Facility based cross-sectional study of self stigma among people with mental illness: towards patient empowerment approach

International Journal of Mental Health Systems

Norbert Müller¹  Sandra Dehning¹  Anne Maria Möller-Leimkühler¹  Guenter Froeschl²  Markos Tesfaye⁴  Eshetu Girma³ 

[1] Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany;Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität, Munich, Germany;CIHLMU Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany;Department of Psychiatry, Jimma University, Jimma, Ethiopia

关键词: People with mental illness;    Mental illness;    Stigma;    Internalized stigma;    Self stigma;   

Others  :  801533
DOI  :  10.1186/1752-4458-7-21

 received in 2013-07-11, accepted in 2013-09-02,  发布年份 2013

【 摘 要 】

Background

Self stigma among people with mental illness results from multiple cognitive and environmental factors and processes. It can negatively affect adherence to psychiatric services, self esteem, hope, social integration and quality of life of people with mental illness. The purpose of this study was to measure the level of self stigma and its correlates among people with mental illness at Jimma University Specialized Hospital, Psychiatry clinic in southwest Ethiopia.

Methods

Facility based cross-sectional study was conducted on 422 consecutive samples of people with mental illness using interviewer administered and pretested internalized stigma of mental illness (ISMI) scale. Data was entered using EPI-DATA and analysis was done using STATA software. Bivariate and multivariate linear regressions were done to identify correlates of self stigma.

Results

On a scale ranging from 1 to 4, the mean self stigma score was 2.32 (SD = 0.30). Females had higher self stigma (std. β = 0.11, P < 0.05) than males. Patients with a history of traditional treatment had higher self stigma (std. β = 0.11, P < 0.05). There was an inverse relationship between level of education and self-stigma (std. β = −0.17, P < 0.01). Perceived signs (std. β = 0.13, P < 0.05) and supernatural causes of mental illness (std. β = 0.16, P < 0.01) were positively correlated with self stigma. Higher number of drug side effects were positively correlated (std. β = 0.15, P < 0.05) while higher self esteem was negatively correlated (std. β = −0.14, P < 0.01) with self stigma.

Conclusions

High feeling of inferiority (alienation) but less agreement with common stereotypes (stereotype endorsement) was found. Female showed higher self stigma than male. History of traditional treatment and higher perceived supernatural explanation of mental illness were associated with higher self stigma. Drug side effects and perceived signs of mental illness were correlated with increased self stigma while education and self esteem decreased self stigma among people with mental illness. Patient empowerment psychosocial interventions and strategies to reduce drug side effects can be helpful in reducing self stigma among people with mental illnesses.

【 授权许可】

   
2013 Girma et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Lauber C: Stigma and discrimination against people with mental illness: a critical appraisal. Epidemiol Psichiatr Soc 2008, 17(1):10-13.
• [2]Thornicroft G: Shunned: Discrimination against people with mental illness. Oxford: Oxford University Press; 2006.
• [3]Lauber CNC, Braunschweig C, Rossler W: Do mental health professionals stigmatize their patients? Acta Psychiatra Scand 2006, 113:51-59.
• [4]Vogel DL, Bitman RL, Hammer JH, Wade NG: Is stigma internalized? The longitudinal impact of public stigma on self-stigma. J Couns Psychol 2013, 60(2):311-316.
• [5]Corrigan PW, Powell KJ, Rusch N: How does stigma affect work in people with serious mental illnesses? Psychiatr Rehabil J 2012, 35(5):381-384.
• [6]Hansson L, Stjernsward S, Svensson B: Perceived and anticipated discrimination in people with mental illness-An interview study. Nord J Psychiatry 2013, 13:1-7.
• [7]Mashiach-Eizenberg M, Hasson-Ohayon I, Yanos PT, Lysaker PH, Roe D: Internalized stigma and quality of life among persons with severe mental illness: the mediating roles of self-esteem and hope. Psychiatry Res 2013, 208(1):15-20.
• [8]Tang IC, Wu HC: Quality of life and self-stigma in individuals with schizophrenia. Psychiatr Q 2012, 83(4):497-507.
• [9]Kranke DA, Floersch J, Kranke BO, Munson MR: A qualitative investigation of self-stigma among adolescents taking psychiatric medication. Psychiatr Serv 2011, 62(8):893-899.
• [10]Yanos PT, Roe D, Lysaker PH: The Impact of Illness Identity on Recovery from Severe Mental Illness. Am J Psychiatr Rehabil 2010, 13(2):73-93.
• [11]Evans-Lacko S, London J, Japhet S, Rusch N, Flach C, Corker E, Henderson C, Thornicroft G: Mass social contact interventions and their effect on mental health related stigma and intended discrimination. BMC Publ Health 2012, 12:489. BioMed Central Full Text
• [12]Stigma and discrimination in mental health. http://www.nmhdu.org.uk/silo/files/nmhdu-factfile-6.pdf webcite
• [13]Mittal D, Sullivan G, Chekuri L, Allee E, Corrigan PW: Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatr Serv 2012, 63(10):974-981.
• [14]Arboleda-Florez J, Stuart H: From sin to science: fighting the stigmatization of mental illnesses. Can J Psychiatry 2012, 57(8):457-463.
• [15]Girma E, Tesfaye M: Patterns of treatment seeking behavior for mental illnesses in Southwest Ethiopia: a hospital based study. BMC Psychiatry 2011, 11:138. BioMed Central Full Text
• [16]Brohan E, Elgie R, Sartorius N, Thornicroft G: Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 2010, 122(1–3):232-238.
• [17]Ghanean HNM, Lars Jacobsson L: Internalized Stigma of Mental Illness in Tehran, Iran. Stigma Research and Action 2011, 1:11-17.
• [18]Assefa D, Shibre T, Asher L, Fekadu A: Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study. BMC Psychiatry 2012, 12:239. BioMed Central Full Text
• [19]Jimma University Specialized Hospital. http://www.ju.edu.et/?q=jimma-university-specialized-hospital-jush webcite
• [20]Department of Psychiatry. http://www.ju.edu.et/cphms/node/129 webcite
• [21]Guy W: Clinical Global Impression (CGI). In ECDEU Assessment Manual for Psychopharmacology. Rockville: MD, U.S.Department of Health, Education, and Welfare; 1976.
• [22]Ritsher JB, Otilingam PG, Grajales M: Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 2003, 121:31-49.
• [23]Rosenberg M: Conceiving the self. New York: Basic Books; 1979.
• [24]West ML, Yanos PT, Smith SM, Roe D, Lysaker PH: Prevalence of internalized stigma among persons with severe mental illness. Stigma Res Action 2011, 1(1):3-10.
• [25]Watson AC, Corrigan P, Larson JE, Sells M: Self-stigma in people with mental illness. Schizophr Bull 2007, 33(6):1312-1318.
• [26]Botha UA, Koen L, Niehaus DJ: Perceptions of a South African schizophrenia population with regards to community attitudes towards their illness. Soc Psychiatry Psychiatr Epidemiol 2006, 41(8):619-623.
• [27]Brohan E, Gauci D, Sartorius N, Thornicroft G: Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: the GAMIAN-Europe study. J Affect Disord 2011, 129(1–3):56-63.
• [28]Yanos PT, Roe D, Markus K, Lysaker PH: Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatr Serv 2008, 59(12):1437-1442.
• [29]Adams C, Wilson P, Bagnall AM: Psychosocial interventions for schizophrenia. Qual Health Care 2000, 9(4):251-256.