Individual correlates of self-stigma in patients with anxiety disorders with and without comorbidities

Attitude of Syrian students toward GAD patients: An online cross-sectional study

Generalized Anxiety Disorder (GAD) is a prevalent condition and a significant cause of mental disability and poor quality of life. People with GAD have chronic worrying, restlessness, and discrimination from the general public; Little is known about the stigmatizing attitudes toward people with GAD among Syrian students. The questionnaires contained demographic data about age, gender, social status, personal stigma toward GAD scale, perceived stigma toward GAD scale, social distance with those with GAD, the participants' usual source of their knowledge about GAD, helpful interventions, and supporting information. A total of 1,370 replies were collected, but only 1,358 were used for analysis as 12 participants declined to complete the survey. About 44.1% of participants agreed that people with GAD could snap out of the problem, most of them being females (32.4% of the total population). Compared to medical students, more non-medical students (7.1% of the total population) believed that anxiety is a sign of personal weakness. This study demonstrated that Syrian college students showed a high level of stigmatizing and socially distancing attitudes toward people with GAD, particularly female and non-medical students.

Internalised stigma, social support, coping and care-giving burden among Chinese family caregivers of adults diagnosed with schizophrenia: A parallel mediation analysis

Care-giving burden and internalised stigma are prevalent among family caregivers of people diagnosed with schizophrenia. Internalised stigma has been regarded as a source of care-giving burden. But it remains unclear if high levels of internalised stigma directly contribute to an increased risk of care-giving burden or if the effects could be buffered by psychological factors. This cross-sectional study was to investigate the relationship between internalised stigma and care-giving burden, and to determine the mediating effects of coping styles and social support. Data were collected from 344 Chinese family caregivers of adults diagnosed with schizophrenia in a psychiatric outpatient department of a tertiary hospital in Changsha, Hunan between April and August 2018. A self-reported questionnaire was used to collect data anonymously. Instruments included the Simplified Coping Style Questionnaire, the Multidimensional Scale of Perceived Social Support, the Internalized Stigma of Mental Illness Scale and the Caregiver Burden Inventory. Data analysis was conducted using descriptive statistics, the Spearman correlation and regression analysis to estimate direct and indirect effects using bootstrap analysis. Results showed that internalised stigma, social support and passive coping were significant correlates of care-giving burden; social support partially mediated the relationship between internalised stigma and care-giving burden; active coping did not show impacts on internalised stigma and care-giving burden. This study provided social workers and healthcare providers with a better understanding of the development of care-giving burden. Comprehensive interventions should be designed to provide supportive resources and reduce the possibilities of internalisation of stigma and passive coping, to alleviate care-giving burden.

The association between comorbidities and stigma among breast cancer survivors

This study aimed to explore the association between types and numbers of comorbidities and stigma among breast cancer survivors (BCSs). A cross-sectional study was conducted among 937 BCSs in Shanghai Cancer Rehabilitation Club. All participants were asked to fill in an online questionnaire including Stigma Scale for Chronic Illnesses 8-item version (SSCI-8) and questions on sociodemographic characteristics and health status. Multivariate linear regression was used to analyze the association between comorbidities and stigma, adjusting for confounding factors. Results showed that nearly 70% of the participants had one or more comorbidities. The participants with stroke, digestive diseases or musculoskeletal diseases had significantly higher stigma than those without the above comorbidities. In addition, stigma was higher among survivors in the group with a greater number of comorbidities. Thus, it is important to strengthen the management of stigma in BCSs, especially for those with comorbidities.

Internalized stigma in obsessive compulsive disorder: Correlates and associations with quality of life

In the present study we aimed to measure IS among outpatients with OCD, and to assess its relationship with clinical and sociodemographic variables, and quality of life. Out of 100 patients assessed, 79 patients with OCD were included in the study. Each patient was assessed using the SCID-5 CV, Y-BOCS, ISMI Scale, and WHOQOL-BREF. There was a strong correlation of IS with lower QoL and severity of OCD symptoms. Avoidance behavior, psychological health and social relationship domains emerged as independent factors related to IS in the regression analysis. There is a need for further studies on a larger samples to identify the specifics of the development and impact of IS in people with OCD.

