Internalized Stigma and Associated Factors in Patients Applying to Psychiatry Outpatient Clinics, A Descriptive Study

Year 2023, Volume: 6 Issue: 1, 107 - 114, 01.01.2023

Şule Özdemir , Neriman Aras

https://doi.org/10.19127/bshealthscience.1192244

Abstract

This study was conducted to investigate internalized stigma and related factors in patients applying to psychiatry outpatient clinics. The descriptive-cross-sectional study was conducted with 187 patients. In the survey included in the study, socio-demographic data, data on previous clinical/disease and Internalized Stigma of Mental Illness (ISMI) Scale were used. It was determined that 16.6% of the patients were hospitalized due to mental illness and 10.7% of them were dismissed due to mental disorders. The total mean score of the participants in ISMI was found to be 56.2±11.3. The scale total score of the patients whose education level was university or higher was found to be lower than the other groups (P = 0.012). The mean scores of the patients with children were significantly lower than those without children (P = 0.012) and the patients living in the village compared to the patients living in the city center (P = 0.002). The total ISMI score was found to be higher in patients who were previously hospitalized due to mental illness and patients who were dismissed due to mental disorders (P = 0.016, P = 0.006, respectively). It was determined that there was a positive and low-level significant relationship between disease duration and ISMI total score (r= 0.152; P = 0.038). Educational status, place of residence, hospitalization due to mental illness, dismissal status due to mental disorders and duration of illness were determined as variables affecting the level of internalized stigma in individuals with mental disorders.

