Prevalence, Characteristics and Socio-Demographic Correlates of Self-Stigma among Leprosy Affected Persons - A Case Study

This study has determined the prevalence of self-stigma, its characteristics in terms of alienation, stereotype endorsement, perceived discrimination and social withdrawal and stigma resistance among leprosy-affected persons and its relationship and extent of this relationship with various socio-demographic features. This has been done by carrying out a cross-sectional survey of 120 active people affected by leprosy during 2020-21. An internationally validated and standardised instrument (ISMI) was used to measure self-stigma. Statistical techniques such as independent t-test, Pearson’s and point biserial correlation and regression analysis were used for data analysis. The study found significant correlations between ISMI self-stigma scores and socio- demographic variables with moderate to minor deviation across the four components of the ISMI scale. The high to low correlation of various components of the ISMI scale found is discrimination experience, followed by stigma resistance, stereotype endorsement and alienation. Overall, the highest self-stigma was found in disabled people affected by leprosy, followed by those whose age was less than 40 years, followed by unemployed and male people affected by leprosy. It was concluded that alienation was maximum among people affected by leprosy who were either disabled, aged less than 40 years or were males. Discrimination experience was reported mainly by unemployed, disabled, males and younger people affected by leprosy. The findings indicate that proper methodology and components of Cognitive Behavioural Therapy may help reduce self-stigma among leprosy-affected persons

Necesidad de apoyo psicológico y etnicidad en personas diagnosticadas con Esquizofrenia: La importancia del componente subjetivo en el abordaje del estigma internalizado / Need for psychological support and ethnicity in people diagnosed with Schizophrenia: The importance of the subjective component in addressing internalized stigma

Objetivo Comparar las características socio-demográficas, la calidad de vida, el malestar psicológico y los niveles de estigma internalizado en una muestra de pacientes con Esquizofrenia pertenecientes a la región de Arica y Parinacota que reciben tratamiento en el mismo sistema de salud mental. Método Participaron 209 pacientes con un diagnóstico de Esquizofrenia usuarios de los servicios públicos ambulatorios de salud mental. Resultados La pertenencia a la etnia Aymara no determinó diferencias en las características sociodemográficas. Por otra parte, el grupo de pacientes Aymara presentó mayores niveles de Alienación en la escala de Estigma Internalizado en comparación al grupo de pacientes No-Aymara. La necesidad de apoyo psicológico es convergente a los niveles de malestar psicológico, la calidad de vida y el estigma internalizado. Conclusiones Los hallazgos refuerzan la adecuada capacidad de los usuarios con Esquizofrenia para valorar sus necesidades de apoyo psicológico durante el tratamiento en función de sus niveles de calidad de vida y malestar psicológico.

Objective The aim of this study was to compare the socio-demographic characteristics, quality of life, psychological distress and levels of internalized stigma in a sample of patients with Schizophrenia belonging to the region of Arica and Parinacota who receive treatment in the same mental health system. Methods 209 patients with a diagnosis of schizophrenia, users of public outpatient mental health services, participated in the study. Results Aymara ethnicity did not determine differences in sociodemographic characteristics. On the other hand, the group of Aymara patients had higher levels of Alienation on the Internalized Stigma Scale compared to the group of Non-Aymara patients. Need for psychological support are convergent to levels of psychological distress, quality of life and internalized stigma. Conclusions The findings emphasize the adequate capacity of users with schizophrenia to assess their psychological support needs during treatment based on their levels of quality of life and psychological distress.

Estigma social e estigma internalizado: a voz das pessoas com transtorno mental e os enfrentamentos necessários / Social stigma and internalized stigma: the voice of persons with mental disorders and the confrontations required

Resumo O estigma internalizado ocorre quando o indivíduo tem consciência do estigma a ele atribuído, concordando e aplicando a si próprio os estereótipos negativos sobre sua doença. A internalização do estigma agrava os sintomas do transtorno mental, levando a isolamento, sentimentos de baixa autoestima, culpa e autorreprovação. Buscou-se produzir mais conhecimentos acerca dessa temática, a partir da visão das pessoas com transtorno mental que participam de ações visando construir coletivamente soluções no cuidado em saúde mental. Com o objetivo de analisar o processo de estigma e estigma internalizado, realizou-se pesquisa qualitativa, com entrevistas semiestruturadas. Os resultados revelaram que o estigma internalizado tem efeitos negativos no indivíduo, e que a família tem forte influência nesse processo.

