Relationships between social stigma, stigma experience and self-stigma and impaired quality of life in schizophrenia across three Latin-American countries

The status of stigma in patients with type 2 diabetes mellitus and its association with medication adherence and quality of life in China: A cross-sectional study

Type 2 diabetes mellitus (T2DM) is a chronic, lifelong disease that can negatively affect patients' mental health and quality of life (QoL). A notable proportion of patients with T2DM worldwide have experienced stigma through instances of discrimination, unfair social treatment and lack of promotion opportunities. Stigma refers to the negative emotional experience of people with illness, often mixed with self-stigmatization. Stigma remains an obstacle to patients' self-management, its association with patients with T2DM on medication adherence and QoL in China are unknown. Therefore, the objective of the study was to analyze the status of stigma in patients with T2DM and its association with medication adherence and QoL in China. A cross-sectional, observational study among 346 inpatients with T2DM in 2 tertiary-level hospitals in Chengdu, China, was conducted using a general data questionnaire, Chinese version type 2 diabetes stigma scale (DSAS-2), Morisky medication adherence scale (MMAS-8) and diabetic QoL specificity scale by convenient sampling method from January to August 2020. The total score and scores for the 3 dimensions of stigma, treated differently, blame and judgment, and self-stigma, were 54.30 ± 12.22, 16.57 ± 4.06, 20.92 ± 4.42, 16.82 ± 4.78, respectively. The scores for medication adherence and QoL were 5.43 ± 1.8 and 73.24 ± 9.38. Pearson correlation analysis showed that the total score of stigma and the scores of each dimension were negatively weak-correlated with the score of medication adherence (r = -0.158 to -0.121, P < .05), and positively moderate-correlated with the score of QoL (R = 0.073 to 0.614, P < .05). Stigma of patients with T2DM was negatively associated with medication adherence, and negatively associated with QoL, namely, the stronger the stigma, the worse the medication adherence and QoL. The results of the hierarchical regression analysis revealed that stigma independently explained 8.8% of the variation in medication adherence and 9.4% to 38.8% of the variation in QoL. The stigma of patients with T2DM was at a moderate degree and negatively correlated with medication adherence and QoL, it is necessary to pay more attention to relieve stigma and negative emotions timely, in order to improve patients' mental health and QoL.

Self-stigma in schizophrenia: a systematic review and meta-analysis of 37 studies from 25 high- and low-to-middle income countries

In schizophrenia, it is currently thought that stigma experience is increased by psychotic and depressive symptomatology, exposure to stigma at the workplace, and that self-stigma levels vary across countries without knowing the factors explaining these variations. The aim of the present meta-analysis was to synthetize the data of observational studies comprehensively exploring multiple self-stigma dimensions and associated factors. A systematic literature search without language or time restrictions was conducted in Medline, Google Scholar, and Web of Science for studies, last 09/2021. Eligible studies that included ≥80% of patients diagnosed with schizophrenia-spectrum disorders and used a validated scale measuring self-stigma dimensions were meta-analysed using random-effects models, followed by subgroup and meta-regression analyses. Study registration: PROSPERO CRD42020185030. Overall, 37 studies (n = 7717) from 25 countries (5 continents) published between 2007 and 2020 were included, with 20 studies conducted in high-income countries. These studies used two scales with total scores ranging 1-4. The mean estimate of perceived stigma was 2.76 [95% confidence interval (CI) = 2.60-2.94], experienced stigma 2.29 [95% CI = 2.18, 2.41], alienation 2.40 [95% CI = 2.29, 2.52], stereotype endorsement 2.14 [95% CI = 2.03, 2.27], social withdrawal 2.28 [95% CI = 2.17, 2.39] and stigma resistance 2.53 [95% CI = 2.43, 2.63]). Self-stigma levels did not reduce over time. Living outside urban areas, low-income, singleness, unemployment, high antipsychotic dose and low functioning were associated with different stigma dimensions. Some stigma dimensions were lower in studies carried out in Europe compared to other regions. Most studies published since 2007 report that self-stigma is a particular concern for a specific subgroup of patients. This subgroup is characterized by unemployment, high antipsychotic dose and low functioning. We identified important other missing factors that should be explored to improve the effectiveness of public policies and personalized interventions to reduce self-stigma. Importantly, classical illness severity indices (psychotic severity, age at illness onset, illness duration) and sociodemographic variables (age, sex and education) were not associated with self-stigma, moderating previous findings.

