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Stigma of Mental Illness-1: Clinical Reflections
Abstract and Figures
Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 years, therapeutic revolutions in psychiatry have not yet been able to reduce stigma. Stigma is a risk factor leading to negative mental health outcomes. It is responsible for treatment seeking delays and reduces the likelihood that a mentally ill patient will receive adequate care. It is evident that delay due to stigma can have devastating consequences. This review will discuss the causes and consequences of stigma related to mental illness.
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... Stigma with relation to MHD is explained as originating from multiple causes. Stigmatisation of adults with MHD may be from either, or both, sources external to an individual (public stigma), or internal sources (self-stigma) (Corrigan & Watson, 2002b;Shrivastava et al., 2012: Campbell & Deacon, 2006, or from the nature of the MHD themselves. Stigma causes behavioural and emotional responses. ...
... The meta-processes which Cassidy, Turnbull and Gumley identified are perceived in three areas; 'within the drama'; 'in relation to self, others and illness'; and 'outside of therapy' (Cassidy et al., 2014, p.356). These three areas can be translated into how dramatherapists are able to distinguish and experience adult clients' stigma in relation to their MHD; the stigma which is explored will often be witnessed within the drama (Jones, 1996(Jones, , 2007, and experienced in relation to others, self, and illness, and outside of therapy (Shrivastava et al., 2012). ...
... 1 Public stigma and self-stigma; determined as important from literature related to stigma attached to adult mental health difficulties (Campbell & Deacon, 2006;Corrigan & Watson, 2002a;Crocker & Major, 1989;Shrivastava et al., 2012). 2 Therapeutic relationship; illuminated by literature corresponding to stigma attached to adult mental health difficulties (Corrigan & Watson, 2002b;Davidson & Strauss, 1992;Estroff, 1989;Strauss, 1989), and reinforced by publications about dramatherapy with adult clients with mental health difficulties (Cassidy et al., 2014;Casson, 2004;Yotis, 2006). ...
This qualitative investigation into practice uses phenomenology and focuses on dramatherapists’ experiences of their adult clients’ stigma in relation to their mental health difficulties. For the purposes of this investigation, stigma is considered as a combination of public stigma and self-stigma. This study explores the dramatherapeutic core process of witnessing as a technique facilitated in the consideration of clients’ stigma related to their mental health. Nine dramatherapists participated in an online questionnaire, and the data was approached using interpretative phenomenological analysis. Findings show that dramatherapists can facilitate exploration of stigma related to mental health difficulties. The nine practitioners believed dramatherapy provided a safe space for both self-stigma and public stigma to be explored. Witnessing is identified as a significant core process. Dramatherapists experience a process of change and transformation in their clients following expression of stigma in relation to their mental health difficulties in therapy.
... Among the major challenges is the stigma of mental illness, which is considered a significant risk factor for negative mental health outcomes [5]. Stigma is found to be responsible for delays in seeking mental support and treatment by individuals and; thereby, can negatively influence therapeutic outcomes [7]. Efforts directed to the public over the years, aiming to spread awareness regarding mental health and reduce stigmatizing behaviors, have achieved positive outcomes in certain populations, especially in the West [8]. ...
... The questionnaire exhibits a 3-factor structure representing three stigma subscales or domains. These include the attitudes of health care providers towards people with mental illness domain with 6 questions (score range: 6-30); disclosure/help-seeking domain with 4 questions (score range: [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]; and social distance domain with 5 questions (score range: 5-25). The questions of, and participant responses to, the 15-item OMS-HC questionnaire are described in the corresponding results section. ...
Stigma towards mental illness poses a significant risk for negative mental health outcomes. Efforts have been undertaken to mitigate self-stigma and stigmatizing behaviors among the public; however, few have considered stigma among healthcare providers, including pharmacists. This study aimed to assess the level of stigma towards mental illness, using the 15-item version of the Opening Minds Scale for Health Care Providers (OMS-HC), and associated factors among pharmacy students and was conducted via a printed questionnaire. A total of 125 students participated and the mean total stigma score was 47.9 with 58.4% of the participants scoring above 45, the midpoint of the possible range of scores. The stigma score was independent of participant demographics, except for grade point average. Higher total stigma scores were observed among subjects who have been prescribed a neuropsychiatric drug before, those who believe that pharmacists should have a role in mental healthcare, those who believe that pharmacists are qualified enough to provide mental health support, and those who are willing to seek help from a pharmacist. The results indicate an overall high stigma score among pharmacy students, which highlights the importance of enhancing pharmacy students’ awareness and knowledge regarding mental healthcare through incorporating additional courses and/or training programs in pharmacy education curricula.
... Stigma related to mental illness is an important barrier to accessing mental health care for the general population and the military population (Corrigan 2004, Greene-Shortridge et al. 2007, Kim et al. 2010, Shrivastava et al. 2012. Stigma related to mental health in the military context may differ from stigmatization in the civilian field due to differences between civilian and military mental health care systems and military and civilian cultures (Skopp et al. 2012). ...
... In summary, the consequences of mental stigma can include negative labeling among the general and military population, threatening social reactions such as discrimination, avoidance of treatment, exclusion, and even situations that lead to violence and suicide. The main effect of stigma is that it creates a vicious circle that further increases discrimination (Shrivastava et al. 2012). According to Pescosolido et al. (1999), society has developed different levels of discrimination and stigma, even among mental illness groups (Corrigan 2004). ...
Due to its nature, the army is an environment with a high risk of mental illness. Research shows that mental health stigma is a common and serious barrier to early and effective treatment for mental disorders that result from the stress of military operations. Given the need for timely and effective mental health intervention, it is important to understand the barriers to seeking mental health help in a military context. Although there is stigma related to mental health in the studies and compilations carried out in the civil and military context in the national and international literature, there is no literature on mental health stigmatization in the military context, especially in the national literature. This study is a compilation research created by reviewing the national and international literature. In this article, it is aimed to present some innovative social work interventions in order to address the sources of stigma that hinders access to mental health care and the factors that reinforce them, in a military context, to potentially reduce stigma and to maximize the benefit of mental health care.
... Although stigma is a transcultural phenomenon, the origin and risk factors are not universal and vary across cultures in which multiple risk factors work synergistically [24]. For example, Ng [25] showed that stigma toward mental illnesses is prevalent in Chinese, Indian, Japanese, South-East Asian, and Islamic cultures. ...
... Some argued that personal, social, familial factors, and even the nature of the illnesses can facilitate stigma [29]. Others have highlighted the role of low education and awareness, perception, and the interaction of the nature and complications of mental illnesses [24]. ...
Background
Mental illnesses stigma is a universal and transcultural phenomenon. While mental illnesses stigma is pervasive in Bangladesh, very little research exists on stigma toward mental illnesses among indigenous communities. This study aimed to investigate the prevailing stigma and the risk factors among different indigenous communities in the Chattogram Hill Tracts (CHT) in Bangladesh.
Methods
A cross-sectional survey was carried out and participants were recruited purposively from Rangamati, a South-Eastern district of Bangladesh in the CHT. Participants from various indigenous communities including Chakma, Marma, Rakhine, Tripura, and Pangkhua were recruited. The 28- item Bangla translated version of the Mental Illnesses Stigma Scale was used. Independent-samples t-test, ANOVA, and multiple regression were performed.
Results
The results indicate evidence of a gender difference with females reporting more stigma than their male counterparts. Age, gender, socioeconomic status, and monthly income are associated with stigma among indigenous people. Further analyses of the subscales indicated significant differences among sociodemographic variables.
Conclusions
The results provide an insight into the prevailing stigma and associate risk factors among indigenous communities. The results may help inform anti-stigma interventions targeting indigenous communities in Bangladesh.
... 12 We believe stigma plays a key role in treatmentseeking delays, as it decreases the likelihood that a psychiatric patient would seek treatment. 27 They dislike being perceived as weak individuals who require assistance from others, especially professional assistance. 28 Some of them fear that others would discover their mental health issues and act improperly. ...
... Stigma emerges from various sources, which function synergistically and have a profound impact on the individual's life. 27 In the consultation process, insufficient knowledge and low self-confidence manifested as obstacles. Practitioners were either unaware of or lacked a proper understanding of the instructions, particularly in regards to the different definitions of alcohol measurements and strengths. ...
Objective
This investigation explored the barriers and facilitators to substance use disorder (SUD) treatment in the integrated paradigm.
Methods
A search technique for barriers and facilitators of SUD treatment was applied to the PubMed and Web of Science databases to identify relevant systematic reviews. The eligibility criteria included systematic review (SR) or SR plus meta-analysis (MA) articles published before the end of 2021, human research, and the English language. Each of the 12 relevant review articles met the inclusion criteria. AMSTAR was utilised to evaluate the methodological quality of the systematic reviews.
Results
Two authors analysed 12 SR/SR-MA articles to identify barriers or facilitators of SUD treatment. The cumulative summary results of these 12 evaluations revealed that barriers and facilitators may be classified into 3 levels: individual, social and structural. By analysing these review papers, 37 structural barriers, 21 individual barriers and 19 social barriers were uncovered, along with 15 structural facilitators, 9 social facilitators and 3 individual facilitators.
Conclusions
The majority of barriers indicated in the review articles included in this analysis are structural, as are the majority of facilitators. Consequently, the design of macro models for the treatment of substance use disorders may yield various outcomes and potentially affect society and individual levels.
... 3 The ...
... Beyond the public health burden, MNS disorders also constitute a significant social and economic burden to the affected individuals, their families and communities. From a social burden perspective, there is an established association between MNS disorders and social exclusion/discrimination (3). In terms of its economic significance, MNS disorders have been found to have the highest total cost among the non-communicable diseases, and this cost is expected to rise to 41% between 2010 and 2030 (4). ...
... They found that stigmatization is typically reported as a barrier to seek health care by 21-23% of participants across the studies for embarrassment, negative social judgment, and employment-related discrimination [8]. Finally, fearing stigma can drive people to hide their illness to avoid discrimination, prevent them from seeking health care and discourage them from taking preventive measures [9]. Unfortunately, this may lead to an increase in the spreading of the disease and result in difficulties in controlling the outbreak [9]. ...
... Finally, fearing stigma can drive people to hide their illness to avoid discrimination, prevent them from seeking health care and discourage them from taking preventive measures [9]. Unfortunately, this may lead to an increase in the spreading of the disease and result in difficulties in controlling the outbreak [9]. ...
Background: COVID-19 has contributed to the development of stigma in the community of Jeddah, thus causing negative attitudes and beliefs toward individuals linked to the disease. Objective: To describe stigma related to COVID-19 positive patients and find out factors associated with stigma subscales. Subjects and Methods: Analytical cross-sectional study conducted on COVID-19 positive patients (lab confirmed) in Jeddah. The sample size was 420 patients, and the data was collected using a validated questionnaire adapted from HIV/AIDS stigma instrument (HASI-P). The data were analysed using the statistical package for the social sciences (SPSS, version 27.0). Results: Total number of responses was (419). The median age was 32 (IQR, 25-43). Both genders, Saudi and non-Saudi, were included. The tool used to measure the COVID-19 related stigma of different six subscales. The verbal abuse had a median of (0, IQR=0-0.25), negative self-perception (median=0, IQR=0.02), health care neglect (median=0, IQR=0-0), social isolation (median=0.2, IQR=0-0.6), fear of contagion (median=0.33, IQR=0-0.83) and workplace stigma (median=0, IQR=0-0). Male gender was significantly associated with social isolation and fear of contagion, while working in the health care field was associated with workplace-related stigma. Conclusion: COVID-19-related social stigma was reported by a considerable number of Jeddah healthcare providers, specifically workplace-related stigma. Unexpectedly, males need more attention as regard to social isolation and fear of contagion. The results of this study can be of used to guide supportive social interventions to suppress the COVID-19 related stigma.
... An analysis of health services in Mumbai by Akhuly and Kulkarni (2010) revealed that drugs were the first line of care, and psychological counselling was under-utilised. Shrivastava et al. (2012) argue that using psychotherapy could be a beneficial tool for anxiety and depression treatment. It has also been argued that psychiatric treatment has the potential to reduce the issues resulting from the stigma surrounding MH discussions. ...
... It has also been argued that psychiatric treatment has the potential to reduce the issues resulting from the stigma surrounding MH discussions. These researchers interviewed patients to determine the steps needed to reduce stigma and found that educating the public and completing psychiatric treatment were relevant themes in their conclusions (Shrivastava et al., 2012). Hence, a greater focus on this treatment could help mitigate mental illnesses in Mumbai. ...
Organisational effectiveness is fundamental for sustainability and
profitability. Effectiveness is measured observing the degree of profit, the reduction of the costs, the production quantity, efficiency and organisational citizenship behaviour (OCB). OCB is the willingness of an employee to perform tasks which are not officially and directly required by the employer, thus do not have any official and direct recompense from the contractual relations. This discretionary behaviour is always related to an enhancement perceived by the organisation. The review covers the last three decades of
research and development in the organisational citizenship behaviour literature and has a special focus on literature from 2010 to 2019. Research led to consider these main outcomes of OCB namely compliance, altruism, organisational justice related to a fair environment workplace, perceived organisational support (POS) related and enhanced by a higher level of collectivism, power distance and uncertainty avoidance; procedural justice (PJ); transformational leadership (TSL) and the psychological contract (PC). This
research would assist academicians, corporates and the general public understands the concept by the critical analysis conducted.
... Penyebab stigma berasal dari berbagai sumber/multi complex yang secara sinergis berimplikasi serius pada kehidupan individu (Shrivastava et al., 2012). Penyebab mungkin berasal dari sumber-sumber pribadi, sosial dan keluarga, serta sifat dari penyakit itu sendiri. ...