Pathways to mental health consultations: A study from a tertiary care setting in India

BACKGROUND

Research indicates that help seeking for mental health is low and often delayed. Understanding pathways to care is crucial to facilitate mental health referrals and reduce the time to consultation.

METHODS

In the present study, 63 individuals were assessed on illness severity, attitudes towards help-seeking and pathways-to-care.

RESULTS

Multiple pathways for therapy were noted, a delayed-pathway, two-step referral pathway and a direct-pathway. Most prominent pathway was the delayed-pathway. The direct-pathway had least treatment delay, contributed by timely recognition of symptoms by the patient. As first point of contact, patients preferred psychiatrists and popularly sought information about treatment via media.

CONCLUSIONS

There are multiple pathways to consultations, often leading to treatment delay in care received. Timely recognition of symptoms was associated a direct pathway and the least delay. These findings have implications for strengthening routes to mental health specialists at early stages and increasing awareness about treatment available.

Associations of Depression and Anxiety with Stigma in a Sample of Patients in Saudi Arabia Who Recovered from COVID-19

Purpose

The coronavirus disease (COVID-19) outbreak combined with social distancing, isolation, and movement restrictions has had a profound impact on individuals’ physical and psychological well-being. The aim of this study was to examine the associations of depression and anxiety with feelings of stigma among patients in Saudi Arabia who have recovered from COVID-19.

Materials and Methods

A cross-sectional survey was conducted between July and December 2020. Trained healthcare providers contacted and interviewed participants by phone. Depression, anxiety, and stigma were assessed using the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7) questionnaire, and the Explanatory Model Interview Catalogue stigma scale (EMIC). Data on sociodemographic characteristics, comorbidities, and family history of mental illness were also collected. Multiple linear regression models were performed to explore factors associated with depression and anxiety.

Results

A total of 174 adult participants (≥18 years old) who had recently recovered from COVID-19 were interviewed. The mean PHQ-9 and GAD-7 scores were 7.53 (±5.04) and 3.77 (±4.47), respectively. About 68% of the participants had at least mild depression (PHQ-9 score of 5–9), whereas only 29.89% had at least mild anxiety (GAD-7 score of 5–9) during their infections with COVID-19. Multiple linear regression showed that females were more vulnerable to depression and anxiety disorders than their male counterparts were (β=3.071 and β=1.86, respectively). Notably, participants’ stigma scores were significantly associated with higher scores on depression and anxiety.

Conclusion

These findings highlight the negative consequences of COVID-19 infection on the mental health of recovered patients. Therefore, considerable attention from local and international health authorities is needed to improve the mental well-being of recovered COVID-19 patients.

Risk factors and impact of stigma on psychiatric patients in Sohag

Background

Stigma among psychiatric patients is pervasive all over the world. Our aim in this study was to investigate risk factors for stigma related to psychiatric disorders and to demonstrate the major consequences of mental stigma for patients who experience mental illness. We conducted a cross-sectional study and applied a stigma scale to 573 patients with psychiatric disorders who attended our outpatient psychiatry clinic. Participants were divided into two groups, group I (no.262) with low stigma score and group II (no.311) with high stigma score. The two groups were compared in term of socio-demographic characteristics (age, gender, level of education, residency, marital status, employment and socioeconomic level), factors related to the psychiatric disorder (duration of illness, number of psychiatric hospital admission and diagnosis) and impact of psychiatric illness (follow-up visits, adherence to medications and suicidal thoughts or attempts).

