The fight against stigma: Multilevel stigma interventions in schizophrenia patients

Association between self-stigma and self-compassion in patients with schizophrenia: A longitudinal study from hospital admission to first follow-up after discharge

AIM

Self-stigma is a major factor preventing the recovery of individuals with schizophrenia. Psychosocial interventions can reduce self-stigma, and mental health nurses may play a crucial role in leading them, but little is known about the modifiable factors that should be targeted. We aimed to investigate the association between self-stigma and self-compassion in patients with schizophrenia from admission to the first follow-up after discharge.

METHODS

Twenty-three patients with schizophrenia were recruited from an acute psychiatric ward in a private psychiatric hospital in Japan. Participants filled out the Japanese versions of the Internalized Stigma of Mental Illness (ISMI) scale, the Self-Compassion Scale (SCS), and the Positive and Negative Syndrome Scale (PANSS) at the following three time points: 1 month after admission, discharge, and first follow-up after discharge at outpatient care. We used a linear mixed model to examine the association between self-stigma, self-compassion, and the symptoms. In the first model, we used self-stigma as a dependent variable and included time of assessment and positive and negative symptoms as independent variables. In the second model, we added self-compassion to the independent variables.

RESULTS

Self-stigma did not change over time. Regarding the linear mixed model, the first model showed that participants with more positive symptoms tended to report worse self-stigma (p = .052). The second model showed a significant association between increasing self-stigma and higher over-identification (p = .001).

CONCLUSIONS

Our results suggest that interventions focusing on over-identification can reduce self-stigma. Nurse-led intervention programs with a focus on over-identification should be further developed for effectiveness.

An exploration of the Indonesian lay mental health workers' (cadres) experiences in performing their roles in community mental health services: a qualitative study

BACKGROUND

Volunteers trained to support community mental health programs in Indonesia are known as 'mental health cadres.' These are lay people trained to provide basic support for people with mental illness in their local communities. The role of cadres in community mental health services is to provide health promotion activities and support for people with mental illness, such as home visits and family assistance. Their contribution can potentially address the challenges health services currently face in remote and resource-limited settings. However, little is currently known about implementing this form of the lay workforce and the experiences of mental health cadres in Indonesia in particular. This study aimed to explore the experience of cadres when performing their roles in community mental health services in Indonesia from the cadres' perspective.

METHODS

The study employed a descriptive qualitative design. Purposive sampling was employed to recruit cadres with at least one year of experience handling those diagnosed with schizophrenia across four geographical areas in Java and Sumatra, Indonesia. Data were collected utilising focus groups undertaken between July and November 2020. Due to COVID-19 restrictions, eight focus group sessions for mental health cadres were carried out virtually via Zoom and non-virtual, facilitated by local moderators. Data were analysed using thematic analysis.

RESULTS

The study involved 71 cadres in four regions: Aceh, Jakarta, West Java and East Java. The majority of participants were looking after their families with a minimum of high school-level qualifications. Four themes were interpreted from the data: (1) Motivation for volunteering, (2) The role of cadres in supporting mental health services, (3) Training and support needs in carrying out cadre roles, and (4) Barriers and facilitators to the implementation of cadre roles in local communities.

CONCLUSIONS

Cadres reported a motivation to help people improve their mental health and reduce the stigma associated with mental illness. Cadres also contributed to secondary and primary prevention of mental illness with some limitations. This study's results are relevant to those wishing to understand and optimise the implementation of lay workforces in resource-limited settings.