... Beberapa penelitian menunjukkan bahwa stigma biasanya muncul dari kurangnya kesadaran, kurangnya pendidikan, kurangnya persepsi, dan sifat dan komplikasi gangguan jiwa (Arboleda-Flórez, 2002). Sebuah penelitian yang menyelidiki persepsi pasien tentang stigma mengungkapkan bahwa stigma dan diskriminasi yang terkait dengan skizofrenia memiliki dampak signifikan pada kehidupan orang-orang tersebut (Shrivastava et al., 2012). ...
Stigma menjadi hal penting dalam intervensi kepada ODGJ, masyarakat dan tenaga kesehatan. Pencegahan stigma sebagai salah satu intervensi pada pelayanan keperawatan jiwa memiliki kompleksitas tersendiri. Pada tulisan ini akan diuraikan terkait stigma yang dapat membantu mahasiswa dalam referensi.
... Additionally, myths and misinformation further reinforce higher levels of social stigma, particularly in instances where individuals have minimal real-life exposure to psychological disorders or other mental health conditions [6]. Media such as films and news reports commonly perpetuate such misinformation by inaccurately depicting psychological disorders and their symptoms [8]. ...
Background
Currently, we know little regarding how stigma attributed to eating disorders compares to that of other psychological disorders and additionally within different types of eating disorders. In the current study, we aimed to explore the stigmatisation of eating disorders by comparing the stigma attributed to anorexia nervosa, bulimia nervosa, and binge-eating disorder, utilising depression as a comparative control.
Methods
A total of 235 participants from the general population were randomly assigned to an anorexia nervosa, bulimia nervosa, binge-eating disorder, or depression condition. Participants responded to a questionnaire consisting of several adapted versions of pre-existing subscales that measured levels of stigma associated with psychological disorders generally, as well as stigma associated with eating disorders specifically. We used several one-way analyses of variance to investigate the differences in stigma attributed towards the aforementioned psychological disorders.
Results
Results suggested that all three eating disorders were significantly more stigmatised than was depression. Between the eating disorders, the three were generally equivalent except that binge-eating disorder was significantly more stigmatised than both anorexia nervosa and bulimia nervosa on a subscale measuring trivialness.
Conclusions
These findings indicate that individuals with eating disorders, including binge-eating disorder, may be at a higher risk of experiencing the negative implications of stigma when compared to other psychological disorders, such as depression. To our knowledge, this study is one of few that directly quantify and compare stigma attributed towards anorexia nervosa, bulimia nervosa, and binge-eating disorder. Through further research, a better understanding around the expression of stigma towards specific eating disorders could inform the development of targeted interventions to help reduce the stigma associated with these disorders. This knowledge could also advance the understanding of the lived experience of individuals living with eating disorders, subsequently informing treatment practices.
... However, the existence of stigma toward MHPs in this population is particularly important. One of the most serious consequences of stigma at this level is the delay among users and patients seeking help, up to eight years for people with MHPs, constituting a risk factor that increases morbidity and mortality [53]. ...
Burnout is a primary psychosocial risk factor in the workplace. Mental health stigma, which includes negative cognitions, emotions, and behaviors, also undermines the performance of social healthcare professionals. This study aimed to explore the levels of burnout in a sample of community social healthcare workers as well as its relationships with variables such as stigma towards mental health problems, professional skills, and job characteristics. An online assessment was conducted with 184 social healthcare professionals (75.5% female, mean age = 40.82 years, SD = 9.9). Medium levels of burnout and stigma and high levels of professional skills were observed. Multiple linear regression analyses revealed that stigma towards mental health problems and professional skills predicted emotional exhaustion (R² = 0.153, F(4, 179) = 9.245, p < 0.001), depersonalization (R² = 0.213, F(3, 180) = 17.540, p < 0.001), and personal accomplishment (R² = 0.289, F(5, 178) = 15.87, p < 0.001). These findings suggest that social healthcare systems could benefit from taking care of the mental health of their workers by addressing burnout, tackling negative attitudes towards mental health problems, and providing professional skills training. This would help to make social healthcare systems more inclusive and of higher quality, thereby reducing health costs.
... Stigma can be defined as the simultaneous occurrence of status loss, labeling, trivialization, and discrimination or segregation in a given situation [2]. Despite significant advancements in mental health care over the past five decades, efforts to reduce psychiatric stigma have been insufficient [3]. The stigma associated with psychiatric disorders, including within healthcare systems and among healthcare providers, remains a significant barrier to better treatment outcomes and recovery, resulting in poor quality of care for psychiatric patients [4,5]. ...
A significant proportion of individuals with psychiatric disorders face dual challenges such as managing the symptoms and disabilities of their conditions and enduring stigma arising from misconceptions about mental illness. This stigma denies them quality-of-life opportunities, such as access to satisfactory healthcare services, better employment, safer housing, and social affiliations. This systematic review aims to evaluate the effect of stigmatization on psychiatric illness outcomes, particularly its influence on treatment adherence, treatment-seeking behavior, and care outcomes. We conducted a systematic review of 39 studies published between 2010 and 2024, focusing on the effects of stigmatization on psychiatric illness outcomes. The review utilized robust methodology following Cochrane guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies from 2010 to 2024 obtained from databases such as PubMed, Embase, Google Scholar, Web of Science, and SCOPUS. The quality of the included studies was assessed using the Appraisal Tool for Cross-Sectional Studies, with most studies rated as moderate to high quality. The findings indicate that stigma in psychiatric illness is closely associated with several factors, including illness duration (mean effect size = 0.42, p < 0.05), frequency of clinic visits (mean reduction = 2.3 visits/year), and diagnosis of psychotic disorders (OR = 1.78, 95% CI: 1.20-2.65). Stigma manifests through misinformation, prejudice, and discrimination, leading to significant barriers to accessing and adhering to psychiatric treatment, thereby worsening health outcomes. It leads to delays in accessing healthcare, poor adherence to medication and follow-up, and negative psychiatric health outcomes, including disempowerment, reduced self-efficacy, increased psychiatric symptoms, and decreased quality of life. Also, stigma extends to caregivers and healthcare professionals, complicating care delivery. This review highlights the need for effective interventions and strategies to address stigma, emphasizing the importance of educational interventions to mitigate the adverse effects of public stigma. Understanding the multifaceted nature of stigma is crucial for developing targeted approaches to improve psychiatric care outcomes and ensure better mental health services for individuals with mental illnesses.
... Any form of negative attitude/belief that either motivates fear or in any way rejects/avoids/discriminates against a person with mental illness is classified as mental health stigma (3). Factors such as illiteracy, religious inclusions and ignorance, urban legends, old wife's tales and a lack of understanding about mental health disorders have all contributed and helped shape the stigma that is currently associated with mental health patients (4). ...
Background: The foundations of a good life encompass both physical and mental health. Mental health stigma, any negative belief motivating fear or discrimination against individuals with mental illness, is a significant barrier to seeking help. This study aims to determine the prevalence of stigma associated with consulting psychiatrists for mental health issues. Methodology: In this cross-sectional study, data was collected from 600 participants from the general population of Islamabad, Pakistan, using non-probability convenient sampling. A self-constructed, self-administered questionnaire was utilized for data collection, with analysis conducted using the chi-square test, frequencies, and valid percentages. Results: Of the participants, 398 (66.6%) were male and 200 (33.4%) were female. Educational levels included matric 69 (11.8%), Inter 82 (14%), Bachelor 173 (29.6%), and Masters & above 199 (34%). Results revealed that 205 (34.9%) participants perceived stigma associated with seeking psychiatric help, 422 (72.5%) viewed it as a sign of weakness, and 376 (65.4%) believed mentally ill patients could pose a danger to others. Regarding treatment preferences, 491 (88.0%) preferred psychiatrists, 38 (6.8%) favored religious leaders, and only 29 (5.2%) preferred confiding in family or friends. Conclusion: While there is a decrease in stigma associated with seeking psychiatric consultation with higher educational attainment, significant stigma persists, particularly among males, attributed to cultural constraints. Despite this, there is a strong inclination towards seeking professional help for psychiatric illnesses, irrespective of religious beliefs.
... remove the stigma associated with mental illness, some members of society continue to view people with mental health problems as flawed, unpredictable, and dangerous (Angermeyer & Dietrich, 2006;Crisp et al., 2000). These stigmatized views frequently lead to discrimination at home, work, and/or school and may lead to loss of friends and feelings of shame that may worsen mental health problems (Shrivastava et al., 2012;Wade et al., 2019). ...
Previous studies have provided some evidence that college students may hesitate to disclose their mental health status because of social stigma; however, more research is needed to identify and understand the factors that influence students’ willingness to disclose. For example, it is unclear how professor characteristics impact the likelihood of disclosure. In the current study we examined whether the gender of the professor (male vs. female) and the professor’s teaching discipline (STEM vs. humanities) affected students' likelihood to disclose a mental health problem. Participants read a fictitious syllabus where the professor was either male or female and taught a chemistry or English course. Then, they were asked to respond to a questionnaire concerning whether they would disclose any mental health problems to the professor teaching the course. Results indicated that students would not disclose their mental health status to a professor via email or office hours. Instead, they would rather skip the class for a mental health day. This effect was especially present if the class was taught by a female professor in humanities. In addition, students of color were more likely to report skipping the class when compared to their White counterparts. These findings raise important implications for our understanding of the relationships between students and professors concerning mental health.
... The stigma associated with mental health conditions (MHCs) remains a significant social issue, with no nation or culture placing the same value on people with MHCs as those without (Rössler, 2016). It has been reported by those who have been impacted that stigma can be worse than the MHC itself (Shrivastava et al., 2012;Thornicroft et al., 2022). Stigma may have a variety of adverse impacts on social inclusion, well-being, employment opportunities, poverty and relationships (Hanlon, 2017), as well as impeding healthcare seeking behaviors and contributing to the nonavailability of quality mental healthcare (Pescosolido and Martin, 2015;Subu et al., 2021). ...
Background
Stigma is significantly impacted by cultural and contextual value systems. People with mental health conditions frequently have to deal with the condition itself and the associated stigma and discrimination. Contextual understanding is essential to design measures and interventions.
Objective
This study aimed to explore the experiences and perceptions of people with mental health conditions, their families and key stakeholders.
Method
A qualitative method used to understand mental health-related stigma and its local contexts. Sixteen participants, including service users, caregivers, service providers and health service administrators, were interviewed.
Result
People with mental health conditions and their caregivers experienced various forms of stigmatization which is linked to attributions about the causality of the illness, overt manifestations of mental health condition leading to easy identification and functional impairments that adversely affect participation. Social contact, lived experiences sharing and training of service providers are relevant intervention strategy to address stigma.
Implication
Stigma and exclusion are prominent in the experiences of people with mental health conditions and their caregivers in this rural Ethiopian setting. Measurement of stigma and the development of interventions should consider how stigma is socially constructed. Anti-stigma interventions need to be implemented alongside expanded local access to mental healthcare.
... Although trends seem to indicate a decline in stigma at a societal level towards mental illness , the rate of decline in negative attitudes towards schizophrenia does not match that of other psychiatric conditions such as depression and anxiety; schizophrenia continues to be associated with the most negative stereotypes (Wood et al., 2014), such as the potential for violence, which has increased since the 1990s (Pescosolido et al., 2019). Research has demonstrated that stigmatised attitudes, presumably caused by a lack of education and misinformation (Shrivastava et al., 2012), can impact the trajectory of the illness (Mueser et al., 2020). Stigma is therefore perceived as a barrier to recovery in schizophrenia (Lysaker et al., 2012). ...
Stigmatised attitudes are known to be associated with negative outcomes in schizophrenia, yet there is little focus on the role of stigma in the recovery process. Attempts to develop interventions to reduce self-stigma in schizophrenia have not been found effective. This paper presents a theoretical integration based on a narrative review of the literature. PsycINFO, Medline and Embase databases were searched up to the 11th December 2023. Studies were included if they were: i) empirical studies using qualitative, quantitative or mixed methods studies investigating mental health stigma; ii) included participants based in the United Kingdom, fluent in English, between the ages of 16 and 70, meeting criteria for a schizophrenia spectrum diagnosis. Fourteen studies were included. In Part 1, we propose a novel theoretical model derived from a synthesis of service-user perspectives on the relationship between stigma and schizophrenia. Stigmatised attitudes were commonly perceived to be caused by a lack of education and further exacerbated by disinformation primarily through the media and cultural communities. Stigma led to negative self-perceptions, negative emotional responses, social isolation and increased symptom severity, ultimately acting as a barrier to recovery. In Part 2, we identify several factors that ameliorate the impact of stigma and promote clinical and subjective recovery among service-users: education, empowerment, self-efficacy, self-acceptance, hope and social support. We argue that the notion of stigma resistance may be helpful in developing new interventions aimed at promoting recovery in individuals with schizophrenia. Wider implications are discussed and recommendations for future research and practice are explored.
... M A I N A R T I C L E S mentally ill patient will receive adequate care (Shrivastava, Johnston, & Bureau, 2012). ...
