Internalized Stigma and its association with Hope, Self-esteem, Self-efficacy and Adherence to Treatment among Outpatient with severe mental illness in Tabriz Razi Hospital

Abstract

Abstract Background: Internalized stigma is associated with many negative effects including psychological problems, social problems, and personal problems. Although some studies have shown the association of internalized stigma with self-esteem, self-efficacy, hope, and even adherence to treatment, but there are serious and conflicting challenges in this regard, especially in developing countries. In Iran as a developing country, fighting against stigma should be the first step in mental health treatment and prevention, because there is no doubt that the stigma of mental illness is the most important obstacle to improving mental health care. So the purpose of this study was understanding procces of internalized stigma and its relationship with hope, self-esteem, self-efficacy, and adherence to treatment in outpatients with severe mental illness to provide a new window for more integrated nursing interventions to provide opportunities to reduce outcomes and improve mental health. Method: In this cross-sectional survey, available sampling method was used. This was conducted on 257 outpatients diagnosed with severe mental illness (Schizophrenia, Bipolar mood disorder, Major depression) who were seeking treatment in the psychiatric clinics of Razi hospital. The Internalized Stigma of Mental Illness (ISMI) questionnaire, the Snyder Dispositional Hope Scale (DHS), the Rosenberg's Self Esteem Scale, and General Self-Efficacy Scale and Drug Attitude Inventory (DAI-10) were used to collecting data. These questionnaires were used after determining the validity and reliability. Data were analyzed by using SPSS 13 software. Results: The mean score of internalized stigma was 1.57±0.49 from a range of 1 to 4.Overall, 58% of participants reported moderate to high internalized stigma. The highest stigma score was in the “stereotype endorsement” subscale. There was a significant correlation between stigma with age, number of hospitalization and duration of disease diagnosis. Also, comparison of mean stigma score in different groups showed that the severity of stigma was higher in people with primary education, unemployed, low income, with schizophrenia and history of hospitalization. A negative significant relationship was found between hope (p<0.001, r=-0.548), self-esteem (p<0.001, r=-0.664) and self-efficacy (p<0.001, r=-0.641) with internalized stigma and each subscale. Adherence to treatment was not found to be significantly associated with the internalized stigma. In the final regression model, which included all psychosocial variables together self-esteem, self-efficacy, age and history of hospitalization were variables significantly predict internalized stigma. Conclusion: The findings of this study indicate that the level of internalized stigma in participants in this study is more common than previous studies. It seem Cultural factors influence this finding. Paying attention to empowering patients through enhancing their self-esteem and self-efficacy as variables that predict stigma levels, especially in high-risk groups, is important.