Results

The mean age of patients with high stigma score (group II) was 29 ± 6 years. High stigma score was more common in females (53.7%), illiterate (11.9%), living in rural areas (58.2%), single (22.83%), unemployed (44.37%) and low socioeconomic class (59.49%). Patients with a high stigma score showed longer duration of psychiatric disorder (43 ± 8 months), more frequent number of psychiatric hospital admission (4.3 ± 0.5) and schizophrenia ((11.25%) and other psychotic disorders (6.49%) were common diagnoses. Patients with a high stigma score show poor adherence to medication (47.91%) and follow-up (44.05%) and a high frequency of suicidal ideation or attempt (47.91%). Significant risk factors predicting high mental stigma were level of education (explaining about 23% of the risk, P = 0.03), duration of mental illness (explaining about 25% of the risk, P = 0.019), number of hospital admissions (explaining about 22.7% of the risk, P = 0.032), diagnosis of mental illness (explaining about 27.7% of the risk, P = 0.01).

Conclusion

Mental stigma is more prevalent among young aged individuals, females, single, unemployed, living in rural areas and those with lower educational and socioeconomic level. Mental stigma has a parallel correlation with psychiatric disorder duration, number of psychiatric hospital admissions, as well as diagnosis of psychotic disorder. The stigma of mental illness from the viewpoint of the patient may lead to delaying the access to care as well as poor adherence to medications and follow-up. Anti-stigma measures can contribute to diminishing the psychiatric illness effect.

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.

Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach

This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of collectivism in the internalization process. Results of the meta-analytic structural equation modeling suggested that self-stigma is a significant mediator in the relationships between experienced stigma and perceived stigma with well-being and recovery variables (indirect effects = 0.02 to -0.16). Experienced and perceived stigma had significant direct effects on well-being and recovery variables (Bs = 0.07 to -0.21, p < 0.05), suggesting that both external (e.g., public stigma) and internal (i.e., self-stigma) influences of stigma work concurrently to affect recovery and well-being of people with mental illness. The results of the mixed effect three-level meta-analytic models showed that collectivism significantly moderated the relationship between experienced and perceived stigma with self-stigma (Bs = 0.06 to 0.11, p < 0.05). This implied that the more collectivistic a culture is, the stronger the correlation between experienced and perceived stigma with self-stigma. Implications to stigma reduction approaches were discussed.

Self-Stigma and Treatment Effectiveness in Patients with SSRI Non-Responsive Obsessive-Compulsive Disorder

Purpose

Obsessive compulsive disorder (OCD) is a debilitating mental disorder that often takes a chronic course. One of the factors influencing the treatment effectiveness in anxiety and depressive disorders is the self-stigma. This study focused on the relationship between the self-stigma, symptomatology, and therapeutic outcomes in patients with OCD.

Patients and Methods

Ninety-four inpatients with OCD, who did not sufficiently respond to at least one selective serotonin reuptake inhibitor trial, participated in the study. They attended a six-week therapeutic program consisting of exposure and response prevention, transdiagnostic group cognitive behavioral therapy, individual sessions, mental imagery, relaxation, sport, and ergotherapy. The participants completed several scales: the Internalized Stigma of Mental Illness Scale (ISMI), the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR), Beck Anxiety Scale (BAI), Beck Depression Scale-II (BDI-II), and Dissociative Experiences Scale (DES). A senior psychiatrist filled in the Clinical Global Impression (CGI-S).

Results

The average scales' scores considerably declined in all measurements except for DES. The self-stigma positively correlated with all psychopathology scales. It was also higher in patients with a comorbid personality disorder (PD). The higher self-stigma predicted a lower change in compulsion, anxiety, and depressive symptoms but not the change of obsessions or the overall psychopathology.

Conclusion

The self-stigma presents an important factor connected to higher severity of OCD. It is also a minor predictor of a lower change in symptomatology after combined treatment.

The relation between self-stigma and loneliness in visually impaired college students: Self-acceptance as mediator

BACKGROUND

Loneliness, a negative emotion that is common in college students, may cause psychological disorders and behavioral issues. Particularly vulnerable are visually impaired college students, who are at an increased risk of loneliness.

OBJECTIVES

This study was aimed at explaining the current situation of loneliness among visually impaired college students as well as its influencing factors and exploring the intermediary role of self-acceptance between self-stigma and loneliness.