Mental health is the foundation of human capability that makes each life worthwhile and meaningful. There has been great progress in mental healthcare in Ghana over the years but too many people are still left behind from reintegration into society after recovery due to discrimination and stigma. In order to harness the full potential of the human resource, there is the need to reintegrate all treated mental health persons. It is for this reason that the Christian Health Association of Ghana which operates over 280 healthcare institutions in Ghana is seeking to deconstruct the way mental healthcare is delivered. The programme seeks to shift from institutional care to community-based care involving interventions by health professionals, peers and key members of the community. The purpose of this study was to gauge knowledge and attitude to stigma, discrimination, and community-based mental healthcare. The country was divided into three zones; coastal, middle and northern. From each zone, an urban and a rural site were selected. Using mixed method approach, qualitative data from caregivers and religious leaders was purposively generated while quantitative data from Junior High School students and nurses was randomly collected. Results showed that age, ethnicity, education, religious affiliation, and occupation were some of the key variables which influence reintegration of treated mentally ill persons. The study concludes that stigma and discrimination against the mentally treated person is a complex issue which needs multifaceted and multi-disciplinary approach including community and home care to solving it.
... Only the principal diagnosis was obtained and considered for each patient; thus, the effects of comorbidities may have been overlooked. In addition, persons affected by some conditions, such as mental or neurogenerative diseases, may avoid seeking treatment altogether due to social stigmas (Shrivastava et al. 2012) or consult with their physician or other health professional rather than seek hospital treatment (Bushnell et al. 2005;Tylee and Walters 2007). Sensitivity analyses incorporating different parameters should be further investigated to examine the robustness of the parameter estimates across the DLNMs for different causes of hospitalization. ...
Although it is a growing area of investigation in the Global Dust Belt, only a few population-level studies have evaluated the human health associations of windblown dust in North America. We investigated whether acute, short-term dust exposures (DE), in Lubbock, Texas (a medium-sized, dust-prone city in the southern Great Plains, USA) were associated with significant increases in hospitalizations on the day of the exposure and up to 7 days afterward. We used the distributed lag non-linear models in time series analysis to describe non-linear relationship between response outcomes and the delayed effects of exposure over time. We found that increased relative risks of hospitalizations for multiple conditions were associated with the two DE approaches that occurred between 2010 and 2014. Consistent with prior studies of dust health effects in other cities in North America, we identified increased hospitalization risks in Lubbock due to neurodegenerative, atherosclerosis, renal, respiratory, asthma, mental, stroke, neoplasms, ischemia, hematologic, musculoskeletal, and associated diseases (aggregation of all causes each associated with at least 5% of hospitalizations) at various dust exposure days. Associations were modified by age, gender, day of the week, and holiday effects. As climate change increases water stresses on dryland agriculture and long periods of drought, dust exposures are likely to increase for residents of dryland cities and with it the likelihood of adverse health effects on people with preexisting conditions. Additional investigations are needed for other dust-prone population centers worldwide to document the health effects of dust exposures and investigate their causes.
... In general, such stigmas stem from a "lack of awareness, lack of education, lack of perception and the nature and complications of mental illness" according to Julio Arboleda-Florez, the Director of the WHO Regional Unit for Research and Training in Psychiatric Epidemiology [1]. It seems that there is a lack of awareness and a lack of perception that prevents a spread of education regarding mental illness in both India and China. ...
Mental illness has been a prevalent issue around the world however; an existing stigma against mental illness is preventing the development of proper mental health care and resources. This phenomenon is seen in the countries of India and China. Considering a stigma is developed within the society based on some beliefs upheld by the general population, it was in the best interest to investigate religions and philosophies that people in both China and India follow and uphold. This paper aims to answer the research question of “In what ways has religion and philosophy, specifically Islam, Hinduism, Buddhism, and Confucianism, affected stigma against mental illness and thus the available mental health care in India and China?”. Through research done on the four religions/philosophies, certain connections could be made. In India, Hinduism views mental illness as a result of a lack of faith and adherence to rituals. In Islam, mental illness is also believed to be due to a lack of faith. Such negative views of mental health could be contributing to the large treatment gap in India. In China, Confucianism seems to be the reason why a mental illness stigma exists. Confucianism emphasizes adherence to societal views, even if that means suppressing emotion. This causes people to look down upon mental illness and justifies people staying away from those with mental illnesses rather than helping them. On the other hand, Buddhism, the majority religion/philosophy in China, seeks to reduce mental health stigma. Buddhist beliefs could be the cause of the increase in demand for mental health care. The connections made are beneficial to understanding the root of mental health stigma and can be used in the future to combat the stigma and start increasing awareness and available mental health care.
... Individuals with a full time employment are known to have better cognitive performance [17]. Provision of employment opportunities in order to uplift socioeconomic status was reported to be beneficial in improving cognitive function and reducing prevalence of stigmatism and social isolation faced in schizophrenia [18] . The inability to perform routine activities (eg: taking prescribed medication , being able to cook , go shopping , cleaning , travelling, taking care of personal hygiene ) of daily life increase the burden and dependency on caregivers (19) .The ability to perform daily activities independently itself has been recognised as one of the prime concern of treatment outcomes in schizophrenia (20). ...
... Stigma is frequently reported in illnesses manifesting behavioural disturbances or socially odd behaviour [14]. Moreover, the stereotype of violence is one of the pillars of stigma in mental disorders [15]. ...
... In addition, these stigmas may in uence how young mother perceive reactions to disclosure of their health status to healthcare providers [28]. Stigma is an important predictor of symptom relapse and noncompliance with treatment [29]. ...
Background
Perinatal mental health (PMH) represents a public health concern due to their impact on the health of mothers and their infants. However, only a small proportion of Chinese mother seek help, and even when perinatal health services are available, mother 's PMH has not improved due to many factors. This study to determine the factors affecting the relationship between care-seeking behavior and PMH, to discover Chinese mother’s attitudes of care-seeking behavior. Understanding mother’s care-seeking behaviors is critical to devising strategies that increase treatment rates for perinatal mental health.
Methods
In this cross-sectional survey, face-to-face interviews were conducted among 1705 mother from early, middle, and late stages of pregnancy in hospitals with an annual delivery volume of at least 5000 in Wuxi during October 2021 to November 2022. Mother’s social demographic information and their different seeking healthcare were collected, also investigated the relationship between care-seeking behavior and PMH, as well as the multiple mediating effects of perceived professional healthcare support (PPHS) and perceived societal stigma or trust. Statistical analyses were performed using IBM SPSS 24.0 and AMOS 24.0, and the mediating effect was evaluated by bootstrapping with 95% confidence intervals (CI).
Results
Among 1705 mothers, 636 (37.3%) sought help from professional, and care-seeking behavior during early pregnancy is easier compared to later stages of pregnancy.However, even mother seeking help from professional, did not positively affect their PMH compared to mother who did not seek help, while reporting the PPHS, social stigma and trust with medical play multiple mediating roles in the relationship between care-seeking behavior and PMH. The perception of PPHS based on the trust or stigma of the medical system may reflect inadequacy surrounding that maternity care services and health education in China, further exploration in future research.
Conclusion
This study highlights the several barriers and facilitators at individual, institutional, doctor-patient relationship, and public policy levels that can affect relationship between mother’s care-seeking behavior and PMH. To effectively address this influence, it is imperative to recognise the need to develop interventions across socio-ecological levels is key.
... Mental health stigma is widespread in India, where socio-cultural factors inhibit treatment-seeking and care (Gaiha et al., 2014). This leads to delays in seeking help for mental illness, delayed diagnosis and treatment, discontinued treatment, and lower possibilities that individuals are able to overcome the condition and participate in a full life (Shrivastava et al., 2012). The National Mental Health Survey 2015-2016 found a truly alarming treatment gap between 70 and 92%, with common mental disorders including depression and anxiety showing a treatment gap of 85%, and severe mental disorders showing a 73.6% of treatment gap (Gururaj et al., 2016). ...
When urban workplaces shut down for the COVID-19 pandemic lockdown in India, a very large number of migrant workers were forced to reverse-migrate to their largely rural points of origin. This article looks at the mental health implications of the period migrants spent without work, back at the low-resource places from which they had out-migrated, in hopes of a better life. Based on qualitative interviews conducted with reverse migrants during the COVID-19 pandemic lockdown, this article has a two-fold aim. The first aim is to reach the experiences and voiced concerns of precarious and vulnerable migrants to those who may be in a position to ameliorate their distress. Since policy-makers tend to lack time, findings from the qualitative data have been summarized in the form of a multi-dimensional typology, open to expansion by further research. The typology sees themes in money, health, information, and isolation. Second, the article follows the issues in the typology to suggest that acknowledgment of the significant role of migrant workers in India's economy, via sensitive enumeration, would be a first, and essential step to address the multiple concerns raised by migrant workers themselves. This baseline information could then be used to build subsequent dependent steps addressing the myriad causes of mental health distress among migrant workers in India.
... Internalized stigma has also been connected to a variety of negative psychosocial consequences in those suffering from mental illness (Livingston & Boyd, 2010). These include poor social support and life satisfaction (Oliveira et al., 2015), limited career options, feeling stigmatised at work (Kumar et al., 2021), marginalisation, rejection, shame, and isolation are just a few examples (Shrivastava et al., 2012). ...
Background: People with mental illnesses face societal stigma, which limits their social chances and meaningful interactions, lowering their self-esteem, life satisfaction and impeding recovery. Aim: The study focuses on exploring the prevalence and association between internalized stigma and self esteem among patients with psychiatric disorders. Methods: This hospital-based study consisted of 360 patients diagnosed with any psychiatric disorders using a purposive sampling selected from the outpatient department (OPD) of the CIIMHANS, Dewada, Chhattisgarh, India. Patients were assessed through the socio-demographic datasheet, Internalized Stigma of Mental Illness Scale (ISMI) and the Rosenberg's Self-Esteem Scale (RSES). Results: The result of this study indicates that internalized stigma was seen to be at a severe level in just under half (42.8%) and more than half low self-esteem (54.2%) among patients with psychiatric disorders. In regression analysis, overall internalized stigma strongly contributes 75.5% to the variance on self-esteem and duration of illness. Conclusion: People who have a psychiatric illness often feel stigmatized. These people are discriminated against, have restricted work opportunities, feel stigmatized at work around the world, which lowers their self-esteem and quality of life
... Mental illness constitutes a huge global burden of disease (Rehm & Shield, 2019), but in low-income and middleincome countries (LMICs) there is a large treatment gap, ranging from 76·3 to 85·4% (Demyttenaere et al., 2004). The gap is generally attributed to challenges related to human resources, stigma, political factors, technology and infrastructure (Shrivastava et al., 2012). ...
In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response to this situation, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHUs) to every district. This study evaluates the barriers and facilitators to mental health service delivery in decentralised MHUs in Sierra Leone using key informant interviews and focus group discussions with 13 purposefully sampled clinical staff and senior management personnel. The interviews were audio-recorded, translated from Krio if necessary, transcribed, and analysed using manifest content analysis. The findings suggest that factors affecting nurse-led mental health service delivery include small workforce and high workload, culture and beliefs, risks, lack of safety measures and required resources, outdated policies, poor salaries, lack of funds for medication, distance, power, influence, and stigma. Factors that could facilitate nurse-led mental health services include: increasing motivation, increasing the workforce, knowledge sharing, mentorship, availability of medication, passion and modern psychiatry. The findings contribute towards understanding the challenges and opportunities faced by the recently established nurse-led decentralised mental health services across Sierra Leone, in order to address the large mental health treatment gap. We hope the findings will inform further policy and planning to improve the quality of decentralised mental healthcare.
... Despite the need to address clergy mental distress, less is known about whether clergy, helpers themselves, seek help to address their mental health problems and from whom they receive help. Research has shown stigma toward mental illness being associated with lower mental health treatment seeking behavior and poorer health outcomes (Shrivastava et al., 2012). Clergy may fear being stigmatized for engaging in mental health therapy, possibly because seeking mental health support may suggest they are unfit to lead their congregation or show a lack of faith (Meek et al., 2003;Proeschold-Bell et al., 2013). ...
Clergy are tasked with multiple interpersonal administrative, organizational, and religious responsibilities, such as preaching, teaching, counseling, administering sacraments, developing lay leader skills, and providing leadership and vision for the congregation and community. The high expectations and demands placed on them put them at an increased risk for mental distress such as depression and anxiety. Little is known about whether and how clergy, helpers themselves, receive care when they experience mental distress. All active United Methodist Church (UMC) clergy in North Carolina were recruited to take a survey in 2019 comprising validated depression and anxiety screeners and questions about mental health service utilization. Bivariate and Poisson regression analyses were conducted on the subset of participants with elevated depressive and anxiety symptoms to determine the extent of mental health service use during four different timeframes and the relationship between service use and sociodemographic variables. A total of 1,489 clergy participated. Of the 222 (15%) who had elevated anxiety or depressive symptoms or both, 49.1% had not ever or recently (in the past two years) seen a mental health professional. Participants were more likely to report using services currently or recently (in the past two years) if they were younger, had depression before age 21, or "very often" felt loved and cared for by their congregation. The rate of mental health service use among UMC clergy is comparable to the national average of service use by US adults with mental distress. However, it is concerning that 49% of clergy with elevated symptoms were not engaged in care. This study points to clergy subgroups to target for an increase in mental health service use. Strategies to support clergy and minimize mental health stigma are needed.
... Thus, exploring the perspectives towards people with schizophrenia among nursing students, as future nurses, will be invaluable in designing anti-stigma interventions for these students and ultimately improving the conditions of people with schizophrenia. Many quantitative studies have investigated nursing students' knowledge of mental illness and/or their stigmatised attitudes and/or intentional behaviours towards people with mental illness [39][40][41][42][43]. Mental illness stigma is influenced by multiple factors [44], especially cultural factors [45]. But little quantitative research considers the cultural factors of stigma. ...
Aim:
This study aims to explore fourth-year nursing students' knowledge of schizophrenia and their attitudes, empathy, and intentional behaviours towards people with schizophrenia.
