Internalized stigma as a barrier to improvement in vocational functioning among people with schizophrenia-spectrum disorders

The Mediating and Moderating Role of Resilience Between Stigma and Illness Identity Among People with Inflammatory Bowel Disease

Background

Stigma is assumed to lead to negative illness identity in one who got chronic illness, and there is a lack of understanding regarding the underly mechanisms. However, no research has examined the extent to which stigma was associated with illness identity in people with IBD. Therefore, we investigated the relationship between stigma and illness identity, specifically to examine whether resilience mediated or moderated the relationship.

Methods

A cross-sectional study was performed among patients diagnosed with inflammatory bowel disease from three tertiary hospitals in Jiangsu Province, China. Measurement instruments included the Stigma Scale for Chronic Illness (SSCI), the Resilience Scale for Patients with Inflammatory Bowel Disease (RS-IBD), and the Illness Identity questionnaire (IIQ). Mediation and moderated mediation analyses were conducted.

Results

A total of 322 patients with IBD were involved in the current study. We observed that there was a strong connection between stigma and rejection and engulfment. Moreover, resilience played a partial or complete mediating role in stigma and engulfment, acceptance and enrichment, and resilience moderates the relationship between stigma and rejection.

Conclusion

The current study examined whether resilience mediated or moderated the relationship between stigma and illness identity. These finding add to the theoretical basis of how stigma influences illness identity and help guide the resilience into engulfment reduction programs for IBD.

Validity and reliability of the Persian version of Recce stigma scale in people with multiple sclerosis and its impact on quality of life

BACKGROUND

There is often a fear of social stigma experienced by people with multiple sclerosis (pwMS), which negatively impacts the quality of their lives (QoL). Currently, no Persian-validated questionnaire is available to assess this issue in pwMS. This study aimed to assess the validaty and reliability of the Persian version of Reece Stigma Scale Multiple Sclerosis (RSS-MS) questionnaire for pwMS.

METHOD

This cross-sectional was conducted between January and February 2023 in Isfahan, Iran. The demographic and clinical information and the RSS-MS and Multiple Sclerosis Impact Scale-29 (MSIS-29) questionnaires were recorded from pwMS. The content validity index (CVI) and content validity ratio (CVR) have been used to evaluate validity. To identify the factors supporting the MS-related stigma, an exploratory factor analysis (EFA) was conducted.

RESULTS

The present study recruited 194 pwMS. Based on factor analysis, only two factors had eigenvalues ≥ 1.0 and exhibited high internal consistency. The Cronbach's α coefficient for internal consistency of the RSS-MS scale was 0.822. More evidence for the construct validity suggested that having higher levels of stigma is significantly correlated with psychological (r = 0.468, p-value < 0.001) and physical dimensions (r = 0.585, p-value < 0.001) of MSIS-29. Expanded Disability Status Scale, disease duration, and treatment duration did not show a significant correlation with stigma (p-value > 0.05).

CONCLUSION

This study indicated that the modified version of the RSS-MS scale in the Persian language showed acceptable validity and reliability for evaluating the stigma among Persian pwMS. Furthermore, this study emphasizes the cruciality of monitoring and addressing stigma among pwMS, as it can potentially enhance medical, psychological, physical, and QoL outcomes.

Beyond One's Attitude Toward the Self: The Role of Social Anxiety in Self-Stigma Among Individuals With Schizophrenia

ABSTRACT

Self-stigma is associated with a variety of negative self-perceptions among people coping with schizophrenia, as well as with different aspects of social behaviors. We explored the associations between self-compassion, self-esteem, social anxiety, and self-stigma among people coping with schizophrenia. The baseline data of 56 adults with schizophrenia who were enrolled in a Metacognitive Reflection and Insight Therapy trial were used. Participants filled out self-report questionnaires measuring self-compassion, self-esteem, social anxiety, and self-stigma. Self-esteem and self-compassion were negatively correlated with self-stigma and social anxiety. Self-compassion was not found to contribute beyond self-esteem to the prediction of self-stigma. Importantly, self-esteem and social anxiety were found to mediate the effects of self-compassion on self-stigma. Thus, it seems that social variables, in addition to self-variables, may lead to the formation of self-stigma among people with schizophrenia. Therefore, alongside addressing self-esteem and self-compassion, integrating therapeutic elements related to coping with social anxiety into interventions would seem to be an important factor in reducing self-stigma among people with serious mental illness.

Associations of internalized stigma with psychosocial functioning and quality of life in people with schizophrenia

BACKGROUND

Schizophrenia is associated with poor functional recovery. Internalized stigma is one of the factors related to the functioning of individuals with schizophrenia. We aimed to investigate whether internalized stigma was associated with subjective and objective recovery-related outcomes after controlling for neurocognition and other important confounders in individuals with schizophrenia.

METHOD

We assessed the socio demographic background, psychopathology, neurocognition, internalized stigma, psychosocial functioning, and quality of life of 86 patients who had schizophrenia. Correlation analyses and multiple linear regression were used to investigate the association of internalized stigma and other variables with recovery-related outcomes.

RESULTS

We found that the negative symptom scores of the Positive and Negative Syndrome Scale but not internalized stigma was associated with psychosocial functioning as measured by the Personal and Social Performance global score. In contrast, internalized stigma was associated with the Psychological, Social relationships, and Environment scores of the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF). Depression was also associated with the Physical health, Psychological, and Social relationships sores of the WHOQOL-BREF.

CONCLUSIONS

While internalized stigma was associated with several domains of quality of life, it was not associated with clinician-rated psychosocial functioning. The effects of internalized stigma on the subjective and objective recovery-related outcomes of individuals with schizophrenia might be divergent.

"The Best of Both Worlds": Experiences of young people attending groups co-facilitated by peer workers and clinicians in a youth mental health service

AIM

Groups facilitated by peer workers have been shown to be effective in improving recovery-related outcomes in adult populations. However, limited research has explored the involvement of peer workers in groups in youth mental health services. This qualitative study aimed to explore young people's experiences of participating in groups co-facilitated by youth peer workers and clinicians.

METHODS

Semi-structured interviews were conducted with 13 young people aged 15-25 years who had attended groups conducted in-person and online at a tertiary youth mental health service. Young people were receiving individual support through the service for a range of mental health concerns. Groups were conducted by two clinicians and a youth peer worker who had used the same service and had undergone training in Intentional Peer Support®. An inductive approach using open, process, in vivo and pattern coding was used to identify key themes. Concept mapping was used to explore the relationships between them.

RESULTS

Nine overarching themes were identified that highlighted the unique and complementary contributions of youth peer worker and clinician roles. The sharing of lived experience by youth peer workers facilitated young people's engagement in group discussions, hope for the future, and sense of belonging, whereas clinical input created a sense of safety, structure and purpose.

