half the subjects answered more than half the TB knowledge questions correctly. Knowledge score was significantly lower among females compared with males (p < 0.002) despite high literacy. Overall stigma scoring was low (mean score = 15.9; total 75). Stigma was higher among females compared with males (p < 0.002); more profound among females receiving female vignettes (Chi-square = 14.1, p < 0.0001). The association was significant even after adjusting for co-variables (OR = 3.323, P = 0.005). Low knowledge showed minimal (statistically insignificant) association with stigma.

CONCLUSIONS

Perceived stigma though low, was more among females and much higher with female vignette, indicating significant gender disparity in stigma towards TB.

Prevalence and associated factors of perceived stigma among medically ill patients on follow-up screened positive for depression in Ethiopia: facility-based cross-sectional study

BACKGROUND

Many people are familiar with the issues of stigma in mental health or HIV, but feeling stigma as an underlying factor for many medically ill-health conditions has not been examined.

METHODS

Institution-based cross-sectional study was conducted on patients followed for medical illnesses and having depression. We recruited 384 participants and who were interviewed by nurses using face-to-face interviews and a systematic random sampling technique applied. We used a perceived devaluation and discrimination, a 12-item tool that is used to measure outcome perceived stigma. Variables were coded and entered Epi Info V.3.5.3 and exported to SPSS V.20 for analysis. Statistical analysis parameters, such as descriptive and multivariate logistic regression, were used for data analysis. Adjusted ORs (AORs) with a 95% CI and p value <0.05 were declared significance.

RESULT

The prevalence of perceived stigma on a patient who followed for medical illness screened positive for depression was found to be around 66.3%. In the multivariate logistic regression, patients with hypertension 61% less likely ((AOR=0.39, 95% CI (0.17 to 0.89)) to have perceived stigma than with asthma and cardiac patients, patients completed higher education 2.15 times ((AOR=2.15; 95% CI 1.05 to 4.40)) more likely to have perceived stigma than which cannot read and write. Patients who had the previous admission with medical illness 1-2 times were 3.52 more likely (AOR=3.52, 95% CI (2.14 to 5.78)) perceived stigma than those who had no hospital admission. Patients who had the previous admission three times with medical illness were 6.1 more likely (AOR=6.1, 95% CI (2.32 to 16.07)) to have perceived stigma than those who had no previous hospital admission.

CONCLUSION

The prevalence of perceived stigma among patients who had on follow-up for medical illnesses was high. Educational status, history of previous hospital admission were considerably associated with higher perceived stigma.

Treatments, Perceived Stigma, and Employment Outcomes among Substance Abusers in China

Employment is a vital component of a substance abuser's recovery, but little is known about how stigma affects employment for substance abusers receiving treatment. The current study investigates the effects of stigma and treatment on employment in the Chinese context. Using a sample of substance abusers (N = 3.978), multiple logistics regressions with moderation effects were employed. The findings show that treatments positively reduce confirmative experiences of anticipated stigma, and promote employment only when respondents do not perceive stigma. The findings highlight the impact of perceived stigma on limiting substance abusers' chances of being employed, implying that eliminating stigma is the foundation for recovery. Possible strategies that can be explored for reducing stigma are discussed.

Stigma and determinant factors among patients with mental disorders: Institution-based cross-sectional study

Objectives:

To assess prevalence and its associated factors of perceived stigma among patients with mental disorders who had appointment for treatment at Debre Markos, Finote Selam, and Felege Hiwot Hospitals, Ethiopia, 2019.

Methods:

At selected hospitals in the Amhara Region, an institution-based cross-sectional study was conducted from 1 February to 1 March 2019. Participants were selected using systematic random sampling technique and data were collected using a standardized questionnaire. The Internalized Stigma Scale was designed to examine the stigma associated with mental disorders. The data were coded and enter into Epi data version 4.4.2.1 before being exported to SPSS version 20 for analysis. Odds ratios and 95% confidence interval were used to show the strength of the association.