Design:
This will be a descriptive qualitative study using focus-group interviews.
Methods:
Fourth-year nursing students on clinical placement in a hospital in Hunan province will be invited for focus-group interviews. Snowball and purposive sampling will be used to recruit nursing students for this study. Five focus-group interviews, each including six participants, will be conducted to explore participants' knowledge, attitudes, intentional behaviours, and empathy towards schizophrenia. The interview will be conducted through the online Tencent video conference platform and the interview data will be collected through the same platform. All interviews will be recorded and transcribed verbatim and analysed with the approach of the content analysis supported by NVivo 12. Simultaneous data collection and analysis will be performed, and the interviews will be continued until data saturation is met. The findings of this study will be helpful in developing effective interventions to decrease the stigma toward schizophrenia among nursing students and those who study healthcare disciplines.
... In many cases, offenses are committed by those who have been violated or wronged themselves, whether through past physical or emotional abuse, unjust social institutions, or poor socioeconomic conditions. Agents with mental illness often face stigma, intolerance, and social marginalization (Shrivastava et al., 2012), and it is possible that these factors play more of a role than the mental illness itself in contributing to any criminal activity. Classical retributivism tends to obscure or downplay the historical and contextual features that influence people's behavior and to frame their actions as the freely chosen ends of independent, autonomous agents. ...
This book brings together insights from the enactivist approach in philosophy of mind and existing work on autonomous agency from both philosophy of action and feminist philosophy. It then utilizes this proposed account of autonomous agency to make sense of the impairments in agency that commonly occur in cases of dissociative identity disorder, mood disorders, and psychopathy. While much of the existing philosophical work on autonomy focuses on threats that come from outside the agent, this book addresses how inner conflict, instability of character, or motivational issues can disrupt agency. In the first half of the book, the author conceptualizes what it means to be self-governing and to exercise autonomous agency. In the second half, she investigates the extent to which agents with various forms of mental disorder are capable of exercising autonomy. In her view, many forms of mental disorder involve disruptions to self-governance, so that agents lack sufficient control over their intentional behavior or are unable to formulate and execute coherent action plans. However, this does not mean that they are utterly incapable of autonomous agency; rather, their ability to exercise this capacity is compromised in important respects. Understanding these agential impairments can help to deepen our understanding of what it means to exercise autonomy, and also devise more effective treatments that restore subjects’ agency. Autonomy, Enactivism, and Mental Disorder will be of interest to researchers and advanced students working in philosophy of mind, philosophy of action, philosophy of psychiatry, and feminist philosophy.
... For example, people with different dialects and ways of speaking, body shape, skin color, and also the level of socioeconomic status can be seen from the ownership of luxury goods that an individual has. The stigma that is given in spaces by the general public is not only a public gesture, but also cognitively, emotionally, and behaviorally (Shrivastava et al. 2012). Therefore, stigma often carries negative and discriminatory elements based on the characteristics of others in the health and mental domains, as well as on gender issues, namely gender, sexuality, race, and culture. ...
Until now, the distribution of Special Schools (SLB) in Indonesia is still considered uneven and does not have adequate quality education or tends to stagnate. This condition is exacerbated by the COVID-19 pandemic, which encourages people with disabilities, especially the Teman Dengar and Teman Tuli communities to conduct online learning activities through video and audio. In line with this, this study seeks to provide steps that can be a solution in creating a friendly environment for people with disabilities, especially for the Teman Dengar and Teman Tuli both in the short and long term through the education sector. In explaining this, this study uses a qualitative method with the Van Kaam data analysis method through the interpretation of primary data from interviews which is expanded through secondary data from literature studies. Based on the data obtained, this study found that the stigma from the community who views the disabled group as a group that has lower quality and does not require higher education is an important factor inhibiting the creation of a friendly environment for disabled groups, especially for the Teman Dengar and Teman Tuli in Indonesia. This study concludes that a friendly environment for persons with disabilities is needed, including in the field of education, such as the use of SIBI and BISINDO in the general education curriculum.
... On the other hand, if stigma is attached to mental health, people will be hesitant to access service for mental health. [12] As a program manager, one needs to have good understanding about various factors that affect access to mental healthcare. Two such factors are poor awareness and stigma. ...
... Int J Ment Health Syst (2021) 15:31 (LMIC), ranging from 76.3 to 85.4%, and research on mental health services in these countries is limited [2,3]. The gap is attributed to human resource constraints, stigma, weak technology and infrastructure, lack of political commitment, culture and traditional beliefs, and lack of research to guide policy formulation and implementation [4]. Task-sharing and health system restructuring have been shown to improve access to healthcare in non-communicable and infectious diseases [5,6]. ...
Background
In sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHU) to every district. This study aims to retrospectively evaluate the uptake of these services by examining the pathways to care, diagnosis, management, and treatment gap, to provide insight into the functioning of these units and the potential burden of mental health disorders in Sierra Leone.
Methods
We evaluated the roll out of MHU using summary data from all units between 1 st January 2015 and 1 st January 2017, to establish the burden of diagnoses among service users, pathways to care, treatments provided, and treatment gaps. Negative binomial regressions examine bivariate relationships between diagnoses, treatments, and medication inaccessibility with demographics (age and sex), location (Freetown vs the rest and Ebola endemic regions vs the rest) and year.
Results
We collected data from 15 MHU covering 13 districts in 24 months. There were 2401 referrals. The largest age category was 25–34 (23.4%). The prominent diagnoses were epilepsy (43.5%, associated with children) and psychosis (17.5%, associated with males). Reported depression (8.6%) and suicide attempts (33 patients) were low. Ebola endemic regions reported higher rates of grief, trauma, and medically unexplained symptoms. In 24.7% of cases where medication was required, it was not accessible.
Conclusions
Nurse-led MHU can have a modest effect on the treatment gap in resource constrained environments such as Sierra Leone, particularly in epilepsy and psychosis.
... On the other hand, if stigma is attached to mental health, people will be hesitant to access service for mental health. [12] As a program manager, one needs to have good understanding about various factors that affect access to mental healthcare. Two such factors are poor awareness and stigma. ...
Background: Mental health‑care settings are not equipped to address holistic care. . Being a program manager, one needs to have good understanding about different barriers of access to mental healthcare services. Poor awareness and stigma attached to mental health are two important barriers of a community-based mental healthcare intervention. There is a dearth of studies that provide information about this. The present study reflects the same. Objective: The objective of this study was to assess people’s knowledge about mental health and perceived stigma and to identify factors that influence them. Methods: The study was conducted under two types of intervention wards – one with urban mental health program (UMHP) and another one with homeless people with mental illness (HPMI). There was a comparison ward with no intervention. Information was collected from 272 respondents through multistage random sampling method from general community. Analysis was done using profile characters of participants as independent variables and knowledge, attitude, and practice (KAP) score and stigma score
as dependent variables. Results: The mean KAP score is 25.5 (range: 13–32). It implies 65.3% cumulative KAP level on mental health. Around 29.9% of people believe that going to a psychiatrist means that a person has mental illness. KAP and stigma scores are influenced by the type of ward but not by any other profile characters. KAP score is higher in UMHP and HPMI wards than the comparison ward. Conclusion: The intervention wards have more KAP score than comparison ward implying the effectiveness of community‑based mental health interventions.
This calls for replication of similar interventions for wider spread of knowledge on mental health among general population.
... The group protocol can be considered feasible because of the good attendance rates and the amount of exercises during the session performed by participants. Although non-adherence (Barkhof et al., 2012) and avoidance of mental health services (Shrivastava et al., 2012) is a prominent problem in populations with severe psychiatric conditions, the current study found good adherence figures that may at least in part be due to the appealing aspects of the aim of the group (i.e. well-being). ...
The process of recovery from mental health can be improved by promoting wellness. Third-generation perspectives promote non-judgmental acceptance of problems as well as the development of a person’s well-being and strengths. The aim of this study is to test the feasibility, acceptability and effectiveness of a group intervention to improve well-being in people with severe psychiatric conditions. Results showed that the protocol was feasible and highly acceptable, showing high attendance and adherence rates as well as high satisfaction. On completion of group therapy, participants reported a significant improvement in self-acceptance and significant decreases in interpersonal sensitivity and depression. The results indicate that positive psychology group therapy may be a powerful complementary strategy among people with severe psychiatric conditions. Though the validity of the study is limited by the lack of comparison group, the present study will allow for the optimisation of trial processes and a future definitive randomised control trial.
Background
Despite initiatives to increase access to mental health care and improve the quality of life for individuals living with mental illness, there is limited information on internalized stigma and its impact on these individuals. This study aimed to determine the prevalence of internalised stigma and identify associated factors (sociodemographic, clinical, and substance use) among people with mental illness attending an outpatient clinic in Ethiopia.
Method
Institution-based cross-sectional study was conducted with patients with mental illness at the University of Gondar Hospital clinic. We recruited 638 participants from the clinic using systematic random sampling with an interval of three applied. Internalised stigma was measured using the nine-item (ISMI-9) Internalised stigma of Mental Illness Scale. Variables were coded and entered into SPSS-28 software for further analysis. To analyze the data, we used descriptive and multivariate logistic regression analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value less than 0.05 were considered significant.
Results
Prevalence of internalised stigma among study participants was 49.1% (95% CI: 45, 52). The following attributes were associated with a greater likelihood of high internalised stigma, participants with no formal education (AOR=2.19, 95% CI:1.33, 3.61); patients with fair self-reported health (AOR=3.12, 95% CI:1.28, 7.59), patients with poor self-reported health (AOR= 9.11, 95% CI: 2.89, 28.73), patients with suicidal ideation (AOR=1.95, 95% CI:1.37, 2.79), alcohol users (AOR= 1.89, 95% CI:1.24,2.91), patient with low self-esteem (AOR=1.55, 95% CI:1.09, 2.21), patient with poor drug adherence (AOR=2.2, 95% CI:1.30,3.71), patients with family history of substance use (AOR= 2.46, 95% CI:1.54,3.93).
Conclusions
The prevalence of high internalised stigma among patients with mental illness in was high. Therefore, anti-stigma activities, early outpatient support, drug adherence information, and reduction of suicidal behaviors are all necessary to reduce stigma in patients with mental illnesses.
Stigma merupakan tanda atau label yang diberikan Masyarakat pada individu tertentu sebagai atribut yang melekat untuk memperburuk citra dan status moral. Stigma untuk Orang dengan gangguan jiwa (ODGJ) diberikan karena ODGJ dianggap individu yang berbeda dan hina (Setiawati, 2012). Stigma yang dirasakan oleh ODGJ berdampak pada kondisi fisik, psikologis dan sosial (Rasmawati, 2018). Angka gangguan jiwa tahun 2018 sebanyak 1.787 jiwa dan hanya sekitar 1.147 jiwa (64,19 %) yang mendapat pelayanan kesehatan. Data gangguan jiwa khusus wilayah kerja Puskesmas Poasia sebanyak 14 jiwa (Profil Dines Kesehatan, 2022). Penelitian ini merupakan penelitian kualitatif dengan pendekatan Interpretative fenomenologis dimana partisipan diberi kesempatan untuk mengeksplorasi informasi terkait stigma terhadap ODGJ. Jumlah partisipan 7 orang yang terdiri dari: 3 orang Kepala Kelurahan, 3 orang warga, dan 1 orang informan kunci yakni programer kesehatan jiwa. Tehnik pengambilan sampel dilakukan secara purposive sampling. Pengumpulan data dilakukan melalui wawancara terstruktur dengan menggunakan pedoman wawancara. Ditemukan 3 informasi penting terkait stigma dalam bentuk stereotip terhadap ODGJ yaitu defenisi ODGJ, penyebab seseorang menderita gangguan jiwa dan keberadaan ODGJ dilingkungan masyarakat. Kesimpulan penelitian adalah pada masyarakat setempat masih melekat adanya pandangan buruk atau stereotip yang dapat dilihat dari bagaimana masyarakat mendefenisikan ODGJ sebagai orang gila, sinting, gila dan miring. Tujuan dari sebutan tersebut untuk mengejek dengan alasan ODGJ berpenampilan acak-acakan dan kotor selain itu ODGJ menunjukkan sikap yang aneh, seperti berbicara sendiri, kadang ketawa tapi tiba-tiba menangis dan juga mengamuk. Implikasi penelitian ini bagi tenaga kesehatan yaitu dapat menjadi acuan untuk menyusun program kesehatan jiwa dalam mengadakan penyuluhan dan edukasi kepada masyarakat tentang kesehatan jiwa dan dampak stigma. Diharapkan penelitian ini juga dapat menjadi bahan kajian khususnya pemerintah kecamatan Poasia dan Kelurahan yang ada dilingkup kecamatan untuk meningkatkan keamanan dan kenyaman masyarakat binaannya melalui sikap caring pada pasien, keluarga dan masyarakat.
Background:
Currently, little is known on how stigma attributed to eating disorders compares to that of other psychological disorders and additionally within eating disorder subtypes. The current study aimed to explore the stigmatisation of eating disorders by comparing the stigma attributed to anorexia nervosa, bulimia nervosa and binge-eating disorder, utilising depression as a comparative control.
Methods:
A total of 235 participants from the general population were randomly assigned to an anorexia nervosa, bulimia nervosa, binge-eating disorder, or depression condition. Participants responded to a questionnaire consisting of several adapted versions of pre-existing subscales that measured levels of stigma associated with psychological disorders generally, as well as stigma associated with eating disorders specifically. Several one-way analyses of variance were conducted to investigate the differences in stigma attributed towards the aforementioned psychological disorders.