The effects of group-based cognitive behavioral therapy in the rehabilitation of patients with chronic schizophrenia with more than two years of community-based mental health group rehabilitation

BACKGROUND

Studies have shown that community-based group rehabilitation activities can have a positive impact on patients.

OBJECTIVE

This study attempted to improve schizophrenia patients' social and self-cognition through short-term group-based cognitive behavioral therapy (G-CBT), break negative coping styles, and improve the patients' quality of life.

METHODS

The patients with schizophrenia who participated in long-term community-based group rehabilitation were treated with G-CBT. Training on coping styles was conducted to improve their self-cognition and social cognition, and the rehabilitation effects of G-CBT on these patients were evaluated.

RESULTS

Compared with the control group, patient scores for self-esteem, self-efficacy, and positive coping in the G-CBT group increased, while patient scores for negative coping decreased. Compared with the control group, the differences in the total scores for mental health and the five dimensions of physical functioning, general health, vitality, social functioning, and emotional role function in the short-form (SF-12) survey were statistically significant. Compared with the baseline data, the differences in self-esteem, self-efficacy, positive coping, negative coping, and quality of life scores were statistically significant.

CONCLUSION

Short-term G-CBT had a good effect on patients with chronic schizophrenia who participated in community-based group rehabilitation for the long-term.

Predictors of Internalized Stigma in Patients with Schizophrenia in Northern Chile: A Longitudinal Study

The study aim was to longitudinally assess internalized stigma in a sample of patients from Northern Chile with a diagnosis of schizophrenia along with indicators of patient recovery, including quality of life, psychotic symptomatology, social cognition, premorbid adjustment, and years of untreated psychosis. The 10-year follow-up of stigma measures and predictors were assessed at public outpatient mental health centers in the city of Arica, Chile, during the months of March–July 2012. A total of 26 patients successfully completed the evaluation. The results revealed that, with the exception of the self-stigma subdimension, no clinically significant changes were seen in the trajectories of internalized stigma ratings between baseline and 10-year follow-up, underscoring the importance of assessing global components such as quality of life and premorbid adjustment during the process of internalizing stigma.

The clinical and psychosocial correlates of self-stigma among people with schizophrenia spectrum disorders across cultures: A systematic review and meta-analysis

BACKGROUND

Individuals with schizophrenia spectrum disorders (SSD) are at heightened risk of experiencing self-stigma, and some cultures are more stigmatizing towards SSD than others. The first purpose of this review is to provide an estimate of the relationship between self-stigma and clinical and psychosocial outcomes. The second purpose is to examine how these relationships vary across cultures.

METHOD

Studies reporting correlations between self-stigma and outcome variable(s) were identified through electronic database searches from June 1, 2021, to January 2, 2022. Mean effect sizes were calculated using Fisher's r-to-Z-transformation.

RESULTS

Sixty-three articles (N = 8925, 22 countries) were included in the systematic review and fifty-three articles (N = 7756) were included in the meta-analysis. For the most studied clinical correlates, self-stigma had a moderate, positive correlation with depressive symptoms (r = 0.49, p &lt; .001), a moderate, negative correlation with functioning (r = -0.39, p &lt; .001), and a positive, small correlation with severity of psychotic symptoms (r = 0.29, p &lt; .001), negative symptoms (r = 0.18, p &lt; .001) and positive symptoms (r = 0.13, p = .01). For the most studied psychosocial correlates, self-stigma had a strong, negative correlation with quality of life (r = -0.52, p &lt; .001) and self-esteem (r = -0.55, p &lt; .001). The correlates of self-stigma were similar across cultures.

DISCUSSION

Self-stigma shows strong to small correlations with clinical and psychosocial variables similarly across cultures. More research is needed to examine underlying mechanisms to develop effective interventions.

"Why I stay in community psychiatric rehabilitation": a semi-structured survey in persons with schizophrenia

AIMS

Although community psychiatric rehabilitation plays an important role in returning persons with schizophrenia to the society, many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study is aimed to explore the underlying causes of this trend and identify possible solutions.