Results:

A total of 610 participants were participated, with a response rate of 98.6%, and 215 (35.2%) of them reported a high level of perceived stigma. Being single (adjusted odds ratio = 1.84, 95% confidence interval: 1.12, 3.02), accessing their medication freely (adjusted odds ratio = 1.70, 95% confidence interval: 1.08, 2.67), having suicidal thoughts (adjusted odds ratio = 1.95, 95% confidence interval: 1.25, 3.03), having low social support (adjusted odds ratio = 5.09, 95% confidence interval: 2.95, 8.76), age 25–34 years (adjusted odds ratio = 1.94, 95% confidence interval: 1.11, 3.40), age 35–44 years (adjusted odds ratio = 2.10, 95% confidence interval: 1.06–4.18), and age > 44 years (adjusted odds ratio = 3.48, 95% confidence interval: 1.67, 7.24) were revealed to be significantly associated with high perceived stigma after multivariable logistic regression analysis ( p < 0.05).

Conclusion:

The prevalence of high perceived stigma was 35.2%, which is found to be high among people who have mental disorders in this study. Being single, accessing their medication freely, having suicidal thoughts, having low social support, and being within the age of (25–34), (35–44), > 44 were all found to be significantly associated with high perceived stigma ( p < 0.05). But married, access medication by fee, have no suicidal thought, having moderate and strong social support, and young age were significantly associated with low perceived stigma.

Stigma Towards Mental Illness at an Academic Tertiary Care Center in Lebanon

OBJECTIVE

Individuals with mental illness may fall victim to stigma. In this cross-sectional study, the authors aimed to explore correlates of stigma towards mental health in a Lebanese private university and its associated tertiary medical center.

METHODS

The authors surveyed students, staff, and faculty at the American University of Beirut and its associated medical center. They assessed stigmatizing behaviors via the Reported and Intended Behavior Scale (RIBS), perceived stigma via the Perceived Devaluation and Discrimination Scale (PDDS), and attitudes towards collaborating with mental health professionals via the Doctors' Attitudes toward Collaborative Care for Mental Health (DACC-MH).

RESULTS

A total of 270 participants (response rate of 18%) provided their responses. The mean scores on the RIBS and PDDS were 15.26 ± 4.75 and 32.25 ± 2.70, respectively. Participants who had higher scores on RIBS were more likely to be younger than 25 years of age (OR=1.869; p=0.026), to have a history of mental illness (OR=2.657; p=0.003), and to interact with individuals with a psychiatric disorder (OR=2.287; p=0.028).

CONCLUSIONS

Results show a mixed pattern of stigmatizing behaviors and perceptions towards mental illness. This highlights the need for mental health awareness campaigns and interventions in the country.

Relationship of Ability of Family Caregivers and Society’s Stigma to Prevent Relapse and Improve the Quality of Life for People with Mental Disorders

People with mental disorders will experience a relapse even after 1 month of getting treatment or care from a health facility. The high recurrence rate can cause a decrease in quality of life. Efforts to prevent recurrence by involving family caregivers and reducing stigma from the community. This study aims to analyze the relationship between the ability of family caregivers and community stigma to prevent recurrence and improve the quality of life of people with mental disorders. This study used a cross-sectional approach. The research location is in Kediri Regency, East Java, Indonesia. Sampling was done by using the multistage random sampling technique. The number of samples is 76 respondents. The variables in this study were the ability of family caregivers, community stigma, disease recurrence, and quality of life for people with mental disorders. The data were analyzed using path analysis with the help of STATA 13. There is a relationship between the ability of family caregivers and community stigma to prevent recurrence and improve the quality of life of people with mental disorders.

Validation of the Italian translation of the perceived stigma scale and resilience assessment in inflammatory bowel disease patients

BACKGROUND

Stigmatization is the separation of an individual from a group due to aspects that make them different. Resilience may in turn influence the perception of stigma. Patients with inflammatory bowel disease (IBD) are susceptible to stigma, although data are very limited.

AIM

To validate an Italian translation of the IBD perceived stigma scale (PSS) in relation to patients’ resilience.

METHODS

Consecutive IBD outpatients were prospectively enrolled (December 2018-September 2019) in an Italian, tertiary referral, IBD center. Clinical and demographic data were collected. Stigma and resilience were evaluated through the IBD-PSS and the 25-item Connor-Davidson Resilience Scale, respectively. The International Quality of Life Assessment Project approach was followed to translate the IBD-PSS into Italian and to establish data quality. Higher scores represent greater perceived stigma and resilience. Multivariable analysis for factors associated with greater stigma was computed.

