An integrative model of internalized stigma and recovery-related outcomes among people diagnosed with schizophrenia in rural China

Zhang, Tianming; Wong, Irene Yin-Ling; Yu, Yuehui; Ni, Shijun; He, Xuesong; Bacon‐Shone, John; Гонг, Ке; Huang, Caili; Hu, Yan; Tang, Mingmin; Wan, Cao; Chan, Cecilia Lai-Wan; Ran, Mao‐Sheng

doi:10.1007/s00127-018-1646-3

Cited by 41 publications

(42 citation statements)

References 56 publications

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“…In the current study, the level of internalized stigma was higher in subjects having no friends, but not significantly different by gender, education level and living status. This was consistent with another study in China (Zhang et al, 2019), where it was found that internalized stigma was significantly negatively associated with perceived social support and social Given that unemployment is associated with higher risk of having stigma, providing vocational rehabilitation and employment support could be beneficial and meaningful to reduce internalized stigma and promote recovery (Ebuenyi, Syurina, Bunders, & Regeer, 2018;Hielscher, & Waghorn, 2017). In particular, in a collectivist culture, as with other Asian countries, an emphasis on family interdependence is pervasive and powerful (Lauber & Rossler, 2007).…”

Section: Discussionsupporting

confidence: 89%

“…Some studies have supported that being female (Asrat, Ayenalem, & Yimer, 2018;Uhlmann et al, 2014), unemployed and unmarried (Picco et al, 2016;Ran et al, 2018) will increase the likelihood of higher levels of internalized stigma. However, a recent study (Zhang et al, 2019) found that internalized stigma was not significantly different based on gender, age, education, marital status and economic status, but rather was negatively associated with perceived social support and social interaction. In addition, disagreement with the diagnosis may increase internalized stigma (Brohan, Slade, Clement, & Thornicroft, 2010;Link, 1987).…”

Section: Introductionmentioning

confidence: 88%

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Factors associated with internalized stigma for Indonesian individuals diagnosed with schizophrenia in a community setting

Pribadi

Lin

Chen

et al. 2020

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Internalized stigma in people diagnosed with mental illness has several negative outcomes; however, it remains unclear in an Indonesian context. The human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of the existing stigma against mental illness and deficiencies in the country's mental healthcare services. What the paper adds to existing knowledge? To the best of our knowledge, this is the first study to examine the level of internalized stigma and related factors among Indonesians diagnosed with schizophrenia. Almost one‐third of the subjects had moderate‐to‐severe levels of internalized stigma, among which discrimination was the strongest type. Specifically, younger and unemployed people with more psychotic symptoms had higher levels of internalized stigma. What are the implications for practice? The provision of adequate pharmacological and psychosocial treatments to help people manage their psychotic symptoms is extremely important to ameliorate stigma. Vocational rehabilitation and employment support for unemployed people may potentially reduce their internalized stigma and promote recovery. Abstract IntroductionThe human rights of people diagnosed with mental illness in Indonesia have been routinely violated because of societal stigma associated with mental illness and deficiencies in the country's mental healthcare services. Knowledge about internalized stigma among people diagnosed with schizophrenia in lower middle‐income Muslim countries is also scarce. AimTo identify the level of internalized stigma and related factors among people diagnosed with schizophrenia in Indonesia. MethodA cross‐sectional survey was conducted with a purposive sample of 300 people diagnosed with schizophrenia from an urban Indonesian psychiatric hospital. ResultsAlmost one‐third of the subjects had moderate‐to‐severe levels of internalized stigma, among which discrimination was the strongest type. Younger age, unemployment status and having psychotic symptoms significantly increased the risk of internalized stigma when analysed in a multivariable ordinal logistic regression. DiscussionThe present study firstly identified the high levels of internalized stigma among Indonesian individuals diagnosed with schizophrenia. Implications for practiceMental health nurses are suggested to provide early anti‐stigma illness management and family psychoeducation interventions to people diagnosed with schizophrenia and their family caregivers, helping them to develop an optimistic understanding about the concept of schizophrenia and mitigating the negative consequences of public and internalized stigma.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 88%

