Self-stigma is defined as a devaluation of the self by internalising negative stereotypes they attribute to themselves or/and attributed to them from external sources (Fung et al
]). A study by Fung et al
]) has found that self-stigma is one of the contributing factors in undermining treatment adherence. Individuals with schizophrenia often endorse a feeling of self-disregard and incompetence (Lysaker et al
]). It may be possible that their self-stigmatised thoughts might, therefore, reduce their motivation and thus readiness for seeking therapy .
Circle of cause and effect from stigma. From this figure we suggest that stigma is interrelated with many other factors such as discrimination, isolation, and finally outcome.
Throughout history and in practically every culture, groups of persons, including mental patients, have been stigmatised. The reasons for such stigmatisation and its maintenance remain obscure. Its association to non adherence to treatment is common but unfortunately difficult to detect in patients with schizoaffective disorder and schizophrenia, of whom almost half take less than 70% of prescribed doses (Goff et al
]). Like patients in all areas of medicine, patients with schizoaffective disorder weigh the perceived benefits of medications against perceived disadvantages; but this process is complicated by their impaired insight, the stigma of the diagnosis, and the often troubling side effects of antipsychotic medication. Interventions to improve adherence include encouraging acceptance of the illness, drawing analogies with treatment for chronic medical disease, and involving the patient in decision-making. Clinicians are required to remain non-judgemental, encouraging patients to disclose problems with adherence and anticipating that improvement in adherence may require a prolonged effort. Selection of antipsychotic medication is critical to avoid adverse side effects, and some medications may provide a sense of well-being, such as improvement in insomnia, anxiety, or depression (Goff et al
Research suggests that the stigma of mental illness can impair treatment utilization in two ways:
- Through perceived public stigma, individuals with mental illness may seek to avoid the public label and stigmatisation of mental illness by choosing not to seek treatment or to discontinue treatment prematurely, and,
- Through internalised stigma, individuals with mental illness may seek to avoid the negative feelings of shame and guilt about themselves by choosing not to seek treatment. These two constructs, public and internalised stigma, are manifest differently within individuals, but they clearly influence each other in their impact on the stigmatised individual. If an individual with mental illness perceives public stigma to be high, they may be more likely to internalise these negative stereotypes than if they perceive public stigma about mental illness to be low (Corrigan, 2004).
Studies also show that interpersonal, economic, and policy factors also mitigate service use. For instance, patients with schizophrenia are less likely to perceive benefits of medications, due to their impaired insight, the stigma of the diagnosis, and the often troubling side effects of antipsychotic medication. Interventions to improve adherence include encouraging acceptance of the illness, drawing analogies with treatments for chronic medical diseases, and involving the patient in decision-making. Pandya et al
]) reported that stigma must be understood through individual experience in specific contexts rather than as a unitary experience. They studied whether diagnosis disclosure can be beneficial. A convenience sample of 258 adults with schizophrenia recruited via the Internet and e-mail lists completed an online survey. Although reactions to disclosure varied, many report worse treatment by police (Patch et al
]) and better treatment by parents after disclosure (Pandya, et al
]). Many also experience worse treatment for medical problems after disclosing their schizophrenia diagnosis. These results emphasise the support for targeted anti-stigma interventions.
In a one-year cross-sectional study with 105 participants face-to-face interviews were conducted to assess participants’ level of self-stigma, readiness for change, insight, and general self-efficacy. The corresponding case therapists in this study reported participants’ level of treatment adherence, psychopathology, and global functioning. The study found that better readiness for action, and lower levels of self-stigma were associated with better treatment participation. Individuals with lesser severity of psychiatric symptoms and female participants had better treatment attendance. The results of a discriminant function analysis showed the combined scores of self-stigma, stages of change, and global functioning measures correctly classified 76.2% participants into adherent/non adherent group membership. Suggestions for further studies and development of self-stigma reduction programme to facilitate recovery and treatment adherence were made (Tsang et al
A critical component of stigma in schizophrenia is the perception that patients are extremely dangerous. The assessment of this concept in the general population by the use of reliable and valid instruments will allow the development of programmes aimed to reduce it. In one study designed to develop an assessment instrument of the public conception of aggressiveness in schizophrenia and to determine its reliability and validity in a community, they reported that more than 40% of the sample of Mexico City authors considered that a patient with schizophrenia was aggressive and dangerous. The CAQ had an adequate internal consistency (alpha=0.74). The results of the factorial analysis showed that two factors explained 61% of the variance. The items of CAQ showed two major areas to evaluate: a) perception of the presentation of aggressive behaviours; and, b) mental illness recognition and social aspects of the stigma of dangerousness. The CAQ is an instrument with adequate psychometric properties that could be useful to evaluate the perception of aggressiveness in schizophrenia among the general population (Fresán et al