Self-stigma in serious mental illness and autism spectrum disorder: Results from the REHABase national psychiatric rehabilitation cohort

Dubreucq, Julien; Plasse, Julien; Gabayet, Franck; Faraldo, Mégane; Blanc, Olivier; Chéreau, Isabelle; Cervello, Sophie; Couhet, Geoffroy; Demily, Caroline; Guillard-Bouhet, Nathalie; Gouache, Benjamin; Jaafari, Nemat; Legrand, Guillaume; Legros-Lafarge, Émilie; Pommier, Romain; Quilès, Clélia; Straub, Donald; Verdoux, Hélène; Vignaga, F.; Massoubre, Catherine; Franck, Nicolás

doi:10.1192/j.eurpsy.2019.12

Cited by 29 publications

(34 citation statements)

References 65 publications

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“…This concurs with findings in serious mental illness where self-stigma has been associated with reduced capacity for intimacy and more negative parenting experiences (61). Self-stigma has been found to affect one in five people with ASD (7,62). It has been associated with poorer recovery-related outcomes (i.e., reduced self-esteem and well-being and higher depression and suicide risk) (7).…”

Section: Access To Adequate Healthcaresupporting

confidence: 83%

“…Self-stigma has been found to affect one in five people with ASD ( 7 , 62 ). It has been associated with poorer recovery-related outcomes (i.e., reduced self-esteem and well-being and higher depression and suicide risk) ( 7 ). Gender-diverse autistic individuals are confronted with multiple sources of stigma (e.g., intersection of ASD and gender identity stigma) and may be at particular risk of self-stigma ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

“…Psychiatric rehabilitation is a person-centered approach that aims to help people with serious mental illness (SMI) or ASD to “be successful and satisfied in the living, working, learning, and social environments of their choice” ( 5 ). Therapeutic tools are selected based on people's strengths, weaknesses, needs for care, and personal life goals as part of a customized recovery-oriented action plan ( 6 , 7 ). The action plan can include strength-based case management, improvements in physical and mental health, peer support interventions, joint crisis plans, cognitive remediation (CR), cognitive behavior therapy (CBT), social skills training (SST), self-stigma reduction, family support, and supported housing and supported employment (SE) ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…Therapeutic tools are selected based on people's strengths, weaknesses, needs for care, and personal life goals as part of a customized recoveryoriented action plan (6,7). The action plan can include strengthbased case management, improvements in physical and mental health, peer support interventions, joint crisis plans, cognitive remediation (CR), cognitive behavior therapy (CBT), social skills training (SST), self-stigma reduction, family support, and supported housing and supported employment (SE) (6,7). Psychiatric rehabilitation interventions have shown small to moderate effectiveness in improving patients'outcomes in adults with ASD (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

Dubreucq

2021

Front. Psychiatry

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Later age of diagnosis, better expressive behaviors, increased use of camouflage strategies but also increased psychiatric symptoms, more unmet needs, and a general lower quality of life are characteristics often associated with female gender in autism spectrum disorder (ASD). Psychiatric rehabilitation has shown small to moderate effectiveness in improving patients' outcomes in ASD. Few gender differences have been found in the response to psychiatric rehabilitation. This might be related to the predominance of males in research samples, but also to the lack of programs directly addressing women's unmet needs. The objectives of the present paper were: (i) to review the needs for care of autistic women in romantic relationships and reproductive health; (ii) to review the existing psychosocial treatments in these domains; and (iii) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed and PsycINFO), following PRISMA guidelines, was conducted on autistic women's needs for care relating to psychiatric rehabilitation in romantic relationships and reproductive health. Out of 27 articles, 22 reported on romantic relationships and 16 used a quantitative design. Most studies were cross-sectional (n = 21) and conducted in North America or Europe. Eight studies reported on interventions addressing romantic relationships; no published study reported on interventions on reproductive health or parenting. Most interventions did not include gender-sensitive content (i.e., gender variance and gender-related social norms, roles, and expectations). Autistic women and autistic gender-diverse individuals may face unique challenges in the domains of romantic relationships and reproductive health (high levels of stigma, high risk of sexual abuse, increased psychiatric symptoms, and more unmet needs). We discussed the potential implications for improving women's access to psychiatric and psychosocial treatment, for designing gender-sensitive recovery-oriented interventions, and for future research.

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Section: Access To Adequate Healthcaresupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

Dubreucq

2021

Front. Psychiatry

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“…For ethical purposes, we have chosen a stepped wedge cluster randomized trial design, with a waiting list type control condition. Previous research from the French national REHABase network showed that (i) most patients were dissatisfied with their interpersonal relationships at the time of admission and asked for interventions improving social function [36] and (ii) elevated self-stigma was frequent (31.2% of the 738 participants [37]) and was negatively associated with recovery-related outcomes. Self-stigma has been negatively associated with patient's longitudinal outcomes and to lower benefits from psychiatric rehabilitation [38].…”

Section: Designmentioning

confidence: 99%

Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial

Dubreucq

Faraldo

Abbes

et al. 2021

Trials

Self Cite

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Background Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning. Methods This is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery. Discussion NECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice. Trial registration ClinicalTrials.gov NCT03972735. Trial registration date 31 May 2019.

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Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta‐analysis

May

Pilkington

Younan³

et al. 2021

Autism Research

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Autism spectrum disorder (ASD) and borderline personality Disorder (BPD) share features, including social and emotion regulation difficulties. The evidence for the overlap in prevalence and clinical characteristics was systematically reviewed. Ovid Medline, PsycInfo, and PubMed were searched until November 30, 2020 using keywords relating to BPD and ASD. Studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort, or casecontrolled design were included. Of 1633 screened studies, 19 were included, of which 12 reported data suitable for meta-analysis. Most samples were of small, clinically ascertained groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across clinical areas. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was within population prevalence estimates of each disorder. Based on this data we were not able to assess whether there is misdiagnosis of one in favor of the other. Neurocognitive differences may underlie similar behavioral symptoms, but further research using larger, well-validated samples is needed. Lay SummaryAutism spectrum disorder (ASD) and borderline personality disorder (BPD) have overlaps in their symptoms. The overlap in how frequently they co-occur and their presentation was systematically reviewed. We searched the key databases and including all studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort or case-controlled design. Of 1633 studies, 19 were included, of which 12 reported data suitable for pooling. Most samples were of small, clinical groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across studies comparing ASD and BPD related symptoms and problems. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was similar to the population prevalence of each disorder. Further research using larger, well-validated samples is needed.

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Self-stigma in serious mental illness and autism spectrum disorder: Results from the REHABase national psychiatric rehabilitation cohort

Cited by 29 publications

References 65 publications

Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

Toward a Gender-Sensitive Approach of Psychiatric Rehabilitation in Autism Spectrum Disorder (ASD): A Systematic Review of Women Needs in the Domains of Romantic Relationships and Reproductive Health

Narrative enhancement and cognitive therapy (NECT) to improve social functioning in people with serious mental illness: study protocol for a stepped-wedge cluster randomized controlled trial

Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta‐analysis

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