METHOD

Seventy-eight college students with visual impairment completed a series of self-report questionnaires, including the Self-Stigma of Disabled Scale (SSDS), the Self-Acceptance Questionnaire (SAQ), and the University of California-Los Angeles (UCLA) Loneliness Scale. Mediation analyses were conducted using PROCESS in SPSS.

RESULTS

Participants' mean loneliness score was 44.97 ± 9.35. Two survey factors were significantly associated with loneliness: visual impairment status and relationship with parents (p < 0.05). When controlling for extent of visual damage and relationship with parents, self-stigma showed a significant predictive effect on loneliness (B = 0.37, t = 4.1023, p < 0.01).

CONCLUSIONS

In China, visually impaired students suffer from a high level of loneliness, and self-acceptance plays a central role in connecting their self-stigma and loneliness.

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

Background.

Self-stigma is a major issue in serious mental illness (SMI) and is negatively associated with patient outcomes. Most studies have been conducted in schizophrenia (SZ). Less is known about self-stigma in other SMI and autism spectrum disorder (ASD). The objectives of this study are: (i) to assess the frequency of self-stigma in a multicentric nonselected psychiatric rehabilitation SMI and ASD sample; and (ii) to investigate the correlates of elevated self-stigma in different SMI conditions and in ASD.

Methods.

A total of 738 SMI or ASD outpatients were recruited from the French National Centers of Reference for Psychiatric Rehabilitation cohort (REHABase). Evaluations included sociodemographic data, illness characteristics, and standardized scales for clinical severity, quality of life, satisfaction with life, wellbeing, personal recovery, a large cognitive battery, and daily functioning assessment.

Results.

31.2% of the total sample had elevated self-stigma. The highest prevalence (43.8%) was found in borderline personality disorder and the lowest (22.2%) in ASD. In the multivariate analysis, elevated self-stigma was best predicted by early stages of personal recovery (moratorium, p = 0.001, OR = 4.0 [1.78–8.98]; awareness, p = 0.011, OR = 2.87 [1.28–6.44]), history of suicide attempt (p = 0.001, OR = 2.27 [1.37–3.76]), insight (p = 0.002, OR = 1.22 [1.08–1.38]), wellbeing (p = 0.037, OR = 0.77 [0.60–0.98]), and satisfaction with interpersonal relationships (p < 0.001, OR = 0.85 [0.78–0.93]).

Conclusions.

The present study has confirmed the importance of addressing self-stigma in SMI and ASD patients enrolled in psychiatric rehabilitation. The effectiveness of psychiatric rehabilitation on self-stigma and the potential mediating effects of changes in self-stigma on treatment outcomes should be further investigated.

Prevalence of self-stigma and its association with self-esteem among psychiatric patients in a Nepalese teaching hospital: a cross-sectional study

BACKGROUND

Stigma against mental illness cuts across all age, religion, ethnic origin or socio-economic status. Similarly, self-stigma among psychiatric patients is also prevalent worldwide. The consequences of self-stigma are low self-esteem, increased severity of symptoms, low treatment adherence, increased rate of suicidality and decreased quality of life. Thus, this study aims to find the prevalence of self-stigma and its association with self-esteem of patients with mental illness in Nepal.

METHODS

This was a cross-sectional study conducted among 180 patients with mental illness attending a psychiatric Outpatient Department (OPD). Non-probability purposive sampling technique was used for the study. The data was collected by face to face interview technique. Structured interview schedule questionnaire (brief version of internalized stigma scale and Rosenberg self-esteem scale) was used to collect the data. Descriptive statistics, inferential statistics and correlation analysis were used for data analysis. P value was set at 0.05.

RESULTS

Overall prevalence of self-stigma was 54.44%. Among those who had self-stigma 48% had mild self-stigma, 34.7% had moderate self-stigma and 17.3% had severe self-stigma. Among the five components of self-stigma scale, the highest mean score was on stereotype endorsement, followed by discrimination experience, social withdrawal, stigma resistance, and the lowest for the component of alienation. Furthermore, strong negative correlation (r = - 0.74) was found between self-stigma and self-esteem. The correlation was still significant (r = - 0.69) after controlling for socio-demographic and clinical variables. Hospital admission and diagnostic category of respondents were significantly associated with self-stigma. However, no significant association was found between socio-demographic variables and self-stigma.