METHODS

This study used a qualitative descriptive design to examine the persons with schizophrenia who stay in rehabilitation centers for longer periods of time. The researchers conducted semi-structured telephone interviews with the patients recruited through purposeful sampling. The audio-recorded interviews were transcribed in transcripts in Chinese. Thematic analysis was performed using Colaizzi's 7-step method.

RESULTS

Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society.

CONCLUSIONS

Persons with schizophrenia with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.

Cognitive Functioning and Its Relationship with Self-Stigma in Men with HIV Who Have Sex with Men: The Mediating Role of Health-Related Quality of Life

Introduction

The human immunodeficiency virus (HIV) stills remains a serious public health problem. HIV acquisition has several negative health consequences, such as a cognitive deterioration or health-related quality of life (HRQoL) impairment. Although these negative consequences could be directly related to a significant increase in self-stigma in this population, few previous studies have analysed the possible associations between these variables. This is especially the case in specific groups of people living with HIV, such as men who have sex with men who could be at a greater risk of stigmatisation. The main aim of the present study was to evaluate the association between cognitive functioning, HRQoL and self-stigma in a group of men with HIV who have sex with men.

Methods

The present study was conducted in the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). The final sample was composed of 70 participants who passed the inclusion and exclusion criteria. All were men with HIV who had sex with men and the sample’s mean age was 45 years. Each participant completed questionnaires on HRQoL and HIV self-stigma. Moreover, they completed an online cognitive assessment through the previously validated platform for cognitive evaluation CogniFit, Inc.

Results

The obtained results showed a significant association between memory functioning impairment, lower levels of HRQoL and higher HIV self-stigma scores. Hence, HRQoL, in the mental summary domain, was shown to be a significant mediator in the relationship between low memory performance and higher HIV self-stigma.

Discussion

Neurocognitive impairment could decrease HRQoL in men with HIV who have sex with men, and hence, reinforce the idea widespread in society that having HIV holds serious consequences. This fact, together with the reduced cognitive abilities to fight against their own self-stigma could represent plausible explanations of the obtained results. In this sense, intervention strategies, oriented towards reducing cognitive impairment, such as those based on cognitive training, and other psychological interventions to promote HRQoL could be effective approaches to prevent the negative effects of HIV self-stigma in this population.

Characteristics associated with self-reported medication adherence in persons with psychosis referred to psychosocial rehabilitation centers

The aim of the present study was to explore the characteristics of psychotropic treatment and of psychosocial functioning associated with self-reported medication adherence in persons with psychosis engaged in rehabilitation. The study was performed in the REHABase cohort including persons referred to a French network of psychosocial rehabilitation centers. Treatment adherence was assessed using the Medication Adherence Rating Scale (MARS). The associations between MARS score (categorized as "low" < 7 vs. "high" ≥ 7) and functioning or psychotropic treatment characteristics were explored using multivariate analyses in 326 participants with schizophrenia spectrum disorders. Regarding psychotropic treatment, high anticholinergic load was the only characteristic associated with poor medication adherence (adjusted OR, aOR 1.98, 95% CI 1.07-3.66). Regarding functioning measures, participants with poor medication adherence were more likely to present with lower stage of recovery (aOR 2.38, 95% CI 1.31-4.32), poor quality of life (aOR 2.17, 95% CI 1.27-3.71), mental well-being (aOR 1.68, 95% CI 1.03-2.72) and self-esteem (aOR 1.74, 95% CI 1.05-2.87), and higher internalized stigma (aOR 1.88, 95% CI 1.09-3.23). Self-reported poor medication adherence is a marker of poor functioning in persons with psychosis. The MARS is a quick and simple measure of adherence that may be helpful in clinical and rehabilitation settings to identify persons with specific rehabilitation needs.

Representaciones de la salud mental en dos diarios de circulación nacional en Perú

ANTECEDENTES

Los medios de comunicación son una de las fuentes que modelan las representaciones de la salud mental. Sólo un estudio previo realizado en Perú ha analizado las noticias sobre la salud mental en los medios de comunicación.

OBJETIVO

describir cómo se representa la salud mental en la prensa escrita de alcance nacional en el Perú.