RESULTS

Overall, 126 IBD patients (mean age 46.1 ± 16.9) were enrolled. The International Quality of Life Assessment criteria for acceptable psychometric properties of the scale were satisfied, with optimal data completeness. There was no ceiling effect, whilst floor effect was present (7.1%). The discriminant validity and the internal consistency reliability were good (Cronbach alpha = 0.87). The overall internal consistency was 95%, and the test-retest reliability was excellent 0.996. The median PSS score was 0.45 (0.20-0.85). Resilience negatively correlated with perceived stigma (Spearman’s correlation = -0.18, 95% confidence intervals: -0.42-0.08, P = 0.03).

CONCLUSION

We herein validated the Italian translation of the PSS scale, also demonstrating that resilience negatively impacts perceived stigma.

Posttraumatic stress disorder intervention for people with severe mental illness in a low-income country primary care setting: a randomized feasibility trial protocol

Background

In this protocol, we outline a mixed-methods randomized feasibility trial of Brief Relaxation, Education and Trauma Healing (BREATHE) Ethiopia. BREATHE Ethiopia is a culturally and contextually adapted intervention for PTSD in participants with severe mental illness. BREATHE Ethiopia maps onto the World Health Organization’s guidelines for posttraumatic stress disorder (PTSD) treatment in low- and middle-income country primary care settings.

Methods

Specifically, this study includes a non-randomized pre-pilot (n = 5) and a randomized feasibility trial comparing BREATHE Ethiopia to Treatment as Usual (n = 40) to assess trial procedures, acceptability, and feasibility of intervention delivery, and investigate potential effectiveness and implementation. In a process evaluation, we will collect data that will be critical for a future fully randomized controlled trial, including the numbers of participants who are eligible, who consent, who engage in treatment, and who complete the assessments, as well as the feasibility and acceptability of assessments and the intervention. Qualitative data on facilitators and barriers to intervention delivery and quantitative data on provider fidelity to the intervention and participant and provider satisfaction will also be collected. Quantitative assessments at baseline, post-treatment, 1-month follow-up, and 3-month follow-up will assess change in mental health symptoms and functional impairment and hypothesized intervention mechanisms, including knowledge about PTSD, stigma, trauma-related cognitions, and physiological arousal.

Discussion

Findings from this study will inform a future fully-powered randomized controlled trial, and if found to be effective, the intervention has the potential to be integrated into mental healthcare scale-up efforts in other low-resource settings.

Trial registration

Registered with ClinicalTrials.gov (NCT04385498) first posted May 13^th, 2020; https://www.clinicaltrials.gov/ct2/show/NCT04385498?term=ethiopia&cond=PTSD&draw=2&rank=1.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-021-00883-3.

Ethnographic Insights into the Quality of Life and Experiences of People Living with Schizophrenia in Harare, Zimbabwe

Schizophrenia is a complex and severe mental disorder affecting more than 20 million people worldwide. This study used focused ethnography to explore the everyday lives of 18 people living with schizophrenia in Zimbabwe and its impact on their quality of life (QOL). Data were collected using semi-structured interviews, observational fieldwork, and the short form of the World Health Organization QOL-BREF questionnaire. Those aged 20-40 years experienced poorer QOL than older people. Family dislocation, living with stigma and discrimination, cost of medications and limited and variable access to treatment and support disrupted participants' ability to enjoy life and function socially.

Prevalence and factors associated with higher levels of perceived stigma among people with schizophrenia Addis Ababa, Ethiopia

Background

Schizophrenia is a severe and disabling chronic mental disorder and accompanied by different levels of a perceived stigma that affects almost all age groups. This perceived stigma negatively impacts the quality of life, physical, and mental well-being of people with schizophrenia. It is also linked with a poor level of functioning, poor adherence to drugs, and increased dropout rate. However, research into perceived stigma and associated factors among people with schizophrenia in low- and middle-income countries are limited. Therefore, this study aimed to explore the perceived stigma and correlates among people with schizophrenia in Ethiopia.

Methods

An institution based cross-sectional study was conducted from May to June 2018. A structured, pre-tested, and interviewer-administered questionnaire was used to collect data. The standardized perceived devaluation and discrimination questionnaire was used to assess perceived stigma. The systematic random sampling technique was used to select study participants. Binary logistic regression analysis was used to identify factors associated with perceived stigma. An odds ratio (OR) with a 95% confidence interval (CI) was computed to assess the strength of the association.

