Internalized stigma experienced by patients with first-episode depression: A study from a tertiary care center

Abstract

Background: Although there is abundant literature on stigma and its correlates in patients with severe mental illnesses such as schizophrenia and bipolar disorder, data on stigma experienced by patients with first-episode depression (FED) are limited. Aims and Objectives: To estimate internalized stigma perceived by patients with FED and to assess the relationship of stigma with sociodemographic and clinical variables. Methodology: This cross-sectional study included 107 patients with FED with duration of illness of at least 1 month, currently not meeting the criteria of syndromal depression (as assessed on Hamilton depression rating scale score ≤ 7). These patients were assessed on Internalized Stigma of Mental Illness Scale (ISMIS) for internalized stigma and Participation Scale for restriction of activities. Results: About two-fifths of patients (41.1%) reported stigma as per the total ISMIS score. In terms of various domains of stigma, stereotype endorsement (54.2%) was reported by the highest proportion of patients and this was followed by alienation (47.7%) and discrimination experience (38.3%). About half of the study sample (49.5%) reported restriction in participation with one-third of the sample reporting having severe or extreme restriction. Younger age, longer duration of depressive episode, and presence of comorbid physical illness were found to be strongly associated with higher level of stigma. Higher level of participation restriction was associated with higher level of stigma in the domains of alienation (P ≤ 0.001) and social withdrawal (P ≤ 0.004). Conclusions: The present study suggests that internalized stigma/self-stigma is highly prevalent among patients with FED. Accordingly, there is a need to develop stigma mitigation programs addressing these patients at the earliest to improve their treatment outcome.