CONCLUSION

Based on the findings of this study, it can be concluded that self-stigma is prevalent among psychiatric patients in Nepal. Most of the respondents experienced stereotype endorsement. Also, higher self-stigma is significantly associated with poor self-esteem suggesting self-stigma reduction programs. Furthermore, strong negative relationship between self-stigma and self-esteem suggests some causal relationship studies to confirm if self-esteem enhancement program can be beneficial to reduce self-stigma among psychiatric patients.

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.

Quality of life, self-stigma, and coping strategies in patients with neurotic spectrum disorders: a cross-sectional study

Background

Modern psychiatry focuses on self-stigma, coping strategies, and quality of life (QoL). This study looked at relationships among severity of symptoms, self-stigma, demographics, coping strategies, and QoL in patients with neurotic spectrum disorders.

Methods

A total of 153 clinically stable participants who met criteria for generalized anxiety disorder, social phobia, panic disorder, agoraphobia, mixed anxiety-depressive disorder, adjustment disorders, somatoform disorders, or obsessive-compulsive disorder were included in a cross-sectional study. Psychiatrists examined patients during regular psychiatric checkups. Patients completed the Quality of Life Satisfaction and Enjoyment Questionnaire (Q-LES-Q), Internalized Stigma of Mental Illness Scale (ISMI), a sociodemographic questionnaire, the Stress Coping Style Questionnaire (Strategie Zvládání Stresu [SVF] 78), and the Clinical Global Impression (CGI) scale.

Results

The diagnostic subgroups differed significantly in age and use of negative coping strategies, but not in other measured clinical or psychological variables. The findings showed that neither sex nor partnership played a role in perceived QoL. All Q-LES-Q domains correlated negatively with all ISMI domains, except school/study. Unemployed and employed groups of patients differed in QoL. Each of the coping strategies, except the need for social support, was related to self-stigma. The findings showed that sex, partnership, education, and employment played no role in self-stigma. No differences between sexes in positive coping strategies, severity of disorder, self-stigma, or QoL were found. QoL correlated significantly with all coping strategies, except for guilt denial. Multiple regression showed the most important factors to be positive coping, employment, and overall self-stigma rating, explaining 32.9% of QoL. Mediation analysis showed self-stigma level and negative coping strategies to be the most influential. The most substantial factors associated with self-stigma, as indicated by regression analysis, were Q-LES-Q total, subjective CGI, and positive coping strategies, which clarified 44.5% of the ISMI.

Conclusion

The study confirmed associations among self-stigma, quality of life, disorder severity, and coping strategies of outpatients with neurotic spectrum disorders.

Self-Stigma and Etiological Attributions About Symptoms Among Individuals Diagnosed With an Anxiety Disorder: Relations With Symptom Severity and Symptom Improvement Following CBT

Nearly one-third of individuals in the U.S. will be diagnosed with an anxiety disorder during their lifetime. Receiving that label can evoke self-stigma, with self-stigma relating to greater symptom severity and negatively impacting treatment outcomes. A lesser-studied variable related to self-stigma is etiological attributions about symptoms, including biological and psychological attributions. The current study examined interrelations among self-stigma, etiological attributions, and symptom severity among 213 individuals diagnosed with an anxiety disorder who completed a cognitive-behavioral treatment (CBT) program. How self-stigma and etiological attributions related to symptom improvement following the program was examined in a subset of participants. Etiological attributions and self-stigma shared positive associations with symptom severity. Regression analyses indicated that, when controlling for overlap among self-stigma and etiological attributions, psychological attributions emerged as particularly relevant for understanding symptom severity. Changes in self-stigma and attributions were positively associated with changes in symptom severity following the CBT program. Study implications are discussed.

Self-stigma and treatment effectiveness in patients with anxiety disorders - a mediation analysis

GOAL

The goal of this study was to explore the impact of self-stigma on the treatment outcomes in patients with anxiety disorders and to find possible mediators of this relationship.

