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Swistak MSc Z, Sookoo Ma S, Jewell PhD T. Integrating Subjective Recovery and Stigma Resistance in Individuals with Schizophrenia: A Narrative Review and Theoretical Integration. Issues Ment Health Nurs 2024; 45:537-551. [PMID: 38684074 DOI: 10.1080/01612840.2024.2341049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Stigmatised attitudes are known to be associated with negative outcomes in schizophrenia, yet there is little focus on the role of stigma in the recovery process. Attempts to develop interventions to reduce self-stigma in schizophrenia have not been found effective. This paper presents a theoretical integration based on a narrative review of the literature. PsycINFO, Medline and Embase databases were searched up to the 11th December 2023. Studies were included if they were: i) empirical studies using qualitative, quantitative or mixed methods studies investigating mental health stigma; ii) included participants based in the United Kingdom, fluent in English, between the ages of 16 and 70, meeting criteria for a schizophrenia spectrum diagnosis. Fourteen studies were included. In Part 1, we propose a novel theoretical model derived from a synthesis of service-user perspectives on the relationship between stigma and schizophrenia. Stigmatised attitudes were commonly perceived to be caused by a lack of education and further exacerbated by disinformation primarily through the media and cultural communities. Stigma led to negative self-perceptions, negative emotional responses, social isolation and increased symptom severity, ultimately acting as a barrier to recovery. In Part 2, we identify several factors that ameliorate the impact of stigma and promote clinical and subjective recovery among service-users: education, empowerment, self-efficacy, self-acceptance, hope and social support. We argue that the notion of stigma resistance may be helpful in developing new interventions aimed at promoting recovery in individuals with schizophrenia. Wider implications are discussed and recommendations for future research and practice are explored.
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Affiliation(s)
- Zosia Swistak MSc
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- The Nightingale Hospital, London, UK
| | - Susan Sookoo Ma
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Tom Jewell PhD
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Narita Z, Hazumi M, Kataoka M, Usuda K, Nishi D. Association between discrimination and subsequent psychotic experiences in patients with COVID-19: A cohort study. Schizophr Res 2024; 267:107-112. [PMID: 38531157 DOI: 10.1016/j.schres.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 01/20/2024] [Accepted: 03/17/2024] [Indexed: 03/28/2024]
Abstract
Although cross-sectional studies have suggested that discrimination has a negative impact on the mental health of patients with COVID-19, no cohort studies with longitudinal data have established a causal relationship. Therefore, this study aimed to investigate the association between COVID-19-related discrimination and subsequent psychotic experiences in individuals who had contracted the disease. Secondary outcomes were PTSD symptoms, psychological distress, and suicidal ideation. We utilized inverse probability weighting and marginal structural models with robust standard errors to analyze the association, accounting for confounders and loss to follow-up. In a sensitivity analysis, we evaluated the robustness of the estimates to potential unmeasured confounding by analyzing E-values. Of 7760 participants who had contracted COVID-19, 5971 were included after excluding those with missing sociodemographic data. Of these, 1736 (29.1 %) reported experiencing COVID-19-related discrimination. Of the 2559 participants who completed the study, 253 (9.9 %) reported having at least one psychotic experience. Participants who reported experiencing any COVID-19-related discrimination showed a higher risk of subsequent psychotic experiences compared with participants without such discrimination (risk difference 6.6 %, 95 % CI 4.0 %-9.9 %; risk ratio 1.82, 95 % CI 1.42-2.47). A negative impact was also found in suicidal ideation, PTSD symptoms, and psychological distress. E-values demonstrated the robustness of some of the observed associations to unmeasured confounding. The study found that COVID-19-related discrimination was associated with subsequent psychotic experiences and other mental health outcomes in individuals who had contracted the disease. A study focusing on prevention strategies, such as an anti-discrimination campaign, is warranted.
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Affiliation(s)
- Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Megumi Hazumi
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Mayumi Kataoka
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Kentaro Usuda
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Daisuke Nishi
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan; Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan.
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Liu ZJ, Feng LS, Li F, Yang LR, Wang WQ, He Y, Meng ZT, Wang YF. Development and validation of the thyroid cancer self-perceived discrimination scale to identify patients at high risk for psychological problems. Front Oncol 2023; 13:1182821. [PMID: 37534245 PMCID: PMC10391158 DOI: 10.3389/fonc.2023.1182821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Objective To develop a Thyroid Cancer Self-Perceived Discrimination Scale (TCSPDS) to identify patients at high risk for psychological problems and to test its reliability, validity and acceptability. Methods Using classical test theory, a total of 176 thyroid cancer patients from November 2021 to October 2022 were recruited to develop the TCSPDS. Item analysis was used to improve the preliminary TCSPDS. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation model (SEM) were used to test the construct validity of the final TCSPDS. Pearson correlation coefficient was used to analyze the validity coefficient between TCSPDS and EORTC QLQ-C30 to test the criterion-related validity (CRV) of the final TCSPDS. The internal consistency coefficient (Cronbach's alpha coefficient), split half reliability (Spearman-Brown coefficient) and test-retest reliability were used to verify the reliability of the final TCSPDS. The questionnaire completion time and effective response rate were used to validate the acceptability of the final TCSPDS. Results The TCSPDS consisted of 20 items and was divided into 3 subscales: 8 items for stigma, 6 items for self-deprecation, and 6 items for social avoidance. The TCSPDS had good validity (χ2/df=1.971, RMSEA=0.074, GFI=0.921, CFI= 0.930, IFI=0.932, TLI=0.901, Validity coefficient=0.767), reliability (Cronbach's alpha=0.867, Spearman-Brown coefficient=0.828, test-retest reliability coefficient=0.981) and acceptability [average completion time (15.01 ± 1.348 minutes) and an effective response rate of 95.14%]. Patients with higher TCSPDS scores reported a lower quality of life (P<0.05). Conclusion The TCSPDS could be used for early identification and assessment of the level of self-perceived discrimination in patients with thyroid cancer, which may provide a scientific basis for health education, social support and psychosocial oncology services in the future, especially in Southwest China.
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Affiliation(s)
- Zhi-jin Liu
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Lin-sen Feng
- Department of Hematology, The Sixth Affiliated Hospital of Kunming Medical University-Yuxi People’s Hospital, Yuxi, China
- Department of Hematology, General Medical College of Kunming Medical University, Kunming, China
| | - Feng Li
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Li-rong Yang
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Wan-qi Wang
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Yuan He
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Zong-ting Meng
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
| | - Yu-feng Wang
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University - Yunnan Cancer Hospital, Kunming, China
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Kingston JL, Schlier B, Lincoln T, So SH, Gaudiano BA, Morris EMJ, Phiri P, Ellett L. Paranoid Thinking as a Function of Minority Group Status and Intersectionality: An International Examination of the Role of Negative Beliefs. Schizophr Bull 2023; 49:1078-1087. [PMID: 36940411 PMCID: PMC10318883 DOI: 10.1093/schbul/sbad027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
BACKGROUND Paranoia is higher in minority group individuals, especially those reporting intersecting aspects of difference. High negative and low positive self and other beliefs, and low social rank, are predictive of paranoia overtime; however, data are typically from majority group participants. This study examined whether social defeat or healthy cultural mistrust best characterizes paranoia in minority groups. STUDY DESIGN Using cross-sectional, survey design, with a large (n = 2510) international sample, moderation analyses (PROCESS) examined whether self and other beliefs, and perceived social rank, operate similarly or differently in minority vs majority group participants. Specifically, we tested whether beliefs moderated the influence of minority group, and intersecting aspects of difference, on paranoia. STUDY RESULTS Paranoia was consistently higher in participants from minority vs majority groups and level of paranoid thinking was significantly higher at each level of the intersectionality index. Negative self/other beliefs were associated with elevated paranoia in all participants. However, in support of the notion of healthy cultural mistrust, low social rank, and low positive self/other beliefs were significantly associated with paranoia in majority group participants but unrelated to paranoia in respective minority group members. CONCLUSIONS Although mixed, our findings signal the need to consider healthy cultural mistrust when examining paranoia in minority groups and bring into question whether "paranoia" accurately describes the experiences of marginalized individuals, at least at low levels of severity. Further research on paranoia in minority groups is crucial to developing culturally appropriate ways of understanding people's experiences in the context of victimization, discrimination, and difference.
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Affiliation(s)
- J L Kingston
- Department of Psychology, Royal Holloway, University of London, Bowyer, UK
| | - B Schlier
- University of Hamburg, Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - T Lincoln
- University of Hamburg, Institute for Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146, Hamburg, Germany
| | - S H So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - B A Gaudiano
- Department of Psychiatry & Human Behavior, Brown University and Butler Hospital, Providence, RI, USA
| | - E M J Morris
- School of Psychology & Public Health, La Trobe University, Bundoora, Melbourne, Australia
| | - P Phiri
- Southern Health NHS Foundation Trust, Botley Rd, West End, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - L Ellett
- School of Psychology, University of Southampton, Southampton, UK
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Monshouwer K, Ten Have M, Tuithof M, van Dorsselaer S, Bak M, Gunter N, Delespaul P, van Os J, de Graaf R. Prevalence, incidence, and persistence of psychotic experiences in the general population: results of a 9-year follow-up study. Psychol Med 2023; 53:3750-3761. [PMID: 36117284 DOI: 10.1017/s0033291722002690] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) frequently occur and are associated with a range of negative health outcomes. Prospective studies on PEs are scarce, and to date no study investigated PE prevalence, incidence, persistence, their risk indicators, and psychiatric comorbidity, in one dataset. Furthermore, most studies are based on self-report, and it is unclear how this compares to clinical interviews. METHODS Data are used from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a psychiatric cohort study among a representative sample of adults (baseline characteristics: N = 6646; 49.6% female; 18-64 years). Results are presented for self-reported and clinically validated PEs. Associations are assessed for mental disorders, socio-demographic, vulnerability, physical health, and substance use factors. RESULTS Based on self-report, at baseline 16.5% of respondents had at least one PE in their lifetime, of those, 30.1% also reported a PE at 3-year follow-up. 4.8% had a first PE at 3-year follow up. The 3-year prevalence of PE was associated with almost all studied risk indicators. Generally, the strongest associations were found for mental health disorders. Prevalence and incidence rates were two to three times higher in self-report than in clinical interview but results on associated factors were similar. CONCLUSIONS Validated prevalence and incidence estimates of PE are substantially lower than self-reported figures but results on associated factors were similar. Therefore, future studies on associations of PEs can rely on relatively inexpensive self-reports of PEs. The associations between PE and mental disorders underline the importance of assessment of PE in general practice.
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Affiliation(s)
- Karin Monshouwer
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Margreet Ten Have
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Marlous Tuithof
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Saskia van Dorsselaer
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- FACT, Mondriaan, Heerlen/Maastricht, The Netherlands
| | - Nicole Gunter
- School of Psychology, Open University, Heerlen, The Netherlands
| | - Philippe Delespaul
- School for Mental Health & Neurosciences, Maastricht University, Maastricht, The Netherlands
- Mondriaan, Heerlen, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department Psychiatry, UMC Utrecht Brain Center, Utrecht, The Netherlands
- King's Health Partners Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Ron de Graaf
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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