Results:
Results suggested that all three eating disorder subtypes were significantly more stigmatised than was depression. Between eating disorder subtypes, the three were generally equivalent except that binge-eating disorder was significantly more stigmatized than both anorexia nervosa and bulimia nervosa on a subscale measuring trivialness.
Conclusions:
These findings indicate that individuals with eating disorders, including binge-eating disorder, may be at a higher risk of experiencing the negative implications of stigma when compared to other psychological disorders, such as depression. To our knowledge, this study is one of few that directly quantify and compare stigma attributed towards anorexia nervosa, bulimia nervosa, and binge-eating disorder. Through further research, a better understanding around the expression of stigma toward specific eating disorder subtypes could inform the development of targeted interventions to help reduce the stigma associated with these disorders. This knowledge could also advance the understanding of the lived experience of individuals living with eating disorders, subsequently informing treatment practices.
People with schizophrenia experienced a higher level of internalized stigma compared to people with other mental disorders. Internalized stigma could lead to pervasive negative effects in their life. Although internalized stigma interventions have shown some benefits, there is a dearth of interventions and meanwhile a lack of evidence as to their effectiveness in people with schizophrenia. This study aims at examining the effectiveness of internalized stigma reduction in people with schizophrenia through a systematic review and meta-analysis. Two electronic databases were searched. Studies were included if they (1) involved community or hospital-based interventions on internalized stigma, (2) included participants who were given a diagnosis of schizophrenia, and (3) were empirical and quantitative in nature. Thirteen articles were selected for extensive review and seven for meta-analysis. A variety of psychosocial interventions were utilized with the majority employing psychoeducation, cognitive behavioral therapy (CBT), social skills training, hope instillation program, and against stigma program. The internalized stigma was used to examine the efficacy of the intervention. Seven studies involving a total of 799 patients were included in the meta-analysis. Assuming a random effects model, the meta-analysis revealed an improvement in internalized stigma favoring the internalized stigma intervention (95% confidence interval [0.492; 1754], P = 0.001), but the heterogeneity among individual effect sizes was substantial ( I ² = 93.20%). Most internalized stigma reduction programs appear to be effective. This systematic review was unable to show light in indicating the most effective intervention, however, demonstrates evidence that psychoeducation is promising. Large-scale randomized control trials and multicomponents of intervention are required to further develop the evidence based of more targeted interventions.
Pharmacological antipsychotic drug interventions represent the cornerstone of the management of patients with schizophrenia and other psychotic spectrum disorders. The choice of the “best” treatment should be made on the basis of several clinical domains. However, despite available treatments, the quality of life reported by patients with schizophrenia taking antipsychotics is still very poor, and this outcome is rarely taken into account in trials assessing the efficacy and effectiveness of antipsychotic treatments. Therefore, we performed a systematic review in order to assess the impact of antipsychotic treatment on patients’ quality of life. In particular, we aimed to identify any differences in the improvement in quality of life according to the (a) type of formulation of antipsychotic drugs (i.e., oral vs. depot vs. long-acting injectable); (b) type of the drug (first vs. second vs. third generation); and (c) patients’ clinical characteristics. One hundred and eleven papers were included in the review. The main findings were as follows: (1) quality of life is usually considered a secondary outcome in trials on the efficacy and effectiveness of drugs; (2) second-generation antipsychotics have a more positive effect on quality of life; and (3) long-acting injectable antipsychotics are associated with a more stable improvement in quality of life and with a good safety and tolerability profile. Our systematic review confirms that quality of life represents a central element for selecting the appropriate treatment for people with schizophrenia. In particular, the availability of new treatments with a better tolerability profile, a proven effectiveness on patients’ cognitive and social functioning, and with a more stable blood concentration might represent the appropriate strategy for improving the quality of life of people with schizophrenia.
Despite the potential and opportunity for nurses in mental health settings to deliver comprehensive care to individuals with severe mental illnesses, existing evidence indicates inadequacy in providing physical health care. To understand this gap, we examined the mental health nurse's attitudes, practices, training needs, and barriers toward physical healthcare of individuals with severe mental illness and explored the associated socio-demographic differences. All mental health nurses working in an apex mental health care center in India were assessed using a self-administered questionnaire, which included a socio-demographic profile and the Physical Health Attitude Scale (PHASe). Overall, the nurses held positive attitudes, with items related to smoking and confidence toward physical health care delivery showing more positive ratings than those items related to attitude and perceived barriers. Lack of motivation from patients and nurse's workload in provision of psychiatric care were perceived as major barriers. Nurses with lesser years of experience had a slightly more positive attitude. The findings have important implications for mental health nursing practice and training toward strengthening holistic nursing care for individuals with severe mental illness, specifically in countries with limited resources.
OBJECTIVE: This study aimed to identify the stigma among medical care providers towards people with Schizophrenia and Obsessive-Compulsive Disorder and the factors associated with increased stigma among them. METHODOLOGY: A cross-sectional study design was used to determine the prevalence of stigma among medical professionals toward patients with Schizophrenia and obsessive-compulsive disorders (OCD). Participants were from one of the best hospitals in Makkah, Saudi Arabia, King Abdullah Medical City (KAMC), in which 283 of their medical care providers were randomly selected using the RAOSOFT calculator technique. All medical care providers at King Abdullah Medical City were included. Medical care providers who refused to participate were excluded. Data entered, cleaned, and analyzed using the Statistical Package for Social Sciences (SPSS) Version 22. RESULTS: The study clarified that medical care providers have less stigmatization towards patients suffering from OCD (53%) than their stigma towards patients with Schizophrenia (54.4%). The study found that (26.4%), and (1.4%) of physicians felt comfortable dealing with OCD and schizophrenic patients, respectively, while (28.2%) and (11.2%) of nurses felt comfortable dealing with OCD and schizophrenic patients, respectively. CONCLUSION: The study concluded that the stigma towards patients with Schizophrenia is higher than it is towards patients with OCD; this stigma is higher among physicians than nursing staff. KEYWORDS: Cross-sectional, Stigma, Schizophrenia, Obsessive-compulsive disorder (OCD), Medical care providers, Medical City.
Objective
This study aimed to investigate stigmatizing attitudes toward depression, schizophrenia, and general anxiety disorder (GAD) among caregivers of patients with mental disorders in China.
Methods
A cross-sectional study was conducted among 607 caregivers in China, using vignettes that described three mental illnesses. Data on the caregivers’ attitudes and other people’s attitudes toward individuals with mental disorders and their willingness to come in contact with people with mental disorders were collected.
Results
In the three vignettes, caregivers agreed that positive outcomes outnumbered negative outcomes. The top two statements endorsing the stigma were “the person could snap out of the problem” and “people with this problem are dangerous.” In the section for perceived stigma, caregivers in the GAD vignette agreed that most people believed this problem is not a real medical illness, compared to schizophrenia. The rates of the statement endorsing unpredictability were significantly different in the schizophrenia (57.2%) and depression (45.5%) vignette, in comparison to the GAD (45.6%) vignette. For personal stigma, the caregivers tended to avoid people described in the depression vignette more often than in the GAD vignette. The caregivers were most unwilling to let the person described in the vignettes marry into their family, especially in the schizophrenia vignette.
Conclusion
Despite the stigma and desire for social distance associated with schizophrenia, depression, and GAD, caregivers often expect positive outcomes. Actions should be taken to improve caregivers’ knowledge about mental health and reduce the stigma.
This study explored perceptions of mental illness and the mentally ill in a South African setting. Informants were a purposive sample of 16 undergraduate students (female = 10, male = 6; age range = 18 to 25 years). Data were collected using semi-structured interviews on their existing understandings of mental illness. Thematic analysis yielded five major themes of mental illness as: (i) strange behaviours; (ii) imbalances in life orientations; (iii) unpredictability and undependability; (iv) biopsychosocial phenomenon; and (v) treatable, not curable. Participants regarded laughing, shouting, or swearing in socially unacceptable contexts as indicating mental unwellness and a danger to self or others. Participants perceived that mental illness is caused by various biopsychosocial systems including damage to the foetus in the mother’s womb, injuries, or accidents causing brain damage. Further participants noted that familial wrongdoing resulting in a curse from the ancestors may also result in mental illness. These beliefs may influence the students’ engagement with the mentally ill in community settings in ways important for recovery intervention design and implementation.
Background
Some have proposed that continuum beliefs of mental illness, which define psychopathology in terms of spectra rather than categories, could help reduce the stigma associated with the mental illness. This review considers the prevalence of continuum beliefs about depression in the general population, their socio-demographic predictors, and the relationship between continuum beliefs and social responses regarding depression.
Aim
To conduct a systematic literature review to synthesise literature on the antecedents, consequences and correlates of continuum beliefs about depression.
Method
The review was conducted in accordance with PRISMA guidelines. A total of eight eligible studies were subjected to quality evaluation and narrative synthesis.
Results
Results revealed that when given the opportunity, most participants endorsed continuum beliefs about depression. Limited research investigated socio-demographic correlates of continuum beliefs, though there was some evidence that prior experience with mental illness predicted greater endorsement of continuum beliefs. Research suggested that continuum beliefs were associated with reduced desire for social distance and increased pro-social behaviour towards people experiencing depression. However, there was insufficient evidence to suggest any effects of continuum beliefs on stereotypes or negative emotional responses.
Limitations
This review synthesises results of only eight studies due to lack of published studies on continuum beliefs of depression. Hence, it prohibits achieving confident conclusions.
Conclusion
This review indicated preliminary correlational links suggesting continuum beliefs hold promise as a tool for stigma reduction.
The emergence of the COVID-19 outbreak has many impacts on people's lives around the world, including social stigma and discrimination against COVID-19 sufferers from the community or people around them. The formation of stigma in society can be influenced by several factors, including knowledge. COVID-19 is a new disease, so public knowledge about COVID-19 is still very minimal. This causes the emergence of fear or concern in the community regarding the disease. This study aims to determine the relationship between the level of knowledge and community stigma against COVID-19 in East Karawang District. The research method is an observational analysis using a cross-sectional design. Data analysis using Chi Square test. The research sample was 150 people in Karawang City, which were taken by purposive sampling. The research data was taken using an instrument in the form of a questionnaire. The results showed that most of the people in East Karawang District had a good level of knowledge (84%) and negative stigma towards COVID-19 sufferers (50.7%). The results of the statistical test showed that there was a significant relationship between the level of knowledge and the stigma of society towards people with COVID-19 in East Karawang District (p<0.05). The high rate of transmission and death caused by COVID-19 can cause fear and anxiety and result in the emergence of a negative stigma against COVID-19 sufferers, even though the level of public knowledge is already good. Abstrak. Wabah COVID-19 memiliki banyak dampak terhadap kehidupan masyarakat di seluruh dunia, diantaranya berupa stigma sosial dan diskriminasi terhadap penderita COVID-19 dari masyarakat atau orang-orang sekitarnya. Terbentuknya stigma dalam masyarakat dapat dipengaruhi oleh beberapa faktor, diantaranya pengetahuan. COVID-19 merupakan penyakit yang baru sehingga pengetahuan masyarakat mengenai COVID-19 masih sangat minimal. Hal tersebut menyebabkan munculnya ketakutan ataupun kekhawatiran di masyarakat terkait penyakit tersebut. Penelitian ini bertujuan untuk mengetahui hubungan antara tingkat pengetahuan dan stigma masyarakat terhadap COVID-19 di Kecamatan Karawang Timur. Penelitian berupa analisis observasional menggunakan desain cross-sectional dengan analisis data menggunakan uji Chi Square. Sampel penelitian sebanyak 150 orang masyarakat di Kota Karawang yang diambil dengan cara purposive sampling. Data penelitian diambil menggunakan instrumen berupa kuisioner. Hasil penelitian menunjukkan bahwa sebagian besar masyarakat di Kecamatan Karawang Timur memiliki tingkat pengetahuan baik (84%) dan stigma negatif terhadap penderita COVID-19 (50,7%). Hasil uji statistik menunjukan terdapatnya hubungan yang signifikan antara tingkat pengetahuan dengan stigma masyarakat terhadap penderita COVID-19 di Kecamatan Karawang Timur (p<0,05). Masih tingginya tingkat penularan dan kematian yang disebabkan COVID-19 dapat menimbulkan rasa takut dan cemas serta mengakibatkan munculnya stigma negatif terhadap penderita COVID-19, meskipun tingkat pengetahuan masyarakat sudah baik.
Mental health problems in Indonesia are still severe, WHO SEARO data for 2017 said that Indonesia is ranked second after India, which is 9. 162. Eight hundred eighty-six patients or around 3.7% of the population. Mismanagement of health where there are still many people with mental disorders who experience mounting actions that require attention and involvement of all parties, including community leaders. The purpose of writing this research is to explore the experience of community leaders in carrying out pasung (physical restraint) on people with mental disorders in Southeast Sulawesi. The method that researchers use is qualitative research with a phenomenological interpretative. Participants, as many as 7 (seven) people and selected with a purposive sampling approach, were then analyzed using Interpretative Phenomenological Analysis (IPA). The results of the study found three themes, namely community and family stigma against ODGJ (people with a mental disorder), reasons for retention actions and challenges of community leaders in the release of pasung. The conclusion is that the process of releasing pasung cannot be separated from the experience of a figure in the community so that by involving them is expected to eliminate the act of retention in the community.
There is a need for community treatment programs for people who are sexually attracted to children, but individuals report difficulty accessing services. Individuals who are sexually attracted to children (n = 293) completed an online anonymous survey that revealed a significant positive association between maladaptive coping and two factors of the treatment motivation measures. The association between maladaptive coping and treatment motivation was attenuated at higher levels of ego dystonic distress/aversion. Results highlight the importance of targeting stigma toward those who are sexually attracted to children to increase treatment seeking behavior.