MÉTODO

se utilizó la técnica de análisis de contenido. Se realizó una búsqueda de artículos a partir de una lista de términos relacionados con salud mental en 30 ediciones de dos diarios de circulación nacional del año 2016. Se identificaron 351 artículos, de los cuales se extrajo información sobre los términos de salud mental utilizados, el nivel de contenido de salud mental, la presencia de fuentes citadas, la inclusión de personajes y la valoración atribuida a estos.

RESULTADOS

271 artículos (77.21%) contenían términos referidos a salud mental, pero sin ser desarrollados, 51 (14.53%) abordaban la salud mental de manera parcial, y solo 29 (8.26%) lo hacían como tema principal. Entre los 80 artículos que abordaban la salud mental de manera parcial o principal, solo 32 (40%) citaban fuentes. Finalmente, de los 59 artículos que hacían referencia a personajes, 29 (49.15%) los describían de manera negativa.

CONCLUSIONES

la prensa escrita suele utilizar términos de salud mental, pero sin desarrollar el tema en profundidad. El uso de fuentes es infrecuente y no se cita a personas con afecciones de salud mental. Al describirlas, se destaca su inestabilidad y peligrosidad. Estos hallazgos sugieren que la prensa escrita podría contribuir al fortalecimiento del estigma relacionado con la salud mental.

Coronavirus Disease 2019-Related Stigma in China: A Descriptive Study

Coronavirus disease 2019 (COVID-19) tremendously impacts the physical and mental health of humans worldwide. Consequently, studies on COVID-19 remain extensive. However, most of them were mainly focused on the pathological mechanisms and treatment methods from medical perspectives. Various reports have indicated that COVID-19 is closely related to stigma and discrimination, but little statistical information has been integrated quantitatively to describe the situation in China. Thus, this study investigated the COVID-19-related stigma of individuals. We collected the online survey data from 1,920 Chinese participants from October to December 2020. Findings showed that 306 (15.94%), 285 (14.84%), 265 (13.80%), and 100 (5.21%) participants endorsed stigma toward individuals in high-risk areas, recovered patients with COVID-19, families of recovered patients with COVID-19, and frontline healthcare providers, respectively. To understand the possible factors that could impact the COVID-19-related stigma, knowledge about COVID-19 was investigated. Generally, knowledge about COVID-19 was negatively associated with COVID-19-related stigma in general, while no significant relationship existed between the knowledge about COVID-19 and the COVID-19-related stigma in the groups who had held COVID-19-related stigma. Ultimately, individuals showed COVID-19-related stigma toward recovered patients and their families, individuals in high-risk areas, and frontline healthcare providers to some extent. The results of this study can provide reference to nations, governments, and organizations in addressing the stigma issues raised by the COVID-19 pandemic.

Influence of Family Dynamics on Stigma Experienced by Patients With Schizophrenia: Mediating Effect of Quality of Life

Background: Stigma is a barrier to schizophrenia recovery; thus, screening the factors that affect stigma experienced by patients with schizophrenia and exploring the interactions between each factor are critical for improved treatment. The purpose of this study was to demonstrate the relationship between quality of life (QoL), family dynamics, and stigma in patients with schizophrenia. Methods: A total of 447 participants with schizophrenia were recruited in the study, namely, 281 community patients and 166 inpatients. Three scales, Schizophrenia Quality of Life Scale (SQLS), Self-rating Scale of Systemic Family (SSFD), and Stigma Scale for Mental Illness (SSMI), were, respectively, used to evaluate three variables: QoL, family dynamics, and stigma. The correlations between each factor in these three scales were evaluated by Spearman's rank correlation analysis. A mediation model was constructed to investigate whether QoL mediated the relationship between stigma and family dynamics. Results: Correlation analysis revealed that most variables in these three scales correlated significantly with each other. Mediational regression analyses indicated that the degree of stigma was affected by family dynamics; that is, good family dynamics predicted less stigma. Surprisingly, we found that a worse QoL was associated with less stigma, and this led to good family dynamics being related to a worse QoL. These findings further suggested that QoL had a mediating effect on the relationship between family dynamics and stigma. Conclusions: This study suggested that more attention should be focused on the multifactorial influence of stigma on patients with schizophrenia. Integrated and personalized interventions regarding QoL and family dynamics can be tailored for patients with schizophrenia to reduce self-stigma.