CONCLUSIONS

These findings support the value of a co-facilitation model in improving the engagement and recovery outcomes for young people experiencing mental health challenges.

Correlates and predictors of perceived stigma and self-stigma in Chinese patients with psychosis

AIMS

In patients with psychosis, perceived stigma (i.e., beliefs about discriminative viewpoints held by the public) and self-stigma (i.e., internalization of such perceived stereotypes) could have devastating consequences. Knowledge about their correlates bears importance for understanding individual differences in stigma experiences, and further, given the social nature of stigma, Asians may show more distinctive features than Westerners.

METHODS

A total of 142 Chinese patients who originally enrolled into a randomized controlled trial during their first-episode psychosis were followed up at 10 years. We explored potential demographics, clinical and psychosocial correlates of perceived stigma and self-stigma.

RESULTS

Stepwise multiple regression analyses indicated that both perceived- and self-stigma were predicted by a more negative attitude to treatment, whereas differential factors including perceived recovery predicted perceived stigma, and quality of life and attention predicted self-stigma.

CONCLUSIONS

These results can help identify individuals susceptible to experiencing perceived- or self-stigma, highlighting the need to consider factors such as attitude towards treatment when designing anti-stigma strategies.

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.

Unpacking stigma: Meta-analyses of correlates and moderators of personal stigma in psychosis

Personal stigma entails perceived, experienced and internalised stigmatisation. Mental Health stigma has been widely researched across a range of countries and a meta-analysis of their associations and moderators in psychosis is timely. Meta-analyses were conducted examining the correlates and moderators of personal stigma in terms of: (1) demographic variables (2) illness related variables (3) symptoms/negative outcomes, and (4) aspects of wellbeing. Associations were obtained from a total of 216 records. Several demographic factors including age, economic status, employment, and rural residence had small associations with aspects of personal stigma (r's = 0.12 to -0.13). Personal stigma aspects were inversely related to medication adherence (r's = -0.20, -0.21), and positively associated with insight and number of hospitalisations (r's = 0.09-0.19). Most symptoms were positively associated with personal stigma (r's = 0.10-0.43), whereas inverse relations with wellbeing variables were identified (r's = -0.13 to -0.54). Moderator effects emerged including that of cultural setting and sex, age and education level, highlighting the role of cultural and demographic factors in shaping personal stigma aspects in psychosis. The present study also highlights the importance of recognizing the negative effect of actual stigma and discrimination experiences; particularly its detrimental impact on self-image and its complex role in shaping the internalisation of societal stigma.

Vocational identity of veterans with co-occurring mental health and substance use disorders

BACKGROUND: No studies have examined vocational identity among individuals with co-occurring mental health and substance use disorders. OBJECTIVE: Influenced by Blustein’s relational theory of working (2011), this study examined the relationships between several social-environmental variables (external/relational conflicts, employment barriers, substance abuse stigma) and vocational identity. METHODS: Eighty-four veterans receiving treatment from the Veterans Health Administration (VHA) for co-occurring mental health and substance use disorders participated in this survey study. RESULTS: Education, employment, clinical, disability, and substance abuse factors were not associated with vocational identity, but external/relational conflicts, employment barriers, and substance abuse stigma were. Multiple regression analysis found that these variables accounted for 34%of the variance in vocational identity and that external/relational conflicts was the only significant predictor. CONCLUSIONS: Findings suggest that more conflictual messages about work from external/relational sources is related to less clarity around one’s vocational interests, goals, and talents.

Mental health stigma and emotional face processing: An ERP study

This study takes the first step toward developing an event-related potential (ERP) measure of bias toward people with mental illnesses. We recorded participants' EEGs while they viewed happy and angry faces; they were told half of the people in the photos were mentally healthy while the other half had a diagnosis of schizophrenia, which was indicated by the color of the frame around each face. Afterward, participants rated how dangerous each face looked to them. Participants rated faces with the schizophrenia designation as more dangerous than those designated as mentally healthy. There were significant interactions between facial expression and mental health label for both the early N170 and later P3 amplitudes. Angry expressions elicited larger N170s than happy ones, but only for faces with the schizophrenia label. Thus, angry faces with the schizophrenia designation appeared to be particularly salient and automatically grabbed our participants' attention, at least initially. In contrast, happy faces with the schizophrenia label elicited larger P3s than those with the mentally healthy designation. This finding suggests that later attentional processes were recruited more when someone with a diagnosis of schizophrenia looked happy, perhaps indicating that participants found this surprising.

Working in disability employment: An interpretative phenomenological study of experiences of people with a diagnosis of schizophrenia

Aim

To understand how employees with schizophrenia in disability employment interpret their work experience.

Method

Nine people with schizophrenia were interviewed. Data were analysed with the interpretative phenomenological analysis.

Results

All participants regarded themselves as ‘persons with mental illness’. Some participants developed their mental illness identity by realising that working without accommodations is difficult. Although participants found working in the current company comfortable because the supervisors provided appropriate accommodations, they were dissatisfied with low salary. A proportion of the participants felt dissatisfaction with the menial work, which led to low levels of self-esteem as they viewed non-disability employment of higher value. In addition, the present study noted a difference between self-labelling and labelling by others; although participants regarded themselves as ‘persons with mental illness’, they felt reluctant to be viewed as such by others. Most of the participants wanted to work in non-disability employment in future for financial and personal reasons, such as to increase self-esteem.

Conclusion

It is imperative that benefits and other issues in disability employment for people with psychosocial disability relating to mental illness are explored more broadly in future research. Further, employers must create healthy workplaces, for all employees regardless of disability can benefit from it.

Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences

Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma-including from mental health providers-predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy.

Support for the social-cognitive model of internalized stigma in serious mental illness

One prominent social-cognitive model of internalized stigma by Corrigan and his colleagues (2012; 2002) proposes that individuals are exposed to societal stereotypes about mental illness, at least tacitly agree with them, and may apply them to oneself, engendering harmful self-beliefs. There is limited empirical support for this model in serious mental illness. Moreover, it is not clearly established how internalized stigma and its associated factors impact recovery in this population. The current study uses structural equation modeling (SEM) to assess the social-cognitive model's goodness of fit in a sample of Veterans with serious mental illness (Veteran sample, n = 248), and then validates the model in a second and independent sample of individuals receiving community-based psychiatric rehabilitation services (community sample, n = 267). Participants completed the Self-Stigma of Mental Illness Scale (SSMIS; Corrigan et al., 2006) and measures of self-esteem, self-efficacy, and recovery attitudes. Consistent with Corrigan and colleagues' formulation of internalized stigma, SEM analyses showed a significant indirect pathway from stereotype awareness, to stereotype agreement, to application to self, to self-esteem decrement, to poorer recovery attitudes. Additionally, there was a significant direct effect from stereotype awareness to self-esteem. This study shows that individuals with serious mental illness experience psychological harm from stigma in two ways: (1) through perceived public prejudice and bias, and (2) through internalizing these negative messages. In particular, stigma harms individuals' self-esteem, which then reduces their recovery attitudes.