BACKGROUND In many rural communities, the cause of mental illness is attributed to black magic, spirit possession of past sin and the coastal region of Karnataka is not exempted from it. The natives of this region ascribe the cause of mental illness to the spirit or demigod, and they seek the help of traditional healers such as spirit dancers for the recovery. This help-seeking behaviour of the people results in delay in seeking psychiatry care and affects the recovery of the person with mental health problems. Therefore, this study explores the opinion of clients undergone traditional healing for mental health problems and the results of the study could contribute to planning an appropriate health promotion activity to promote community mental health. METHODS The present study was explorative, undertaken in the Udupi district of Karnataka state, which explores the views of the respondents about the cause of mental health problem and the outcome of traditional healing for their problems. Altogether 200 clients visiting traditional healers for mental health care were interviewed based on the snowball sampling technique and the interview schedule was used as a tool to gather the data. RESULTS Of the 200 respondents interviewed, 27.5 percent were adults (31 to 40 years), while 43.1 percent were unemployed. Black magic was found to be the major cause for mental health problems among 25.5 percent of the respondents; whereas, 26 percent of the respondents felt recovered completely after undergoing traditional healing for mental health problems. CONCLUSIONS The recognition of mental health problems is very much essential for people with mental health problems to seek professional help. This could help mental health professionals to diagnose illness at the very beginning and provide better mental health care. However, the explanatory model of the patients needs to be taken into consideration while providing modern medical care. KEY WORDS Black Magic, Mental Illness, Serpent Worship, Spirt Dancer, Traditional Healers
Investigated the effect of reading a newspaper article reporting a violent crime committed by a mental patient on attitudes toward people with mental illnesses with 120 college students. Ss completed the Community Attitudes Toward Mental Illness Scales. Ss reading the target article without first reading an article with corrective information reported harsher attitudes toward those with mental illness than Ss who either read a prophylactic article prior to reading the target article or who read articles unrelated to mental illness. Findings suggest that negative media reports contribute to negative attitudes toward people with mental illnesses, and that corrective information may be effective in mitigating the effect of these negative reports. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
People with serious illness or disability are often burdened with social stigma that promotes a cycle of poverty via unemployment, inadequate housing and threats to mental health. Stigma may be conceptualized in terms of self-stigma (e.g., shame and lowered self-esteem) or public stigma (e.g., the general public's prejudice towards the stigmatized). This article examines two psychological processes that underlie public stigma: associative processes and rule-based processes. Associative processes are quick and relatively automatic whereas rule-based processes take longer to manifest themselves and involve deliberate thinking. Associative and rule-based thinking require different assessment instruments, follow a different time course and lead to different effects (e.g., stigma-by-association vs attributional processing that results in blame). Of greatest importance is the fact that each process may require a different stigma-prevention strategy.
Millions of chronic mentally sick are living in this country without proper care. Human rights of most of these patients both for treatment and for leading a life of dignity have been seriously abrogated. This oration discusses the extent of the problem & reviews the won\ done in this area in India and abroad. Major emphasis is to develop a programme for destigmatization of mental illness and to develop suitable models of care for chronic mentally sick keeping the realities of Indian situation in mind. The proposed programme emphasises on multi modal care of the mentally sick and involvement of local self government institutions like panchayats & municipal corporations.
Risk assessment is increasingly used to inform decisions regarding the psychiatric treatment of patients with schizophrenia and other serious mental disorders.
To examine the theoretical limits of risk assessment and risk categorization as applied to a range of harms known to be associated with schizophrenia.
Using known rates of suicide, homicide, self-harm, and violence in schizophrenia, a hypothetical tool with an unrealistically high level of accuracy was used to calculate the proportion of true- and false-positive risk categorizations.
Risk categorization incorrectly classified a large proportion of patients as being at high risk of violence toward themselves and others.
Risk assessment and categorization have severe limitations. A large proportion of patients classified as being at high risk will not, in fact, cause or suffer any harm. Unintended consequences of inaccurate risk categorization include unwarranted detention for some patients, failure to treat others, misallocation of scarce health resources, and the stigma arising from patients' being labeled as dangerous.
Background: Although there is evidence of greater stigmatization of schizophrenia in comparison to depression, there has been little investigation of the reasons for this difference.
Aims: To examine the role of beliefs about depression and schizophrenia in mediating the difference in preferred social distance towards individuals with these two disorders.
Methods: In Study I, 200 undergraduates completed questionnaires concerning beliefs about depression or schizophrenia and willingness to interact with an individual who has one of the two disorders. In Study II, 103 members of a community service club completed similar measures.
Results: For both samples, beliefs about likely appropriateness of social behaviour showed evidence of mediating differences in preferred level of social distance. In addition, differences in perceived danger may have been a mediator for the undergraduate sample and perceived prognosis for the service club respondents.
Conclusions: Beliefs about social appropriateness, danger and prognosis, which have implications for likely costs and benefits of interaction, are more likely to mediate differences in social distance towards the disorders than beliefs concerning causation or continuity with normal experience.
Major international studies on course and outcome of schizophrenia suggest a better prognosis in the rural world and in low-income nations. Industrialization is thought to result in increased stigma for mental illness, which in turn is thought to worsen prognosis. The lack of an ethnographically derived and cross-culturally valid measure of stigma has hampered investigation. The present study deploys such a scale and examines stigmatizing attitudes towards the severely mentally ill among rural and urban community dwellers in India.
To test the hypothesis that there are fewer stigmatizing attitudes towards the mentally ill amongst rural compared to urban community dwellers in India.
An ethnographically derived and vignette-based stigmatization scale was administered to a general community sample comprising two rural and one urban site in India. Responses were analyzed using univariate and multivariate statistical methods.
Rural Indians showed significantly higher stigma scores, especially those with a manual occupation. The overall pattern of differences between rural and urban samples suggests that the former deploy a punitive model towards the severely mentally ill, while the urban group expressed a liberal view of severe mental illness. Urban Indians showed a strong link between stigma and not wishing to work with a mentally ill individual, whereas no such link existed for rural Indians.
This is the first study, using an ethnographically derived stigmatization scale, to report increased stigma amongst a rural Indian population. Findings from this study do not fully support the industrialization hypothesis to explain better outcome of severe mental illness in low-income nations. The lack of a link between stigma and work attitudes may partly explain this phenomenon.
There has been a substantial increase in research on mental illness related stigma over the past 10 years, with many measures in use. This study aims to review current practice in the survey measurement of mental illness stigma, prejudice and discrimination experienced by people who have personal experience of mental illness. We will identify measures used, their characteristics and psychometric properties.
A narrative literature review of survey measures of mental illness stigma was conducted. The databases Medline, PsychInfo and the British Nursing Index were searched for the period 1990-2009.
57 studies were included in the review. 14 survey measures of mental illness stigma were identified. Seven of the located measures addressed aspects of perceived stigma, 10 aspects of experienced stigma and 5 aspects of self-stigma. Of the identified studies, 79% used one of the measures of perceived stigma, 46% one of the measures of experienced stigma and 33% one of the measures of self-stigma. All measures presented some information on psychometric properties.
The review was structured by considering perceived, experienced and self stigma as separate but related constructs. It provides a resource to aid researchers in selecting the measure of mental illness stigma which is most appropriate to their purpose.
It is important to understand stigma in India, given its varied culture and mixture of rural and urban populations. Information from western literature cannot be applied without considering the sociocultural differences.
The research aimed to study the subjective experiences of stigma and discrimination undergone by people suffering from schizophrenia in rural and urban environments in India.
Patients were selected from the outpatient services of six adult psychiatric units of the National Institute of Mental Health and Neurosciences (NIMHANS), India, and from the six outreach centers located in rural areas.
Two hundred patients diagnosed with schizophrenia were selected from rural and urban areas. The experiences of stigma and discrimination were assessed using a semi-structured instrument. STATISTICAL TECHNIQUES: Both quantitative and qualitative analyses were done.
Significant differences were seen between rural and urban respondents. Urban respondents felt the need to hide their illness and avoided illness histories in job applications, whereas rural respondents experienced more ridicule, shame, and discrimination. The narratives provide direct views of patients, supporting the key findings.
Mental health programs and policies need to be sensitive to the consumers' needs and to organize services and to effectively decrease stigma and discrimination.
Background: Despite the fact that about 10% of children experience mental health problems, they tend to hold negative views about mental illness. The objective of this study was to investigate the views of Nigerian schoolchildren towards individuals with mental illness or mental health problems.
Methods: A cross-sectional design was used. Junior and senior secondary schoolchildren from rural and urban southwest Nigeria were asked: ‘What sorts of words or phrases might you use to describe someone who experiences mental health problems?’ The responses were tabulated, grouped and interpreted by qualitative thematic analysis.
Results: Of 164 students, 132 (80.5%) responded to the question. Six major themes emerged from the answers. The most popular descriptions were ‘derogatory terms’ (33%). This was followed by ‘abnormal appearance and behaviour’ (29.6%); ‘don’t know’ answers (13.6%); ‘physical illness and disability’ (13.6%); ‘negative emotional states’ (6.8%); and ‘language and communication difficulties’ (3.4%). Conclusion: The results suggest that, similar to findings elsewhere, stigmatization of mental illness is highly prevalent among Nigerian children. This may be underpinned by lack of knowledge regarding mental health problems and/or fuelled by the media. Educational interventions and encouraging contact with mentally ill persons could play a role in reducing stigma among schoolchildren.
In this issue, Woods et al1 report data analyses that support the validity of the criteria for identifying the prodrome stage of psychotic disorders. We have previously placed emphasis on this issue with a special theme.2–8 Questions related to the development of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-V) now emerge. Should clinical practice move in the direction of early detection of risk status? Do research findings warrant interventions at the prodrome stage in general clinical practice? If the answers are yes, then DSM-V and International Classification of Diseases, Twelfth Revision, will be challenged to provide clinicians with a diagnostic category to support this shift in practice. This will be an essential step for providing education, encouraging clinical intervention, and supporting research on these clinical activities. The DSM-V workgroup responsible for psychotic disorders is considering creating a new diagnostic class for this purpose. Although I chair the DSM-V Psychoses Workgroup, this editorial represents personal views, not recommendations, of the Psychosis Workgroup or official decisions of the DSM-V Task Force. These views are informed, however, by discussions with workgroup members (http://www.psych.org/MainMenu/Research/DSMIV/DSMV.aspx), especially Ming Tsuang, and advisors Tom McGlashan and Scott Woods.
Experiencing stigma by patients with mental illness in their day to day lives has substantial importance in treatment, compliance and quality of life. There is dearth of information and researches in experiences/ perceptions and coping of stigma in Nepal.
The objective of this study was to find out experiences/ perceptions and coping of stigma and stigmatizations among patients with mental illness.
This is a retrospective, cross sectional study of patients admitted in psychiatry ward. Patients were assessed using self-report questionnaire which focused on beliefs about discrimination against mental illness, rejection experiences, and ways of coping with stigma. Patient's socio demographic profiles were also assessed.
Fifty three patients completed questionnaire concerning various constructs of stigma. There were 29 male patients and 24 female patients. Majority (N=45; 84.9%) were of Hindu religion but there were mixed numbers regarding caste. Most of the patients were aware of the stigma associated with mental illness. There were experiences of rejection by family members and colleagues (N=23; 43.4%) and health care professional (N=16; 30.2%). There were strong perceptions of stigmatization felt by patients in different social circumstances. Though maintaining secrecy and avoidance/withdrawal of stigma provoking scenario were not experienced much, there was a strong sense of advocacy whenever there was any negative view of mental illness. Some of the questionnaire items in "perception", "rejection" and "coping" showed statistical significance (p=0.001).
People with mental illness experience stigma during their course of illness and treatment and it is an important determinant for the relapse of symptoms and non-compliance to treatment. Despite experiencing stigma, patients were generally treated fairly by other people. Patients develop various mechanisms to cope with stigma, mostly secrecy and avoidance. Advocacy and anti-stigma campaign along with positive attitudes of health professionals play important role in decreasing stigmatizing experiences in patients.
Treatment and prevention studies over the past decade have enrolled patients believed to be at risk for future psychosis. These patients were considered at risk for psychosis by virtue of meeting research criteria derived from retrospective accounts of the psychosis prodrome. This study evaluated the diagnostic validity of the prospective "prodromal risk syndrome" construct. Patients assessed by the Structured Interview for Prodromal Syndromes as meeting criteria of prodromal syndromes (n = 377) from the North American Prodrome Longitudinal Study were compared with normal comparison (NC, n = 196), help-seeking comparison (HSC, n = 198), familial high-risk (FHR, n = 40), and schizotypal personality disorder (SPD, n = 49) groups. Comparisons were made on variables from cross-sectional demographic, symptom, functional, comorbid diagnostic, and family history domains of assessment as well as on follow-up outcome. Prodromal risk syndrome patients as a group were robustly distinguished from NC subjects across all domains and distinguished from HSC subjects and from FHR subjects on most measures in many of these domains. Adolescent and young adult SPD patients, while distinct from prodromal patients on definitional grounds, were similar to prodromals on multiple measures, consistent with SPD in young patients possibly being an independent risk syndrome for psychosis. The strong evidence of diagnostic validity for the prodromal risk syndrome for first psychosis raises the question of its evaluation for inclusion in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).