Results

The prevalence of high perceived stigma was found to be 62.6% [95% CI 58.3, 67.4]. In the multivariate logistic regression, female sex [AOR = 2.30, 95% CI 1.42, 3.71], age of onset of schizophrenia [AOR = 1.85, 95% CI 1.19, 2.89], multiple hospitalizations [AOR = 1.7, 95% CI 1.16, 3.27], and duration of illness 1–5 years [AOR = 2, 95% CI 1.01, 3.27], 6–10 years [AOR = 2.48, 95% CI 1.29, 4.74], and ˃10 years [AOR = 2.85, 95% CI 1.40, 5.79] were factors significantly associated with higher perceived stigma.

Conclusion

In the present study, the prevalence of high perceived stigma among people with schizophrenia was found to be 62.6%. Female sex, age of onset of schizophrenia, multiple hospitalizations, and duration of illness were factors significantly associated with higher perceived stigma. Measures to enhance the awareness of the patients, their families and their social networks about perceived stigma and associated factors, by the leading government and healthcare institutions are warranted.

Magnitude and Associated Factors of Perceived Stigma among Adults with Mental Illness in Ethiopia

Background

Many people with mental illness perceive and experience stigma caused by other people's knowledge, attitudes, and behavior. The stigma can lead to patients' impoverishment, social marginalization, poor adherence to medication, and low quality of life, worsen the disease, decrease health-seeking behavior, and have a negative impact on socioeconomic well-being. Therefore, this study aimed to explore these issues.

Objective

To assess the magnitude and associated factors of perceived stigma among adults with mental illness in an Ethiopian setting.

Methods

A facility-based, cross-sectional study design with a consecutive sampling technique was employed from September 1 to 30, 2012. Data for perceived stigma were assessed by using the perceived devaluation-discrimination (PDD) scale from new or returning patients. The data was analyzed by using the Statistical Package for the Social Sciences (SPSS) version 20. The results were described with the frequency table, graph, mean, and standard deviation. Bivariate analysis was used to get candidate variables for multivariate logistic regression analysis. Variables with a P value of < 0.05 at multivariate analysis were considered statistically associated with perceived stigma.

Results

A total of 384 participants were interviewed and the response rate was 100%. The prevalence of high and low perceived stigma was 51% and 44%, respectively. Having substance use history (AOR=0.6, 95% CI: 0.4–0.9) and family support (AOR=2.5, 95% CI: 1.5–4.3) and medication side effects (AOR=0.6, 95% CI: 0.5–0.8) were associated statistically with higher perceived stigma of people with mental illness.

Conclusion

Perceived stigma is a major problem of adults with mental illness in this outpatient setting in Ethiopia. Patients who had substance use and family support and medication side effects were more likely to have high perceived stigma. Therefore, screening and management of substance use, social support, and medication side effect should be strengthened for people with mental illness.

A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries

BACKGROUND

Stigma is associated with health conditions that drive disease burden in low- and middle-income countries (LMICs), including HIV, tuberculosis, mental health problems, epilepsy, and substance use disorders. However, the literature discussing the relationship between stigma and health outcomes is largely fragmented within disease-specific siloes, thus limiting the identification of common moderators or mechanisms through which stigma potentiates adverse health outcomes as well as the development of broadly relevant stigma mitigation interventions.

METHODS

We conducted a scoping review to provide a critical overview of the breadth of research on stigma for each of the five aforementioned conditions in LMICs, including their methodological strengths and limitations.

RESULTS

Across the range of diseases and disorders studied, stigma is associated with poor health outcomes, including help- and treatment-seeking behaviors. Common methodological limitations include a lack of prospective studies, non-representative samples resulting in limited generalizability, and a dearth of data on mediators and moderators of the relationship between stigma and health outcomes.

CONCLUSIONS

Implementing effective stigma mitigation interventions at scale necessitates transdisciplinary longitudinal studies that examine how stigma potentiates the risk for adverse outcomes for high-burden health conditions in community-based samples in LMICs.

Prevalence, factors and reasons associated with missed first appointments among out-patients with schizophrenia at the Federal Neuro-Psychiatric Hospital, Benin City

BACKGROUND

Non-attendance to clinic appointments is associated with poorer treatment outcomes. There is a dearth of information about missed first clinic appointments among patients with schizophrenia in Nigeria.