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

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.

Self-stigma in psychotic disorders: Clinical, cognitive, and functional correlates in a diverse sample

Self-stigma in mental illness is linked to negative clinical and functional outcomes, but little is known about its correlates specifically in psychotic disorders. Here we investigated the role of clinical symptoms, cognition, and vocational status as correlates of self-stigma in 98 individuals with psychotic disorders (36 Black American, 32 White Hispanic, 11 White Non-Hispanic, 11 Asian American). A principal component analysis of the Internalized Stigma of Mental Illness scale yielded three components: Experiential Stigma, Stereotype Endorsement, and Stigma Resistance. Higher Experiential Stigma was associated with greater severity of affective symptoms and lower vocational status. Higher Stigma Resistance was associated with higher social and non-social cognition, and higher vocational status. Stereotype Endorsement did not significantly correlate with any predictor variable. Linear regression models showed that 13% of the variance in Experiential Stigma was explained by affective symptoms and vocational status, and 20% of the variance in Stigma Resistance was explained by non-social cognition and vocational status. These findings provide new information about the correlates of self-stigma in an ethnically and racially diverse psychotic disorder sample. Such information may lead to a better understanding of self-stigma mechanisms in this population.

The Ending Self-Stigma for Posttraumatic Stress Disorder (ESS-P) Program: Results of a Pilot Randomized Trial

Experiences of and concerns about encountering stigma are common among veterans with posttraumatic stress disorder (PTSD). One common and serious consequence is self-stigma, which is when an individual comes to believe that common negative stereotypes and assumptions about PTSD are true of oneself. The current study was a pilot randomized trial that evaluated the feasibility, acceptability, and preliminary outcomes of the Ending Self-Stigma for PTSD (ESS-P) program, a nine-session group intervention that aims to assist veterans with PTSD learn tools and strategies to address stigma and self-stigma. Veterans (N = 57) with a diagnosis of PTSD who were receiving treatment in U.S. Veterans Health Administration outpatient mental health programs were recruited. Participants were randomized to either ESS-P or minimally enhanced treatment as usual and assessed at baseline and after treatment on clinical symptoms, self-stigma, self-efficacy, recovery, and sense of belonging. Information on mental health treatment utilization for the 3 months before and after group treatment was also collected. Compared to controls, there was a significant decrease in self-stigma, d = -0.77, and symptoms of depression, d = -0.76, along with significant increases in general and social self-efficacy, ds = 0.73 and 0.60, respectively, and psychological experience of belonging, d = 0.46, among ESS-P participants. There were no differences regarding recovery status or changes in treatment utilization. The results of the pilot study suggest that participation in ESS-P may help reduce self-stigma and improve self-efficacy and a sense of belonging in veterans with PTSD.

How much 'lived experience' is enough? Understanding mental health lived experience work from a management perspective

Objective The aim of this study was to explore management understanding of the lived experience required for designated lived experience or peer roles within mental health. Method This qualitative study used semi-structured interviews and one focus group with 29 participants employed in diverse management roles from the public and not-for-profit health and community sector in Queensland, Australia. Results The findings indicate a lack of consensus in defining 'lived experience', including what lived experience is required to be eligible for designated roles. Although some participants were clear on what designated roles added to the workforce, uncertainty and attempts to avoid stigma led to some participants questioning the need for designated roles. Conclusion This study suggests the ongoing expansion of the lived experience workforce is affected by challenges in defining 'lived experience' as a requirement for designated roles and fears regarding stigmatised identities. What is known about the topic? In the mental health sector, opportunities and challenges exist in attempting to effectively incorporate the emerging lived experience or peer workforce. Research has highlighted the need for support from senior management, the need for role clarity and the risk of 'othering' for the lived experience workforce. What does this paper add? This paper responds to the gap in existing research on the experiences of management in defining and articulating their understanding of lived experience and potential impact of uncertainty and inconsistency in understanding for the lived experience workforce. What are the implications for practitioners? This study identifies the need to strengthen management understanding of lived experience to facilitate ongoing development of lived experience roles.

The impact of illness identity on recovery from severe mental illness: A review of the evidence

The "Illness Identity" model proposed that self-stigma impacts hope and self-esteem and subsequently leads to a cascade of negative effects on outcomes related to recovery among people diagnosed with severe mental illnesses. The purpose of the present review is to take stock of research support for the model. The citation index SCOPUS was reviewed for all papers published in peer-reviewed journals in English between 2010 and 2019 citing one of the initial 3 articles discussing the model: 111 studies met inclusion criteria and were reviewed. The most frequently tested, and supported, aspects of the model were relationships between self-stigma and self-esteem, hope, psychiatric symptoms and social relationships. Least frequently studied areas were relationships with suicide, avoidant coping, treatment adherence and vocational functioning, although they were supported in the majority of studies. The "insight paradox" was also tested in a relatively small number of studies, with mixed results. Findings were robust to geographic location of study, method, and subpopulation studied. Findings indicate that a large body of research has tested, and largely supported, the various components of the Illness Identity model, although some components need further investigation and there is a need for more comprehensive tests of the model.

The self-stigmatization of patients with schizophrenia: A phenomenological study

This study aimed to explore the self-stigma of schizophrenia patients. Qualitative phenomenological approach, purposive sampling and unstructured one-on-one interviews were used. Narratives were analyzed using Colaizzi's method. Data saturation was reached after 15 had been interviewed. Three themes and six sub-themes were revealed: the origin of the self-stigma (experience of self-stigma from the outside and the inside), the suffering experience of self-stigma (alienation from others and negative inner feelings), and coping with the self-stigma (acceptance and change of mind). The study supports the importance to increase awareness of self-stigma and suggests effective measures to help patients deal with this challenge.

Coping with information style and family burden: Possible roles of self-stigma and hope among parents of children in a psychiatric inpatient unit

Objective

Parents of children who are hospitalized in inpatient psychiatric units must cope with significant challenges. One of these challenges relates to the way in which they cope with illness-related information. The current study examined the relationship between two such coping styles – monitoring and blunting – and family burden among parents of children in a psychiatric inpatient unit. Moreover, the possible moderating roles played by hope and self-stigma in these associations were also examined.