Employing data from a statewide study of sheltered-care residents and facilities in California, combined with archival data describing the census tracts in which these facilities are located, the authors analyze the impact of community reaction on sheltered-care residents in different types of neighborhoods. Findings suggest that conservative middle-class communities are most likely to exhibit extreme negative reactions that can have a deleterious impact on the social integration of residents in community care. Liberal, nontraditional neighborhoods conform most closely to the ideal accepting community. In liberal, nontraditional neighborhoods and conservative working-class neighborhoods a moderate level of community reaction actually facilitates the social integration of sheltered-care residents.
This study investigated what type of information reduces stigmatization of schizophrenia. Subjects were presented with one
of six varying descriptions of a hypothetical case in which a target individual had recovered from a mental disorder. Subjects
were asked if they knew someone with a mental illness. Those individuals who had no previous contact perceived the mentally
ill as dangerous and chose to maintain a greater social distance from them. In general, knowledge of the symptoms associated
with the acute phase of schizophrenia created more stigma than the label of schizophrenia alone. In contrast, more information
about the target individuals post-treatment living arrangements (i.e., supervised care) reduced negative judgments. Implications
for public education and future research are discussed.
The relationships of stigma to both depression and somatization were studied in psychiatric patients in South India to test the hypothesis that stigma is positively related to depressive symptoms and negatively related to somatoform symptoms.
Illness experience, symptom prominence, and indicators of stigma for 80 psychiatric outpatients were addressed with the Explanatory Model Interview Catalogue. Stigma scores and ratings of symptom prominence were derived. The Structured Clinical Interview for DSM-III-R and the Hamilton Depression Rating Scale were administered to assess psychiatric diagnoses and symptoms of depression. Clinical narratives were analyzed to clarify the nature of relationships between stigma and symptom prominence.
The mean stigma scores were 18.2 (SD = 13.0) for patients with somatoform disorders only, 36.0 (SD = 19.0) for patients with depressive disorders only, and 26.8 (SD = 16.0) for those with mixed depressive and somatoform disorders. The stigma scores were positively related to depressive symptoms, as indicated by Hamilton scale scores and prominence ratings for depressive symptoms, but stigma was inversely related to somatoform symptoms, as indicated by ratings of symptom prominence. Although both depressive and somatic symptoms were distressing, qualitative analysis clarified meanings of perceived stigma, showing that depressive symptoms, unlike somatic symptoms, were construed as socially disadvantageous.
The tendency to perceive and report distress in psychological or somatic terms is influenced by various social and cultural factors, including the degree of stigma associated with particular symptoms. This study with the Explanatory Model Interview Catalogue demonstrates how quantitative and qualitative methods can be effectively combined to examine key issues in cultural psychiatry.
The extent to which mental health consumers encounter stigma in their daily lives is a matter of substantial importance for their recovery and quality of life. This article summarizes the results of a nationwide survey of 1,301 mental health consumers concerning their experience of stigma and discrimination. Survey results and followup interviews with 100 respondents revealed experience of stigma from a variety of sources, including communities, families, churches, coworkers, and mental health caregivers. The majority of respondents tended to try to conceal their disorders and worried a great deal that others would find out about their psychiatric status and treat them unfavorably. They reported discouragement, hurt, anger, and lowered self-esteem as results of their experiences, and they urged public education as a means for reducing stigma. Some reported that involvement in advocacy and speaking out when stigma and discrimination were encountered helped them to cope with stigma. Limitations to generalization of results include the self-selection, relatively high functioning of participants, and respondent connections to a specific advocacy organization-the National Alliance for the Mentally Ill.
Programmes to destigmatise 'mental illness' have traditionally been based on the 'mental illness is an illness like any other' metaphor and have been largely unsuccessful. By measuring attitudes towards, and etiology beliefs about, 'mental illness' before and after a series of four undergraduate lectures presenting the psychosocial causes of, and solutions to, severe mental health problems, this study (a) replicated previous studies demonstrating a relationship between biogenetic causal beliefs and negative attitudes towards 'mental patients'; (b) found that following the lectures attitudes improved, particularly around the key variables of dangerousness and unpredictability; and (c) demonstrated that amount of contact with people who had received psychiatric treatment was an even stronger predictor of positive attitudes than acceptance of a psychosocial perspective.
Stigma is a social devaluation of a person because of personal attribute leading to an experience of sense of shame, disgrace and social isolation. The nature of stigma in schizophrenia and its relationship to attribution was studied in one hundred and fifty-nine urban patients of Madras, India who fulfilled DSM-IV criteria for schizophrenia. The response of the primary care givers to fourteen questions on stigma and 14 on what they thought attributed to the illness was elicited. Based on the mean stigma score, the entire sample was divided into two groups- those with high and low stigma. Marriage, fear of rejection by neighbour, and the need to hide the fact from others were some of the more stigmatising aspects. Many care givers reported feelings of depression and sorrow. Discriminant function analysis showed that female sex of the patient and a younger age of both patient and caregiver were related to higher stigma. Among attribution items, having no explanation to offer, and attributions to faulty biological functioning, character of life style, substance abuse and intimate interpersonal relationship discriminated between the two groups. The relevance of stigma in the cultural context is described.
The authors' goal was to examine the extent to which perceived stigma affected treatment discontinuation in young and older adults with major depression.
A two-stage sampling design identified 92 new admissions of outpatients with major depression. Perceived stigma was assessed at admission. Discontinuation of treatment was recorded at 3-month follow-up.
Although younger patients reported perceiving more stigma than older patients, stigma predicted treatment discontinuation only among the older patients.
Patients' perceptions of stigma at the start of treatment influence their subsequent treatment behavior. Stigma is an appropriate target for intervention aimed at improving treatment adherence and outcomes.
Major depression is undertreated despite the availability of effective treatments. Psychological barriers to treatment, such as perceived stigma and minimization of the need for care, may be important obstacles to adherence to the pharmacologic treatment of major depression. The authors examined the impact of barriers that were present at the initiation of antidepressant drug therapy on medication adherence in a mixed-age sample of outpatients with major depression.
A two-stage sampling design was used to identify adults with a diagnosis of major depressive disorder, as determined by the Structured Clinical Interview for Diagnosis, who sought mental health treatment at outpatient clinics. Additional instruments were administered to 134 newly admitted adults who had been taking a prescribed antidepressant medication for at least a week to assess perceived stigma, self-rated severity of illness, and views about treatment. The patients were reinterviewed three months later and were classified as adherent or nonadherent on the basis of self-reported estimates of the number and frequency of missed doses.
Medication adherence was associated with lower perceived stigma, higher self-rated severity of illness, age over 60 years, and absence of personality pathology. No other characteristics of treatment or illness were significantly related to medication adherence.
Perceived stigma associated with mental illness and individuals' views about the illness play an important role in adherence to treatment for depression. Clinicians' attention to psychological barriers early in treatment may improve medication adherence and ultimately affect the course of illness.
Objective: Psychosocial treatment compliance is essential for effective treatment outcomes. A psychometrically valid compliance scale is required for identifying possible obstacles causing treatment non-compliance and testing the effectiveness of compliance therapy. This study developed a scale to measure psychosocial treatment compliance of people with psychotic disorders and established its psychometric properties.
Method: An initial item pool was generated by literature review and contacts with psychiatric professionals. The content validity and cultural relevancy of this scale were examined by experienced researchers, mental health professionals and mental health consumers which resulted in the 17-item Psychosocial Treatment Compliance Scale (PTCS). Some 108 adults with a DSM-IV diagnosis of psychosis verified by certified psychiatrists were recruited from mental hospitals and social service settings in Hong Kong. Self-stigma, self-esteem, self-efficacy, insight and attitudes to medication of the participants were measured by relevant assessment instruments through interviews. Case therapists then filled in the PTCS and recorded their demographic data. SPSS version 11.0 was used for data analysis.
Results: Exploratory factor analysis revealed a two-factor solution (participation and attendance) accounting for 70.74% of the variance. Test–retest reliability and internal consistency were 0.90 and 0.96, respectively, for ‘participation’; and 0.86 and 0.87, respectively, for ‘attendance’. Its convergent validity was supported by the correlational relationships with measures on self-stigma, self-esteem, self-efficacy, insight and attitudes to medication.
Conclusion: PTCS is a reliable and valid scale which may be used to measure the compliance to psychosocial treatment of people with psychotic disorders.
Introduction:The stigma of mental illness is not a modern phenomenon, but it can now be approached scientifically. The stigma, because of the mental illness which characterizes a person, can be explained by the natural propensity of man to deliver biased and stereotyped estimates to phenomena he cannot explain, accept or face. Methodology:This study is an attempt to describe the concept of stigma and the impact of the stigma of mental illness in the personal and social life of the individual. The search for sources of this review was made through books on the topic and articles of the last twenty years, from online internet sources (pubmed, scopus, google scholar). Literature Review:Stigma brought about by illness from mental illness, is a complex process and concept, located in social interaction and the dynamics of social relations. The social stigma borne by mental illness in general, as well as the lack of information, ignorance, stereotypes, myths and prejudices, are the main reasons that characterize, even today, depression as a taboo subject. The stigma of mental illness is indeliblyimprinted in the identity of human suffering. In any case, the impact of stigma is critical for people who are sick. The psychological stress and difficult conditions that shape their daily lives aggravate their already compromised mental health, having a significant impact on the course and outcome of the disease itself. Key strategies to address stigma are protest, education and contact. Conclusions:A significant step in combating the stigma is to raise public awareness on the issues of mental health and their inclusion in society.
Our paper couples previous research on attitudes toward people with mental illness and more general sociological research on attitudes toward "out-groups " to examine the role of five factors that influence the public's willingness to interact with people with mental health problems, including: the nature of the behavior described, causal attributions of the behavior's source, perceived dangerousness of the person, the label of "mental illness," and the sociodemographic characteristics of respondents. Using vignette data from the 1996 General Social Survey (N = 1,444), we find that respondents discriminate among different types of mental health problems by expressing more desire to avoid those with drug and alcohol problems than with those with mental illness. Consistent with research on racial attitudes, we also find that Americans who attribute mental health problems to structural causes (e.g., stress or genetic/biological causes) are more willing to interact with the vignette person than those who see individual causes (e.g., "bad character" or the "way the person was raised") as the root of the problem. However, even controlling for these factors, respondents who label the vignette a "mental illness " also express a preference for greater social distance. Finally, while the sociodemographic characteristics of the respondent appear to play a minimal role in preferences for social distance, the degree of dangerousness that the public ascribes to people with mental health problems is important and appears to mediate the influence of effects of labeling a person as mentally ill.
This paper hypothesizes that official labeling gives personal relevance to an individual's beliefs about how others respond to mental patients. According to this view, people develop conceptions of what others think of mental patients long before they become patients. These conceptions include the belief that others devalue and discriminate against mental patients. When people enter psychiatric treatment and are labeled, these beliefs become personally applicable and lead to self-devaluation and/or the fear of rejection by others. Such reactions may have negative effects on both psychological and social functioning. This hypothesis was tested by comparing samples of community residents and psychiatric patients from the Washington Heights section of New York city. Five groups were formed (1) first-treatment contact patients, (2) repeat-treatment contact patients, (3) formerly treated community residents, (4) untreated community cases, and (5) community residents with no evidence of severe psychopathology. These groups were administered a scale that measured beliefs that mental patients would be devalued and discriminated against by most people. Scores on this scale were associated with demoralization, income loss, and unemployment in labeled groups but not in unlabeled groups. The results suggest that labeling may produce negative outcomes like those specified by the classic concept of secondary deviance.
A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries. Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education. A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels. Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders. The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers and donors. Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing the risk of mental disorders. Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment.
This study experimentally explored hiring recommendations involving disabled job applicants. One hundred eight supervisors and mid-level managers reviewed the cover letter and resume of an applicant and the job description for a simulated position. The applicant's type of disability and cause of disability were systematically manipulated in the resume and cover letter. The results demonstrated that subjects made different recommendations for hiring the applicant as a function of the type as well as the cause of the disability. Implications for employers' bias are discussed and suggestions for future research are presented.
Patients with cranial and cervical dystonia (CCD) suffer from visible involuntary facial, head, and neck movements. Therefore, the social appearance of patients with CCD may be seriously affected and self-perceived stigma can be a major source of disability. The present study investigated enacted social stigmatization of patients with CCD. In a pilot study, a semantic differential scale for assessment of stigma was constructed and validated. The final scale contained eight items representing personality traits to be rated on a seven-point scale (−3 negative extreme to 3 positive extreme). Short video sequences (15 seconds) of patients with various types of CCD and age- and sex-matched healthy controls were presented to a sample of 80 biology students (mean age, 19.8 ± 2.3 years). Immediately after presentation of each video sequence, the students were asked to perform stigma ratings. Significant differences between CCD patients and controls were found on all eight items (P < 0.001 for each). CCD patients were rated as less accountable for their actions, less likeable, less trustworthy, less attractive, less self-confident, more odd and different, more reserved, and more piteous than controls. CCD patients are subject to serious prejudice and enacted stigmatization. There is a need for informing the public about the nature and symptoms of this disorder and a need to support patients to cope with stigmatization. © 2006 Movement Disorder Society
Considerable research has documented the stigmatization of people with mental illnesses and its negative consequences. Recently
it has been shown that stigma may also seriously affect families of psychiatric patients, but little empirical research has
addressed this problem. We examine perceptions of and reactions to stigma among 156 parents and. spouses of a population-based
sample of first-admission psychiatric patients. While most family members did not perceive themselves as being avoided by
others because of their relative's hospitalization, half reported concealing the hospitalization at least to some degree.
Both the characteristics of the mental illness (the stigmatizing mark) and the social characteristics of the family were significantly
related to levels of family stigma. Family mem bers were more likely to conceal the mental illness if they did not live with
their ill relative, if the relative was female, and if the relative had less severe positive symptoms. Family members with
more education and whose relative had experienced an episode of illness within the past 6 months reported greater avoidance
by others.