METHOD

Two hundred and nine patients with anxiety disorders, who were hospitalized in a psychotherapeutic department, attended the study. The average age was 39.2±12.4 years; two-thirds were women. Most of the patients used a long-term medication. The participants underwent either cognitive behavioral therapy (CBT) or short psychodynamic therapy. The selection to the psychotherapy was not randomized. All individuals completed several scales - Beck Depression Inventory, the second edition (BDI-II), Beck Anxiety Inventory (BAI), Dissociative Experience Scale (DES), Sheehan Disability Scale (SDS), subjective Clinical Global Impression (subjCGI), and The Internalized Stigma of Mental Illness Scale (ISMI). A senior psychiatrist filled out the objective CGI (objCGI).

RESULTS

The patients significantly improved in the severity of anxiety (BAI), depression (BDI-II), and overall severity of the mental disorder (objCGI). The self-stigma predicted a lower change of the objCGI, but not a change of the anxiety and depressive symptoms severity. Anxiety, depressive symptoms, dissociation, and disability were assessed as possible mediators of the relationship between the self-stigma and the treatment change. None of them were significant.

CONCLUSION

Self-stigma lowers the effectiveness of the combined treatment of anxiety disorders. Future research should explore other possible mediators influencing this relationship.

The factor structure of the Dispositional Hope Scale in hemiplegic stroke patients

BACKGROUND

Hope is an important coping strategy and psychological resource for patients with a chronic illness. Stroke patients are exposed to stressful situations such as limited daily life activities, cognitive impairments and financial burdens.

AIM

This study investigated the factor structure of the Dispositional Hope Scale (DHS) and verified its validity when examining stroke patients.

METHODS

This methodological study used secondary, cross-sectional data analysis to investigate the factors related to participation restriction in chronic stroke patients. The DHS's reliability was assessed by calculating the internal consistency of Cronbach's α. The structure of the DHS was analyzed by confirmatory factor analysis. The one-factor model (Korean version), two-factor model (original version) and bifactor models were compared.

RESULTS

The fit indices provided evidence for the two-factor DHS model among hemiplegic stroke patients. Although the two-factor model was identified as superior by the Akaike information criterion value, both models had strong goodness-of-fit indices. The DHS had an adequate level of internal consistency in measuring hope in stroke patients.

CONCLUSIONS

The DHS is a valid, reliable and useful tool for examining hemiplegic stroke patients. Identifying the psychometric properties of the DHS can help health professionals implement program development for stroke patients.

Internalized stigma in psoriasis: A multicenter study

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self-esteem and life-satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross-sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire-12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.

Stigma and psychological distress in suicide survivors

BACKGROUND

Suicide bereavement is frequently related to clinically significant psychological distress and affected by stigma. This study was designed to evaluate the relationship between psychological distress by psychopathological domains and stigma, in a sample of individuals bereaved by suicide (suicide survivors).

METHODS

The data were collected between January 2012 and December 2014 and included information on sociodemographic variables (gender, age, marital status and education level) and responses to the Stigma of Suicide Survivor scale (STOSSS) and the Brief Symptom Inventory (BSI). One hundred and fifty-five suicide survivors completed the evaluation and were included in the study.

RESULTS

Levels of psychological distress in suicide survivors, as measured by BSI, were positively related to levels of perceived stigma toward suicide survivors, as measured by STOSSS. The association was not affected by age and gender, or by marital status, education level, days from suicide or a personal history of suicide attempt. Participants with higher scores on almost all subscales of the BSI, particularly the interpersonal sensitivity and paranoid ideation subscales, reported the highest levels of perceived stigma toward suicide survivors.

CONCLUSION

Levels of distress in subjects bereaved by the suicide of a relative or friend were positively associated with levels of perceived stigma toward suicide survivors. Specific interventions dedicated to the bereavement of suicide survivors might help to alleviate not only psychological distress but also stigma towards loss by suicide.