Factors associated with internalized stigma for Indonesian individuals diagnosed with schizophrenia in a community setting

Pribadi

Lin

Chen

et al. 2020

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

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“…Higher rates are associated with lower rates of help‐seeking, and this may be especially the case among some minority ethnic groups and among older people. A mediation analysis has suggested that help‐seeking may be especially impaired among people with both higher levels of internalized stigma and depression 313 .…”

Section: Internalized Stigmamentioning

confidence: 99%

“…Further contextual and environmental factors also appear to play a role in internalized stigma, including how mental disorders are portrayed in the media, as well as cultural explanatory models of mental illness, with supernatural accounts being found to be more common among people with higher rates of internalized stigma. This stigma is also positively associated with psychiatric symptom severity and negatively associated with treatment adherence 313 .…”

Section: Internalized Stigmamentioning

confidence: 99%

The clinical characterization of the patient with primary psychosis aimed at personalization of management

et al. 2021

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The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medication is prescribed, with second‐generation antipsychotics usually preferred to first‐generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence‐based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves “recovery‐oriented”, it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient’s needs in terms of employment, housing, self‐care, social relationships and education, and offers a focus on identity, meaning and resilience.

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“…Apart from public stigma, patients often have self-stigma which lowers their self-esteem. A study on patients with schizophrenia found that self-stigma was associated with weaker social support, interaction, and functioning, which in turn affected their symptoms and recovery [65].…”

Section: Stigma Related To Psychiatric Illnesses and Advancement Of Amentioning

confidence: 99%

Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies

Zhang

Sun

Jatchavala

et al. 2019

IJERPH

129

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Background: In psychiatry, stigma is an attitude of disapproval towards people with mental illnesses. Psychiatric disorders are common in Asia but some Asians receive inadequate treatment. Previous review found that Asians with mental illness were perceived to be dangerous and aggressive. There is a need for renewed efforts to understand stigma and strategies which can effectively reduce stigma in specific Asian societies. The objective of this systematic review was to provide an up-to-date overview of existing research and status on stigma experienced by psychiatric patients and anti-stigma campaigns in China, Hong Kong, Japan, Singapore, Korea, and Thailand. Methods: A systematic literature search was conducted in the following databases, including PubMed, PsycINFO, Embase, Web of Science, and local databases. Studies published in English and the official language of included countries/territories were considered for inclusion in the systematic review. Any article on stigma related to any form of psychiatric illness in the six Asian societies was included. Results: One hundred and twenty-three articles were included for this systematic review. This review has six major findings. Firstly, Asians with mental illnesses were considered as dangerous and aggressive, especially patients suffering from schizophrenia and bipolar disorder; second, psychiatric illnesses in Asian societies were less socially-acceptable and were viewed as being personal weaknesses; third, stigma experienced by family members was pervasive and this is known as family stigma; fourth, this systemic review reported more initiatives to handle stigma in Asian societies than a decade ago; fifth, there have been initiatives to treat psychiatric patients in the community; and sixth, the role of supernatural and religious approaches to psychiatric illness was not prevailing. Conclusion: This systematic review provides an overview of the available scientific evidence that points to areas of needed intervention to reduce and ultimately eliminate inequities in mental health in Asia.

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An integrative model of internalized stigma and recovery-related outcomes among people diagnosed with schizophrenia in rural China

Cited by 41 publications

References 56 publications

Factors associated with internalized stigma for Indonesian individuals diagnosed with schizophrenia in a community setting

Factors associated with internalized stigma for Indonesian individuals diagnosed with schizophrenia in a community setting

The clinical characterization of the patient with primary psychosis aimed at personalization of management

Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies

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