Patterns of experienced and anticipated discrimination in patients with Schizophrenia. Italian results from the INDIGO international multisite project

Abstract

SUMMARYAims— To describe patterns of experienced andanticipated discrimination in a sample of schizophrenic patients recruited in Italy in the context of the International Study of Discrimination and Stigma Outcomes (INDIGO).Methods— Cross-sectional survey on a sample of 50 people with clinical diagnosis of schizophrenia recruited in the Italian INDIGO sites of Verona and Brescia. The 41-item interview-based Discrimination and Stigma Scale (DISC-10), which assesses how experienced and anticipated discrimination affects the life of people with schizophrenia, was used.Results— The most frequently occurring areas of experienced discrimination were discrimination by family members (44%), making and keeping friends (33%), keeping (36%) and finding a job (34%), getting or keeping a driving licence (32%). Anticipated discrimination was common in applying for work, training or education (58%), lookingfor close relationships (50%) and doing something important (48%); 68% felt the need to conceal their diagnosis. Positive experiences were rare, and getting welfare benefits/disability pensions was the only area where participants reported being treated with advantage (34%) more commonly than with disadvantage (8%). Overall, experienced discrimination reported by Italian patients was in the intermediate position of the score range of all INDIGO sites, whereas anticipated discrimination was lower than that reported in the other countries.Conclusions— Interventions to reduce discrimination against people with schizophrenia may need to address both actual and anticipated discrimination. Targeted therapeutic strategies aiming to improve self-esteem of people with schizophrenia may be usefulto facilitate their social participation and full inclusion in the community.Declaration of Interest: The authors declare they have not competing interests.

The Role of Experienced and Anticipated Discrimination in the Lives of People With First-Episode Psychosis

“…This pattern was expected, given that the needs of people experiencing a first episode of psychosis-who are generally young, living with their families, attending educational or training systems, and seeking to enter the labor market-substantially differ from those of individuals with an illness of longer duration (21,22). This hypothesis was not confirmed because we found that the main sources of discrimination reported by first-episode patients (family, friendship, and job) substantially overlap with those observed among people with chronic schizophrenia (7,19) ( Figure 1). This finding suggests that interpersonal relations (either with family members or with people outside the family) and employment are frequently problematic domains for patients with psychosis in general, regardless of their illness phase.…”

“…The most frequent areas for anticipated discrimination (.30%) were being avoided by other people and stopping oneself from having close personal relationships and from applying for work, education, or training. Figure 1 illustrates how experienced discrimination reported by these firstepisode patients compares with that reported by patients with long-standing schizophrenia who were recruited in the Italian INDIGO sites (19) and those who were recruited across all INDIGO sites (7). Figure 2 compares anticipated discrimination for these groups.…”

“…Only recently has research begun to explore patients' self-reported experiences of discrimination; all of the more recent studies have examined patients with long-standing psychiatric conditions (2,7,(15)(16)(17)(18)(19)(20). To the best of our knowledge, no study has specifically addressed the ways in which discrimination (that is, the behavioral component of stigma) affects the lives of persons experiencing a first episode of psychosis.…”

“…In addition, research indicates that reported discrimination levels tend to increase as the illness progresses; specifically, time from first mental health service contact has been found to be associated with a higher level of experienced discrimination (7,19). This finding suggests that patients experiencing a first episode of psychosis may be less exposed than patients with chronic illness to the pernicious effects of discrimination and may therefore experience less discrimination.…”

“…Third, higher levels of perceived discrimination were expected to be associated with more severe symptoms and poorer social functioning, as assessed by both clinician-rated and patient-rated measures. To address the first two hypotheses, data from people with long-standing psychosis recruited in Italy for the INDIGO (INternational study of DIscrimination and stiGma Outcomes) schizophrenia study were also used (7,19).…”