Stigma Resistance in Stable Schizophrenia: The Relative Contributions of Stereotype Endorsement, Self-Reflection, Self-Esteem, and Coping Styles

Individual stigma in people with severe mental illness: Associations with public stigma, psychological capital, cognitive appraisal and coping orientations

INTRODUCTION

The reason why some people with severe mental illness (SMI) maintain positive self-identity, while some are affected by the stigmatized environment is unclear.

AIMS

To describe the status of individual stigma and explore the relationship between self-stigma, stigma resistance and related variables in people with SMI.

METHODS

A cross-sectional study was conducted from April 2021 to March 2022. The Chinese version of Internalized Stigma of Mental Illness Scale and Stigma Resistance Scale were used to assess individual stigma. Perceived public stigma, psychological capital, stigma stress appraisal and coping orientations were also measured by scales. Data was provided by 422 patients with schizophrenia or bipolar disorder, from one psychiatric hospital and four community healthcare centers in China. A structural equation model was applied for analysis.

RESULTS

The total mean scores of self-stigma and stigma resistance were (2.06 ± 0.65), and (3.95 ± 0.84). Perceived public stigma was the primary condition for constructing individual stigma, which indirectly affected self-stigma (β = 0.268) and stigma resistance (β = -0.145). Stigma stress appraisal mediated the transformation of public stigma into individual, which had direct and indirect effects on self-stigma (β = 0.417, 0.166), and an indirect effect on stigma resistance (β = -0.374). Secrecy positively affected self-stigma (β = 0.117), while positive coping positively affected stigma resistance (β = 0.380). Psychological capital significantly directly impacted individual stigma.

CONCLUSIONS

Findings highlighted how public stigma determines the degree to which patients with SMI deal with stigma stress appraisal, and how this influences individuals. Anti-stigma programs and interventions to improve individuals' psychological capital and coping capabilities should be emphasized.

Exploring the factors that predict quality of life, and the relationship between recovery orientation and quality of life in adults with severe mental health difficulties

Integration of intrapersonal, interpersonal and environmental factors has been proposed to enhance understanding of psychological quality of life (QOL) in adults with severe and enduring mental illness (SMI). This study examined the contribution of factors such as self-stigma, coping style and personal recovery orientation to psychological QOL in SMI; compared QOL outcomes to norms from the general population; and examined the association between personal recovery orientation and overall QOL. 70 participants with SMI completed measures of QOL (including psychological QOL), personal recovery orientation, coping, perceived stigma, psychological distress and demographic variables. Regression analysis found that only adaptive coping and psychological distress contributed significantly to psychological QOL. Personal recovery orientation was significantly associated with overall subjective QOL. Participants had lower QOL in the psychological and social relationships domains compared to the general population. Findings support the positive contribution of adaptive coping to psychological QOL, and the positive association between personal recovery orientation and overall QOL.

Stigma and related influencing factors in postoperative oral cancer patients in China: a cross-sectional study

PURPOSE

To examine the level of stigma and identify its influencing factors among postoperative oral cancer patients in China.

METHODS

In total, 274 postoperative oral cancer patients were recruited from a Grade A Tertiary Hospital in China using convenience sampling methods. Patients completed the Social Impact Scale (SIS), Medical Coping Mode Questionnaire (MCMQ), Social Support Rating Scale (SSRS), and General Self-efficacy Scale (GSE).

RESULTS

Stigma reported by postoperative oral cancer patients was moderate (50.17 ± 21.24). Stepped multiple linear regression showed that the related factors influencing their feelings of stigma were educational level (β =  - 0.110, P = 0.001), smoking (β =  - 0.152, P < 0.001), betel quid (β =  - 0.120, P = 0.001), tumor location (β =  - 0.390, P < 0.001), tumor stage (β = 0.219, P < 0.001), self-efficacy (β =  - 0.253, P < 0.001), and confrontation (β =  - 0.117, P = 0.001) and avoidance (β = 0.123, P < 0.001), which explained 74.2% of the total variation in stigma (F = 99.378, P < 0.001).

CONCLUSIONS

Stigma was positively predicted by tumor stage and avoidance but negatively predicted by education level, smoking, betel quid, tumor location, confrontation, and self-efficacy. Further work should focus on developing interventions to reduce stigma by improving protective factors and decreasing risk factors.