Methods

Questionnaires regarding coping with information style, self-stigma, hope and family burden were administered to 70 parents.

Results

A main positive effect of hope and a main negative effect of self-stigma were uncovered. An interaction between self-stigma and monitoring was also revealed, suggesting that for parents with high self-stigma, compared to those with low self-stigma, more monitoring was related to more burden.

Conclusions

Tailoring family interventions according to coping style and self-stigma is highly recommended as a mean to reduce the family burden of parents whose child is hospitalized in a psychiatric inpatient unit.

A factor analytic evaluation of the Self-Stigma Scale-Short (SSS-S) among psychosocial clubhouse members in the United States

The main purpose of this study was to examine the factor structure, the internal consistency, and other aspects of validity of the English version of the Self-Stigma Scale-Short (SSS-S). In the present study, the SSS-S was assessed in a sample of 194 adults with psychiatric disabilities from four Psychosocial Clubhouses in the Southern and Midwestern United States. Exploratory factor analysis (EFA; n = 98) supported a one-factor structure of the SSS-S, which accounted for 59% of the variance. Confirmatory factor analysis (CFA; n = 96) demonstrated that the factor structure of the SSS-S was satisfactory. The scale was also reliable, with a Cronbach's alpha of 0.93 and 0.91 for the EFA and CFA samples, respectively. The SSS-S showed adequate convergent and criterion-related validity, as indicated by statistically significant positive correlations between internalized stigma with perceived societal stigma, symptom severity, and functional impairment, as well as negative correlations between internalized stigma with perceived social self-efficacy, social support, and resiliency. Overall, these findings support the English version of the SSS-S as a valid and reliable tool for determining the internalized stigma of adults with psychiatric disabilities in clinical settings and similar research.

Correlates of internalized stigma levels in people with psychosis in the Czech Republic

BACKGROUND

Internalized stigma negatively affects lives and prognosis of individuals with psychosis.

AIM

This study aimed to identify correlates of internalized stigma among individuals with psychosis in a sample of community care users in the Czech Republic.

METHODS

A cross-sectional study was conducted among 133 community service users with psychosis. A shortened version of the Internalized Stigma of Mental Illness (ISMI-10) scale was used alongside the 5-level EQ-5D version (EQ-5D-5L), assessing health-related quality of life. Descriptive and linear regression analyses were performed in order to determine levels of internalized stigma and its correlates.

RESULTS

High levels of internalized stigma were reported in 25% of participants. Lower internalized stigma levels were associated with better self-reported health status and being married, and higher internalized stigma with a longer period of time since initial contact with psychiatric care.

CONCLUSION

Lower internalized stigma levels are associated with better self-reported health-related quality of life. In addition, clients having used psychiatric care for longer periods of time reported significantly higher internalized stigma levels. Therefore, authors suggest self-stigma reduction interventions based in a community setting with an emphasis on targeting clients with chronic psychosis.

The adaptation and validation of a stigma measure for individuals with multiple sclerosis

Purpose: Stigma negatively impacts quality of life for individuals with multiple sclerosis. Availability of instruments to assess levels of stigma are crucial for monitoring and targeted intervention. The study aims to adapt the Reece Stigma Scale for use with this specific population and examine its reliability and validity.Methods: The scale was administered the 137 participants included in a larger study on identity and multiple sclerosis. Validity was evaluated utilizing the Downing model, as well as assessing potentially related constructs, including adherence, depression, anxiety, quality of life, self-efficacy, and post-traumatic growth.Results: Principal component analysis revealed a one factor solution with excellent internal consistency. Additional construct support offered evidence that higher levels of stigma are related to lower adherence and self-management efficacy, higher levels of anxiety and depressive symptoms, as well as more dissatisfaction with quality of life.Conclusions: This study provides preliminary support for an adapted version of the Reece Stigma Scale, specific to the multiple sclerosis population. The validation data suggests strong psychometric properties. Our findings underscore the clinical importance of measuring and addressing stigma among these patients, with the potential to improve medical (i.e., adherence), psychological (i.e., depression and anxiety), and quality of life outcomes.Implications for rehabilitationUnderstanding stigma-related experiences is crucial to enhance psychosocial factors related to multiple sclerosis.Stigma-related experiences also impact disease treatment outcomes for individuals with multiple sclerosis.The Reece Stigma Scale is a valid and reliable measure of felt stigma created for use in HIV populations. This study adapted and validated the use of the scale among individuals with multiple sclerosis.Clinicians and researchers working within the rehabilitation and treatment area of multiple sclerosis may benefit from using the adapted Reece Stigma Scale to measure and address stigma experiences.

Neural and cognitive correlates of stigma and social rejection in individuals with Serious Mental Illness (SMI): A systematic review of the literature

Stigma and self-stigma are major issues for people with Serious Mental Illness (SMI). This review's aims were to determine the cognitive and neural processes underlying the effects of stigma and social rejection in people with SMI. A stepwise systematic literature review (PRISMA) was conducted by searching PubMed, Medline and Web of Science using the following keywords: "cyberball" OR "stereotype threat" OR "implicit association test" AND "mental illness". The articles included met the following criteria: (a) reporting on social rejection, stigma or self-stigma (b) diagnosis of SMI (c) available data on the underlying mechanisms. Our search on July 31th 2018 found in 955 articles on PubMed and 3,362 on Web of Science. Hypersensitivity to acute social rejection was found and associated with more self-related negative emotions and more dysfunctional emotion regulation strategies. People with SMI under-performed in cognitive tasks when confronted with stigma. Stigma resistance was described with its neural correlates. Psychiatric symptoms, duration of illness and baseline non-specific distress influenced the response to acute social rejection or stigma. The samples, methods, and reported outcomes were heterogeneous and difficult to compare. Future studies should investigate the associations between self-stigma and responses to acute and chronic social rejection.

Self-stigma versus stigma resistance in schizophrenia: Associations with resilience, premorbid adjustment, and clinical symptoms

Self-stigma is regarded as a barrier to recovery from schizophrenia and the identification of factors protecting from its development may help identify vulnerable patients and subsequently, implement effective preventive and therapeutic interventions. Hence, this study aimed to assess whether resilience, premorbid adjustment, and psychopathology might differently impact self-stigma and stigma resistance among 54 regular attendees of a specialized outpatient clinic. There was no significant association between sociodemographic variables and self-stigma/stigma resistance, while resilience was negatively correlated with self-stigma and positively correlated with stigma resistance. In addition, we detected a negative correlation between self-stigma and both academic and social functioning during late adolescence. Most residual symptoms correlated with self-stigma, while no association was found between stigma resistance and psychopathology, except for depressed symptoms. These data provide evidence that future self-stigma reduction interventions may consider to focus on the improvement of resilience in order to promote schizophrenia patients' stigma resistance. In addition, the improvement of depressive symptoms as well as interventions focusing on the strengthening of social adjustment during the prodromal phase may be effective in preventing self-stigma.

