Internalized stigma in people with severe mental illness in rural China

Ran, Mao‐Sheng; Zhang, Tianming; Wong, Irene Yin-Ling; Yang, Xin; Liu, Changcheng; Liu, Bo; Luo, Wei; Kuang, Weihong; Thornicroft, Graham; Chan, Cecilia Lai-Wan

doi:10.1177/0020764017743999

Cited by 56 publications

(71 citation statements)

References 39 publications

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“…Moreover, unemployed and unmarried subjects had higher levels of internalized stigma in the current study. Consistently, previous evidence supports that unemployment, insufficient finances and a lack of family support are risk factors for a high level of internalized stigma (Picco et al, 2016;Ran et al, 2018). 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.…”

Section: Discussionsupporting

confidence: 73%

“…Those who are younger in age and have experienced early onset, shorter illness duration and fewer hospitalizations may experience higher levels of internalized stigma (Grover et al, 2017;Singh, Mattoo, & Grover, 2016). 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.…”

Section: Introductionmentioning

confidence: 99%

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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: 73%

Section: Introductionmentioning

confidence: 99%

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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“…major depressive disorder and bipolar disorder), which are leading causes of disability. 5,6 Evidence strongly suggests that people with SMI are at increased risk of drifting into or remaining in poverty because of reduced productivity, increased medical costs, stigma and loss of employment-associated earnings. 7 Meanwhile, a negative impact because of SMI also occurs at the household level, especially in societies that rely on the role of families in patient care.…”

Section: Impact Of Severe Mental Illness On Povertymentioning

confidence: 99%

“…9 In general, those households are less likely to benefit from the trickle-down effect of external development. 5,10 The most recent nationwide data from the China Mental Health Survey showed the weighted prevalence of any disorder (excluding dementia) in China was 16.6%, with the lifetime prevalence of schizophrenia and any mood disorder being 0.6 and 7.4%, respectively. 11 Data regarding poverty among people with SMI is scarce in China.…”

Section: Impact Of Severe Mental Illness On Povertymentioning

confidence: 99%

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Household poverty in people with severe mental illness in rural China: 1994–2015

Luo

et al. 2020

BJPsych open

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Background Little is known about poverty trends in people with severe mental illness (SMI) over a long time span, especially under conditions of fast socioeconomic development. Aims This study aims to unravel changes in household poverty levels among people with SMI in a fast-changing rural community in China. Method Two mental health surveys, using ICD-10, were conducted in the same six townships of Xinjin county, Chengdu, China. A total of 711 and 1042 people with SMI identified in 1994 and 2015, respectively, participated in the study. The Foster-Greer-Thorbecke poverty index was adopted to measure the changes in household poverty. These changes were decomposed into effects of growth and equity using a static decomposition method. Factors associated with household poverty in 1994 and 2015 were examined and compared by regression analyses. Results The proportion of poor households, as measured by the headcount ratio, increased significantly from 29.8% in 1994 to 39.5% in 2015. Decomposition showed that poverty in households containing people with SMI had worsened because of a redistribution effect. Factors associated with household poverty had also changed during the study period. The patient's age, ability to work and family size were of paramount significance in 2015. Conclusions This study shows that the levels of poverty faced by households containing people with SMI has become more pressing with China's fast socioeconomic development. It calls for further integration of mental health recovery and targeted antipoverty interventions for people with SMI as a development priority.

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Differential diagnosis of borderline personality disorder and bipolar disorder: Self‐concept, identity and self‐esteem

Wright

Lari

Iazzetta

et al. 2021

Clin Psychology and Psychoth

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Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi‐structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self‐concept and self‐esteem may help distinguish the two disorders, when they are not co‐morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well‐documented identity diffusion, and the self‐concept appears predominantly negative; shifts in self‐concept and self‐esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self‐concept and self‐esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.

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Internalized stigma in people with severe mental illness in rural China

Cited by 56 publications

References 39 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

Household poverty in people with severe mental illness in rural China: 1994–2015

Differential diagnosis of borderline personality disorder and bipolar disorder: Self‐concept, identity and self‐esteem

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