AIMS

To determine the prevalence, correlates and reasons for missed first appointment among out-patients with schizophrenia at the Federal Neuro-Psychiatric Hospital, Benin City, Nigeria.

METHOD

A cross-sectional descriptive study among 275 out-patients with schizophrenia, using the Mini International Neuro-Psychiatric Interview and the Brief Psychiatric Rating Scale.

RESULTS

The prevalence of missed first appointment was 31%. Higher BPRS score was associated with missing the appointment. The main reasons for missed appointments were: forgetting the appointment date and patient's refusal to come to the clinic.

CONCLUSIONS

Missed first out-patient clinic appointment is common among patients with schizophrenia at the study site, forgetting appointment dates being a common reason. Among other recommendations, methods of reminding patients and caregivers of appointment dates at the study location may need to be explored.

DECLARATION OF INTEREST

None.

Stigma and discrimination experienced by people with schizophrenia living in the community in Guangzhou, China

The aims of this study were to investigate experienced stigma and discrimination and their associated factors in people with schizophrenia who live in the community in Guangzhou, China. A total of 384 people with schizophrenia were randomly recruited from four districts of Guangzhou and completed the scales and questionnaires: Internalized Stigma of Mental Illness scale (ISMI), Self-Esteem Scale (SES), Discrimination and Stigma Scale (DISC-12), Brief Psychiatric Rating Scale (BPRS), PANSS negative scale (PANSS-N), Global Assessment of Functioning (GAF) and Schizophrenia Quality of Life Scale (SQLS). Insight and medication compliance were evaluated by psychiatrists. Data were analyzed by using descriptive statistics, Pearson correlation and multivariable linear regression. We found a significant positive correlation between BPRS score and PANSS-N score, GAF score was significantly negative correlated with SQLS score, Insight score was significantly negative correlated with medication compliance score, ISMI score was significantly positive correlated with SES score and experienced discrimination score. Multivariable linear regression found SQLS, SES and experienced discrimination were the main independent variables of ISMI and experienced discrimination was the most important factor of ISMI. Our findings suggest that people with schizophrenia often experienced stigma and discrimination in this Chinese population, and more anti-stigma interventions should be provided.

Pathways to psychiatric care for mental disorders: a retrospective study of patients seeking mental health services at a public psychiatric facility in Ghana

Background

The process to seek for care by patients who experience episodes of mental disorders may determine how and where they receive the needed treatment. This study aimed to understand the pathways that people with mental disorders traversed for psychiatric services, particularly where these individuals will first seek treatment and the factors that influence such pathways to mental health care.

Methods

A cross-sectional study conducted at Pantang psychiatric hospital in Accra, Ghana involving 107 patients of ages 18 and older and their family members. The study adapted the World Health Organization’s (WHO) pathway encounter form to collect information about patients’ pathway contacts for psychiatric care. Chi Square test was done to determine patients’ first point of contact and any association between the independent variables (clinical diagnosis and socio-demographic factors) and first pathway contact. Multiple regression analyses were also done to estimate the odds of patients’ first pathway contact.

Results

Overall, nearly 48 % of patients initially contacted non-psychiatric treatment centers (faith-based, traditional healers and general medical practitioners) as their first point of contact for treatment of mental disorders. A little more than half of the patients went directly to the formal public psychiatric facility as their first point of contact for care of their mental disorders. Patients’ occupation was significantly associated with their first point of contact for psychiatric care (χ² = 6.91; p < 0.033). Those with secondary education were less likely to initially seek care from the formal public psychiatric hospital compared to those with no formal education (uOR = 0.86; 95 % CI 0.18–4.08).

Conclusion

Patients used different pathways to seek psychiatric care, namely direct pathway to a psychiatric hospital or through transition from informal non-psychiatric service providers. Since nearly half of patients do not initially seek mental health care directly at the formal psychiatric facility, it is important for the government of Ghana to increase funding to the mental health authorities in Ghana as a matter of priority so that more individuals can be identified and integrated into mainstream psychiatric treatment and general health facilities where there are trained Community Mental Health Officers (CMHO) and Clinical Psychiatric Officers (CPO) to provide early intervention and treatment.