Paucity of Interventions Addressing Personal Stigma Associated With Schizophrenia

A study explored patient and caregiver awareness of disease curability and life expectancy with mali
A study explored patient and caregiver awareness of disease curability and life expectancy with mali
Almost half (49.2%) of patients diagnosed with schizophrenia spectrum disorders report alienation/shame.

It is clear that stigma and discrimination in relation to neuropsychiatric conditions have many negative consequences for the affected individuals. Thus, interventions aiming to reduce stigmatization, and to improve stigma-related knowledge and attitudes, are crucial to minimize discrimination of individuals with mental health issues.

In a systematic review, published in World Psychiatry, authors noted that, “perceived and experienced stigma, as well as self-stigma, are frequent in patients with schizophrenia spectrum disorders,” and that the “lack of interventions targeting personal stigma is striking.”

The investigators identified 54 articles published between 1994 and 2011, and have examined the prevalence, correlates and effects of personal stigma in patients diagnosed with schizophrenia.

A high percentage of patients had perceived stigma (64.5%), more than half of the patients had experienced stigma in the past (55.9%), and almost half reported alienation (shame) as the most common feature of self-stigma (49.2%).

With regard to the studies that were included in the review, sample sizes ranged from 31 to 1 229 participants (total: n=5 871, mean: n=267), and mean age ranged from 24.5 (SD=6.3) to 54.3 (SD=16.6) years. Majority of the studies were conducted in Europe and the United States (71.7%), and the percentage of male participants ranged between 38% and 71%.

In their report, the investigators write that perceived/experienced stigma significantly predicts higher incidence of depressive symptoms and social anxiety, lower quality of life, self-efficacy, self-esteem, and lower social function. Similarly, self-stigma significantly predicts less recovery, support, and less treatment.

The highest rate of anticipated/perceived stigma was reported in interpersonal interactions (80%), and the lowest in insurance-related structural discrimination (33.7%).

The lowest rate of experienced stigma was reported with regard to structural stigma (6%), and the highest with regard to patients experiencing rejection in interpersonal relations (87%).

It is important to note that, in their systematic review of the literature, the researchers identified only two intervention trials designed to target personal stigma. According to the authors, “this is in contrast to numerous interventions aimed at reducing public stigma.” 

One of the two studies found a significant decrease in the perceived discrimination score and greater coping skills in the experimental group involved in a 10-week culturally sensitive psycho-educational group program. However, the other of the two published studies did not include a control group. 

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Gerlinger G, Hauser M, De Hert M, et al. Personal stigma in schizophrenia spectrum disorders: a systematic review of prevalence rates, correlates, impact and interventions. World Psychiatry. 2013;12:155-164.