Abstract Internalized stigma occurs when individuals become aware of the stigma assigned to them, agree, and apply these negative stereotypes about their illness to themselves. The internalization of stigma aggravates the symptoms of mental disorders, leading to isolation, feelings of low self-esteem, guilt, and self-condemnation. Our goal was to produce more knowledge on this topic from the point of view of people with mental disorders who participate in activities aimed at collectively building mental health care solutions. With the objective of analyzing the process of stigma and internalized stigma, we carried out qualitative research using semi-structured interviews. The results showed that internalized stigma has negative effects on individuals, and that the family has a strong influence on this process.

The Insight Paradox among Outpatients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: The primary objective was to test the phenomenon known as the insight paradox, which refers to the association between higher levels of insight and lower self-esteem, higher hopelessness, and a higher perception of social prejudice among patients with schizophrenia. METHODS: A total of 216 outpatients with schizophrenia according to the DSM-IV diagnostic criteria were recruited. All participants were receiving ongoing outpatient treatment and were in a stable phase of the disorder. The participants were divided into a good-insight (N=109) and a poor-insight (N=107) group by the direct interview and the mean score of questionnaire. The parameters used for analysis and comparison were demographic variables (age, gender, education), clinical variables (age at onset, number of hospitalizations), self-esteem, hopelessness, self-stigma, and quality of life. RESULTS: Compared with the poor-insight group, the good-insight group was found to have a lower number of hospitalizations, lower self-esteem, higher hopelessness, lower quality of life, and a higher level of internalized stigma. CONCLUSION: The insight can cause the negative consequences in patients with schizophrenia. Therefore, clinicians should pay attention to the negative aspects of insight for improving the quality of life in the treatment of patients with schizophrenia.

The mediating role of internalized stigma between insight and self-esteem among patients with schizophrenia / 中华行为医学与脑科学杂志

Objective@#To explore the relationship between internalized stigma and insight, self-esteem in patients with schizophrenia.@*Methods@#A total of 144 schizophrenic patients were investigated by the general information questionnaire, insight and treatment attitude questionnaire (ITAQ), internalized stigma of mental illness scale-Chinese version (ISMI-C) and the self-esteem scale (SES). Pearson correlative analysis and Bootstrap program mediation effect test were used to data analysis.@*Results@#There was a significantly positively correlation between insight score(11.24±4.08) and internalized stigma score(2.18±0.65) of 144 schizophrenic patients(r=0.236, P<0.05). The Self-esteem score(27.57±3.76) was negatively correlated with insight score(r=-0.177, P<0.05) and internalized stigma score(r=-0.661, P<0.05). The mediation effect test analysis showed that the internalized stigma played a full mediating role in the relationship between insight and self-esteem, and the effect size was -0.143.@*Conclusion@#Insight can indirectly affect self-esteem via internalized stigma in patients with schizophrenia.Taking measures to decrease inpatients' internalized stigma level and improve their illness awareness should be paid attention in clinical practice.

The mediating role of internalized stigma between insight and self-esteem among patients with schizo-phrenia / 中华行为医学与脑科学杂志

Objective To explore the relationship between internalized stigma and insight,self-es-teem in patients with schizophrenia. Methods A total of 144 schizophrenic patients were investigated by the general information questionnaire,insight and treatment attitude questionnaire (ITAQ),internalized stigma of mental illness scale-Chinese version (ISMI-C) and the self-esteem scale (SES). Pearson correlative analysis and Bootstrap program mediation effect test were used to data analysis. Results There was a significantly positively correlation between insight score(11. 24±4. 08) and internalized stigma score(2. 18±0. 65) of 144 schizophrenic patients(r=0. 236,P<0. 05). The Self-esteem score(27. 57±3. 76) was negatively correlated with insight score(r=-0. 177,P<0. 05) and internalized stigma score(r=-0. 661,P<0. 05). The mediation effect test analysis showed that the internalized stigma played a full mediating role in the relationship between insight and self-esteem,and the effect size was -0. 143. Conclusion Insight can indirectly affect self-es-teem via internalized stigma in patients with schizophrenia. Taking measures to decrease inpatients' internal-ized stigma level and improve their illness awareness should be paid attention in clinical practice.

