Abstract
BackgroundDespite the potential impact on treatment adherence and recovery, there is a dearth of data on the extent and correlates of internalized stigma in patients with schizophrenia in low income countries. We conducted a study to determine the extent, domains and correlates of internalized stigma amongst outpatients with schizophrenia in Ethiopia.MethodsThe study was a cross-sectional facility-based survey conducted at a specialist psychiatric hospital in Addis Ababa, Ethiopia. Consecutive consenting individuals with a diagnosis of schizophrenia were recruited and assessed using an Amharic version of the Internalized Stigma of Mental Illness (ISMI) scale.ResultsData were collected from 212 individuals, who were mostly single (71.2%), unemployed (70.3%) and male (65.1%). Nearly all participants (97.4%) expressed agreement to at least one stigma item contained in the ISMI; 46.7% had a moderate to high mean stigma score. Rural residence (OR = 5.67; 95% CI = 2.30, 13.00; p < 0.001), single marital status (OR = 3.39; 95% CI = 1.40, 8.22; p = 0.019) and having prominent psychotic symptoms (OR = 2.33; 95% CI = 1.17, 4.61; p = 0.016) were associated independently with a higher stigma score. Almost half of those who discontinued their treatment reported that they had done so because of perceived stigma. Those who had attempted suicide (45.3%) were more likely to have a high stigma score (OR = 2.29; 95% CI = 1.27, 4.11; p = 0.006). Over 60% of the variation in the experience of stigma was explained by four factors: social withdrawal (16.7%), perceived discrimination (14.1%), alienation (13.9%) and stereotype endorsement (12.7%).ConclusionInternalized stigma is a major problem among persons with schizophrenia in this outpatient setting in Ethiopia. Internalized stigma has the potential to substantially affect adherence to medication and is likely to affect the recovery process.
Highlights
Despite the potential impact on treatment adherence and recovery, there is a dearth of data on the extent and correlates of internalized stigma in patients with schizophrenia in low income countries
Because of the above consequences and related negative impacts such as social withdrawal, poor vocational functioning and worse quality of life [5,6,7,9,10,11,12,13,14], internalized stigma is emerging as a key factor that can hold back the recovery process
Prevalence of internalized stigma This study demonstrates the high burden of internalized stigma among patients with schizophrenia attending a specialist hospital in Ethiopia
Summary
Despite the potential impact on treatment adherence and recovery, there is a dearth of data on the extent and correlates of internalized stigma in patients with schizophrenia in low income countries. Public stigma (or social stigma) typically describes the endorsement of stereotypes and enacted behaviours against people with mental illness by professionals and the general population [2,3]. The person believes that others think s/he is not worthwhile or should not, for example be married, and believes that s/he is not worth much and should not be married. This changes fundamentally the perception the person has about themselves and leads to a change in the person’s behaviour in a way that matches the internalized perceptions. Because of the above consequences and related negative impacts such as social withdrawal, poor vocational functioning and worse quality of life [5,6,7,9,10,11,12,13,14], internalized stigma is emerging as a key factor that can hold back the recovery process
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