Stability and mutual prospective relationships of stereotyped beliefs about mental illness, hope and depressive symptoms among people with schizophrenia spectrum disorders

Internalized stigma, hope and depressive symptoms are important variables in the recovery process of people with schizophrenia spectrum disorders, but little is known about their stability or relationship among each other over time. This study aims to unravel the longitudinal stability and relationships of these variables. 99 participants were included in this prospective study assessing internalized stigma, hope and depressive symptoms at baseline, with a first follow-up after three months and a second follow-up after six months. Multilevel models examined if the variables changed over time and a correlation coefficient was conducted to show their relationship to each other. Hope stayed stable over time, whereas internalized stigma and depressive symptoms significantly decreased over the study period. The correlation coefficient showed that internalized stigma and depressive symptoms influenced each other moderately over time. Thus, while hope was a stable construct over time, internalized stigma and depressive symptoms changed significantly and were correlated to each other positively. This implies that participants may adjust to their chronic condition over time, and recovery focused interventions should target both psychological dimensions at the same time.

Overlap and distinction between measures of insight and self-stigma

Multiple studies on insight into one's illness and self-stigma among patients with serious mental illness and their relatives have shown that these constructs are related to one another and that they affect outcome. However, a critical exploration of the items used to assess both constructs raises questions with regard to the possible overlapping and centrality of items. The current study used five different samples to explore the possible overlap and distinction between insight and self-stigma, and to identify central items, via network analyses and principal component factor analysis. Findings from the network analyses showed overlap between insight and self-stigma exist with a relatively clearer observational distinction between the constructs among the two parent samples in comparison to the patient samples. Principal component factor analysis constrained to two factors showed that a relatively high percentage of items were not loaded on either factor, and in a few datasets, several insight items were loaded on the self-stigma scale and vice versa. The author discusses implications for research and calls for rethinking the way insight is assessed. Clinical implications are also discussed in reference to central items of social isolation, future worries and stereotype endorsement among the different study groups.

Effectiveness of a social inclusion program in people with non-affective psychosis

BACKGROUND

People with psychotic illness suffer from reduced quality of life and often from an insufficient level of social inclusion. These variables are associated with several negative outcomes, such as higher neuro-cognitive deficits, negative symptoms, internalised stigma, increased cardiovascular risk and, most importantly, excess mortality. To date, only a minority of social interventions in psychosis have been investigated. Since 2011, the Department of Mental Health and Substance Abuse in Modena introduced the "Social Point" program, which provides social inclusion interventions to promote active social participation for patients suffering from severe mental illness. The aim of this study was to assess whether a social inclusion intervention is associated with better outcomes in terms of personal and social recovery, with particular reference to the areas of social functioning and activity, and subjective dimensions such as self-esteem, self-stigma and perceived quality of life.

METHODS

A cross-sectional design was adopted to compare 30 subjects, selected at the completion of "Social Point" program, with a group of subjects, matched for socio-demographic and clinical features, selected from a wait list for "Social Point". All subjects were evaluated by means of instruments assessing: level of disability, level of functioning, severity of psychopathology, self-esteem, internalised stigma and quality of life.

RESULTS

Overall, the results of the study suggest that social inclusion interventions may be effective in people suffering from non-affective psychosis. A dose-effect relationship was also found between higher number of activities per patient and better outcomes within both social and psychopathological domains. However, due to the cross-sectional design of the study no definitive causality can be inferred.

CONCLUSION

Psychosocial interventions promoting social inclusion are likely to represent an effective approach to improve personal and social recovery.

Prediction of self-stigma in early psychosis: 3-Year follow-up of the randomized-controlled trial on extended early intervention

BACKGROUND

Self-stigma represents a major barrier to recovery in people with psychotic disorders but is understudied in early illness stage. Longitudinal investigation of prediction for self-stigma is scarce and none is conducted in early psychosis. We aimed to prospectively examine baseline predictors of self-stigma in early psychosis patients in the context of a 3-year follow-up of a randomized-controlled trial (RCT) comparing 1-year extension of early intervention (EI) with step-down psychiatric care for first-episode psychosis (FEP).

METHOD

One hundred sixty Chinese patients were recruited from a specialized EI program for FEP in Hong Kong after they had completed this 2-year EI service, and underwent a 12-month RCT. Participants were followed up and reassessed 3years after inclusion to the trial. Comprehensive evaluation encompassing clinical, functional, subjective quality of life and treatment-related variables were conducted. Data analysis was based on 136 participants who completed self-stigma assessment at 3-year follow-up.

RESULTS

Fifty patients (36.8%) had moderate to high levels of self-stigma at 3-year follow-up. Multivariate regression analysis revealed that female gender, prior psychiatric hospitalization, longer duration of untreated psychosis and greater positive symptom severity at study intake independently predicted self-stigma at the end of 3-year study period.

CONCLUSION

Our results of more than one-third of early psychosis patients experienced significant self-stigma underscore the clinical needs for early identification and intervention of self-stigmatization in the initial years of psychotic illness. Further research is warranted to clarify prediction profile and longitudinal course of self-stigma in the early illness phase.

Direct and indirect associations between dysfunctional attitudes, self-stigma, hopefulness and social inclusion in young people experiencing psychosis

OBJECTIVE

Social inclusion and vocational activity are central to personal recovery for young people with psychosis. Studies with people experiencing long term psychosis suggest negative self-beliefs are important, but less is known about whether this association is present for young service users or about the potential influence of positive self-beliefs such as hopefulness. The aim of the current paper was to investigate the direct and indirect associations between dysfunctional attitudes, self-stigma, hopefulness, social inclusion and vocational activity for young people with psychosis.

METHOD

A 5-month longitudinal study was conducted with young psychosis service users. Measures of dysfunctional attitudes and self-stigma and vocational activity were obtained at baseline. Measures of hopefulness, social inclusion and vocational activity were obtained at follow-up.

RESULTS

Hopefulness mediates the associations between self-stigma, social inclusion and vocational activity. Self-stigma may have a greater influence on social inclusion with age. Dysfunctional attitudes do not significantly predict social inclusion or change in vocational activity status.

CONCLUSION

Findings suggest that the impact of self-stigma may extend beyond social and occupational withdrawal and undermine subjective community belonging. Findings encourage an increased emphasis on facilitating hopefulness for young people who experience psychosis.

[What support of young presenting a first psychotic episode, when schooling is being challenged?]

