Mixed-methods analysis of internalized stigma correlates in poorly adherent individuals with bipolar disorder

Abstract

Background Internalized stigma, which occurs when stigmatized individuals accept society’s assessment and incorporate this assessment into their sense of self, is prevalent in individuals with bipolar disorder (BD). This study explored the correlates of internalized stigma in a research sample of patients with BD who were poorly adherent to their medications. Methods Both quantitative and qualitative analyses were performed. Scores of 115 individuals with BD on the Internalized Stigma of Mental Illness (ISMI) scale were correlated with scores on the General Self-Efficacy (GSE) Scale, Brief Psychiatric Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Young Mania Rating Scale (YMRS). Regression was run for GSE (dependent variable) and ISMI (independent variable). In-depth qualitative interviews were conducted on a representative subsample (N=21). Results Internalized stigma levels were moderately high. Internalized stigma and self-efficacy correlated, and internalized stigma related to self-efficacy after adjusting for demographic variables (age, gender, years of education), comorbidities, and symptom severity (BPRS and MADRS). Internalized stigma was also associated with the BD symptoms of depression, anxiety, guilt feelings, suspiciousness, and hallucinogenic behaviors. No association was found with mania. Conclusions Because internalized stigma has strong psychosocial and psychiatric symptom associations, it is recommended that clinicians address both societal stigma and internalized stigma. Strategies such as cognitive-behavioral therapy may help modify BD patients’ internalized stigma.

Internalized stigmatization and social functioning in psychiatric patients

“…It was determined that patients who had been obliged to leave employment experienced internalized stigmatization at a higher level and those who had harmed themselves or others, and this difference was found to be statistically significant. It has been determined in other studies that mental illness with a low education level, or who are unemployed, have low social support, or have low self-sufficiency experience greater internalized stigmatization (12,13,22). These results are similar to those of our study.…”

“…In another study following up patients with a diagnosis of schizophrenia, it was determined that the mean ISMI scores of these patients were significantly higher than those of patients followed up with a diagnosis of bipolar disorder, and that as self-respect and perceived social support decreased, the level of internalized stigmatization rose (10). The findings of our study are similar to the results of many studies in the literatüre (10)(11)(12)(13)19). Significant difference was determined in our study according to gender between in terms of stigmatization.…”

Medicalizing the Disclosure of Mental Health: Transnational Perspectives of Ethical Workplace Policy Among Healthcare Workers

“…Pescosolido et al (), in their research on the “Framework Integrating Normative Influences on Stigma (FINIS),” discuss how enacted norms internalized within workplace policy contribute to “equality and inequality” (p. 437). Howland et al () and Pescosolido et al () both argue for a change in the mindset within social systems. To reduce the internalized stigma of mental health illness in the workplace, Wallace () recommends access to support networks for medical professionals to promote awareness.…”

“…Public perception of mental health is further misinterpreted by how stigma is internalized publicly within society (Howland, Levin, Blixen, Tatsuoka, & Sajatovic, 2016;Latalova et al, 2013;Pescosolido, 2013). Oftentimes, mental health diagnoses such as bipolar disorder are defined by how society defines and stereotypes as a specific type of condition (Howland et al, 2016;Pescosolido, Manago, & Monahan, 2019;Pescosolido, Martin, Lang, & Olafsdottir, 2008). According to Howland et al (2016), the psychological consequences of "internalized stigma" can negatively and socially affect how patients function within the workplace (p. 174).…”

“…Oftentimes, mental health diagnoses such as bipolar disorder are defined by how society defines and stereotypes as a specific type of condition (Howland et al, 2016;Pescosolido, Manago, & Monahan, 2019;Pescosolido, Martin, Lang, & Olafsdottir, 2008). According to Howland et al (2016), the psychological consequences of "internalized stigma" can negatively and socially affect how patients function within the workplace (p. 174). Pescosolido et al (2008), in their research on the "Framework Integrating Normative Influences on Stigma (FINIS)," discuss how enacted norms internalized within workplace policy contribute to "equality and inequality" (p. 437).…”