Self-stigma among caregivers of people with mental illness: toward caregivers’ empowerment

Abstract

Background

In addition to economic and material burdens, caregivers of people with mental illness are exposed to psychosocial challenges. Self-stigma is among the psychological challenges that can be exacerbated by intrinsic and/or extrinsic factors. Caregivers’ self-stigma can negatively influence the patients’ treatment and rehabilitation process. The objective of this study was to measure the level and correlates of self-stigma among caregivers of people with mental illness.

Methods

An interviewer-administered cross-sectional study was conducted in the Jimma University Specialized Hospital Psychiatry Clinic in Ethiopia on a sample of 422 caregivers. Data were collected by trained nurses working in the clinic using a pretested questionnaire. Multivariate linear regression was performed to identify the correlates of self-stigma among caregivers of people with mental illness.

Results

The majority (70.38%) of the caregivers were male. On a scale of 0 to 15, with 0 being low and 15 being high, the average self-stigmatizing attitude score was 4.68 (±4.11). A statistically significant difference in mean self-stigma score was found between urban and rural respondents (t=3.95, P<0.05). Self-stigma of caregivers showed significant positive correlation with perceived signs of mental illness (r=0.18, P<0.001), perceived supernatural explanations of mental illness (r=0.26, P<0.001), and perceived psychosocial and biological explanations of mental illness (r=0.12, P<0.01). The only independent predictor of caregivers’ self-stigma was perceived supernatural explanation of mental illness (standardized β=0.22, P<0.001).

Conclusion

The tendency of caregivers to avoid being identified with the patients was observed. Low exposure to mental health information was also reported. Caregivers’ self-stigma in this study was significantly correlated with perceived supernatural explanation of mental illness. Since caregivers’ self-stigma may negatively influence patients’ treatment-seeking, adherence, and rehabilitation processes, programs that enhance coping strategies by strengthening self-esteem and empowerment by health care providers and establish family support groups may be helpful to tackle self-stigma among caregivers of people with mental illness.

Keywords:

• self-stigma
• internalized stigma
• caregivers
• mental illness

Acknowledgments

We are thankful for the support from the Department of Health Education and Behavioral Sciences, Jimma University Specialized Hospital and Psychiatry Department in Ethiopia. We appreciate the valuable contributions from the data collectors, data entry clerks, supervisors, and respondents. We forward our sincere thanks to the CIH^LMU Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany, and its funding agencies, the German Academic Exchange Service (DAAD), the DAAD-Exceed Program, and the German Ministry for Economic Cooperation and Development for their support. This study was supported by the Köhler foundation. Thanks to Danielle Schaub for editing the manuscript.

Author contributions

Eshetu Girma, Markos Tesfaye, and Sandra Dehning designed the study, and were involved in the data collection, analysis, and drafting of the manuscript. Guenter Froeschl, Anne Maria Möller-Leimkühler, and Norbert Mueller were involved in the design of the study, analysis of the data, and critically reviewed the manuscript. All authors read and approved the final manuscript.

Disclosure

The authors declare no conflicts of interest in this work.