Psychiatric disorders (more specifically mood disorders and psychosis) represent the 1st cause of disability among young people. Unemployment rate between 75 to 95% for the person with schizophrenia. It is correlated to poor social integration and bad economic status, worse symptomatology loss of autonomy as well as global bad functioning. It is responsible of more than half of the overall cost of psychosis. The onset of most of psychiatric disorders occur between the age of 25 and 35 years old, a critical time in young adult life when they should build their professional as well as social future. Without appropriate care, young adult are unable to build satisfactory emotional relationships, continue their studies, live independently or fit into life. They are frequently dependent on their environment. They also have an increased suicide rate and frequent comorbid substance abuse. Despite this context, their care pathway is often marked by a delay or premature stop of care, drug treatments not always suitable and a lack of specific relay post-hospitalization regarding continuity of professional training or studies. All factors impacting future employability of adolescents. Furthermore they spend most of their time in school and school plays a key part in an individual's development including peer relationships, social interactions, academic attainment, cognitive progress, emotional control, behavioral expectations and physical and moral development. These areas are also reciprocally affected by mental illness. The initial phases of FEP are characterized by impaired academic performance, change in social behaviors and increasing absences from school, reflecting the prodrome of the illness that leads to disengagement from education. Functional decline often precedes onset of clinical symptoms and many adolescents and young adults are therefore isolated from school before their illness is recognized. School support staff may fail to recognize those who are functionally impaired because of evolving FEP although school is a key setting for promoting positive mental health, fostering resilience, detecting and responding to emerging mental ill health. So, people with psychotic illness have low levels of secondary school completion. School dropout has been defined as leaving education without obtaining a minimal credential, most often a higher secondary education diploma. In France, the school is compulsory up to the age of 16. Consequences are significant: among young people without a degree out of initial training for one to four years and present on the labour market, 47% are unemployed. School dropout depends on a number of factors, including grades, family and social environment and the relationship with the school, but also the emergence of psychiatric disorders. For first episode psychotic patients, age of onset, lack of family support, longer duration of psychosis, levels of premorbid global functioning and education, negative and cognitive symptoms, addictions, depressive comorbidities and stigma plays an important role in school dropout. However, young adults have historically received less treatment than expected considering prevalence of mental illness at that age. In the last few decades, early intervention programs for psychosis have been developed all around the world in order to promote rehabilitation and prevent long-term disabilities. Early intervention programs focus on the special needs of young people and their families and engage in some form of assertive community treatment, which attempts to treat patients in the community rather than using inpatient services. For early intervention in psychosis programs, the goal is to keep patients engaged with treatment, prevent them from further psychotic episodes and hospitalizations and promote rehabilitation. The additional services of an early intervention program include staff specialized in psychosis treatment, family/group/individual counseling sessions, assertive case management, and low-dose second generation anti-psychotics. In these programs, psychiatric rehabilitation practitioners already use individual counseling and supported education programs (SEd) to improve postsecondary educational outcomes. The goals of SEd are for individuals with serious mental illness to successfully be able to set and achieve an educational goal (e.g., training certificate or degree), to improve educational competencies (literacy, study skills, time management), to navigate the educational environment (e.g., applications, financial assistance), and to improve motivation toward completing educational goals. These approaches are often combined with efforts to support transitions to sustainable employment. Current evidence of these interventions are weak with limited information on specific difficulties experienced by young adults with FEP in educational tasks. Adaptive strategies are needed by young adults with FEP to succeed in educational settings but most studies do not explore it with rigorous methodology. However, common SEd components emerge: specialized and dedicated staffing, one-on-one and group skill-building activities, assistance with navigating the academic setting and coordinating different services, and linkages with mental health counseling. Continued specification, and testing of SEd core components are still needed. It is important that occupational therapy researchers and practitioners develop, and evaluate effective interventions to improve education outcomes for young adults with FEP. The objective of this work is to define school dropout, assess causes and consequences of FEP. How to help young people to maintain education? We will detail measures to support the academic re-insertion in France.

Narrative development and supported employment of persons with severe mental illness

Background: While the relationship between objective recovery and work among persons with severe mental illness (SMI) is well-established, few studies have examined the link between subjective recovery and employment.Aims: The study investigated the prospective relationship between narrative development at the start of supported employment (SE) and positive work outcomes.Methods: The authors employed a time-limited, mixed-method longitudinal design to examine the relationship between the baseline narrative development of 38 SE participants with SMI and employment outcomes eight months later, as well as whether narratives evolved over the course of the study.Results: While narrative development was unrelated to work for the 59% of participants who were employed at the end of the study, unemployed individuals showed more developed baseline narratives overall, as well as enriched baseline emotional connectedness and social worth. Higher emotional connectedness at the start of SE programs was predictive of fewer hours worked eight months later, controlling for executive functioning, negative symptoms and self-esteem. Although workers showed no narrative changes over time, those without work demonstrated increased agency over the eight months of the study.Conclusion: Further research is warranted to clarify the relationship between richer personal narratives and unemployment.

Individual and Neighborhood Predictors of Mental Illness Stigma in New York State

While studies indicate that stigmatizing attitudes persist in the general public, individual and neighborhood level factors that are associated with increased likelihood of holding stigmatizing attitudes have been seldom studied. This study examined the demographic and neighborhood correlates of stigmatizing attitudes among community members in New York State. Data were drawn from the Pulse of New York State Survey, a random-digit dial survey of 806 New York State residents. Variables studied included demographic information, the Attitudes Toward Mental Illness scale, and neighborhood disadvantage at the zip code level (using data on community characteristics from the 2000 and 2010 Census). Higher levels of completed education predicted less stigmatizing attitudes. Higher levels of neighborhood disadvantage predicted more stigmatizing attitudes with the 2000 Census, and obtained marginal significance within the 2010 Census. Political affiliation demonstrated the strongest relationship, with more conservative ideology predicting more stigmatizing attitudes. Results highlight the need to consider political affiliation and neighborhood disadvantage as target areas when planning interventions for reducing mental illness stigma.

Promoting positive perceptions and person centred care toward people with mental health problems using co-design with nursing students

BACKGROUND

People experiencing severe mental health problems often feel excluded from society due to stigmatization and prejudice. They typically experience negativity and lack life opportunities, which can be reinforced by the attitudes of those around them. Health care professionals, especially nurses, have the opportunity to challenge negative perceptions through role-modelling hope and positive expectation, breaking down barriers to participation and challenging discrimination. However, student nurses can enter the profession with attitudes similar to those of wider society and unless addressed can foster life-limiting approaches toward those for whom they are providing care.

AIM

This study aimed to design a person-centred education approach in response to an evaluation of the attitudes of nursing students in Turkey toward people with mental health problems.

METHOD

A qualitative design adopting descriptive phenomenology. Data were collected from 12 undergraduate nursing students by using in-depth semi-structured interviews. Data were transcribed and themes identified which were used to co-design a person-centred education approach.

RESULTS

Three themes emerged from the data; (1) meanings attributed to mental illness, (2) moving from fear to understanding, (3) promoting hope and positive change Students typically demonstrated perceptions/attitudes that could be inhibiting to future practice.

CONCLUSIONS

The pedagogy employed in this study moved away from a focus on signs and symptoms of illness to person-centred approaches. More positive perceptions of mental health can be developed through codesigned, person-centred educational approaches.

Self-clarity and different clusters of insight and self-stigma in mental illness

The current study explored the self-experience of persons with Serious Mental Illness (SMI) by investigating the associations between different insight and self-stigma clusters, self-clarity, hope, recovery, and functioning. One hundred seven persons diagnosed with a SMI were administered six scales: self-concept clarity, self-stigma, insight into the illness, hope, recovery, and functioning. Correlations and cluster analyses were performed. Insight, as measured by a self-report scale was not related to any other variable. Self-stigma was negatively associated with self-clarity, hope, recovery and functioning. Three clusters emerged: moderate stigma/high insight (n=31), high stigma/moderate insight (n=28), and low stigma/low insight (n=42). The group with low stigma and low insight had higher mean levels of self-clarity and hope than the other two groups. There were no significant differences between cluster 1 (moderate stigma/high insight) and cluster 2 (high stigma/moderate insight) in all the variables beside self-clarity. The group with moderate stigma and high insight had significantly higher mean levels of self-clarity than the group with high stigma and moderate insight. Results reveal that when people diagnosed with SMI do not have high levels of self-stigma they often report a positive and clear sense of self accompanied with hope, regardless of having low insight.

Internalised stigma in people with rheumatoid arthritis: a cross sectional study to establish the psychometric properties of the ISMI-RA

Background

Internalised stigma is theorized to be the internalisation and legitimisation of stereotypes of the diagnosis held in society and has not been quantified within patients with Rheumatoid Arthritis. This study aimed to: validate a modified version of a measure of internalised stigma, (the Internalised Stigma of Mental Illness scale, ISMI) for use in a group of patients diagnosed with rheumatoid arthritis; establish the consistency of the construct being measured, and to explore the levels of internalised stigma within this group.

Methods

A cross-sectional survey was conducted in London, UK with participants receiving out-patient treatment for Rheumatoid Arthritis. Participants completed the ISMI-Rheumatoid Arthritis (ISMI-RA) and a measure of self-esteem.

Results

One hundred respondents were interviewed by phone. The ISMI-RA was found to be reliable using a measure of internal consistency (α = 0.85) showed concurrent validity with the Index of Self Esteem (r = 0.58, p < 0.01) and discriminant validity with no association with gender (t = 1.43, p = 0.61). A quarter of respondents reported internalised stigma to a ‘severe’ level. Acceptability and feasibility were established. A confirmatory factor analysis provided some support for the model of internalised stigma.

Conclusions

The application of the ISMI-RA among the Rheumatoid Arthritis population looks promising. Internalised stigma was found to be present within this group. More research is needed to generalize these results and to explore the effects of internalised stigma on treatment adherence and quality of life.

Internalized Stigma and Perceived Family Support in Acute Psychiatric In-Patient Units

AIM

This descriptive study aims to identify the relationship between internalized stigma and perceived family support in patients hospitalized in an acute psychiatric unit.

METHOD

The sample is composed of 224 patients treated in an acute inpatient psychiatric ward in İstanbul, Turkey. The data were collected using information obtained from the Internalized Stigma of Mental Illness Scale and Social Support from Family Scale.

RESULTS

The mean age of the patients was 37±11.56years, and the mean duration of treatment was 6.27±5.81years. Most patients had been hospitalized three or more times. Of the total number of patients, 66.1% had been taken to the hospital by family members. We noted a statistically significant negative correlation between the total scores obtained from the perceived Social Support from Family Scale and the Internalized Stigma of Mental Illness Scale.

CONCLUSION

The patients were observed to stigmatize themselves more when the perceived social support from their family had decreased.

Self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia

BACKGROUND

We investigated self-perceived cognitive deficits and their relationship with internalized stigma and quality of life in patients with schizophrenia in order to shed light on the clinical correlates of subjective cognitive deficits in schizophrenia.

METHODS

Seventy outpatients with schizophrenia were evaluated. Patients' self-perceived cognitive deficits, internalized stigma, and subjective quality of life were assessed using the Scale to Investigate Cognition in Schizophrenia (SSTICS), the Internalized Stigma of Mental Illness Scale (ISMI), and the Schizophrenia Quality of Life Scale Revision 4 (SQLS-R4), respectively. Correlation and regression analyses controlling for the severity of symptoms of schizophrenia were performed, and a mediation analysis was conducted to examine the hypothesis that internalized stigma mediates the relationship between self-perceived cognitive deficits and subjective quality of life.

RESULTS

Pearson's partial correlation analysis showed significant correlations among the SSTICS, ISMI, and SQLS-R4 scores (P<0.01). Multiple regression analysis showed that the SSTICS and ISMI scores significantly predicted the SQLS-R4 score (P<0.01). Mediation analysis revealed that the strength of the association between the SSTICS and SQLS-R4 scores decreased from β=0.74 (P<0.01) to β=0.56 (P<0.01), when the ISMI score was statistically controlled. The Sobel test revealed that this difference was significant (P<0.01), indicating that internalized stigma partially mediated the relationship between self-perceived cognitive deficits and quality of life.

CONCLUSION

The present study indicates that self-perceived cognitive deficits are significantly associated with internalized stigma and quality of life. Furthermore, internalized stigma was identified as a partial mediator of the relationship between self-perceived cognitive deficits and quality of life. These findings suggest that clinicians should be aware that patients with schizophrenia experience significantly greater self-stigma when they suffer subjective cognitive deficits, and that this may further compromise their quality of life.

Social functioning and internalized stigma in individuals diagnosed with substance use disorder

The aim of this descriptive study was to determine social functioning and internalized stigma in individuals with substance use disorder. The study sample consisted of 105 patients diagnosed with substance use disorder according to the DSM-IV-TR diagnostic criteria. A Descriptive Information Form, Internalized Stigma of Mental Illness Scale (ISMI) and Social Functioning Scale (SFS) were used for data collection. Average total SFS score of the patients was 103.25±25.09 points, indicating an intermediate level of social functioning. Average total ISMI score of patients was 2.92±0.48 points, reflecting a high level of internalized stigma. A negative significant association was observed between the internalized stigma levels and social functioning of patients. These results suggest that rehabilitation of substance users should include counseling services in order to reduce internal perception of stigma and improve their social functioning.

