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ABSTRACT
Internalized stigma is a barrier to mental health care in China, and stigma reduction is expected to promote treatment utilization, especially for mood disorders and schizophrenia. We aimed to identify the most common domains of internalized stigma of mental illness and to test the hypothesis that people with more severe mood disorders evidence more internalized stigma than those with less severe disorders. The Internalized Stigma of Mental Illness (ISMI) was administered to 366 outpatients with various mood disorders in Shanghai. Reliability statistics were calculated and frequently-endorsed items were identified. The magnitude of internalized stigma was compared among diagnostic categories and among sociodemographic groups. Except for stigma resistance, the ISMI and its subscales had good internal consistency. Across subgroups, stereotype endorsement was most commonly reported. Bipolar (versus depressive) disorders, male gender, and less education were associated with more internalized stigma, especially social withdrawal. Contrasting findings in Western countries, those with family history of mental illness trended toward more internalized stigma. We conclude that anti-stigma interventions should focus on reducing social withdrawal and stereotype endorsement, especially for those with more severe mood disorders, males, less educated individuals, and those with family history of mental illness.
Acknowledgements
The authors would like to gratefully thank all the participants and the staff members who provided assistance during the survey administration.
Disclosure statement
No potential conflict of interest was reported by the authors.
Ethics approval and informed consent
All procedures for this study were reviewed and approved by the Institutional Review Board of the Shanghai Medical Center. Written informed consent documents were obtained from all participants before any study-related procedures were performed.
Notes on contributors
Ms. Meghan L. Smith is a doctoral student studying epidemiology at the Boston University School of Public Health. She has experience in psychiatric and social epidemiology research with a special interest in the measurement of mental health outcomes.
Dr. Lawrence H. Yang is an Associate Professor in Social and Behavioral Sciences at the New York University College of Global Public Health. From his National Institutes of Mental Health K-award, he has formulated theoretical work on how culture relates to stigma and implemented interventions for Chinese immigrants with psychosis in New York City. Dr. Yang has extensive research in global mental health and most recently has received an R01 examining the cognition in the ‘natural state’ of psychosis in China.
Ms. Debbie Huang is a doctoral student studying psychiatric epidemiology at the Mailman School of Public Health, Columbia University. Her research interests include psychometrics and mental health outcomes in Asian populations.
Dr. Kathleen M. Pike is the Director of the Global Mental Health Program (GMHP) at Columbia University - a WHO Collaborating Center for Capacity Building and Training in Global Mental Health. She also currently serves on the Global Fund for Mental Health Leadership Team, working to establish improved policy and enhanced funding to support mental health research.
Dr. Pike has conducted pioneering work in the area of risk factors for eating disorders and also has research interests in aging, serving as the Associate Director of the Health and Aging Policy Fellows Program.
Dr. Chengmei Yuan is an associate psychiatrist who has worked in a special mental health center for 16 years. She works with patients with mood or psychotic disorders. She contributed to data collection for the present study.
Dr. Zhen Wang is a psychiatrist who actively pursues research on the neurobiological and psychological basis of traumatic stress-related disorders and obsessive compulsive disorder. He is currently the vice President of the Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine.