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BMC Psychiatry

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Open Access 01-12-2019 | Research article

Prevalence of self-stigma and its association with self-esteem among psychiatric patients in a Nepalese teaching hospital: a cross-sectional study

Authors: Shanta Maharjan, Bimala Panthee

Published in: BMC Psychiatry | Issue 1/2019

Abstract

Background

Stigma against mental illness cuts across all age, religion, ethnic origin or socio-economic status. Similarly, self-stigma among psychiatric patients is also prevalent worldwide. The consequences of self-stigma are low self-esteem, increased severity of symptoms, low treatment adherence, increased rate of suicidality and decreased quality of life. Thus, this study aims to find the prevalence of self-stigma and its association with self-esteem of patients with mental illness in Nepal.

Methods

This was a cross-sectional study conducted among 180 patients with mental illness attending a psychiatric Outpatient Department (OPD). Non-probability purposive sampling technique was used for the study. The data was collected by face to face interview technique. Structured interview schedule questionnaire (brief version of internalized stigma scale and Rosenberg self-esteem scale) was used to collect the data. Descriptive statistics, inferential statistics and correlation analysis were used for data analysis. P value was set at 0.05.

Results

Overall prevalence of self-stigma was 54.44%. Among those who had self-stigma 48% had mild self-stigma, 34.7% had moderate self-stigma and 17.3% had severe self-stigma. Among the five components of self-stigma scale, the highest mean score was on stereotype endorsement, followed by discrimination experience, social withdrawal, stigma resistance, and the lowest for the component of alienation. Furthermore, strong negative correlation (r = − 0.74) was found between self-stigma and self-esteem. The correlation was still significant (r = − 0.69) after controlling for socio-demographic and clinical variables. Hospital admission and diagnostic category of respondents were significantly associated with self-stigma. However, no significant association was found between socio-demographic variables and self-stigma.

Conclusion

Based on the findings of this study, it can be concluded that self-stigma is prevalent among psychiatric patients in Nepal. Most of the respondents experienced stereotype endorsement. Also, higher self-stigma is significantly associated with poor self-esteem suggesting self-stigma reduction programs. Furthermore, strong negative relationship between self-stigma and self-esteem suggests some causal relationship studies to confirm if self-esteem enhancement program can be beneficial to reduce self-stigma among psychiatric patients.

Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016;3(2):171–8. https://doi.org/10.1016/s2215-0366(15)00505-2.CrossRefPubMed

Boyd JE, Otilingam PG, Deforge BR. Brief version of the internalized stigma of mental illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination. Psychiatr Rehabil J. 2014;37(1):17–23. https://doi.org/10.1037/prj0000035.CrossRefPubMed

Adhikari SR. Stigma in mental illness: relative’s perspective. JPAN. 2015;3(2):6. https://doi.org/10.3126/jpan.v3i2.12393.CrossRef

Rusch N, Corrigan PW, Todd AR, Bodenhausen GV. Implicit self-stigma in people with mental illness. J Nerv Ment Dis. 2010;198(2):150–3. https://doi.org/10.1097/NMD.0b013e3181cc43b5.CrossRefPubMed

West ML, Yanos PT, Smith SM, Roe D, Lysaker PH. Prevalence of internalized stigma among persons with severe mental illness. Stigma Res Action. 2011;1(1):3. https://doi.org/10.5463/sra.v1i1.9.CrossRefPubMedPubMedCentral

Assefa D, Shibre T, Asher L, Fekadu A. Internalized stigma among patients with schizophrenia in Ethiopia: a cross-sectional facility-based study. BMC Psychiatry. 2012;12(1):239. https://doi.org/10.1186/1471-244x-12-239.CrossRefPubMedPubMedCentral

Ibrahim AW, Mukhtar Y, Sadique P, Tahir BM, Olabisi AM, Bukar RI, et al. A facility-based assessment of internalized stigma among patients with severe mental illnesses in Maiduguri, North-Eastern Nigeria. Int Neuropsychiatr Dis J. 2016;61(1):1–11. https://doi.org/10.1155/2018/1987581.CrossRef

Young DK-W, Ng PY-N. The prevalence and predictors of self-stigma of individuals with mental health illness in two Chinese cities. Int J Soc Psychiatry. 2016;62(2):176–85. https://doi.org/10.1177/0020764015614596.CrossRefPubMed

Modi L, Gedam SR, Shivji IA, Babar V, Patil P. Comparison of total self-stigma between schizophrenia and alcohol dependence patients. Int J High Risk Behav Addict. 2018;7(3). https://doi.org/10.5812/ijhrba.61043.