Bipolar disorder and self-stigma: A comparison with schizophrenia

AIM

Even though numerous studies have focused on the effects of self-stigma on patients with schizophrenia, little is known about self-stigma of patients with bipolar disorder (BD). In this study, a self-administered scale of self-stigmatising attitudes of patients with BD and schizophrenia was used to explore these attitudes, examine the potential differences between the two groups and study the factors that influence stigma within groups.

METHODS

Self-stigma of 120 patients with schizophrenia and BD was assessed with the Self-stigma Questionnaire (SSQ) and the Stigma Inventory for Mental Illness (SIMI). Presence of clinical symptoms, overall functioning and level of self-esteem were also evaluated.

RESULTS

Self-stigma is present in both groups but differs in its intensity. Patients with BD experience self-stigma in a lesser degree without affecting their social life or overall functioning. Patients with schizophrenia adopt more intense self-stigmatising attitudes leading to social exclusion and lower level of overall functioning.

LIMITATIONS

The results are limited by the small sample size, whereas the inclusion of other questionnaires would broaden our insight to self-stigma.

CONCLUSIONS

Self-stigma has a direct effect on overall functioning of patients with BD and schizophrenia tampering the clinical outcome of therapeutic interventions. Therefore, it should be incorporated in every treatment plan and be addressed as a clinical symptom of the mental illness.

The Internalized Stigma of Mental Illness: Cross-Cultural Adaptation and Psychometric Properties of the Portuguese Version of the ISMI Scale

This study examined the psychometric properties of the Portuguese version of the ISMI scale in a sample of 253 adult psychiatric outpatients. The exploratory factor analysis replicated the five factor structure of the scale. The results revealed good internal consistency. Criterion-related validity supported the variability in response to stigma across clinical diagnoses. Thus, the Portuguese version of the ISMI scale can be considered appropriate to measure and differentiate between stigmatization experiences. Also, in order to design more focused approaches aimed to reduce the negative effects of internalized stigma, its use in institutional and in community-based mental health services is recommended.

Psychological Predictors of Vocational Success for People with Psychotic Illness

People diagnosed with psychotic illness continue to be underrepresented in the workforce despite the widespread provision of vocational rehabilitation services for people experiencing mental illness. A systematic literature review was undertaken using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to identify psychological predictors of successful return to work for this population. The databases searched were PsycARTICLES, PsycINFO, PubMed, ProQuest, Cumulative Index of Nursing and Allied Health (CINAHL), and Taylor & Francis Online. A total of 4,076 articles were located and of these, 29 articles were analysed as part of this review. The data extracted was synthesised using a narrative approach. A number of psychological factors were identified which are predictive of successful return to work. These factors include but are not limited to identity, self-management of illness, social cognition, hope and self-esteem and motivation. On the basis of the reviewed literature, practice guidelines are proposed which support the psychological processes identified as pivotal to vocational success for people diagnosed with psychotic illness.

Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness

We aimed to examine internalized stigma of patients with mental illness in Korea and identify the contributing factors to internalized stigma among socio-demographic, clinical, and psychosocial variables using a cross-sectional study design. A total of 160 patients were recruited from a university mental hospital. We collected socio-demographic data, clinical variables and administered self-report scales to measure internalized stigma and levels of self-esteem, hopelessness, social support, and social conflict. Internalized stigma was identified in 8.1% of patients in our sample. High internalized stigma was independently predicted by low self-esteem, high hopelessness, and high social conflict among the psychosocial variables. Our finding suggests that simple psychoeducation only for insight gaining cannot improve internalized stigma. To manage internalized stigma in mentally ill patients, it is needed to promote hope and self-esteem. We also suggest that a relevant psychosocial intervention, such as developing coping skills for social conflict with family, can help patients overcome their internalized stigma.

Aspects of perceived stigma: the Stigma Inventory for Mental Illness, its development, latent structure and psychometric properties

OBJECTIVE

The aim of this study was to develop a new brief and easy to administer self-stigma scale for mental illness as well as to assess the correlations between self-stigma and psychopathology of chronic schizophrenic patients.

METHODS

The Stigma Inventory for Mental Illness (SIMI) was administered to 100 outpatients diagnosed with schizophrenia. Psychopathology and overall functioning were assessed with the Positive and Negative Symptom Scale (PANSS) and Global Assessment Scale (GAS), respectively.

RESULTS

The final scale consists of 12 items. Factor analysis concluded to two dimensions: perceptions of social stigma and self-efficacy. Both factors were found to be reliable (high internal consistency and stability coefficients). Significant correlations were present with psychopathology, functioning and selected items from the Community Attitudes toward the Mentally Ill (CAMI) inventory.

CONCLUSION

The SIMI scale is a reliable and valid psychometric tool that can be used to assess patient's self-stigma and self-efficacy. The findings suggest also that psychopathology has an immediate effect on endorsing self-stigmatizing attitudes.

Longitudinal course of self-labeling, stigma stress and well-being among young people at risk of psychosis

Stigma may undermine the well-being of young people at risk of psychosis. We therefore measured self-labeling, stigma variables and well-being at baseline and again one year later among 77 at-risk participants. An increase in self-labeling during this period predicted heightened stigma stress after one year and a decrease in stigma stress predicted better well-being at follow-up, controlling for symptoms, psychiatric comorbidity and sociodemographic variables. Besides early intervention programmes, strategies are needed to reduce the public stigma associated with at-risk status and to support young people at risk to better cope with self-labeling and stigma stress.

The influence of adjunctive treatment and metacognitive deficits in schizophrenia on the experience of work

Enhancing work function is now widely considered a core element of comprehensive schizophrenia treatment. While research efforts have illuminated factors that influence how well patients perform at work, less is known about the factors influencing the subjective experience of work. It is not known how, and to what extent, symptoms, cognitive deficits or metacognitive capacities impact job satisfaction and whether treatment can have an effect on job satisfaction. To explore this issue, data from a trial in which participants in a six-month vocational program were assigned to either a standard support group or a cognitive behavioral group therapy, and asked to fill in weekly self-reports of job satisfaction was analyzed. Work satisfaction and the consistency of these ratings were compared between the two groups and the moderating influence of metacognitive capacity was analyzed. A significant interaction effect revealed that higher metacognitive capacity predicted higher average job satisfaction only in the CBT group. Additionally, higher metacognitive capacity led to a more varied appraisal of work satisfaction only in the support group.