Keywords

Internalized stigma, Stigmatization, Mental illness, Mental disorders

References

• Andersen SM, Harthorn BH. 1989. The recognition, diagnosis, and treatment of mental disorders by primary care physicians. Med Care, 27(9):869-886.
• Ayar D, Karasu F, Sahpolat M. 2018. The relationship between levels of solution-focused thinking and internalized stigma and social functionality in mental disorders. Perspect Psychiatr Care. doi: 10.1111/ppc.12944.
• Beyazyüz M, Beyazyüz E, Albayrak Y, Baykal S, Göka E. 2015. Bir Eğitim Araştırma Hastanesi Psikiyatri Polikliniğine Başvuran Hastalarda İçselleştirilmiş Damgalanma Düzeylerinin Bazı Tanı Grupları, Sosyodemografik Özellikler ve Benlik Saygısı ile İlişkisi. In Yeni Symposium, 53: 2.
• Boyd-Ritsher J, Otilingam P, Grajales M. 2003. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatric Res, 121: 31-49.
• Bozan M. 2019. The analysis of internalized stigma and social functioning of the service users of community mental health centre: The case of Eskisehir. Master's Thesis. Hacettepe University, Institute of Social Sciences Department of Social Work, Ankara.
• Coşkun S, Güven-Caymaz N. 2012. Bir kamu ve özel psikiyatri hastanesine başvuran hastaların içselleştirilmiş damgalanma düzeyi yönünden karşılaştırılması. Psikiyatri Hemşireliği Dergisi, 3: 121-128.
• Çakmak C, Konca M. 2019. Seçilmiş OECD Ülkelerinin Ruh Sağlığı Hizmetleri Performansının Değerlendirilmesi. Anemon Muş Alparslan Üniversitesi Sosyal Bilimler Dergisi, 7(2): 51-56.
• Çam O, Çuhadar D. 2011. Ruhsal Hastalığa Sahip Bireylerde Damgalama Süreci ve İçselleştirilmiş Damgalama. J Psy Nurs, 3: 136-40.
• Erkoç Y, Çom S, Torunoğlu MA, Alataş G, Kahiloğulları AK. T.C. Sağlık Bakanlığı Ulusal Ruh Sağlığı Eylem Planı (2011-2023). Ankara, T.C. Sağlık Bakanlığı Yayınları, 2011, Yayın No: 847.
• Ersoy M, Varan A. 2007. Ruhsal hastalıklarda İçselleştirilmiş Damgalanma Ölçeği Türkçe Formu'nun güvenilirlik ve geçerlik çalışması. Turk Psikiyatri Derg, 18: 163-71.
• Faul F, Erdfelder E, Lang AG, Buchner A. 2007. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods, 39(2):175-91. doi: 10.3758/bf03193146.
• Gonzales JJ, Magruder KM, Keith SJ. 1994. Mental disorders in primary care services: an update. Public Health Rep, 109(2): 251-258.
• González Domínguez S, Muñoz M, Ausín B, Castellanos MA, Pérez Santos E. 2018. Age related self stigma of people over 65 years old: Adaptation of the Internalized Stigma of Mental Illness Scale (ISMI) for use in age related self stigma (IS65+) in a Spanish sample. Aging & Mental Health, 22(2): 50-256.
• Hongo M, Oshima F, Nishinaka H, Seto M, Ohtani T, Shimizu E. 2021. Reliability and Validity of the Japanese Version of the Barriers to Access to Care Evaluation Scale Version 3 for People With Mental Disorders: an Online Survey Study. Front Psychol, 12: 760184. doi: 10.3389/fpsyg.2021.760184.
• Kizilağaç F. 2018. Investigation of Early Maladaptive Schemas and Internalized Stigma in Patients with Obsessive Compulsive Disorder. Specialization Thesis in Medicine, Kocaeli University Faculty of Medicine, Kocaeli.
• Kök H, Demir S. 2018. Şizofreni ve bipolar bozukluğu olan hastalarda içselleştirilmiş damgalanma, benlik saygısı ve algılanan sosyal destek. Cukurova Medical J, 43(1): 99-106.
• Kurt A, Ersan EE, Savaş I. 2021. Community Mental Health Center Service and outpatient psychiatry self stigmatization of patients receiving outpatient services and comparison of subjective recovery states. Journal of Psychiatric Nursing, 12(2): 103-112. https://doi.org/10. 14744/phd.2020.73383.
• Link B, Phelan J. 2001. Conceptualizing stigma. Annu Rev Sociol, 27: 363-85.
• Mercan HM. 2017. The Effect of Internalized Stigma on Quality of Life and Treatment Adherence in Obsessive Compulsive Disorder Patients. Master's Thesis. Gaziantep University Institute of Health Sciences, Gaziantep.
• OECD (2019) Mental Health. http://www.oecd.org/els/health-systems/mentalhealth.htm (accessed date: September 22, 2022).
• Picco L, Pang S, Lau Y. W, Jeyagurunathan A, Satghare P, Abdin E, Subramaniam M. 2016. Internalized Stigma Among Psychiatric Outpatients: Associations with Quality Of Life, Functioning, Hope and Self-Esteem. Psychiatry Research, 246:500-506.
• Solano NH, Whitbourne SK. 2001. Coping with schizophrenia: patterns in later adulthood. International Journal of Aging and Human Development, 53: 1-10.
• Tel H, Ertekin-Pınar Ş. 2012. Ayaktan izlenen psikiyatri hastalarında içselleştirilmiş damgalama ve benlik saygısı. Psikiyatri Hemşireliği Dergisi, 3: 61-66.
• Turan DN. 2019. Psychoeducation and work practices in chronic mental disorders. Current Approaches in Psychiatry, 11(1): 120-128. https://doi.org/10.18863/pgy.367359.
• WHO (2013) Mental Health Action Plan 2013-2020. https://apps.who.int/iris/handle/10665/89966 (accessed date: September 12, 2022).
• World Health Organization (WHO). 2016. Global health estimates 2015: Disease burden by cause, age, sex, by country and by region, 2000-2015. https://www.who.int/healthinfo/global_burden_disease/estimates/en/ (accessed date: September 22, 2022).
• World Health Organization. Regional Office for the Eastern Mediterranean. (2019). Mental health atlas 2017: resources for mental health in the Eastern Mediterranean Region. World Health Organization. Regional Office for the Eastern Mediterranean. https://apps.who.int/iris/handle/10665/327491 (accessed date: September 21, 2022).
• World mental health report: transforming mental health for all. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO. https://www.who.int/publications/i/item/9789240049338 (accessed date: September 12, 2022).
• Yildirim T, Kavak Budak F. 2020. The relationship between internalized stigma and loneliness in patients with schizophrenia. Perspectives in Psychiatric Care, 56(1): 168-174.