Internalized stigma in schizophrenia: a cross-sectional study of prevalence and predictors

ABSTRACT

Self-stigma is a major problem in schizophrenia, with far reaching consequences on treatment and overall outcome, but scarcely examined. In this study we investigated the prevalence and predictors of internalized stigma in schizophrenia in an outpatient population. We recruited 370 adult outpatients with DSM-IV diagnosis of schizophrenia. All participants were interviewed with a sociodemographic and clinical questionnaire, the 18-item Brief Psychiatric Rating Scale (BPRS-18) and the 29-item Internalized Stigma of Mental Illness (ISMI) scale. The mean age of participants was 37.87 (± 11.24) years, and included 189 (51.1%) females. The prevalence of high self-stigma was 16.5%. As per ISMI subscales, high experience of discrimination was reported more by participants (24.1%) compared to high alienation (22.4%), high stereotype endorsement(8.6%), and high social withdrawal (20.3%). Only 28.1% of participants scored high on stigma resistance. Following regression analysis, the experience of high self-stigma was independently related to lack of formal education (OR = 3.908), absence of good social support (OR = 0.387), high psychopathology based on the BPRS-18 (OR = 1.156) and less than US$25 average income per month (OR = 0.4990). Self-stigma is a major challenge among patients with schizophrenia beyond acute in-patient treatment. Routine information elicited during clinic visits may help index those with high stigma risk to warrant further exploration and targeted anti-stigma intervention if needed.

KEYWORDS:

• Self-stigma
• internalized stigma
• schizophrenia
• stigma
• Nigeria

Acknowledgements

We would like to thank all consultants and staff of the Federal Neuropsychiatric Hospital, Lagos, for providing an enabling environment to conduct this study as well as Drs A. Adelufosi and T. Mosanya for their invaluable contributions to the study. This work was presented as an oral presentation at the 14th International Congress of Behavioral Medicine, Melbourne, Australia in December, 2016.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Babatunde Fadipe (MBBS, MSc, FWACP) is consultant psychiatrist at the Lagos University Teaching Hospital, Idi-Araba, Lagos where he is involved in rendering clinical service, teaching and research. In the last few years, his practice and research have focused on psychosocial issues in health and among underserved populations, stigma, psycho-oncology, addiction and mental health advocacy. He is a member of the INDIGO network, a collaboration of research colleagues in over 30 countries worldwide committed to developing knowledge about mental illness-related stigma and discrimination.

Timothy O. Adebowale is a Practitioner/Implementer. He is an astute clinician and experienced mental health service administrator with full, and specialist registration of the Medical and Dental Council of Nigeria, and the General Medical Council, United Kingdom. He is currently a Consultant Psychiatrist (General Adult, Community and Rehabilitation Psychiatry), and Medical Director at the Neuropsychiatric Hospital, Ogun state, Nigeria. He has formal training and ample experience in community mental health service planning, delivery, evaluation and research. He serves as the programme coordinator of the Aro Primary Care Mental Health Programme for Ogun State.

Adegboyega Ogunwale is a Consultant Psychiatrist at the Neuropsychiatric Hospital, Ogun State, Nigeria. His research has focused on psychiatric defences and Nigerian criminal law, civil law and ethics, stigma as well as mental health legislation in Nigeria. He is a member of the International Association of Forensic Mental Health Services (IAFMHS) and currently serves as the Chair of the Africa Interest Group of the association. He has presented several papers at both local and international conferences and has a good number of publications in peer-reviewed journals. He also serves as a peer-reviewer for learned journals in various areas of psychiatry.

Yetunde O. Fadipe (MBChB, FMCFM) is a Consultant Family Physician at the Lagos University Teaching Hospital where she is involved in research and clinical work. She is also a faculty member of the residency training program of the institution. Her interests include non-communicable diseases including mental health problems especially among adolescents.

Abdul-Hakeem A. Ojeyinka (MBBS) is a young, conscientious physician with keen interest in mental health research. He has been a beneficiary of several academic laurels. He is presently undergoing a mandatory National youth service program.

Andrew T. Olagunju (MBBS, MSc, FWACP, FMCPsych.) is an academic psychiatrist with Senior Lecturer position at the College of Medicine, University of Lagos and work as consultant psychiatrist at the Lagos University Teaching Hospital. He is also engaged in a doctoral project in Translational Psychiatry at the University of Adelaide. His works are contained in reputable peer-reviewed journals, and co-investigates on cutting-edge projects on novel intervention, evidence-based clinical practice and strengthening of global mental health to alleviate suffering of people with mental illness and their caregivers.

ORCID

Babatunde Fadipe http://orcid.org/0000-0001-6079-0882

Andrew T. Olagunju http://orcid.org/0000-0003-1736-9886