10.

Holubova M, Prasko J, Ociskova M, Marackova M, Grambal A, Slepecky M. Self-stigma and quality of life in patients with depressive disorder: a cross-sectional study. Neuropsychiatr Dis Treat. 2016;12:2677–87. https://doi.org/10.2147/NDT.S118593.CrossRefPubMedPubMedCentral

11.

Cinculova A, Prasko J, Kamaradova D, Ociskova M, Latalova K, Vrbova K, et al. Adherence, self-stigma and discontinuation of pharmacotherapy in patients with anxiety disorders - cross-sectional study. Neuro Endocrinol Lett. 2017;38(6):429–6.PubMed

12.

Batinic B, Lemonis E, Opacic G. Effects of internalized stigma of mental disorder on quality of life and self-esteem in panic disorder patients. J Clin Res Bioeth. 2014;5(5):1. https://doi.org/10.4172/2155-9627.1000196.CrossRef

13.

Yanos PT, Roe D, Lysaker PH. The impact of illness identity on recovery from severe mental illness. Am J Psychiatr Rehabil. 2010;13(2):73–93.CrossRef

14.

Latalova K, Prasko J, Kamaradova D, Ociskova M, Cinculova A, Grambal A, et al. Self-stigma and suicidality in patients with neurotic spectrum disorder - a cross sectional study. Neuro Endocrinol Lett. 2014;35(6):474–80.PubMed

15.

Pokharel B, Pokharel A. Perceived stigma towards mental illness among college students of western Nepal. Birat J Health Sci. 2018;2(3):4. https://doi.org/10.3126/bjhs.v2i3.18946.CrossRef

16.

Lannin DG, Vogel DL, Brenner RE, Tucker JR. Predicting self-esteem and intentions to seek counseling:the internalized stigma model Ψ. Couns Psychol. 2015;43(1):64–93. https://doi.org/10.1177/0011000014541550.CrossRef

17.

Evans-Lacko S, Brohan E, Mojtabai R, Thornicroft G. Association between public views of mental illness and self-stigma among individuals with mental illness in 14 European countries. Psychol Med. 2012;42(8):1741–52.CrossRef

18.

Mann M, Hosman CMH, Schaalma HP, de Vries NK. Self-esteem in a broad-spectrum approach for mental health promotion. Health Educ Res. 2004;19(4):357–72. https://doi.org/10.1093/her/cyg041.CrossRefPubMed

19.

World Health Organization. Multisectoral action plan for the prevention and control of non communicable diseases (2014-2020) government of Nepal. 2013. Available from: http://www.searo.who.int/nepal/mediacentre/ncd_multisectoral_action_plan.pdf. Cited 14 Sept 2019.

20.

Link BG, Cullen FT, Struening E, Shrout PE, Dohrenwend BP. A modified labeling theory approach to mental disorders: an empirical assessment. Am Sociol Rev. 1989:400–23. https://doi.org/10.1186/1472-6963-10-80.

21.

Sadock BJ. Psychiatric report, medical record and medical error. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock’s comprehensive textbook of psychiatry. 9th ed. Philadelphia: Lippincott Williams and Wilkins; 2009. p. 907–18.

22.

Lysaker PH, Roe D, Yanos PT. Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, Hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophr Bull (Bp). 2006;33(1):192–9. https://doi.org/10.1093/schbul/sbl016.CrossRef

23.

Rosenberg M. Society and the adolescent self-image. Princeton: Princeton University Press; 1965.

24.

Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health. 2005;8(2):94–104. https://doi.org/10.1111/j.1524-4733.2005.04054.x.CrossRefPubMed

25.

Kim WJ, Song YJ, Ryu H-S, Ryu V, Kim JM, Ha RY, et al. Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness. Psychiatry Res. 2015;225(3):433–9. https://doi.org/10.1016/j.psychres.2014.11.071.CrossRefPubMed

26.

Grover S, Avashi A, Singh A, Dan A, Neogi R, Kaur E, et al. Stigma experienced by patients with severe mental disorders: a nationwide multicentric study from India. Psychiatry Res. 2017;257:550–8. https://doi.org/10.1016/j.psychres.2017.08.027.CrossRefPubMed

27.

Singh A, Mattoo S, Grover S. Stigma and its correlates in patients with schizophrenia attending a general hospital psychiatric unit. Indian J Psychiatry. 2016;58(3):291–300. https://doi.org/10.4103/0019-5545.192024.CrossRefPubMedPubMedCentral

28.

Segalovich J, Doron A, Behrbalk P, Kurs R, Romem P. Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia. Arch Psychiatr Nurs. 2013;27(5):231–4. https://doi.org/10.1016/j.apnu.2013.05.002.CrossRefPubMed

29.

Kumari S, Banerjee I, Majhi G, Chaudhury S, Singh A, Verma A. Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients. Med J DY Patil Univ. 2014;7:550–7. https://doi.org/10.4103/0975-2870.140365.CrossRef

30.

Livingston JD, Boyd JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med (1982). 2010;71(12):2150–61. https://doi.org/10.1016/j.socscimed.2010.09.030.CrossRef

31.

Asrat B, Ayenalem AE, Yimer T. Internalized stigma among patients with mental illness attending psychiatric follow-up at Dilla University Referral Hospital, Southern Ethiopia. Psychiatry J. 2018;2018:7. https://doi.org/10.1155/2018/1987581.CrossRef

32.

Lv Y, Wolf A, Wang X. Experienced stigma and self-stigma in Chinese patients with schizophrenia. Gen Hosp Psychiatry. 2013;35(1):83–8. https://doi.org/10.1016/j.genhosppsych.2012.07.007.CrossRefPubMed

33.

Shimotsu S, Horikawa N. Self-stigma in depressive patients: association of cognitive schemata, depression, and self-esteem. Asian J Psychiatr. 2016;24:125–9. https://doi.org/10.1016/j.ajp.2016.09.003.CrossRefPubMed

34.

Vrbova K, Kamaradova D, Latalova K, Ociskova M, Prasko J, Mainerova B, et al. Self-stigma and adherence to medication in patients with psychotic disorders--cross-sectional study. Neuro Endocrinol Lett. 2014;35(7):645–52.PubMed

35.

Bonfils KA, Lysaker PH, Yanos PT, Siegel A, Leonhardt BL, James AV, et al. Self-stigma in PTSD: prevalence and correlates. Psychiatry Res. 2018;265:7–12. https://doi.org/10.1016/j.psychres.CrossRefPubMed

36.

Ociskova M, Prasko J, Kamaradova D, Grambal A, Sigmundova Z. Individual correlates of self-stigma in patients with anxiety disorders with and without comorbidities. Neuropsychiatr Dis Treat. 2015;11:1767. https://doi.org/10.2147/NDT.S87737.CrossRefPubMedPubMedCentral

37.

Yanos PT, Lucksted A, Drapalski AL, Roe D, Lysaker P. Interventions targeting mental health self-stigma: a review and comparison. Psychiatr Rehabil J. 2015;38(2):171.CrossRef

Title: Prevalence of self-stigma and its association with self-esteem among psychiatric patients in a Nepalese teaching hospital: a cross-sectional study
Authors: Shanta Maharjan
Bimala Panthee
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2019
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-019-2344-8

At a glance: The STEP trials

Springer Medicine

Prevalence of self-stigma and its association with self-esteem among psychiatric patients in a Nepalese teaching hospital: a cross-sectional study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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