Living with schizophrenia in India: Gender perspectives

Epidemiology and Prevention Research Group-EPRG, Department of Psychiatry, Washington University School of Medicine, 40 N Kingshighway, Suite 4, St. Louis, MO 63108, USA.
Transcultural Psychiatry (Impact Factor: 0.99). 11/2011; 48(5):569-84. DOI: 10.1177/1363461511418872
Source: PubMed


This study explores gender issues from a sociocultural perspective related to stigma among people suffering from schizophrenia in India. Stigma experiences were assessed by conducting semistructured interviews with 200 patients attending urban or rural psychiatry clinics. The resulting narratives were examined by thematic content analysis. Men with schizophrenia reported being unmarried, hid their illness in job applications and from others, and experienced ridicule and shame. They reported that their experience of stigma was most acute at their places of employment. Women reported experiences of stigma in relation to marriage, pregnancy, and childbirth. Both men and women revealed specific cultural myths about their illnesses and described how these had negatively affected their lives. Information gathered from this study can be useful to understand the needs of individuals who suffer from schizophrenia to improve the quality of their treatment, and plan culturally appropriate interventions to counter stigma and discrimination.

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Available from: Santosh Loganathan, Sep 24, 2014
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    • "Harrison, Croudace, Mason, Glazebrook, & Medley, 1996; McCreadie, 1982; Ran et al., 2011; Ucok et al., 2012), educational attainment (Cougnard, Goumilloux, Monello, & Verdoux, 2009), previous work history (Mueser, Salyers, & Mueser, 2001; Schennach-Wolff, Musil, Moller, & Riedel, 2012), marital status (Evert, Harvey, Trauer, & Herrman, 2003; Loganathan & Murthy, 2011; Midin et al., 2011; Srinivasan & Thara, 1997) and rural or urban environment (Munk-Jorgensen & Mortensen, 1992; Yang et al., 2013) are associated with vocational outcome. In turn, the following clinical factors have been found to increase unemployment rates: severity of negative symptoms (Erickson, Jaafari, & Lysaker, 2011; Marwaha et al., 2009; Schennach- Wolff et al., 2009), impaired insight (Erickson et al., 2011), cognitive dysfunction (Tsang, Leung, Chung, Bell, & Cheung, 2010), duration of untreated psychosis (Chang et al., 2012) and older age of schizophrenia onset (Ran et al., 2011), comorbid metabolic syndrome (Medeiros- Ferreira, Obiols, Navarro-Pastor, & Zuniga-Lagares, 2013) and the number (Lay, Blanz, Hartmann, & Schmidt, 2000) and duration (Nordt, Muller, Rossler, & Lauber, 2007) of hospitalizations. "
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    ABSTRACT: Background: Steady employment constitutes one of most important aspects of functional recovery in schizophrenia. Therefore, there is a need for understanding clinical and demographic factors predicting vocational status in schizophrenia. Methods: Clinical and demographic data of 1,010 schizophrenia patients were gathered from public outpatient clinics. We compared patients who maintained employment between the diagnosis time point and the day of assessment, with the patients who were employed in the diagnosis time point but were unemployed on the day of assessment with respect to clinical and demographic variables. Results: Lower educational attainment, lower-income region of residence, medical comorbidities (obesity, diabetes and hypertension), first hospitalization at inpatient unit in comparison with the day hospital, higher total number of hospitalizations and the number of inpatient hospitalizations were found to serve as predictors of unemployment throughout the course of schizophrenia. After application of Bonferroni correction and logistic binary regression analysis, lower educational attainment, higher number of inpatient hospitalizations and obesity predicted unemployment. Conclusion: Education, obesity and the number of inpatient hospitalizations seem to predict vocational outcome in schizophrenia. This study warrants further investigation of medical comorbidities in schizophrenia in terms of social consequences in order to indicate the direction of this relationship.
    Full-text · Article · Apr 2015 · International Journal of Social Psychiatry
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    • "Some spoke about lack of respect from family members (Loganathan and Murthy, 2008). Men experienced stigma most strongly in regard to employment, and women in relation to marriage and childbirth (Loganathan and Murthy, 2011). In another study, stigmatising reactions were often enacted by family members and neighbours (Murthy, 2005). "
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    ABSTRACT: Stigma contributes greatly to the burden of schizophrenia and is a major obstacle to recovery, yet, little is known about the subjective experiences of those directly affected in low and middle income countries. This paper aims to describe the experiences of stigma and discrimination of people living with schizophrenia (PLS) in three sites in India and to identify factors influencing negative discrimination. The study used mixed methods and was nested in a randomised controlled trial of community care for schizophrenia. Between November 2009 and October 2010, data on four aspects of stigma experienced by PLS and several clinical variables were collected from 282 PLS and 282 caregivers and analysed using multivariate regression. In addition, in-depth-interviews with PLS and caregivers (36 each) were carried out and analysed using thematic analysis. Quantitative findings indicate that experiences of negative discrimination were reported less commonly (42%) than more internalised forms of stigma experience such as a sense of alienation (79%) and significantly less often than in studies carried out elsewhere. Experiences of negative discrimination were independently predicted by higher levels of positive symptoms of schizophrenia, lower levels of negative symptoms of schizophrenia, higher caregiver knowledge about symptomatology, lower PLS age and not having a source of drinking water in the home. Qualitative findings illustrate the major impact of stigma on ‘what matters most’ in the lives of PLS and highlight three key domains influencing the themes of 'negative reactions' and ‘negative views and feelings about the self’, i.e., ‘others finding out’, ‘behaviours and manifestations of the illness’ and ‘reduced ability to meet role expectations’. Findings have implications for conceptualising and measuring stigma and add to the rationale for enhancing psycho-social interventions to support those facing discrimination. Findings also highlight the importance of addressing public stigma and achieving higher level social and political structural change.
    Full-text · Article · Oct 2014 · Social Science & Medicine
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    • "While the community provides important support – socially and financially – it also provides an opportunity for stigmatization and loss of social standing for the individual concerned (Hugo, Boshoff & Traut, 2003; Kakuma, et. al., Laher & Khan, 2011; Mavundla, Toth, & Mphelane, 2009; McConnochie, 2012; Loganathan & Murthy, 2011; Padayachee & Laher, in press). Spirit possession and spiritual illnesses do not carry as much stigma as mental illness, hence it has been argued that individuals would present more often with spiritual illnesses as these are more socially acceptable. "
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    ABSTRACT: Increasingly, research, teaching, and practice emphasize the need for cultural competency among healthcare practitioners. Most training programmes include modules on cultural competency based on a knowledge, skills, and awareness model. In line with the knowledge and awareness objectives of cultural competency, this article focuses on the conceptualization of illness from an Islamic, Hindu, and African perspective. It discusses spiritual illness, a category of illness recognized in all three traditions but marginalized in mainstream literature. This marginalization has given rise to debates as to whether a separate Islamic psychology, a Hindu psychology, African psychology (or other Psychology) should exist. This article explores these areas briefly concluding with arguments on the need for current teaching, research, and practice to take more cognizance of cultural views of illness.
    Full-text · Article · Mar 2014 · South African journal of psychology = Suid-Afrikaanse tydskrif vir sielkunde
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