Stigma and expressed emotions

Abstract

Severe psychiatric illnesses such as schizophrenia, major depression, bipolar mood disorder, and schizoaffective disorder are among the most burdensome and stigmatized illnesses worldwide and are associated with negative expressed emotions from relatives toward patients. The aim of the study was to evaluate stigma and negative expressed emotions and their burden among patients with severe psychiatric illnesses and among their family members. The sample consisted of 194 patients with severe psychiatric illnesses, attending a psychiatric outpatient department, and 386 family members. Family members were screened for stigma and expressed emotions using the Discrimination–Devaluation Scale and the Camberwell Family Interview scale. Diagnosis of patients with severe psychiatric illnesses was made according to Diagnostic and statistical manual of mental disorders, 4th ed., text revised (DSM-IV-TR) criteria. Rating scales such as the 18-item Brief Psychiatric Rating Scale, the Scale for the Assessment of Negative Symptoms, and the Global Assessment of Functioning scale were administered to the patients. Family members showed a high level of stigma and discrimination (48.76±9.98 as per the Discrimination–Devaluation Scale). The frequency of high expressed emotions was significantly higher than that of low expressed emotion [70.72% (6.37±1.25) versus 29.28% (1.31±1.56); P<0.01]. There were no significant differences in stigma and negative expressed emotion among the various DSM-IV-TR diagnoses of severe psychiatric illnesses. Stigma and expressed emotions are associated with higher scores in Brief Psychiatric Rating Scale, increased numbers of admission, lower scores in Global Assessment of Functioning, increased numbers of relapses, and lower scores in Short Form 36 (SF-36) (P<0.01), and with lower scores in Scale for the Assessment of Negative Symptoms and longer duration of illness in years (P<0.05). Patients with severe psychiatric illnesses are under considerable burden due to stigma and negative expressed emotions directed at them. Clinicians should assess the effect of stigma and expressed emotion as part of the standard workup for patients with severe psychiatric illnesses, and interventions should be planned to reduce it.