Anxious temperament as a risk factor of suicide attempt

OBJECTIVE

Suicide has been reported to be associated with cyclothymic, irritable, depressive and anxious temperaments. In contrast, hyperthymic temperament has been reported to be protective against suicide. In the present study, we hypothesized that Japanese patients with suicide attempt may have higher scores of cyclothymic, irritable, depressive, and anxious temperaments but lower scores of hyperthymic temperament than non-suicidal patients. In order to examine this hypothesis, we investigated Japanese patients of a university emergency center.

METHODS

The association of temperament and suicide attempt was investigated in 116 patients referred to a university emergency center for intoxication or injury. Of them, 35 patients of suspected suicide attempt were categorized as 18 patients who intended to die with attempted suicide and suffered from self-inflicted but not fatal injury (Suicide Attempt II), 4 patients whose intention to die were undetermined although they suffered from self-inflicted injury (Undetermined Suicide-Related Behavior II), and 13 patients who had no intention to die although they suffered from self-inflicted injury (Self-Harm II). Logistic regression analyses and multiple regression analyses were used to identify factors associated with the present suicide attempt and the number of suicide attempts, respectively.

RESULTS

Anxious temperament scores were significantly and directly associated with Suicide Attempt II group whereas irritable temperament scores were associated with Self-Harm II group.

CONCLUSION

The present findings suggest that those with anxious temperament may have more suicide attempts than those with other temperaments, indicating anxious temperament as a risk factor of suicide attempt.

Comparison of self-stigma and quality of life in patients with depressive disorders and schizophrenia spectrum disorders - a cross-sectional study

BACKGROUND

The views of one's self-stigma and quality of life (QoL) in patients with schizophrenia and depressive disorders are significant subjective notions, both being proven to affect patient's functioning in life. The objective of this study was to investigate the QoL and self-stigma in connection with demographic factors and compare the two groups of patients in terms of those variables.

METHODS

In a cross-sectional study, the outpatients with schizophrenia spectrum disorders and depressive disorders completed the Quality of Life Satisfaction and Enjoyment Questionnaire, the Internalized Stigma of Mental Illness Scale, and a demographic questionnaire during a routine psychiatric control. Furthermore, both patients and their psychiatrists evaluated the severity of the disorder by Clinical Global Impression-Severity scale.

RESULTS

The QoL of patients with depressive disorders or schizophrenia spectrum disorders did not significantly differ between the two groups. In both groups, unemployment was perceived to be a significant factor decreasing the QoL. Self-stigma was detected to be higher in patients with schizophrenia spectrum disorders than in patients with depressive disorders. A strong correlation was found between the two scales, meaning that those with higher levels of self-stigmatization were less prone to see their life as fulfilling and joyful.

CONCLUSION

This study shows that the degree of the internalized stigma can be an important aspect linked to the QoL irrespective of the diagnostic category.

Self-stigma and quality of life in patients with depressive disorder: a cross-sectional study

BACKGROUND

Self-stigma is a maladaptive psychosocial phenomenon that can affect many areas of patients' lives and have a negative impact on their quality of life (QoL). This study explored the association between self-stigma, QoL, demographic data, and the severity of symptoms in patients with depressive disorder.

PATIENTS AND METHODS

Patients who met the International Classification of Diseases, 10th revision, research criteria for depressive disorder were enrolled in this cross-sectional study. All outpatients completed the following measurements: the Quality of Life Enjoyment and Satisfaction Questionnaire, the Internalized Stigma of Mental Illness Scale, demographic questionnaire, and the objective and subjective Clinical Global Impression-Severity scales that measure the severity of disorder. A total of 81 depressive disorder patients (with persistent affective disorder - dysthymia, major depressive disorder, or recurrent depressive disorder) and 43 healthy controls participated in this study.

RESULTS

Compared with the healthy control group, a lower QoL was observed in patients with depressive disorder. The level of self-stigma correlated positively with total symptom severity score and negatively with QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and score of self-stigma were significantly associated with QoL.

CONCLUSION

This study suggests a lower QoL in patients with depressive disorder in comparison with healthy controls and a negative impact of self-stigma level on QoL in patients suffering from depressive disorders.