Comparisons of the Clinical Variables between High and Low Self-Stigma Group in the Outpatients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: The purpose of this research was to investigate the differences of clinical variables between high and low self-stigma group in the outpatients with schizophrenia. METHODS: 209 schizophrenic outpatients were assigned to high self stigma group (n=76) and low self stigma group (n=133) based on the scores of perceived stigma, and compared age, sex, education, age of onset, duration of illness, number of hospitalization, symptom, social functioning, insight, self-esteem, empowerment between two groups. RESULTS: 1) The high self-stigma group had significantly lower age of onset, higher duration of illness and number of hospitalizations compared to the low self-stigma group. 2) In the PANSS, the high self-stigma group showed significantly higher score in the total score and general symptoms compared to the low self-stigma group. No significant difference was found in the positive symptoms and negative symptoms between two groups. 3) The high self-stigma group had significantly lower empowerment and self-esteem compared to the low self-stigma group. 4) The high self-stigma group had significantly higher insight compared to the low self-stigma group. CONCLUSION: Self-stigma in patients with schizophrenia directly reduces self-esteem and empowerment, and may cause depression and a lower quality of life. Therefore, identifying self-stigma and its degree is one of the important factors for good outcome.

O auto-estigma dos usuários de álcool e drogas ilícitas e os serviços de saúde: uma revisão integrativa da literatura / The self-stigma of alcohol and illicit drug users and health services: an integrative review of the literature / El auto-estigma de los usuarios de alcohol y drogas ilícitas y los servicios de salud: um repaso integrativa de la literatura

OBJETIVOS: identificar, analisar e sintetizar evidências científicas sobre a relação entre o estigma existente nos serviços de saúde no que se refere aos usuários de álcool e drogas ilícitas e o auto-estigma destes usuários. MÉTODO: revisão integrativa da literatura, através de cinco etapas distintas. RESULTADOS: do total de artigos encontrados nas bases de dados, 07 foram selecionados e analisados, resultando nas categorias "O estigma público nos serviços de saúde" e "A relação entre o estigma nos serviços de saúde e o auto-estigma em usuários de álcool e drogas ilícitas". CONCLUSÃO: o auto-estigma é influenciado pelo estigma público propagado, principalmente, por autoridades e por profissionais de saúde. Uma das alternativas para atenuar o cenário do auto-estigma é o apoio social.

OBJECTIVES: To identify, analyze and synthesize scientific evidence on the relationship between the stigma existing in health services regarding alcohol users and illicit drugs and the self-stigma of these users. METHOD: integrative review of the literature, through five distinct stages. RESULTS: of the total of articles found in the databases, 07 were selected and analyzed, resulting in the categories "Public stigma in health services" and "The relationship between stigma in health services and self-stigma in alcohol users and illicit drugs. " CONCLUSION: self-stigma is influenced by public stigma propagated, mainly by authorities and health professionals. One of the alternatives to attenuate the scenario of self-stigma is social support.

OBJETIVOS: identificar, analizar y sintetizar evidencias científicas sobre la relación entre el estigma existente en los servicios de salud en el que se refiere a los usuarios de alcohol y drogas ilícitas y el auto-estigma de estos usuarios. MÉTODO: revisión integrativa de la literatura, por medio de cinco etapas distinguidas. RESULTADOS: del total de artículos encontrados en las bases de datos, 07 fueron seleccionados y analizados, resultando en las categorias "El estigma público en los servicios de salud" y "La relación entre el estigma en los servicios de salud y el auto-estigma em usuarios de alcohol y drogas ilícitas". CONCLUSIÓN: el auto-estigma es influenciado por el estigma público propagado, principalmente, por autoridades y por profesionales de salud. Una de las alternativas para atenuar el escenario del auto-estigma es el apoyo social.

Impact of Internalized Stigma, Anger Expression Style, and Mental Health Service Satisfaction on Self-esteem in Inpatients with Schizophrenia / 정신간호학회지

PURPOSE: This study was performed to identify how internalized stigma, anger expression style, and mental health service satisfaction impact on the self-esteem of inpatients with schizophrenia. METHODS: For this descriptive correlational study, 191 inpatients with schizophrenia participated. They had been admitted to one of six mental hospitals in three areas of South Korea. Data were collected from August 1 to November 30, 2016 using self-report questionnaires and data were analyzed using t-test, one-way ANOVA, Pearson correlation coefficients, and stepwise multiple regression with IBM SPSS 22.0. RESULTS: The significant predictors of self-esteem in inpatients with schizophrenia were internalized stigma, anger expression style, and mental health service satisfaction, explaining 36% of the variance in self-esteem. The most significant predictor of self-esteem in inpatients with schizophrenia was internalized stigma. CONCLUSION: Study findings suggest that a significant reduction in the internalized stigma of inpatients with schizophrenia increases their self-esteem. It is also, necessary to improve adaptive anger expression style and mental health service satisfaction.

