Self-Stigmatization Affects Medication Adherence in Schizophrenia
Researchers examined which factors affected patients’ attitude toward medication adherence in schizophrenia.
Self-stigmatization has a significant influence on medication adherence attitude for patients with schizophrenia, according to findings from a study published in Psychiatry Review.
Patients with higher levels of self-stigmatization also had lower subjective well-being, an increased number of depressive symptoms, and were more likely to be men.
Previous research has found that medication adherence attitude (which reflects the patient's beliefs toward drug treatment) consistently influences adherence behavior, with a negative attitude being associated with a higher likelihood of discontinuation. In this study, the researchers wanted to explore what factors affect medication adherence attitude for patients with schizophrenia.
The study included 81 adults with a diagnosis of schizophrenia or schizoaffective disorder recruited from the inpatient and outpatient units of the Department of Psychiatry and Psychotherapy at the University Hospital Muenster in Germany as well as a nearby psychiatric clinic. All patients were age 17 years or older, were currently taking at least 1 antipsychotic medication with completed titration phase and clear indication for maintenance therapy, and had stable psychopathologic condition within the previous 7 days.
To assess the participants' self-stigmatization, the researchers used the German version of the Internalized Stigma of Mental Illness Scale, which has a 1 to 4 range. Higher values indicate a higher level of self-stigmatization. Overall, patients scored an average of 2.1 on the Internalized Stigma of Mental Illness scale, indicating mild internalized stigma. Men consistently scored higher than women on all Internalized Stigma of Mental Illness subscales. Participants with higher levels of self-stigmatization had lower subjective well-being and more depressive symptoms compared with those with lower levels of self-stigmatization.
To assess the participants' attitude toward antipsychotic medication, the researchers used the German version of the Rating of Medical Influence Scale. Higher values indicate a more positive overall attitude towards medication. Participants with higher Rating of Medical Influence Scale scores showed better insight into illness, lower degree of self-stigmatization, and good subjective knowledge about medication compared with those with lower Rating of Medical Influence Scale scores.
The researchers recommend that clinicians focus on ways to enhance or correct patients' insights into their illness and educate them about their medication.
“The careful evaluation of potential self-stigmatizing tendencies seems quite essential, particularly in male patients and in the co-presence of low wellbeing and depressive symptoms,” wrote the researchers. “This might not only allow for adjustments of misconceptions and the enhancement of health literacy, but could also help to identify appropriate coping strategies that, in turn, could facilitate the relief from subjective burden and self-stigma.”
Feldhaus T, Falke S, von Gruchalla L, et al. The impact of self-stigmatization on medication attitude in schizophrenia patients. Psychiatry Res. 2018;261:391-399.