Exploring the experience of relatives living with individuals diagnosed with schizophrenia in Oman: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Relatives of individuals diagnosed with schizophrenia experience financial, social, emotional and physical burden. There is a lack of studies on the experience and needs of caregivers of individuals diagnosed with schizophrenia in the Arab world. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This is the first qualitative study to reflect the voice of parents, siblings and spouses living with schizophrenia in the Arab world. The study explored the needs of relatives of hospitalized patients. This study revealed some positive elements of caregiving experience, especially among siblings. The concept of stigma resistance may guide the establishment of stigma reduction programmes. Violence towards the relatives or vice versa is a sensitive issue that needs to be addressed and reported. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should address parents, spouses and siblings' specific needs and challenges to include them in their relatives' treatment plan. Understanding the experience, feelings and needs of relatives living with schizophrenia would enable mental health nurses to provide a range of interventions to help reduce caregivers' burden and promote the positive gains from the caregiving experience. The study emphasizes the need for culturally adapted family interventions to effectively assist relatives in providing care and adjusting to the caregiving role. ABSTRACT: Introduction Relatives of individuals diagnosed with schizophrenia often experience positive and negative impacts. Much of the literature on family experience with schizophrenia comes from western culture, and less is known about Arabic speaking countries. There has been no previous attempt to qualitatively investigate the lived experience of relatives of hospitalized patients with schizophrenia in the Arab world. Aim To explore the experience and needs of Omani relatives of hospitalized patients diagnosed with schizophrenia. Method Qualitative semi-structured interviews with twenty relatives of hospitalized patients from Oman. The interviews were analysed using framework analysis. Results Parents, spouses and siblings were confronted with a burden specific to the demand of different life situations, and their needs differ accordingly. The findings showed four themes: burden, stigma, violence and needs. Discussion This study provides insight into the experience of Omani relatives living with schizophrenia. Although the caregiving experience appears negative, some positive elements of caregiving experience were prominent among siblings. Furthermore, the violence phenomenon among individuals with schizophrenia needs to be addressed as a priority. Implications for practice Understanding the experience, feelings and needs of relatives living with schizophrenia would enable mental health nurses to provide a range of interventions to help reduce caregivers' burden and promote the positive gains from the caregiving experience. The concept of stigma resistance in the Arab world may guide the establishment of stigma reduction programmes.

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.

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.

Coping Strategies for Oral Health Problems by People with Schizophrenia

BACKGROUND

Persons with schizophrenia are particularity susceptible to poor oral health. Symptoms of schizophrenia often affect oral health behaviors and lifestyle. The aim was to explore coping strategies used by people with schizophrenia in oral health in order to understand and to best involve them in the management of their own oral health in daily life.

MATERIALS AND METHODS

This is systematic review reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. We included cross-sectional and longitudinal quantitative and qualitative studies that 1) examined coping strategies regarding oral health in persons with schizophrenia or 2) examined coping strategies were used in dental care. We included studies conducted with at least one PWS aged 18 years old more and without restriction on sex, socioeconomic status, or language.

RESULTS

The 8 studies included suggest that coping strategies depends on complex translation processes that can be either personal (e.g., psychological symptomatology, neuropsychological functioning to adversely affect hope, self-esteem, self-stigma, self-determination, sense of coherence, and resilience) and/or environmental factors (e.g., peer support and efficacy of rehabilitations programs). We further identified that the main factor influencing coping strategies was dental stress situation.

CONCLUSIONS

This review suggests that coping strategies play a crucial role in the recovery process for oral health of PWS. Translation processes in oral health should be more explored in the future to clarify the capacity of PWS to cope with essential self-care in oral health on daily life.

Correlates and moderators of stigma resistance among people with severe mental illness

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.

Recovery from schizophrenia: is it possible?

PURPOSE OF REVIEW

Schizophrenia has a heterogeneous range of end states, from severe cases requiring repeated hospitalization to cases in which a single illness episode is followed by complete remission. The purpose of the present review is to examine recent literature on recovery in schizophrenia, focusing on the predictive factors and on the possibility to achieve it.

RECENT FINDINGS

Roughly half of schizophrenia patients recovered or significantly improved over the long term, suggesting that functional remission is possible. Several factors predict the course of schizophrenia, including demographic, clinical, and treatment characteristics, as well as socioeconomic variables. Antipsychotics are a fundamental element of schizophrenia treatment, although the available antipsychotics have significant limitations. In this context, psychosocial interventions are supported by substantial evidence of efficacy in many outcome measures and rehabilitation interventions should be considered as an evidence-based practice and need to become a part of the standard treatment of schizophrenia.

SUMMARY

As recovery is a multidimensional concept, some authors suggested that at least two areas should be taken into account: clinical remission and social functioning. Functional outcome should be a priority target for therapeutic interventions in schizophrenia and in this perspective measuring treatment response, remission and functional recovery is essential. Only an integrated and multifaceted approach involving pharmacotherapy, psychosocial interventions, and attention to environmental circumstances can improve outcome in schizophrenia.