Correlates of affiliate stigma among family caregivers of people with mental illness: A systematic review and meta‐analysis

Abstract

Accessible Summary What is known on the subject? A growing body of qualitative and quantitative research has investigated the experiences of affiliated stigma for family members of PWMI. Some findings are contradictory and have not been considered systematically. What does the paper adds to existing knowledge? Family caregivers of PWMI may encounter affiliate stigma, but no systematic review or meta‐analysis has been conducted to evaluate affiliate stigma among them. We identified eight variables significantly related to affiliate stigma among caregivers of PWMI. The findings can be used to help clinical practice to develop health promotion and prevention strategies. What are the implications for practice? Affiliate stigma was prevalent among the family caregivers of PWMI and is important for clinicians to consider. Health‐focused interventions for family caregivers can mediate the impact of affiliated stigma through provision of social support by practitioners, such as respite care based on the “Senses Framework,” self‐help groups and online support program. And the caregivers of PWMI might benefit from further support (e.g., psychoeducation) to improve their knowledge about mental illness. Abstract IntroductionMany studies have investigated the correlates of affiliate stigma among family caregivers of people with mental illness (PWMI). Thus far, no systematic review or meta‐analysis has been conducted to synthesize these results. Aims/QuestionThis review aims to identify the correlates of affiliate stigma among family caregivers of PWMI. MethodWe searched four databases including PubMed, PsycINFO, EMBASE and Web of Science for studies that investigated the association of affiliate sigma with socio‐demographic, psychosocial and disease‐related factors. ResultsTwenty‐two studies including 3,381 participants met the inclusion criteria. Eighteen variables were included for the meta‐analysis. For disease‐related characteristics, only “disease attribution” and “care time/day” were associated with affiliate stigma. For psychosocial characteristics, “support from others,” “burden,” “depression,” “stress,” “distress” and “face concern” were related to affiliate stigma. DiscussionThis review is the first to assess the association of affiliate stigma with other characteristics of interest. However, the findings are limited due to a very small number of studies. Researchers should conduct in‐depth study in this area and improve the quality of the literature. Implications for practiceHealth‐focused interventions for family caregivers such as respite care, self‐help groups, online support program and psychosocial education can mediate the impact of affiliated stigma.

Affiliate Stigma and Related Factors in Family Caregivers of Children with Attention-Deficit/Hyperactivity Disorder

“…Affiliate stigma may result in more serious consequences than courtesy stigma does [16]. Affiliate stigma may not only enhance caregivers' psychological distress and reduce their quality of life [17,18] but also abate the care they provide for affiliated people and cooperation with health care professionals [19]. It is crucial to evaluate and reduce affiliate stigma among caregivers of people with mental illness [20].…”

“…A growing body of research has investigated affiliate stigma in family caregivers of people with schizophrenia, depression, or affective disorders [19]. These studies have not only demonstrated that affiliate stigma is prevalent among family caregivers but also revealed that health-focused interventions for caregivers can reduce the effect of affiliate stigma by providing social support from medical professionals [19]. However, few studies have focused on affiliate stigma in family caregivers of children with ADHD.…”

“…Identification of factors that contribute to developing affiliate stigma is crucial in promoting interventions and prevention. A review of studies demonstrated that results are mixed regarding associations between affiliate stigma and sociodemographic characteristics (such as age, gender, and education levels) of caregivers and affiliated people with mental illnesses (mainly schizophrenia and affective disorders) [19]. In addition, meta-analyses revealed that no sociodemographic or symptom severity factor was significantly associated with affiliate stigma [19].…”

“…A review of studies demonstrated that results are mixed regarding associations between affiliate stigma and sociodemographic characteristics (such as age, gender, and education levels) of caregivers and affiliated people with mental illnesses (mainly schizophrenia and affective disorders) [19]. In addition, meta-analyses revealed that no sociodemographic or symptom severity factor was significantly associated with affiliate stigma [19]. To our knowledge, only one study examined the relationship between children's ADHD symptoms and affiliate stigma [22], whereas no study has examined the sociodemographic factors of affiliate stigma in family caregivers of children with ADHD.…”

Selecting Leaders for Behavioral Health Programs

“…They feel the stigma directed toward the person with the mental illness, and the stigma directed toward the families. 9 Disparities on the local level can be addressed by behavioral health nursing presence in the community. Community mental health support systems vary considerably across the county, and the resources need to be available, updated, and disseminated to all who need service.…”