Awareness of Stigma Among Persons With Schizophrenia

Departments of Anthropology and Psychiatry, University of California, San Diego, 9500 Gilman Ave., La Jolla, CA 92093, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 08/2009; 197(7):520-9. DOI: 10.1097/NMD.0b013e3181aad5e9
Source: PubMed


This article investigates the subjective experience of stigma attached to schizophrenia-related disorders. We examine data from anthropological interviews from a community sample of 90 out-patients residing in a metropolitan area of the United States. Patients were under treatment with atypical antipsychotic medication, and their symptoms were for the most part relatively well controlled. Overall, 96% of participants reported an awareness of stigma that permeated their daily life. Based on an understanding of stigma as a product of interpersonal, reciprocal social processes, we identify 6 types of social relations and 5 identity domains in which social stigma is routinely encountered by participants. We describe the experience of stigma in each of these 11 subcategories, and suggest that taken together they constitute a framework of social and personal factors involved in the struggle to recover from psychotic illness. Among types of social relations, anonymous social interactions most commonly generated an awareness of stigma. Among identity domains, being a person who regularly takes medication was most commonly associated with an awareness of stigma. The finding that multiple forms of stigma are encountered irrespective of substantial symptomatic, functional, and subjectively perceived improvement creates a complex situation of stigma despite recovery.

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Available from: Janis H. Jenkins, Jul 28, 2015
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    • "Many researchers contend that stigma might be a potentially important factor contributing to non-adherence to antipsychotics (Lacro et al., 2002; Sajatovic and Jenkins, 2007; Velligan et al., 2009). Non-adherence leads to increased hospitalization, higher health care costs and is a predictor of poor outcome related to relapse rates (Haddad et al., 2014), progressive brain damage (van Haren et al., 2007), suicide (Velligan et al., 2009) and overall mortality (Tiihonen et al., 2011). "
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    ABSTRACT: The aims of this naturalistic non-interventional study were to quantify the level of stigma and discrimination in persons with schizophrenia and to test for potential associations between different types of stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS(®)) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS(®) adherence≤0.80) was observed in 30 (27.3%). When DISC subscale scores (SD) were entered in separate regression models, neither experienced nor anticipated stigma was associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by a healthcare system or cultural and sociodemographic contexts. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Oct 2014 · Psychiatry Research
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    • "Of the four factors we derived, three identify sources of stigma, while self-stigma, one of the most commonly found in other instruments to measure stigma [12,21], is the internalization of the public stigma; it is the experience of the self [17]. Our qualitative work however, showed that the other three areas of stigma were of much greater concern to patients and carers and thus this section of the scale is brief. "
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    ABSTRACT: Background People with schizophrenia face prejudice and discrimination from a number of sources including professionals and families. The degree of stigma perceived and experienced varies across cultures and communities. We aimed to develop a cross-cultural measure of the stigma perceived by people with schizophrenia. Method Items for the scale were developed from qualitative group interviews with people with schizophrenia in six countries. The scale was then applied in face-to-face interviews with 164 participants, 103 of which were repeated after 30 days. Principal Axis Factoring and Promax rotation evaluated the structure of the scale; Horn’s parallel combined with bootstrapping determined the number of factors; and intra-class correlation assessed test-retest reliability. Results The final scale has 31 items and four factors: informal social networks, socio-institutional, health professionals and self-stigma. Cronbach’s alpha was 0.84 for the Factor 1; 0.81 for Factor 2; 0.74 for Factor 3, and 0.75 for Factor 4. Correlation matrix among factors revealed that most were in the moderate range [0.31-0.49], with the strongest occurring between perception of stigma in the informal network and self-stigma and there was also a weaker correlation between stigma from health professionals and self-stigma. Test-retest reliability was highest for informal networks [ICC 0.76 [0.67 -0.83]] and self-stigma [ICC 0.74 [0.64-0.81]]. There were no significant differences in the scoring due to sex or age. Service users in Argentina had the highest scores in almost all dimensions. Conclusions The MARISTAN stigma scale is a reliable measure of the stigma of schizophrenia and related psychoses across several cultures. A confirmatory factor analysis is needed to assess the stability of its factor structure.
    Full-text · Article · Jun 2014 · BMC Psychiatry

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