Mixed-methods analysis of internalized stigma correlates in poorly adherent individuals with bipolar disorder

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• 作者：Molly Howland^a ; ^{molly.howland@case.edu" class="auth_mail" title="E-mail the corresponding author} ; Jennifer Levin^a ; ^b ; ^{jennifer.levin@uhhospitals.org" class="auth_mail" title="E-mail the corresponding author} ; Carol Blixen^a ; ^{cxb28@case.edu" class="auth_mail" title="E-mail the corresponding author} ; Curtis Tatsuoka^b ; ^c ; ^d ; ^{cmt66@case.edu" class="auth_mail" title="E-mail the corresponding author} ; Martha Sajatovic^a ; ^b ; ^d ; ^e ; ^{martha.sajatovic@uhhospitals.org" class="auth_mail" title="E-mail the corresponding author}
• 刊名：Comprehensive Psychiatry
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：70
• 期：Complete
• 页码：174-180
• 全文大小：215 K

文摘

Internalized stigma, which occurs when stigmatized individuals accept society's assessment and incorporate this assessment into their sense of self, is prevalent in individuals with bipolar disorder (BD). This study explored the correlates of internalized stigma in a research sample of patients with BD who were poorly adherent to their medications.

Methods

Both quantitative and qualitative analyses were performed. Scores of 115 individuals with BD on the Internalized Stigma of Mental Illness (ISMI) scale were correlated with scores on the General Self-Efficacy (GSE) Scale, Brief Psychiatric Rating Scale (BPRS), Montgomery–Asberg Depression Rating Scale (MADRS), and Young Mania Rating Scale (YMRS). Regression was run for GSE (dependent variable) and ISMI (independent variable). In-depth qualitative interviews were conducted on a representative subsample (N = 21).

Results

Internalized stigma levels were moderately high. Internalized stigma and self-efficacy correlated, and internalized stigma related to self-efficacy after adjusting for demographic variables (age, gender, years of education), comorbidities, and symptom severity (BPRS and MADRS). Internalized stigma was also associated with the BD symptoms of depression, anxiety, guilt feelings, suspiciousness, and hallucinogenic behaviors. No association was found with mania.

Conclusions

Because internalized stigma has strong psychosocial and psychiatric symptom associations, it is recommended that clinicians address both societal stigma and internalized stigma. Strategies such as cognitive–behavioral therapy may help modify BD patients' internalized stigma.