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

Abstract

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.

Internalized stigma in patients with schizophrenia: A hospital-based cross-sectional study from Nepal

“…This finding is in line with a study from China conducted among severe mental disorders in rural communities using the same tool for measuring stigma [25]. However, this estimate is higher compared to most other studies within Nepal [15,17] and other parts [8,28] of the world. Studies comparing stigma scores within diagnostic categories have persistently reported higher self-stigma scores for schizophrenia and psychosis compared to affective disorders and this could be the main reason behind the discrepancy reported [25,29].…”

“…conducted elsewhere have reported inconsistent results with some studies reporting highest scores for alienation [14] and least for endorsement subscale [9,14,30], and other studies reporting highest scores for discrimination experience [28,30] with the same assessment tool.…”

Effects of Mindfulness-Based Cognitive Therapy on Stigma in Female Patients With Schizophrenia

“…The level of stigma attracts more and more attention, as it has become one of the most important indicators to measure the recovery of schizophrenia patients (23). Previous research showed that when patients with schizophrenia were stable, they could still feel disappointed, isolated and helpless (24). When they are faced with misfortune or setback, the individual's acceptance of their own shortcomings and understanding of their own abilities are defective.…”

Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis

“…A literature review on mental health in Indonesia conducted in PubMed returned 161 studies published between 1949 and 2020. However, only 15 of these studies discussed stigma either directly or in the context of Indonesian mental health services [18,[30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Among these 15 studies, six discussed stigma in general, consequences of stigma (i.e., "pasung" or confinement), attitudes toward mental health, and perceptions of mental health [18,30,31,[41][42][43].…”

“…However, only 15 of these studies discussed stigma either directly or in the context of Indonesian mental health services [18,[30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Among these 15 studies, six discussed stigma in general, consequences of stigma (i.e., "pasung" or confinement), attitudes toward mental health, and perceptions of mental health [18,30,31,[41][42][43]. Previous investigations of stigma in Indonesia mainly examined personal stigma, with a focus on the perceptions of those with mental illness and their families, how they respond to stigmatization in their lives, and the impact of stigma on access to mental health facilities or treatment [18,[20][21][22][23]44].…”