Adaptación cultural de instrumentos de medida sobre estigma y enfermedad mental en la Ciudad de México / Cultural adaptation of instruments to measure stigma and mental illness in Mexico City

This article forms part of a collaborative study in which research teams from Canada and Mexico participated. The general objective is to describe the cultural adaptation and semantic validation of three instruments for measuring stigma and mental illness in Mexico City. The criteria of understanding, acceptance, relevance and semantic integrity were used to adapt the following instruments: The Internalized Stigma Inventory (ISMI), the Opinions on Mental Illness Survey (OMI) and the Devaluation and Discrimination Scale (DDS). Four Individual interviews and four group interviews were carried out with 37 informants from different groups (health personnel, persons with diagnostic of mental disorders, relatives and the general population). Lastly, an analysis was carried out on the contents of the information obtained. The instruments proved to be culturally appropriate for the population in Mexico in the various groups studied. The adapted versions would be useful for establishing comparative analyses with other countries. The scope and limitations of the process of semantic equivalence were analyzed in the transcultural research.

Este trabajo forma parte de un estudio colaborativo en el que participan equipos de investigación en Canadá y México. El objetivo general consiste en describir el proceso de adaptación cultural y validación semántica de tres instrumentos de medición sobre el estigma y la enfermedad mental en la Ciudad de México. A partir de los criterios de comprensión, aceptación, relevancia e integridad semántica se adaptaron los siguientes instrumentos: el Inventario de Estigma Internalizado (ISMI), el Cuestionario de Opiniones hacia la Enfermedad Mental (OMI) y la Escala de Percepción de la Devaluación y Discriminación hacia la Enfermedad Mental (DDS). Para ello se llevaron a cabo cuatro entrevistas individuales y cuatro grupales con 37 informantes de diversos sectores (personal de salud, personas con diagnóstico de trastorno mental grave, familiares y población general). Finalmente se efectuó un análisis de contenido de la información obtenida. Los instrumentos adaptados fueron culturalmente apropiados para la población de los diferentes grupos estudiados en México. Las versiones adaptadas serán de utilidad para establecer análisis comparativos con otras regiones. Se analizan los alcances y limitaciones del proceso de equivalencia semántica en la investigación transcultural.

Factors Affecting Internalized Stigma of Patient with Schizophrenia / 정신간호학회지

PURPOSE: The purpose of this study was to explore internalized stigma of patients with schizophrenia and examine factors contributing to their internalized stigma. METHODS: Participants in this study were 173 patients schizophrenia living in Busan. Data were collected between January 2 to 16, 2012 using the Korean version of the Internalized Stigma of Mental Illness Scale (ISMI), and measurements of Self-esteem, Depression, Family and Social support, and Insight. Data were analyzed using the SPSS/WIN 18.0 program. RESULTS: The mean score for internalized stigma was 68.8+/-12.15. The significant factors influencing internalized stigma were depression, insight, admission status, mental health center services, number of admissions, self-esteem, and family support. These factors explained 40.8% of the variance. CONCLUSION: The results suggest that in development and practice of programs to decrease internalized stigma in patients with schizophrenia factors identified in this study as influencing internalized stigma should be considered.

A Study on the Reliability and Validity of the Korean Version of Internalized Stigma of Mental Illness Scale (K-ISMI) / 신경정신의학

OBJECTIVES: The Internalized Stigma of Mental Illness (ISMI) scale designed to measure the subjective experience of stigma with sub-scales measuring Alienation, Stereotype Endorsement, Perceived Discrimination, Stigma Resistance, and Social withdrawal. The purpose of this study was to examine the reliability and validity of the Korean version of ISMI. METHODS: The subjects were 194 schizophrenic patients and 205 peoples with depressive disorder. K-ISMI, CES-D (The Center for Epidemiologic Studies Depression Scale) and Self Esteem scale were performed. RESULTS: Results showed that the ISMI had high internal consistence and split-half reliabilities. The internal consistency coefficients (Cronbach alpha) of each subscale ranged from .83 to .93. The validity of the ISMI was investigated by principal axis factoring analysis, yielding 5 factors of alienation, perceived discrimination, negative stereotype, stigma resistance, devaluation and social withdrawal. 5 subscales explained 60.67% of total variance. Concurrent validity was supported by comparisons against scales measuring related constructs. As expected, the ISMI had positive correlations with CES-D, and it had negative correlation with self-esteem scale. Subsidiary analysis showed that schizophrenic patients showed higher internalized stigma than depressed patients. CONCLUSION: Overall, the findings support the utility of ISMI as a tool to evaluate internalized stigma of persons with mental illness. Interventions that can lessen internalized stigma may well hasten the recovery process in individuals with mental illness.