Nonadherence with medication treatment is common but difficult to detect in patients with schizoaffective disorder and schizophrenia, almost half of whom take less than 70% of prescribed doses. Like patients in all areas of medicine, patients with schizoaffective disorder weigh the perceived benefits of medications against perceived disadvantages, but this process is complicated by their impaired insight, the stigma of the diagnosis, and the often troubling side effects of antipsychotic medication. Interventions to improve adherence include encouraging acceptance of the illness, drawing analogies with treatment for chronic medical disease, and involving the patient in decision making. Clinicians must remain nonjudgmental, encouraging patients to disclose problems with adherence and anticipating that improvement in adherence may require a prolonged effort. Selection of antipsychotic medication is critical to avoid adverse side effects, and some medications may provide a sense of well-being, such as improvement in insomnia, anxiety, or depression. Depot (rather than oral) antipsychotics can improve adherence and provide the clinician with reliable information about the dosage of medication received, which can be used for purposes of dose adjustments or to guide response to relapse.
In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force's findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.
A longer duration of untreated psychosis (DUP) is associated with greater morbidity in the early course of schizophrenia. This formative, hypothesis-generating study explored the effects of stigma, as perceived by family members, on DUP.
Qualitative interviews were conducted with 12 African American family members directly involved in treatment initiation for a relative with first-episode psychosis. Data analysis relied on a grounded theory approach. A testable model informed by constructs of Link's modified labelling theory was developed.
Four main themes were identified, including: (i) society's beliefs about mental illnesses; (ii) families' beliefs about mental illnesses; (iii) fear of the label of a mental illness; and (iv) a raised threshold for the initiation of treatment. A grounded theory model was developed as a schematic representation of the themes and subthemes uncovered in the family members' narratives.
The findings suggest that due to fear of the official label of a mental illness, certain coping mechanisms may be adopted by families, which may result in a raised threshold for treatment initiation, and ultimately treatment delay. If the relationships within the grounded theory model are confirmed by further qualitative and quantitative research, public educational programs could be developed with the aim of reducing this threshold, ultimately decreasing DUP.
Schizophrenia is regarded as one of the most stigmatized mental illnesses. Relatively few studies have investigated actual stigma experiences among people with schizophrenia and the factors which may contribute to it.
This cross-sectional study assesses the extent of stigma experienced by patients with schizophrenia and attempts to establish its clinical and sociodemographic predictors.
A total of 153 subjects with schizophrenia (62 outpatients and 91 inpatients) were evaluated with the use of the Stigma section of the Consumer Experiences of Stigma Questionnaire (CESQ) and several instruments measuring their subjective quality of life, social functioning and severity of psychiatric symptoms.
Stigmatization experiences were common among respondents who most frequently reported having concealed their illness (86%), witnessed others saying offensive things about the mentally ill (69%), worried about being viewed unfavorably (63%) and been treated as less competent (59%). Higher levels of stigma were related to lower subjective quality of life and younger age of illness onset. No significant associations were found between stigma and symptoms or level of social functioning.
Our findings point at the reduced life satisfaction as a key aspect of the subjective experience of the stigma of schizophrenia.
Good insight into illness in patients with schizophrenia is related not only to medication compliance and high service engagement, but also to depression, low self-esteem, and low quality of life. The detrimental effects of insight pose a problem for treatment.
To investigate whether the negative associations of good insight are moderated by perceived stigma.
Respondents were 114 patients with schizophrenia spectrum disorders. We used Analyses of Variance (ANOVA) and Structural Equation Modeling (SEM) to test moderation.
Good insight was associated with high service engagement and high compliance. Also, good insight was associated with depressed mood, low quality of life, and negative self-esteem. This association was strong when stigma was high and weak when stigma was low. SEM showed that the constrained model performed significantly worse than the unconstrained model, in which detrimental associations of insight were free to vary across stigma groups (chi(2)=19.082; df=3; p<.001).
Our results suggest that the associations of insight with depression, low quality of life, and negative self-esteem are moderated by stigma. Patients with good insight who do not perceive much stigmatization seem to be best off across various outcome parameters. Those with poor insight have problems with service engagement and medication compliance. Patients with good insight accompanied by stigmatizing beliefs have the highest risk of experiencing low quality of life, negative self-esteem, and depressed mood. A clinical implication is that when it is attempted to increase insight, perceived stigma should also be addressed.
The problems of the haves differ substantially from those of the have-nots. Individuals in developing societies have to fight mainly against infectious and communicable diseases, while in the developed world the battles are mainly against lifestyle diseases. Yet, at a very fundamental level, the problems are the same-the fight is against distress, disability, and premature death; against human exploitation and for human development and self-actualisation; against the callousness to critical concerns in regimes and scientific power centres.
While there has been great progress in the treatment of individual diseases, human pathology continues to increase. Sicknesses are not decreasing in number, they are only changing in type.
The primary diseases of poverty like TB, malaria, and HIV/AIDS-and the often co-morbid and ubiquitous malnutrition-take their toll on helpless populations in developing countries. Poverty is not just income deprivation but capability deprivation and optimism deprivation as well.
While life expectancy may have increased in the haves, and infant and maternal mortality reduced, these gains have not necessarily ensured that well-being results. There are ever-multiplying numbers of individuals whose well-being is compromised due to lifestyle diseases. These diseases are the result of faulty lifestyles and the consequent crippling stress. But it serves no one's purpose to understand them as such. So, the prescription pad continues to prevail over lifestyle-change counselling or research.
The struggle to achieve well-being and positive health, to ensure longevity, to combat lifestyle stress and professional burnout, and to reduce psychosomatic ailments continues unabated, with hardly an end in sight.
We thus realise that morbidity, disability, and death assail all three societies: the ones with infectious diseases, the ones with diseases of poverty, and the ones with lifestyle diseases. If it is bacteria in their various forms that are the culprit in infectious diseases, it is poverty/deprivation in its various manifestations that is the culprit in poverty-related diseases, and it is lifestyle stress in its various avatars that is the culprit in lifestyle diseases. It is as though poverty and lifestyle stress have become the modern “bacteria” of developing and developed societies, respectively.
For those societies afflicted with diseases of poverty, of course, the prime concern is to escape from the deadly grip of poverty-disease-deprivation-helplessness; but, while so doing, they must be careful not to land in the lap of lifestyle diseases. For the haves, the need is to seek well-being, positive health, and inner rootedness; to ask science not only to give them new pills for new ills, but to define and study how negative emotions hamper health and how positive ones promote it; to find out what is inner peace, what is the connection between spirituality and health, what is well-being, what is self-actualisation, what prevents disease, what leads to longevity, how simplicity impacts health, what attitudes help cope with chronic sicknesses, how sicknesses can be reversed (not just treated), etc. Studies on well-being, longevity, and simplicity need the concerted attention of researchers.
The task ahead is cut out for each one of us: physician, patient, caregiver, biomedical researcher, writer/journalist, science administrator, policy maker, ethicist, man of religion, practitioner of alternate/complementary medicine, citizen of a world community, etc. Each one must do his or her bit to ensure freedom from disease and achieve well-being.
Those in the developed world have the means to make life meaningful but, often, have lost the meaning of life itself; those in the developing world are fighting for survival but, often, have recipes to make life meaningful. This is especially true of a society like India, which is rapidly emerging from its underdeveloped status. It is an ancient civilization, with a philosophical outlook based on a robust mix of the temporal and the spiritual, with vibrant indigenous biomedical and related disciplines, for example, Ayurveda, Yoga, etc. It also has a burgeoning corpus of modern biomedical knowledge in active conversation with the rest of the world. It should be especially careful that, while it does not negate the fruits of economic development and scientific/biomedical advance that seem to beckon it in this century, it does not also forget the values that have added meaning and purpose to life; values that the ancients bequeathed it, drawn from their experiential knowledge down the centuries.
The means that the developed have could combine with the recipes to make them meaningful that the developing have. That is the challenge ahead for mankind as it gropes its way out of poverty, disease, despair, alienation, anomie, and the ubiquitous all-devouring lifestyle stresses, and takes halting steps towards well-being and the glory of human development.
Poor adherence to medications is common in individuals with schizophrenia, and can lead to relapse and re-hospitalization. This paper presents the findings of an Australian study of the factors affecting antipsychotic medication taking in individuals with schizophrenia. The Factors Influencing Neuroleptic Medication Taking Scale was used with a non-probability sample of mental health service users. Ethics approval was obtained from a university and a hospital ethics committee. Data were analysed using spss version 15. Most participants had insight into their illness and were aware of the stigma of mental illness. Around 70% experienced annoying side effects, while nearly half admitted alcohol consumption. About one-fifth admitted they had missed taking medications during the previous week. Significant others played a variable role in medication taking. Over 80% were satisfied with their relationships with health professionals, but were less satisfied with access to these professionals, especially psychiatrists. Logistic regression analysis showed that age, impact of medication side effects, and access to psychiatrists were independent predictors of medication omission. It is argued that medication taking is a complex issue, which needs to be taken into consideration in health professional training and measures to promote adherence.
Mentally ill persons who have been charged with crimes present difficult dilemmas for correctional authorities and mental health system administrators. The authors examine the scope of the problem, the legal issues and treatment needs of this population during incarceration, and the obstacles in caring for them after their eventual release from prison. They recommend that mentally ill offenders be afforded the same level of mental health care available to mentally ill residents in other institutions and in the community. The need for postrelease supervision and coordination between mental health and correctional authorities are central issues in reintegrating mentally ill offenders into the community.
Whereas past researchers have treated targets of stereotypes as though they have uniform reactions to their stereotyped status (e.g., J. Crocker & B. Major, 1989; C. M. Steele & J. Aronson, 1995), it is proposed here that targets differ in the extent to which they expect to be stereotyped by others (i.e., stigma consciousness). Six studies, 5 of which validate the stigma-consciousness questionnaire (SCQ), are presented. The results suggest that the SCQ is a reliable and valid instrument for detecting differences in stigma consciousness. In addition, scores on the SCQ predict perceptions of discrimination and the ability to generate convincing examples of such discrimination. The final study highlights a behavioral consequence of stigma consciousness: the tendency for people high in stigma consciousness to forgo opportunities to invalidate stereotypes about their group. The relation of stigma consciousness to past research on targets of stereotypes is considered as is the issue of how stigma consciousness may encourage continued stereotyping.
Previous work has suggested that delusions are associated with a higher risk of violence, particularly delusions in which patients believe that people are seeking to harm them or that outside forces are controlling their minds (denoted as "threat/control override" delusions). This study explores the relationship between delusions and violence among patients recently discharged from acute psychiatric hospitalization.
Data were drawn from the MacArthur Violence Risk Assessment Study, a study of violence in the community that followed 1,136 recently discharged psychiatric patients for 1 year. Interviews at discharge and at five 10-week intervals gathered clinical, historical, situational, and dispositional information, including the presence and nature of delusional thoughts. Violence was ascertained from reports of subjects, collateral informants, and official records.
Neither delusions in general nor threat/control override delusions in particular were associated with a higher risk of violent behavior. Comparisons with prior studies suggest that reliance on subject self-reports of delusional symptoms may result in mislabeling as delusions other phenomena that can contribute to violence.
Although delusions can precipitate violence in individual cases, these data suggest that they do not increase the overall risk of violence in persons with mental illness in the year after discharge from hospitalization.
The purpose of this study was to use a very simple self-report measure to identify patients who did not believe they were mentally ill and describe their characteristics. The study included 177 inpatients and outpatients with schizophrenia. Multivariate regression methods analyzed the relationship between illness belief and sociodemographic, clinical, and attitudinal factors. Thirty-seven percent of subjects did not believe they were mentally ill. Younger age, fewer depressive symptoms, lower perceived medication efficacy, greater satisfaction with current mental health, and less concern about mental illness stigma were associated with not believing one was mentally ill. Outpatients with fewer hospitalizations were less likely to believe they were ill. Inpatients with more hospitalizations were less likely to believe they were ill and had poor medication adherence. Readily identifying patients who do not believe they are mentally ill may be useful to clinicians and policymakers when matching at-risk patients with adherence interventions.
We surveyed public attitudes toward people with schizophrenia as part of a pilot project for the World Psychiatric Association's Global Campaign to Fight Stigma and Discrimination Because of Schizophrenia.
We conducted random-digit telephone surveys with 1653 respondents (aged 15 years or over) residing in 2 adjacent rural and urban health regions (71.9% response rate). A brief interview collected information on experiences with people with a mental illness or schizophrenia, knowledge of causes and treatments for schizophrenia, and levels of social distance felt toward people with schizophrenia.
One-half of the sample had known someone treated for schizophrenia or another mental illness. Of those able to identify a cause of schizophrenia (two-thirds), most identified a biological cause, usually a brain disease. Social distance increased with the level of intimacy required. One in 5 respondents thought they would be unable to maintain a friendship with, one-half would be unable to room with, and three-quarters would be unable to marry, someone with schizophrenia. Those over 60 were least knowledgeable or enlightened and the most socially distancing. Greater knowledge was associated with less-distancing attitudes. When other factors were controlled, exposure to the mentally ill was not correlated with knowledge or attitudes, even among those who had worked in agencies providing services to the mentally ill.
Most respondents were relatively well informed and progressive in their reported understanding of schizophrenia and its treatment. Clear subgroup differences were apparent with respect to age and knowledge. Knowledge of schizophrenia, not exposure to the mentally ill, was a central modifiable correlate of stigma.